Substance Use & Misuse, 49:17511758, 2014

Copyright 
C 2014 Informa Healthcare USA, Inc.
ISSN: 1082-6084 print / 1532-2491 online
DOI: 10.3109/10826084.2014.880175

ORIGINAL ARTICLE

Frequency of Use, Awareness, and Attitudes Toward Side Effects of

AnabolicAndrogenic Steroids Consumption Among Male Medical
Students in Iran

Mohammad Reza Fayyazi Bordbar, Ebrahim Abdollahian, Roya Samadi

and Hamid Dolatabadi

Psychiatry and Behavioral Sciences Research Center, Ibn-e-Sina Hospital, Faculty of Medicine, Mashhad University of
Medical Sciences, Mashhad, Iran

they could increase muscle strength to approximately 5%

This study was conducted to determine the frequency
of anabolicandrogenic steroids consumption in male
students studying at the university and their aware-
ness, attitude, and role of sports activities; the present
descriptive study was conducted on 271 volunteers in
2008. The data collected by self-report questionnaires
was analyzed by descriptive inferential statistics. The
prevalence of consumption was 3.3%, and it was signif-
icantly higher in those with a history of bodybuilding or
athletic performance. The overall awareness rate was
low, and the attitude was too optimistic. It seems that
unawareness, incorrect attitude, and history of athletic
performance increases the risk of consumption.
Keywords anabolicandrogenic steroids, attitude, bodybuilding,
knowledge, prevalence
INTRODUCTION
Anabolic steroid drugs are synthetic derivatives of testos-
terone that have both anabolic and androgenic effects
(Woerdeman, de Hon, Levi M, & de Ronde, 2010).
Anabolicandrogenic steroid (AAS) use is a global bur-
den, and there is an increasing interest at the interna-
tional level in the consumption of these drugs (Costine
et al., 2010; Thiblin & Peterson, 2005; Pope & Brower,
2009; Eisenberg & Galloway, 2005; Santos, da Rocha,
& da Silva, 2011). According to general beliefs, AAS
are necessary for reaching the highest peaks of success
in sport (Eisenberg & Galloway, 2005; Sjoqvist, Garle
& Rane, 2008). Coupled with an appropriate diet, these
drugs can help in gaining weight; especially by increasing
muscle mass (Eisenberg & Galloway, 2005). In addition,
(Eisenberg & Galloway, 2005), and these small changes
could make a difference between anonymity and a world
record in one point or one-hundredth of a second (Thib-
lin & Peterson, 2005; Pope & Brower, 2009). Some of the
effects of AAS on improving performance may be cardio-
vascular as well as psychological (Kohtz & Frye, 2012).
People in a wide range of professions such as profes-
sional athletes (in this article, professional athlete is de-
fined as an individual participating in official sport teams
or championship tournaments; especially in the fields of
bodybuilding, weightlifting, wrestling, and football), am-
ateur bodybuilders, and young people desirous of devel-
oping a muscular body may use them (Eisenberg & Gal-
loway, 2005; Thiblin, & Peterson, 2005; Scott, 2010).
Bodybuilders usually use these drugs to have a muscular
body and are rewarded through the admiration of others.
Other athletes also use these drugs, as encouraged by their
trainers, to enhance their performance (Eisenberg & Gal-
loway, 2005; Pope & Brower, 2009; Parkinson & Evans,
2006; Kokkevi, Fotiou, Chileva, Nociar, & Miller, 2008).
AAS are the most prevalent prohibited substances
detected on doping tests among athletes (Fitch, 2008).
The prevalence of abuse used to be higher among ath-
letes (Eisenberg & Galloway, 2005) but, nowadays, most
consumers of AAS are non-athletes (Pope & Brower,
2009; Parkinson & Evans, 2006; Kanayama, Hudson &
Pope, 2008; Cohen, Collins, Darkes & Gwartney, 2007;
Hildebrandt, Schlundt, Langenbucher & Chung, 2006;
Kanayama, Pope & Hudson, 2001). A typical consumer is
an individual approximately 30 years of age, with higher
education and a relatively lucrative job, who does not
do professional sports and uses AAS just to enhance his

