Table 1 Characteristics of qualitative/descriptive studies presenting data on polypharmacy in AAS users
From: Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis
First author, year, reference | Country | Study type | AAS users | Recruitment site/mode | Non-AAS substances ever used |
|---|---|---|---|---|---|
Ahlgrim 2009 [9] | USA | Case study | 41-year-old male former bodybuilder | Hospital | Captopril, carvedilol, digoxin, furosemide, growth hormone, hydrochlorothiazide, spironolactone, torsemide, |
Angoorani 2009 [10] | Iran | Interview | 843 bodybuilders aged 16 to 40 years | Gymnasium | Amphetamine |
Bilard 2011 [11] | France | Interview | 203 bodybuilders | Voluntary | Beta-2-agonists, cannabinoids, glucocorticosteroids, peptide hormones |
Chandler 2014 [12] | UK | Interview | 8 persons | Online forums, syringe exchange center | Aromatase inhibitors, clenbuterol, 2,4-dinitrophenol, clomiphene, diuretics, ephedrine, growth hormone releasing peptide, growth hormone, human chorionic gonadotropin (hCG), insulin-like growth factor 1, insulin, mechano growth factor, melanotan, mephedrone, tamoxifen, thyroid hormones, viagra®/cialis® |
Cornford 2014 [13] | England | Interview and focus group | 30 males aged 20 to 40 years | Syringe exchange center | Heroin |
Davies 2011 [14] | England | Interview and questionnaire† | 9 male bodybuilders | Gymnasium | Creatine, dietary supplements |
Dunn 2010 [15] | Australia | Interview and questionnaire† | 70 persons | Community | Alcohol, cannabis, cocaine, ecstasy, gamma hydroxybutyrate, hallucinogens, inhalants, ketamine, amphetamine |
Filiault 2010 [16] | Australia, Canada, USA | Interview and questionnaire† | 16 gay male athletes aged 18 to 52 years | Gay sporting groups | Creatine, dietary supplements, growth hormone, recovery drinks |
Fudala 2003 [17] | USA | Interview | 7 males aged 22 to 33 years | Gymnasium and community | Alcohol, analgesics, cannabis, cocaine, stimulants, growth hormone, human chorionic gonadotropin (hCG), insulin-like growth factor 1 |
Gårevik 2010 [18] | Sweden | Interview | 45 offenders; mean age 30 years | Police station | Amphetamine, anti-oestrogens, benzodiazepines, cannabis, clenbuterol, cocaine, diazepam, ephedra, ephedrine, growth hormone, human chorionic gonadotropin (hCG), heroin, insulin, sildenafil |
Goldfield 2009 [19] | Canada | Interview and questionnaire† | 8 female bodybuilders | Gymnasium | Diuretics, laxatives |
Gruber 1998 [20] | USA | Interview | 19 female weightlifters | Gymnasium | Clenbuterol, ephedrine, narcotics/other drugs |
Gruber 1999 [21] | USA | Interview | 5 female bodybuilders | Gymnasium | Alcohol, cannabis, cocaine, clenbuterol, dietary supplements, other drugs, other performance-enhancing drugs |
Gruber 2000 [22] | USA | Interview | 25 female weightlifters; mean age 31 years | Gymnasium | Aminogluthemide, amphetamine, caffeine, clenbuterol, diuretics, ephedrine, hydroxyl butyrate, human chorionic gonadotropin (hCG), growth hormone, laxatives, nalbuphine, other opioids, tamoxifen, thyroid hormones, yohimbine |
Hegazy 2013 [23] | USA | Case study | 28-year-old male | Clinic | Alcohol, amphetamine, opioids |
Hoff 2012 [24] | Sweden | Interview | 11 male (10 powerlifters, 1 weightlifter) | Swedish Sports Confederation | Alcohol, amphetamine, cocaine, narcotics, others |
Hope 2013 [25] | England and Wales | Interview and questionnaire† | 340 injecting drug users | Syringe exchange center | 2,4-dinitrophenol, alcohol, amphetamine, anti-oestrogens, clenbuterol, cocaine, ephedrine, erythropoietin, growth hormone, human chorionic gonadotropin (hCG), insulin, melanotan II, nalbuphine, thyroid hormones, diuretics, PDE5i, viagra®/cialis® |
Kanayama 2003 [26] | USA | Interview and questionnaire† | 48 male weightlifters; mean age 29 years | Gymnasium and sports supplement store | Alcohol, cannabis, cocaine, opioids, other narcotics/illicit drugs |
