@2024 Afarand., IRAN

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ISSN: 1027-1457    Scientific Journal of Forensic Medicine 2019;25(1):1-7

Background
Anabolic steroids are considered performance-enhancing drugs. … [1-8]. Hard workouts are recommended for high sports conditions; but, some people, such as those who are not able or do not like to do such exercises, use steroids.
Previous Studies
The use of steroids involves some complications, including cardiovascular events such as increased blood pressure, increased low-density lipoprotein (LDL), increased hematocrit, arrhythmia, and sudden death risk, psychiatric complications (such as increased irritability, aggression, violence, depression, euphoria, dependence, and addiction), increased liver enzymes, jaundice, and cholestasis, skeletal complications (such as early closure of growth plates, hip bone necrosis), increased risk of damage to tendons, abnormal sperm count (e.g. testicular atrophy, impotence, sterility), skin complications (such as Acne, edema, fatty hair, and skin rash), and effects on the reproductive system of women (uterine atrophy, breast atrophy, bass sound, menstrual disorders, and baldness with male pattern) [2, 5, 9-11]. In a study conducted in Mashhad, 64% of the athletes used steroid drugs [12]. In another study in Rasht, 67% of the athletes had a history of steroid use, which showed a significant relationship between anabolic steroids and their heroic achievements in Iran [13].
Aim(s)
The aim of this study was to investigate the prevalence of these drugs and the awareness of male athletes and their coaches about the side effects of performance-enhancing drugs in Shahroud, Iran.
Research type
This research is a descriptive cross sectional study.
Research society, place and time
This study was conducted in 2012 among the bodybuilding athletes in Shahroud, Iran.
Sampling method and number
200 of the bodybuilding athletes were selected by random cluster sampling from 12 different gyms in different regions of the city, so that they covered all geographical directions of the city.
Used devices&materials
After coordinating with the physical education office of Shahroud, 200 male athletes, who exercised 3 days a week and 2 hours a day at the gyms, were selected. The reason for this factor was merely the evaluation of the individuals, who were professional bodybuilder based on the scientific definition. So, we referred to the gyms at different hours of the day and provided the athletes, who were willing to cooperate in the project, with the questionnaire containing questions about the demographic information of athletes and their status of using performance-enhancing drugs (Testosterone, Nandrolone, Oxymetholone, Methane, Dianabol, Primobolan, Omnadren, Winstrol, Sustanol, Prohormone) with a one-year time limit and athletes' awareness of the side effects of these drugs; the information were completed by interviewing. The research questionnaire consisted of 21 questions, which were adopted from Nilsson et al. [14] questionnaires. This questionnaire contained various questions measuring the knowledge, attitude, and prevalence of anabolic-androgenic steroids, of which 5 questions were for ground information, 9 questions for awareness, 4 questions for attitude, and 3 questions for the prevalence of consumption. The validity of this questionnaire was confirmed by experts in biostatistics, physical education, sports science, psychology, and pharmacology and its reliability was 0.84 with Cronbach's alpha. Given the prohibition of the use of performance-enhancing drugs by athletes and the lack of possible response of some of them, the interviewees and coaches of the gyms were assured that the information obtained would be completely confidential and information would not be individually examined, but in collective analysis and except for the researcher, no individual or organization will be aware of the content of the individual's information. The data were analyzed by SPSS 18.0 software, using Chi-square test.
Findings by Text
Of the 200 male athletes of gyms in Shahroud, 59.5% used anabolic steroids, the most common of which were nandrolone (41.5%), testosterone (39.5%), and prohormone (39.0%; Diagram 1). 11.8% of them stated that they used all types of drugs listed in the questionnaire (10 types; Table 1). The mean age of athletes was 26.2±6.8 years (age range of 16-46 years), of whom 36.5% were between 20 and 24 years old. 34.8% of them were under 20 years old and 73.9% of athletes aged 34-30 years consumed at least one type of anabolic steroids. The prevalence of all drugs was associated with increased age (p<0.05; Table 2). 68.0% of the athletes were single and the rest were married. 