ROID RAGE!! Is it real?
Or just an ass-hole on steroids!
We have all heard it before, “Roid Rage” is BS. It’s not true! People say- there is no evidence that Roid Rage exists and that guy who is acting like a crazy jerk, known to be on steroids is just “an ASS-HOLE on steroids!” Ok, I get it, but being the Doc, I feel obligated to do my research on what is really going on here. Everyone knows that I am the medical expert on the clinical side of anabolic/androgenic steroids AAS and that I take care of men who are using or have used AAS and are suffering. I’ve been doing this since 2003! My clinical interest and expertise lies within Anabolic Steroid Induced Hypogonadism ASIH and the cardiovascular affects resulting from AAS use. Of course, I have am well versed regarding the psychiatric affects of AAS, but I have always stayed away from writing this particular article- For the fear of the unknown!
Trying to understand so-called “roid rage” is a frustrating undertaking. From the equivocal findings of (usually) small observational and placebo studies, to popularized pejorative media accounts, and roid-deniers on steroid websites, it’s clear that there is no consensus on the definition of this phenomenon or what causes it. The best one can do is provide a representative sample of these sources to see where, if at all, these converge.
To prepare for this article, I spent hours reviewing the Evidenced-Based-Data on steroids and psychiatric events. Boy was I amazed and wow, how much I learned! I found tons of data, but became increasingly confused. There is definitely no slam dunk on this issue, as per the “experts” and I would assume it is because there is no obvious mechanism of action- no smoking gun, at least that we can find today. Here is one of the more “respectable” reports that I found:
Illicit Anabolic-Androgenic Steroid Use
Gen Kanayama, M.D., PhD., James I. Hudson, M.D., Sc.D., and Harrison G. Pope, Jr, M.D., M.P.H.
Horm Behav. 2010 Jun; 58(1): 111–121.
The consensus of the above field studies is that some AAS users exhibit hypomanic or manic symptoms during AAS exposure, occasionally (albeit rarely) accompanied by psychotic symptoms. Some studies have also reported users showing depressive symptoms, occasionally associated with suicide, usually during AAS withdrawal. However, it is impossible to estimate the prevalence of these syndromes in the overall population of illicit AAS users, because there is such wide variation among the various studies. Some studies report relatively frequent and often severe pathology (Pope and Katz, 1988; Thiblin et al., 1999b), whereas others find little or even none (Bahrke et al., 1992). These differences may be partially attributable to differences in the doses of AAS used, with more frequent symptoms in studies that included large numbers of high-dose AAS users (particularly those ingesting the equivalent of more than 1000 mg of testosterone per week; see discussions in (Pope and Brower, 2009; Pope and Katz, 2003). Differences in methods of selection and evaluation of participants also likely contributed to differences in the findings.
The evidence of the above laboratory studies, combined with the extensive experience of field studies, strongly suggests that high doses of AAS may indeed produce psychiatric effects, and that these effects cannot be fully explained by psychosocial factors. However, it is also clear that these effects are quite unpredictable and idiosyncratic: most illicit users, including even those ingesting high doses, exhibit little or no psychopathology, whereas a few demonstrate striking mood changes, aggression, and even violence in association with AAS use. This same idiosyncratic pattern has also been documented in animals; for example, most hamsters administered AAS display aggressiveness, but some show little behavioral change (Clark and Henderson, 2003; DeLeon et al., 2002; Melloni et al., 1997). In humans, there also appears to be an idiosyncratic association of depression with hypogonadism following AAS withdrawal. For example, in one laboratory study of pharmacology induced hypogonadism, most men showed little or no depression, while a few showed marked depressive symptoms (Schmidt et al., 2004). Although the non-uniform nature of AAS psychological effects, both at physiologic doses (Kanayama et al., 2007a; Rubinow and Schmidt, 1996) and at supraphysiologic doses (Pope and Brower, 2009), has long been acknowledged, its mechanism is still unclear. Preliminary findings in animals (Clark and Henderson, 2003; DeLeon et al., 2002; Fischer et al., 2007; Grimes and Melloni, 2006) and humans (Daly, 2001; Daly et al., 2003; Daly et al., 2001) have implicated a variety of possible associations with brain neurochemistry and hormonal levels, with several studies suggesting that serotonergic effects may play a key role.
One thing I can definitely agree with is that when people take large doses of AAS and certain types of AAS, like Tren ( AKA Devil’s Juice) their personalities can change. No experienced steroid user will argue this. And the marked depression that can follow abrupt discontinuation of ASS is 100% for real!! After more than a decade in the business, I can vouch for this. When I analyze all of the studies of Roid Rage that I have read, I noticed a number of common themes. It seems almost universal that the authors differentiate frank psychosis vs impulse control and Testosterone Replacement Therapy TRT vs AAS use. And unlike studies where there are clear measurable variables and end points, e.g. blood pressure, lipid values, hemoglobin and kidney function, determining a cause-effect series of events regarding AAS use and psychiatric issues is onerous. Nonetheless, when discussing Roid Rage, one has to consider the perspective of who is being questioned. It is clear that when AAS users are asked about Roid Rage, they get defensive and minimize its relevance vs non-AAS users who tend to assert that such a state exists, without adequate scientific support.
What to think?
When I draw from my professional experiences, I would say that it is true that “impulse control” is the psychiatric feature that is affected by AAS use and that there is no organic or tangible changes that occur secondary to AAS use- at least that can be quantified. For whatever it is worth, the accounts of Roid Rage that have resulted in serious harm pale when one considers that there are millions of people actively using AAS. Is this impulse control regulation truly pathologic and is it reproducible by AAS use? What are the mechanisms-of-action? We clearly see alcohol, illicit drugs, prescription drugs and even caffeine being implicated in aggressive behavior, poor impulse control and even death. Some of these are accepted agents in our American culture and we have developed a sense of “personal self-regulation” and responsibility when it comes to dealing with these scenarios. Will AAS use and Roid Rage fall into such pedestrian means? That is yet to be known. I can tell you this, anyone who uses AAS knows that they can experience occasional emotional liability, but for the most part, the great majority AAS users experience a sense of well-being, hence the reason why they stay on these agents for extended periods. I am not giving AAS use a blessing, I am simply stating the anecdotal truth. I have heard many AAS users tell me in confidence that they realize that they have to be careful with their impulse control when on AAS- especially when they are on high doses and with certain types of AASs. It seems that AAS users admit that Roid Rage CAN BE real, but most of them are able to possess the self-control to be cool. This is an amazing fact! Maybe the better question is; with the known emotional side affects of AAS, why would someone compensate for such disability and what mechanism drives them to do so? This seems more likely to help heal any potential suffering rather than generate arguments between those who see this topic from two very different vantage points.
Therefore, as a scientist, I would have to say that smoking gun for AAS related Roid Rage is at-large and that crazy guy on gear is thus AN ASS-HOLE ON STEROIDS!
Stay Strong, Healthy and Sane!