The authors thank the Vice chancellor of Mashhad University of Medical Sciences, Parisa Samadi (medical student), and Dr Mehri Baghban
Haghighi for their worthwhile assistance with this study.
Address correspondence to Roya Samadi, Psychiatry and Behavioral Sciences Research Center, Ibn-e-Sina Hospital, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran; E-mail: royasamadi10@gmail.com; pbsrc@mums.ac.ir
1751
1752 M. R. F. BORDBAR ET AL.
physique (Cohen et al., 2007). However, a study con-
ducted in 2012 among the general population in Sweden
showed that the history of illegal drug use and misuse of
prescribed drugs have the strongest association with AAS
abuse. When this factor was controlled for, a significant
correlation was seen between exercise, lower education,
and abuse (Hakansson, Mickelsson, Wallin & Berglund,
2012).
AAS dependence is defined according to the crite-
ria specified in the Diagnostic and Statistical Manual of
Mental Disorders, Text Revision (DSM-IV-TR) (Brower,
2009; Eisenberg & Galloway, 2005). Although these
drugs are not used for the purpose of getting a high or the
effects of acute toxicity, as seen with other drugs (Hilder-
brandt, Yehuda, & Alfano, 2011; Parkinson & Evans,
2006), dependence on AAS may affect the brain opi-
oid system (Kanayama, Brower, Wood, Hudson, & Harri-
son, 2009). Approximately 30% of AAS consumers show
a dependence syndrome (Kanayama, Hudson, & Harri-
son, 2009). AAS abusers usually abuse other substances
such as alcohol (Eisenberg & Galloway, 2005), mari-
juana (Pope & Brower, 2009), cocaine (Pope & Brower,
2009; Miller et al., 2005), caffeine and methamphetamine
(Eisenberg & Galloway, 2005), and opioids (Kanayama
et al., 2009; Eisenberg & Galloway, 2005). In addition,
smoking common among them (Eisenberg & Galloway,
2005; Pope & Brower, 2009). Although consumers con-
sult doctors mostly due to medical complications rather
than the psychological consequences (Brower, 2009),
the dosage to achieve the desired goals, which some-
times exceeds the amounts used in medical applications
by 20 to 200 times (Eisenberg & Galloway, 2005), in-
creases the risk of undesirable medical and psycholog-
ical consequences. Being exposed to AAS, even for as
brief a duration as 48 hours, may cause neuronal toxi-
city (Caraci et al., 2011) that might be irreversible, es-
pecially with long-term consumption (Kanayama et al.,
2008). Any contact with AAS during adolescence, when
there is hormone-sensitive development, will lead to a
wide range of consequences and create some disorders
at the cellularmolecular level, such as changes in brain
serotonin levels (Lumia & McGinnis, 2010). Loss of men-
tal function (Eisenberg & Galloway, 2005; Sadock &
Sadock, 2007), anxiety (Costine et al., 2010), and mood
disorders are other potential complications (Kanayama
et al., 2008). A range of aggressive behaviors was ob-
served among consumers (Pope & Brower, 2009; Eisen-
berg & Galloway, 2005), and may be the only sign of
abuse. Aggressive behaviors among youths using AAS is
3 times more prevalent compared with the general popu-
lation (Pope & Brower, 2009). Violent crimes, aggressive
behavior, expulsion from competitions due to testing pos-
itive on doping tests, and the high rate of morbidity and
mortality due to AAS use will bring about many physical
and spiritual damages to the society (Eisenberg & Gal-
loway, 2005; Pope & Brower, 2009).
It seems that AAS use without a doctors prescription
and without being aware of their serious side effects has
become prevalent even among educated people in the so-
ciety. However, very few studies have been performed on
this group. Studying the prevalence of AAS abuse and the
awareness and attitude of students in the medical sciences
field toward these drugs is very important, because the
awareness and attitude of this group could also affect the
attitude of the people who are referred to them. Therefore,
this study was designed and conducted to determine the
frequency of AAS consumption as well as awareness and
attitude toward side effects in male students studying the
medical sciences in Mashhad. Moreover, considering the
role of professional sports on influencing the need to use
these drugs, students of medical sciences with a history of
athletic performance were compared with other groups.
MATERIALS AND METHODS
The present descriptive, correlational study was con-
ducted among 271 male students living in the dormito-
ries of Mashhad University of Medical Sciences (MUMS)
from 2008 to 2009 academic years, with the approval of
the ethics committee of the MUMS as a medical disserta-
tion. All students living in the dormitory were invited to
take part in the research, after coordination with university
and dormitory authorities.
As the study population consisted of young male stu-
dents of the medical sciences living in the dormitory,
we had a nearly homogenous population in many demo-
graphic aspects (e.g., socio-economic status). Religious
beliefs were not investigated in our study, but to the best
of our knowledge, the subjects were almost unanimously
Muslims.
The tool for data collection in this study was a self-
reported questionnaire comprising 31 questions chosen
from the questionnaires of Tamoski and colleagues, Ran-
dell and colleagues, and Nelson and colleagues, and its
reliability and validity had been proved in a study con-
ducted in Isfahan (Kargarfard, Ghias, Karimzadegan &
Kashi, 2006). This questionnaire includes 10 questions for
obtaining background demographic information, seven
questions related to the level of awareness, eight ques-
tions related to attitude, six questions related to AAS use
prevalence, one question about the history of bodybuild-
ing activity, and one question about performing any other
professional sports activity in the past or at present. In this
research, a professional athlete was defined as an individ-
ual participating in official sport teams or championship
tournaments. In total, 280 questionnaires were distributed
in the dormitories of MUMS by the researchers. After ex-
plaining to the students about the aims of the study, they
were asked to fill the questionnaire if they were interested
in participation in the study. While distributing the ques-
tionnaires, it was emphasized that the information col-
lected would be kept confidential, and the results would
be used collectively only for research purposes. The sub-
jects had 30 minutes on average to answer the question-
naires. The data was analyzed by SPSS software V. 14
using appropriate statistical methods. Descriptive statisti-
cal analysis was used to determine the frequency, percent-
age, average, and standard deviation. Comparison of the
 ANABOLIC STEROIDS AMONG MEDICAL SCIENCES STUDENTS 1753