Kanayama 2003 [27] | USA | Interview | 24 male drug users; mean age 32 years | Clinic | Alcohol, cocaine, heroin, nalbuphine, opioids, oxycodone |
Kanayama 2009 [28] | USA | Interview | 62 male weightlifters | Gymnasium and sports supplement store | Alcohol, cannabis, cocaine, opioids, other performance-enhancing drugs, other drugs |
Katz 1990 [29] | USA | Case study | 23-year-old male bodybuilder | Gymnasium | Alcohol, cocaine |
Kimergård 2014 [30] | England and Wales | Interview | 24 males aged 21 to 61 years; mean age 34 years | Gymnasium, prison, steroid clinic and charity, syringe exchange centre | Amphetamine, clenbuterol, growth hormone, ephedrine, human chorionic gonadotropin (hCG), insulin, melanotan II, sildenafil, tamoxifen |
Klötz 2010 [31] | Sweden | Interview | 33 male prisoners aged 21 to 52 years | Prison | Antidepressants, anti-oestrogen, aspirin®, benzodiazepines, caffeine, cannabis, central stimulating drugs, clenbuterol, creatine, diuretics, ephedrine, Gamma hydroxybutyrate, insulin-like growth factor 1, insulin, genotropine, muscle relaxing drugs, myoblast, opiates, other drugs, potency increasing drugs, somatotropine, testicular function recovering hormones |
Korkia 1993 [32] | England, Scotland, and Wales | Interview | 110 persons (13 female) aged 16 to 63 years | Clinic, gymnasium, syringe exchange centre | Antibiotics, corticosteroids, dietary supplements, diuretics, esiclene, human chorionic gonadotropin (hCG), oestrogen-antagonist drug, growth hormone, thiomucase, thyroxine |
Korkia 1996 [33] | England | Interview and questionnaire† | 15 females; mean age 28 years | Not specified | Clenbuterol, growth hormone, nolvadex, nubain®, thiomucase, triacana |
Kusserow 1990 [34] | USA | Interview | 72 (6 female) persons (mostly adolescents); 14 to 25 years; mean age 20 years | Not specified | Alcohol, blood pressure regulators, ‘downers’, estrogen inhibitors, growth hormone, cannabis, Recreational substances/drugs, ‘uppers’ |
Larance 2008 [35] | Australia | Interview | 60 males aged 17 to 59 years | Gymnasium, internet forums, supplement shops | Anti-oestrogenic agents, aspirin®, benzodiazepines, caffeine, cannabis, cocaine, clenbuterol dehydroepiandrosterone (DHEA), diuretics, ecstasy, hallucinogens, heroin, human chorionic gonadotrophin (hCG), ephedrine, growth hormone, inhalants, insulin-like growth factors, insulin, meth/amphetamine, thyroxine |
Lenehan 1996 [36] | England | Interview | 386 persons aged 17 to 56 years; mean age 28 years | Gymnasium | Clenbuterol, corticosteroids, diuretics, growth hormone, human chorionic gonadotropin (hCG), thyroxine, insulin-like growth factor 1, nubain®, tamoxifen |
Lundholm 2010 [37] | Sweden | Interview | 924 (20 female) persons | Prison | Benzodiazepines, cannabis, cocaine, meth/amphetamine, opiates |
Malone 1995 [38] | USA | Interview | 77 (6 female) powerlifters and bodybuilders | Gymnasium | Alcohol, cocaine, hallucinogen, opioids, sedatives, stimulants, tetrahydrocannabinol, tobacco |
McBride 1996 [39] | Wales | Case study | 3 males: 1 AAS dealer and roofer aged 27 years, 1 bodybuilder aged 22 years, and 1 gym owner aged 26 years) | Not specified | Amphetamine, cannabis, clenbuterol, human chorionic gonadotropin (hCG), nalbuphine, tamoxifen, temazepam |
McKillop 1987 [40] | Scotland | Interview | 8 male bodybuilders aged 17 to 32 years | Gymnasium | Furosemide, thiazides, thyroxine, human chorionic gonadotropin (hCG) |
Moss 1992 [41] | USA | Interview | 50 male bodybuilders | Gymnasium | Clomiphene citrate, human chorionic gonadotropin (hCG) |
Moss 1993 [42] | USA | Interview | 30 male bodybuilders | Gymnasium | Clomiphene citrate, human chorionic gonadotropin (hCG) |
Pappa 2012 [43] | Europe | Interview | 9 athletes aged 19 to 26 years | Community via snowball sampling | Analgesics, amphetamine, caffeine, cannabis, dietary supplements, diuretics, erythropoietin. |