57.4% of the single athletes and 64.1% of the married athletes used at least one type of anabolic steroid. The most commonly used drugs were testosterone (36.0%) in single athletes and nandrolone (50.0%) in married athletes. The use of dianabol (p=0.021), sustanol (p=0.031), and oxymetholone (p=0.01) in married athletes was significantly higher than the single ones. 68.8% of the athletes with less than diploma, 56.9% of the athletes with diploma level, and 61.3% of athletes with university education used at least one anabolic steroid drug. The most commonly used drug was testosterone, nandrolone and methane (56.3%) in people with less than diploma, nandrolone in people with diploma (40.4%), and testosterone (42.7%) athletes in people with university education. There was no significant relationship between the level of literacy and the type of drug used (p>0.05; Table 3). 86.2% of the athletes, who had a history of the championship, had used at least one of the anabolic steroids, among which prohormone (66.2%) had the highest intake among athletes (Table 4). 3.4% of those practicing for 3 days a week and 58.9% of athletes with 4 days training and 68.3% of athletes with 5-6 days training used at least one type of anabolic steroid, which showed a significant difference (p=0.05). The most commonly used drug was testosterone and nandrolone (21.7%) in athletes with 3 days training, nandrolone (35.8%) in athletes with 4 days training, and testosterone and nandrolone (53.7%) in athletes with 5-6 days training. The use of testosterone (p=0.002), nandrolone (p=0.007), methane (p=0.018), dianabol (p=0.021), sustanol (p=0.005), and prohormone (p=0.001) was significantly correlated with the increase in the number of exercises. 88.2% of the bodybuilders, who used anabolic steroid drugs in Shahroud, stated "increased muscle mass" and "attract others' attention to muscle mass" as the reasons of consumption of anabolic steroid drugs (Table 5). 90.8% of the bodybuilders, who used anabolic steroids, believed that the use of these drugs is necessary for professional athletes. 88.2% believed that these drugs really improve the performance of the athletes. 33.6% said they would recommend using these drugs to others. 67.2% of the athletes using anabolic steroids said they provide the drug in the open market. 52.1% said providing the drugs is easy. 63.5% of those, who used these drugs, said they use them based on the recommendation of the coach. 34.8% mentioned friends recommending the use of these drugs. 33.6% of the athletes stated they did not know much about the side effects of these drugs.
Main comparison to the similar studies
In a study in high schools of the United States, it was found that only 2.7% of boys and girls used these drugs. In a study conducted by Kargarfar et al., the use of these drugs was higher in Iranian students (8.3%), but there is still a significant difference in the level of use of these drugs with professional athletes [15]. In a study in Singapore, 77% of the professional athletes reported using at least one anabolic supplement [16]. In studies in conducted Tehran, the level of use of the anabolic steroids is estimated about 30% [17]. In studies carried out in Hamedan, Kermanshah, and Semnan, about 19%, 38%, and 27.3% of the athletes report anabolic steroid drug use, respectively, the level of which is much lower than in studies abroad [10, 16, 18, 19]. Studies performed in Mashhad and Tehran on bodybuilding athletes showed that 92% and 100% of the professional athletes in these cities used these drugs [20]. In a study in Semnan [6] as well as the Iranian Toxicology Center [2, 6], the most commonly used drug is oxymetholone, which is not consistent with the result of the current study (common use of nandrolone). ….. [21-30].
Suggestions
It is suggested that in future studies, the awareness of the coaches of bodybuilding athletes as well as the coaches in country, province, and city levels in different categories should be considered.
Limitations
In this study, there were some weaknesses; it was necessary to investigate the awareness of the coaches of bodybuilding athletes as well as the coaches in country, province, and city levels in different categories.
Conclusions
59.5% of male bodybuilders in Shahroud use anabolic steroids, the most common of which is nandrolone. The high levels of consumption and low awareness of consumers about the complications of these drugs and the easy access of athletes to these drugs show the necessity of informing athletes and coaches about the complications of anabolic steroids and the formulation of prevention programs.
Acknowledgments
We would like to appreciate the Deputy of Research and Technology of Semnan University of Medical Sciences for funding this research, the physical education office of Shahroud for their good cooperation, as well as Dr. Saba Maher Banai for compiling the plan, and Mr. Reza Naderi (Iranian bodybuilding champion), who helped us in conducting this research.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
Due to the fact that the project was approved several years ago, it does not have ethical permission.
Funding Sources
The Deputy of Research and Technology of Semnan University of Medical Sciences funded this research.

TABLES and CHARTS

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