TABLE 1. Demographic characteristics, history of championship, and AAS abuse, and their correlation with awareness, prevalence, and
attitude toward AAS

AAS1 abuse Knowledge Attitude Prevalence

F2 % F P Mean P Mean P Mean P

Age <21 85 31.4 P = 0.690 4 0.620 1 0.060 1 0.790

2125 152 56.1 4 2 1
2630 26 9.6 4 1.5 1
>30 8 2.9 2 2 1
Major Medicine 67 24.7 0.940 4 0.040 2 0.820 1 0.009
Dental 18 6.6 2 1 0
Pharmacy 37 13.7 3 1 0
Nursing 30 11.1 4 1 1
Others 119 43.9 4 1 1
Academic degree Associate 61 22.5 2 0.480 4 0.110 1 0.980 1 0.060
Bachelor 70 25.8 4 4 1 1
Masters 15 5.6 0 6 1.5 1
Doctoral 125 46.1 3 4 1.5 1
History of championship Yes 85 31.4 6 P = 0.030 4 0.850 1 0.190 1 < 0.001
No 186 68.6 3 4 2 0
History of bodybuilding Yes 99 36.5 8 P = 0.006 4.5 0.040 1 0.89 1 < 0.001
No 172 63.5 1 4 1 1
History of AAS abuse Yes 9 3.3 4 0.540 3 0.02
No 262 96.7 4 1

