Research on abusive use of anabolic androgenic steroids: the SOS cohort (Study of Steroid Abusers)

• Grant number: 23/10778-0
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• Start date: February 01, 2025
• End date: January 31, 2026
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Bruno Gualano
• Grantee: Rafael de Almeida Azevedo
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

The abusive use (defined as non-therapeutic) of anabolic androgenic steroids (AAS) is a silent epidemic that can negatively affect the health of men and women of various age groups. In March 2023, the Federal Council of Medicine (Resolution No. 2,333) contraindicated the use of AAS for aesthetic and physical performance purposes, based on the rationale that the abusive use of AAS increases the risk of cardiovascular accidents, sudden death and episodes of mental disorders. However, the scientific evidence on the topic is sparse and considered of low quality, since controlled studies run into the obvious ethical impossibility of prescribing such substances in supraphysiological doses to healthy humans. Given these limitations, studies with prospective cohorts and a multidisciplinary approach are carried out with regular AAS users, that is, individuals who already plan or currently use AAS in their routine. This project aims to (i) prospectively investigate the impacts of abusive use of AAS on general health, assessed in a multifocal way, in males and females and (ii) identify possible risk factors for adverse events resulting from the abusive use of AAS. The project will be composed of regular AAS users (estimated ~200 participants), males and females with no clinical indication for AAS, aged e13 years and declared intention to start using AAS for aesthetic purposes and/or physical performance within two weeks after recruitment. The research team will only collect data on the participants' health parameters, without prescribing substances of any kind. However, medical care at the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo will be provided in the case of an adverse event occurs due to the use of AAS. Participants will attend the laboratory to carry out a battery of evaluations made up of several medical specialties from the consortium, specifically, established for this project, called SOS - Study of Steroid Abusers. Assessments will take place before starting AAS use (T0), after 50% of planned AAS use (T0.5), immediately at the end of the cycle (T1) and one month after the cycle (T2). If the participant reports starting a new cycle before moment T2, evaluations T0, T0.5 and T1 will be repeated, and T2 will be readjusted. The battery of assessments will include collection of venous blood (to measure concentrations of various metabolites and hormones), tests of vascular, cardiac and respiratory function at rest and at maximal aerobic exercise, maximal muscular strength, assessment of body composition, health anamnesis and questionnaires on socioeconomic data, evaluations of pubertal milestones, history of AAS use, adverse events, aspects of quality of life related to health, sleep and physical activity, eating habits and disorders and body image, depressive symptoms, anxiety, fatigue, aggressiveness, and tests of cognitive function. It is important to emphasize that this project will continue beyond the proposed period, setting up a new line of research linked to the SOS consortium established between different areas of Internal Medicine. Thus, after moment T2, the participant will be invited to carry out an annually battery of assessments, for a period of 4 years. It is expected that, as a result of the project, the training of human and technical resources and scientific advances on the damage to health from the use of AAS and, possible elaboration of harm reduction strategies. We also intend to launch campaigns and booklets aimed at the population, warning about the risks associated with the abusive use of AAS, as well as harm reduction measures, to be developed based on the findings and experiences of this study. Furthermore, the continuity of the line of research is expected as a result, through the consortium established to monitor users for at least another four years.