Perry 1990 [44] | USA | Interview and questionnaire† | 20 male weightlifters aged 18 to 28 years | Gymnasium | Human chorionic gonadotropin (hCG) |
Perry 2003 [45] | USA | Interview | 10 male weightlifters aged 21 to 40 years | Gymnasium | Aspirin®, caffeine, clomiphene, creatine, dietary supplement, ephedrine, glutamine, liothyronine, protein powder, yohimbine |
Peters 1997 [46] | Australia | Interview and questionnaire† | 100 persons (6 female) aged 18 to 50 years | Advertisements, gymnasium, interviews, radio, sports shops and associations, syringe exchange centre | Alcohol, aminogluthimide, amphetamine, antibiotics, beta blockers, caffeine, cannabis, chromium picolinate, clenbuterol, cocaine, daonil®, dietary supplement, diuretics, ecstasy, ephedrine, growth hormone, human chorionic gonadotropin (hCG), hydroxocobal amin, insulin-like growth factor 1, insulin, oestrogen antagonist, pregnyl®, proviron®, teroxin (T3), thyroxine |
Pope 1988 [47] | USA | Interview | 41 male bodybuilders and footballers | Gymnasium | Alcohol, cannabis, cigarettes, cocaine, human chorionic gonadotropin (hCG) |
Pope 1994 [48] | USA | Interview | 88 athletes; mean age 26 years | Gymnasium | Alcohol, cannabis, tobacco |
Rashid 2000 [49] | USA | Case study | 40-year-old male | Clinic | Cocaine, cannabis, ‘uppers’, ‘downers’, lysergic acid diethylamide (LSD) |
Schäfer 2011 [50] | Denmark | Case study | 26-year-old male bodybuilder | Clinic | Erythropoietin |
Silvester 1995 [51] | USA | Interview | 22 former athletes aged 36 to 66 years | Not specified | Growth hormone |
Skårberg 2007 [52] | Sweden | Interview and questionnaire† | 18 male drug users; mean age 35 years | Clinic | Alcohol, narcotics/other drugs |
Skårberg 2008 [53] | Sweden | Interview | 6 drug users (2 female) | Clinic | Alcohol, amphetamine, analgesics, anti-catabolics, anti-oestrogens, aspirin®, benzodiazepines, bronchodilators, buprenorphine, caffeine, cannabis, cocaine, codeine, conjugated linoleic acid, creatine, dietary supplements, ecstasy, ephedra, ephedrine, growth hormone, Herbal products, insulin growth factor 1, insulin, protein powder, testosterone releasers |
Skårberg 2009 [54] | Sweden | Interview and questionnaire† | 32 male drug users | Clinic | Alcohol, amphetamine, anti-oestrogen (clomid), analgesics, anti-acne drug, anti-catabolics, anti-depressants, anti-hypertensive drugs, anti-oestrogens, benzodiazepines, bronchodilators, cannabis, cocaine, creatine, dietary supplements, diuretics, ephedrine, fat-loss agents, gamma hydroxybutyrate, growth hormone, heroin, insulin, insulin-like growth factor 1, levodopa, muscle oil (synthol), non-steroidal anti-inflammatory drugs, opioid, plant steroid compounds, protein powder, stimulants, testosterone boosters, thyroid hormone |
Strauss 1985 [55] | USA | Interview | 10 weight-trained female athletes; mean age 33 years | Personal contact | Acetaminophen, aspirin®, benoxaprofen, Ben-Gay®, caffeine, calcium, choline and inositol, dietary supplements, dimethyl sulfoxide, codeine, electrolyte solution, epinephrine, furosemide, growth hormone, levodopa, lidocaine, naproxen, oxycodone hydrochloride, phenylbutazone, piroxicam, potassium, suntan pills, thyroglobulin, vitamins |
Tallon 2007 [56] | Scotland | Interview and questionnaire† | 30 males aged 18 to 43 years; mean age 27 years | Gymnasium | Alcohol, cannabis, cocaine, clenbuterol, dietary supplements, diuretics, ecstasy, growth hormone, insulin, tamoxifen |
Wilson-Fearon 1999 [57] | England | Case study | 29-year-old bodybuilder | Not specified | Clenbuterol, dietary supplements, diuretics, growth hormone, human chorionic gonadotropin (hCG), thiomucase |
Wines 1999 [58] | USA | Interview | 11 weightlifters (5 female) aged 19 to 42 years | Gymnasium | Alcohol, buprenorphine, heroin, hydrocodone, nalbuphine, other drugs |