Chi-square test

KruskalWallis test

MannWhitney test
AAS = anabolic androgenic steroid; F = frequency

averages and the relationship between variables were done
through testing the assumptions of inferential statistics.
RESULTS
In total, 271 out of 280 questionnaires were returned
(96% response rate). The mean age of the participants
was 22.23, with an age range of 18 to 25 years. The par-
ticipants were mostly in the 21- to 25-year age group
(56.1%), and were studying in one of 13 fields related
to the medical sciences. Most (44.3%) were medical sci-
ences students (medical, dental, and pharmacy). Other de-
mographic characteristics of the students are presented in
Table 1. Eighty-five students had a history of participat-
ing in championship sporting events at the provincial or
national level. The most prevalent sports were football
(30 students), martial arts (13 students), and volleyball
(nine students). Among them, 32 students were undertak-
ing sports professionally at the time of responding to the
questionnaire. Ninety-nine participants (36.5%) had ex-
perienced bodybuilding activities, 66.7% of whom were
involved for less than 6 months. The frequency of distri-
bution of activity duration in the field of bodybuilding is
listed in Table 2. The most common sources of informa-
tion for students about AAS included: books and journals
(32.1%), television (14%), friends (10.7%), and the Inter-
net (8.9%). In total, 152 students (56.1%) were familiar
with some of the side effects of AAS, and 74 students
(27.3%) stated that they had observed these side effects
in their friends or relatives. Some attitudes of students to-
ward AAS use have been described in Table 3.
Only 22 students (8.1%), out of the entire group, be-
lieved that athletes should be allowed to use these drugs.
Overall, 140 students (51.7%) knew some people who
used these drugs, and 79 students (29.2%) stated that they
had been encouraged to use these drugs. Nine students
(3.3%) had a history of using AAS, and three of them were
using AAS at the time of study participation. Moreover,
seven students intended to use these drugs in the future.
Seventeen students (6.3%) stated that they intended to use
AAS in the future, and 30 students (11.1%) were not sure
about using these drugs in future. Eighty students (29.5%)
expressed that, if they knew any drugs with the same an-
abolic effects as these drugs but without any side effects,
they would use them, whereas 56 students (20.7%) were
not sure whether they would use the drugs even in this
case. In total, 126 participants (46.5%) declared that they
would not use these drugs under any circumstances.
TABLE 2. Distribution of activity duration in bodybuilding
among the students of medical sciences
Duration Number
of activity of persons Percentage
<6 months 66 66.7
612 months 14 14.1
>1 year 19 19.2
1754 M. R. F. BORDBAR ET AL.

TABLE 3. Attitudes of students about AAS

Agree Doubtful Disagree

Statement Number Percentage Number Percentage Number Percentage

Olympic athletes use AAS 70 25.8 129 47.6 72 26.6

Professional bodybuilders use AAS 166 61.3 78 28.8 27 9.9
High school athlete students use AAS 63 23.2 128 47.2 80 29.6
AAS use without a good nutrition and regular exercise may 13 4.7 84 31.0 174 64.2
increase muscle volume and strength
Using AAS can enhance the athletic performance 61 22.5 92 33.9 118 43.5
Careful consumption of AAS wont cause complications 33 15.9 110 40.6 128 47.3
AAS are totally harmless drugs 11 4.1 53 19.6 207 74.2
AAS use is a kind of drug abuse 98 36.2 62 22.9 111 40.9

There was no significant correlation between age, field
of study, and academic level of the students and history
of using AAS (P = 0.69; P = 0.94; and P = 0.48, re-
spectively). The prevalence of AAS consumers who had a
history of athletic performance at different championship
levels (city, provincial, or national) with a history of body-
building activity was significantly higher than those who
did not have such a background (P = 0.003 and P =
0.0006, respectively).
The awareness score of the questionnaire showed the
extent of familiarity with these drugs and their side ef-
fects. The attitude score demonstrated the students point
of view toward AAS consumption, and it had a direct rela-
tionship with the optimistic attitudes and notions in spite
of scientific facts. Table 1 includes the comparison among
awareness, attitude, and prevalence in different age and
educational groups. Awareness and attitude is compared
between consumers and nonconsumers, while taking ath-
letic and bodybuilding history into consideration. In this
table, examining rank correlation revealed that there are
significant correlations between awareness and attitude
and also between awareness and prevalence (rs = 0.501,
P = 0.004) (rs = 0.3, P = 0.009), respectively. However,
there was no significant correlation between prevalence
and attitude (P = 0.15).
DISCUSSION
This study was conducted to determine the frequency of
AAS consumption, awareness, and attitude of male stu-
dents of the medical sciences toward the side effects with
consideration of the role of history of athletic performance
in this regard. The study indicated that AAS use is preva-
lent among the youth studying in the field of medical
sciences. The few researches done in this field in Iran
have shown different prevalence of AAS use in various
regions of the country (13%20%), although the target
population of these studies were mostly athletes (Nojoumi
& Behravan, 2005; Hazave & Abdol-maleki, 2000; Kar-
garfard et al., 2006; Kargarfard, Kasha, & Sarlak, 2009;
Sepehri & Moosavifar, 2003).
The only study in a student population was carried out
in 2006 in Isfahan, and revealed the prevalence of AAS
consumption to be 8.3% (Kargarfard et al., 2006). How-
ever, no similar investigation had been performed among
students of medical sciences. Studies from different coun-
tries worldwide have estimated the lifetime prevalence in
young men to be at least 3% (Wanjek, Rosendahl, Strauss
& Gabriel, 2007), which is close to the prevalence rate
obtained in our study.
In a study performed in Sweden on 1,752 members of
sports clubs, the lifetime prevalence of AAS use was 9.3%
(Nilsson, Spak, Marklund, Baigi, & Allebeck, 2005). An-
other study in 2004, conducted in Germany, showed the
prevalence of AAS consumption to be 0.7% among stu-
dents; however, awareness about the risks of AAS use was
low in both consumer and nonconsumer groups (Wan-
jek et al., 2007). In the study conducted by Kargarfard
and colleagues, the prevalence of use was 8.3% (Kargard-
fard et al., 2006), which is obviously higher than the esti-
mated prevalence rate in our study. This difference might
be probably due to some factors, such as a higher rate
of professional sports activities (67% in Isfahan study vs.
31.4% in our study), higher frequency of bodybuilding ac-
tivity (66% in Isfahan study vs. 36.5% in our study), and
the focus of our study on the students of medical sciences
who are expected to have higher-than-average awareness
and more realistic attitudes toward these substances.
In the studies done in other countries, the prevalence of
consumption is between 0.6% to 12% in the male general
population (Thiblin & Peterson, 2005; Pope & Brower,
2009; Eisenberg & Galloway, 2005; Wanjek et al., 2007;
Rachon, Pokrywka & Suchecka-Rachon, 2006). The to-
tal prevalence of consumption in our study is within the
estimated range of these studies (3.3%). However, in our
study, the prevalence rate was 7.2% among students with
a history of professional athletic activity and 8.4% in stu-
dents with a history of bodybuilding activity. This is in
agreement with the fact that the prevalence of AAS use in
athletes, particularly bodybuilders, is significantly higher
than in the general population. Studies have reported the
prevalence of AAS consumption in this group to be be-
tween 6.2% to 44% (Thiblin & Peterson, 2005; Pope &
Brower, 2009; Eisenberg & Galloway, 2005; Parkinson &
Evans, 2006; Sadock & Sadock, 2007). The prevalence
of AAS use among athletes was higher than among other
students in our study as well, which is in accordance with
global estimations of AAS consumption prevalence in
 ANABOLIC STEROIDS AMONG MEDICAL SCIENCES STUDENTS
athletes. In a study carried out in Hamedan-Iran in 1998 on
bodybuilders, the prevalence of consumption was 19.2%
(Hazave & Abdol-maleki, 2000). In two other separate
studies conducted in Karaj and Kerman, Iran in 2008 on
bodybuilders, the frequency of consumption was 13% and
18.8%, respectively (Sepehri & Moosavifar, 2003; No-
joumi & Behravan, 2005), which is significantly higher
than the frequency of AAS use among students active in
bodybuilding in our study (8.3%). Some possible reasons
could be the small number of students active in the field
of bodybuilding in our study (99 students) and the higher
familiarity of the students of medical sciences with AAS
and their side effects. In our study, the awareness rate was
low for all students. Moreover, the awareness rate in med-
ical and pharmacy students was not significantly differ-
ent from the others. Although 68% of medical students
and 66% of pharmacy students had been educated about
the side effects of AAS in their courses, their mean score
in questions related to awareness was less than 55%, and
only 45% of medical and 46% of pharmacy students con-
sidered the use of these drugs harmful. Furthermore, their
awareness did not significantly improve their attitude, and
only 49% of medical and 32% of pharmacy students con-
sidered AAS use as drug abuse. The awareness rate among
the students with a history of bodybuilding activity was
significantly higher than that among the other students. It
should be noted that, even in this group, only 62% of the
questions related to awareness were answered correctly.
Moreover, their awareness was mostly limited to familiar-
ity with AAS drugs and their anabolic effects, and only
44% of them knew about the side effects. However, their
awareness did not lead them to develop an appropriate at-
titude; therefore, only 33% considered AAS use as drug
abuse. Furthermore, 12% intended to use these drugs and
14% were doubtful of using these drugs in the future.
It is noteworthy that higher educational level had no ef-
fect on their level of awareness. There was no meaningful
correlation between academic level or field of study and
AAS abuse. Although the study performed by Cohen and
colleagues introduces educated people as the typical con-
sumers of AAS (Cohen et al., 2007), in a study conducted
in Sweden, there was a significant relationship between
AAS abuse and low educational level (Hakansson et al.,
2012).
The comparison between the attitudes of users and
nonusers shows that users have a more optimistic atti-
tude toward using drugs and only 32% of users consid-
ered using drugs as harmful; 66% suggested using drugs
to others, and only 22% considered it to be drug abuse;
77% intended to use the drugs in the future. There was
no significant correlation between age, field of study, aca-
demic level, history of professional athletic performance,
and history of bodybuilding activity with attitude toward
AAS use. Higher awareness in bodybuilder students did
not result in a significant decrease in their nonscientific
attitudes. In a study in Germany, both consumer and non-
consumer groups had little awareness of AAS and an-
swered less than 60% of the questions correctly, which
is consistent with the results of our study (Wanjek et al.,
1755
2007). Furthermore, in other studies, the overall levels of
awareness about these drugs and their side effects were
reported to be low (Eisenberg & Galloway, 2005). In a
study conducted in Sweden, the general level of aware-
ness was reported to be low, although the level of aware-
ness in consumers was significantly higher than in others
(Nilsson et al., 2005). However, in our study, although the
population included the students of medical sciences, such
a relationship was not found. A study in Poland in 2006
revealed that the awareness of individuals with a history
of AAS consumption was significantly lower than others,
and they were less familiar with the side effects of AAS,
which is contrary to the results of our study (Rachon et al.,
2006). In the studies carried out in Hamedan, Karaj, and
Kerman on bodybuilder athletes and the study done in Is-
fahan on students, the overall levels of awareness were
reported to be low, similar to our findings (Hazave &
Abdol-maleki, 2000; Nojoumi & Behravan, 2005; Sepehri
& Moosavifar, 2003; Kargarfard et al., 2006). In the stud-
ies performed in Hamedan, Karaj, and Isfahan, awareness
was significantly higher in athletes than others, contrary
to that in our study, which did not demonstrate such an
association. One possible explanation can be the differ-
ence between study populations. Assuming that students
of medical sciences have an overall higher-than-average
awareness rate, a smaller difference between the levels
of awareness among consumers and nonconsumers is to
be expected (Kargarfard et al., 2006; Nojoumi & Behra-
van, 2005; Hazave & Abdol-maleki, 2000). In the study
conducted in Karaj, unlike our study, there was a signifi-
cant, but small, relationship between the age and level of
awareness, wherein the level of awareness was higher in
older individuals. In addition, in contrast with our study
and the studies carried out in Isfahan and Kerman, there
was a significant difference between educational level and
level of awareness in this study: awareness was higher at
higher educational levels (Sepehri & Moosavifar, 2003;
Kargarfard et al., 2006; Nojoumi & Behravan, 2005). In
the study performed in Isfahan, the awareness rate of the
students who had a history of professional athletic activ-
ity was significantly higher than among other students,
which is consistent with the results of other studies. How-
ever, such a difference was not observed in our study, al-
though the awareness rate in the students with a history of
bodybuilding was higher than in others. (Kargarfard et al.,
2006; Parkinson & Evans, 2006; Pope & Brower, 2009;
Eisenberg & Galloway, 2005).
In the studies conducted in Hamedan, Kerman, and
Isfahan, the most common source of information was
friends (Kargarfard et al., 2006; Hazave e, 1996; Sepehri
& Moosavifar, 2003), whereas, in our study, it was books,
journals, and the Internet. This difference could be due
to the nature of our students field of study and their
wide access to medical and pharmaceutical sources. In
several American studies as well as the studies carried
out in Sweden and Poland in 2006, the attitude of con-
sumers toward these drugs was significantly more opti-
mistic and nonscientific than that of nonconsumers, a find-
ing consistent with the results of our study and the studies
1756 M. R. F. BORDBAR ET AL.

conducted in Kerman and Isfahan (Sepehri & Moosavi- pharmacists, and athletic coaches, together with general
far, 2003; Rachon et al., 2006; Eisenberg & Galloway, education of the at-risk population, introducing safe al-
2005; Kargarfard et al., 2006; Nilsson et al., 2005 Wan- ternative methods, and bringing in some legislation to re-
jek et al., 2007). In addition, no significant difference duce easy access, especially for teenagers, can play effec-
was observed between the consumption rates of students tive roles in reducing the tendency toward AAS use and
in different fields of study. Students with a history of the prevalence of AAS consumption. Preventive interven-
professional athletic performance or bodybuilding activ- tions should not be limited to athletes. It should cover all
ity had significantly higher prevalence rates than others. young people who suffer from behavioral disorders and
Prevalence rate had no meaningful correlation with the are at risk of AAS abuse. Focusing on athletes will only
attitude toward AAS use. However, the prevalence and result in losing the largest AAS consumer group (Cohen
awareness rate were found to have a significant and direct et al., 2007).
relationship with each other. This relationship was also
present between awareness and attitude rates. These find-
ings are in accordance with the study conducted in Isfahan Declaration of Interest
(Kargarfard et al., 2006). The authors report no conflicts of interest. The authors
alone are responsible for the content and writing of the ar-
CONCLUSIONS
ticle. This research was performed as a dissertation after
approval by the ethics committee of the Mashhad Univer-
Although using AAS and being in contact with consumers sity of Medical Sciences.
will lead to more familiarity with these drugs, they will This study received financial support via a grant from
only increase ones information in a limited and deficient the vice chancellor of research of the university.
fashion without increasing awareness toward the possible,
dangerous side effects of these drugs, leading eventually
to optimistic and nonscientific attitudes. If these false be- THE AUTHORS
liefs become prevalent among the youth, then the com- Dr Mohammad Reza Fayyazi
petitive nature of sports, usage of these drugs by other Bordbar is an associate
athletes, extensive advertising on the established anabolic professor of Psychiatry at
Mashhad University of Medical
properties of these drugs, and the tendency among youth
Sciences. He has been working
to desire development of muscular bodies and better ap-
on the science of addiction,
pearance, further provoked by media advertisements, will mood disorders, psychotherapy,
lead to significant increases in the use of these drugs. Fur- and mental health for 12 years.
thermore, the low level of awareness in medical and phar- He has published his findings in
macy students as those with potential to be trusted sources several international publications
of information for others in the future is alarming for the in his field. Address: Ibn-e-
propagation of inaccurate information and nonscientific Sina Hospital, Hor-e-Ameli
attitudes toward AAS in the society. Blvd., Mashhad, Iran. E-mail:
Fayyazzimr@mums.ac.ir
Limitations and Suggestions
Because this study aims to investigate the prevalence and
attitude in a specific population (students of medical sci-
ences), the results obtained from this study might not be
generalizable to the whole society in some aspects. Fur- Dr Ebrahim Abdollahian
thermore, as the measurement tools are self-reporting, the is professor of Child and
results are dependent on the students candid statements Adolescent Psychiatry at
to a great extent, and, considering the probable tendency Mashhad University of Medical
to hide drug use, reliability is not evident. Sciences. His main areas of
As the attitude of the students of medical sciences to- interest are attention-deficit
ward these drugs may affect the attitude of their future hyperactivity disorder (ADHD),
clients, it is deemed necessary to investigate the causes psychopharmacology, and
contributing to their high rate of unrealistic attitudes de- addiction. He graduated
in general psychiatry from
spite their high awareness. Moreover, regarding the stud-
Mashhad University of Medical
ies that show a considerable decrease in the prevalence of Sciences in 1977 and in child
AAS abuse subsequent to education and improving atti- and adolescent psychiatry from
tudes, some interventions may be needed in this area for The Ohio State University in 1995. He has many publications
the students of medical sciences (Allahverdipour, Jalilian in international journals and has also authored and translated
& Shaghaghi, 2012; Goldberg et al., 1996; Tavousi et al., a number of books in the field of psychiatry. He has done oral
2009; Nilsson, Allebeck, Marklund, Baigi, & Fridlund, and poster presentations at local and international congresses.
2004). Comprehensive prevention programs with a focus Address: Ibn-e-Sina Hospital, Hor-e-Ameli Blvd., Mashhad, Iran.
on multiple risk factors and based on educating doctors, E-mail: abdollahiane@mums.ac.ir
 ANABOLIC STEROIDS AMONG MEDICAL SCIENCES STUDENTS 1757

Dr Roya Samadi graduated tor expression and anxiety-like behaviors in the female mouse.
in psychiatry from Mashhad Psychoneuroendocrinology, 35(10), 147385.
University of Medical Sciences Eisenberg, E. R., & Galloway, G. P.. Anabolic-androgenic steroids.
in 2013. She has authored In: J. H. Lowinson, P. Ruiz, R. B. Mill man, J. G. Long lord.
and published articles in the Substance abuse. (4th edn, pp. 421447). Philadelphia: Lippin-
field of psychogeriatrics, cott Williams & Wilkins; 2005.
psychopharmacology, and Fitch, K. D. (2008). Androgenic-anabolic steroids and the Olympic
psychosomatics besides her games. Asian Journal of Andrology, 10(3), 384390.
work on addiction. Address: Ibn- Goldberg, L, Elliot, D, Clarke, G. N., MacKinnon, D. P., Moe, E,
e-Sina Hospital, Hor-e-Ameli Zoref, L, et al. Effects of a multidimensional anabolic steroid
Blvd., Mashhad, Iran. E-mail: prevention intervention. The Adolescents Training and Learning
royasamadi10@gmail.com; to Avoid Steroids (ATLAS) Program. JAMA: The Journal of the
PBSRC@mums.ac.ir American Medical Association, 276(19), 15551562.
Hakansson, A, Mickelsson, K, Wallin, C, & Berglund, M. (2012).
Dr Hamid Dolatabadi. General Anabolic androgenic steroids in the general population: user
physician. The present article characteristics and associations with substance use. European
is based on his thesis as a Addiction Research, 18(2), 8390. Epub 2012 Jan 28.
requirement for his degree Hazave, M. M., & Abdol-maleki, M. H. (2000). Review the status
of medicine. Address: Ibn-e- of anabolic steroid abuse among bodybuilders athletes in 1376
Sina Hospital, Hor-e-Ameli in Hamadan. Journal of University of Medical Sciences, 6(2),
Blvd., Mashhad, Iran. E-mail: 318.
PBSRC@mums.ac.ir Hildebrandt, T, Schlundt, D, Langenbucher, J, & Chung, T. (2006).
Presence of muscle dysmorphia symptomology among male
weightlifters. Comprehensive Psychiatry, 47(2), 127135.
Hildebrandt, T., Yehuda, R, & Alfano, L. (2011). What can allosta-
sis tell us about anabolic-androgenic steroid addiction?. Devel-
opment and Psychopathology, 23(3), 907919.
GLOSSARY Kanayama, G., Brower, K. J., Wood, R. I., Hudson, J. I., & Harrison,
G. P., Jr. (2009). Anabolic-androgenic steroid dependence: An
Anabolicandrogenic steroids: Synthetic derivatives of emerging disorder. Addiction, 104(12), 19661978.
testosterone that have anabolic and androgenic effects Kanayama, G., Hudson, J. I., & Harrison, G. P. Jr. (2009). Features
simultaneously. of men with anabolic-androgenic steroid dependence: A com-
Attitude: A persons perspective toward a specified target parison with nondependent AAS users and with AAS nonusers.
and way of saying and doing things. Drug and Alcohol Dependence, 102(13), 130137.
Bodybuilding: The use of progressive resistance exercises Kanayama G., Hudson, J. I., & Harrison, G. P. Jr. (2008). Long-term
to control and develop ones musculature. psychiatric and medical consequences of anabolic-androgenic
steroid abuse. A looming public health concern?. Drug and Al-
Knowledge: Familiarity with something, acquired through
cohol Dependence, 98(12), 112.
experience or education. Kanayama, G, Pope, H. G. Jr, & Hudson, J. I. (2001). Body image
Prevalence: The proportion of a population found to have drugs: A growing psychosomatic problem. Psychotherapy and
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Kargarfard, A., Kasha, A., & Sarlak, Z. (2009). Prevalence of er-
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