Anabolic-androgenic steroids are linked to depression and anxiety in male bodybuilders: the hidden psychogenic side of anabolic androgenic steroids

Figures & data

Table 1. Distribution of demographic, hematological, biochemical, and hormonal parameters in anabolic steroid user and non-user groups.

Variables	Control Group (n = 25)	AAS users (n = 25)	p
Age (years)	31.3 ± 5.5 (27.0–35.5)	31.1 ± 8.8 (23.0–39.0)	0.683*
BMI (kg/ m^2)	24.2 ± 1.9 (23.0–25.9)	26.5 ± 3.2 (24.8–28.8)	0.003**
Hemoglobin (g/dL)	15.0 ± 0.8 (14.4–15.7)	15.5 ± 0.9 (14.9–16.1)	0.077**
Wbc (10^3/uL)	6.6 ± 1.2 (5.8–7.8)	7.7 ± 1.9 (6.4–8.7)	0.020**
Platelet (10^3/uL)	222.5 ± 57.5 (169.0–270.0)	262.9 ± 68.1 (217.0–318.0)	0.028**
ALT (IU/L)	23.8 ± 9.4 (16.5–30.0)	56.9 ± 32.3 (34.5–78.0)	<0.001*
AST (IU/L)	23.2 ± 6.4 (19.0–26.5)	44.9 ± 23.4 (27.0–59.0)	<0.001*
LDH (IU/L)	161.2 ± 22.7 (143.5–178)	199.5 ± 50.6 (165.0–227)	0.002**
GGT (U/L)	25.4 ± 12.9 (15.0–31.5)	21.6 ± 8.9 (14.5–27.0)	0.346*
ALP (U/L)	56.0 ± 18.1 (40.5–70.5)	70.4 ± 20.0 (60.0–76.5)	0.011**
CK (U/L)	161.2 ± 88.9 (92.5–245.5)	730.9 ± 475.0 (278.5–1166.5)	<0.001*
LDL-C (mg/dL)	126.8 ± 33.7 (104.5–146)	111.1 ± 35.1 (84.5–133)	0.113**
HDL-C (mg/dL)	47.4 ± 8.9 (43–50.5)	44.6 ± 11.3 (39.0–46.5)	0.075*
Triglycerides (mg/dL)	129.9 ± 60.3 (79.5–179.0)	95.2 ± 36.4 (67.0–127.5)	0.018**
Total C (mg/dL)	201.6 ± 36.4 (181.5–215.0)	172.4 ± 36.5 (149.0–198.0)	0.007**
FPG (mg/dL)	88.4 ± 6.9 (84.0–92.5)	91.4 ± 13.8 (81.0–97.0)	0.340**
Sodium (mEq/L)	138.6 ± 1.6 (138.0–139.0)	139.0 ± 1.6 (138.0–140.0)	0.449*
Potassium (mEq/L)	4.3 ± 0.3 (4.0–4.6)	4.5 ± 0.3 (4.2–4.8)	0.055**
Creatinine (mg/dL)	0.9 ± 0.1 (0.8–0.9)	1.0 ± 0.1 (0.9–1.2)	0.001**
Urea (mg/dL)	32.9 ± 8.1 (27.0–37.5)	38.5 ± 8.8 (31.4–43.0)	0.009*
TSH (mIU/L)	1.9 ± 0.9 (1.2–2.1)	2.5 ± 1.2 (1.6–3.8)	0.079*
FT4 (ng/dL)	1.0 ± 0.1 (0.9–1.2)	1.1 ± 0.1 (1.1–1.2)	0.009*
FSH (mIU/mL)	4.2 ± 1.5 (3.3–4.9)	2.0 ± 1.9 (0.4–3.7)	<0.001*
LH (mIU/mL)	4.6 ± 1.4 (3.5–5.9)	2.0 ± 2.1 (0.1–4.0)	<0.001*
Testosterone (ng/mL)	461.6 ± 130.5 (374.0–576.5)	841.5 ± 458.6 (534.0–1500.0)	<0.001*
Cortisol (ug/dL)	18.3 ± 3.7 (15.0–20.5)	18.9 ± 3.4 (16.4–22.0)	0.587**
Eastridol (pg/mL)	29.1 ± 8.6 (23.2–34.2)	33.6 ± 12.9 (25.7–42.2)	0.154*
Prolactin (ng/mL)	8.6 ± 4.2 (6.0–9.7)	7.1 ± 4.1 (5.2–8.9)	0.190*
Up/Uc (mg/g)	49.4 ± 16.7 (37.6–60.2)	65.2 ± 28.0 (48.4–73.4)	0.009*

Mean ± Standard Deviation (IQR).

*: Mann Whitney U Test.

**: Independent Samples T Test.

AAS: anabolic-androgenic steroids; ALP: alkaline phosphatase; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: Body Mass Index; FPG: fasting plasma glucose; GGT: gamma-glutamyl transferase; HDL-C: high-density lipoprotein-cholesterol; LDH: lactate dehydrogenase; LDL-C: low-density lipoprotein-cholesterol; PLT: platelets; Total C: total cholesterol; WBC: white blood cells. FSH: follicle stimulating hormone; FT4: free thyroxine; LH: luteinizing hormone; TT: total testosterone; TSH: thyroid stimulating hormone; Up/Uc: urine protein-to-creatinine ratio.

Bold p values indicate statistical significance.

Table 2. Depression and anxiety scores of the anabolic-androgenic steroid users and the control groups.

	AAS^a user group median (min–max)	Control group median (min–max)	p value
Beck Anxiety Inventory score	5.8 ± 3.7 (2.5–9.0)	1.2 ± 1.2 (0.0–2.0)	<0.001*
Beck Depression Inventory score	6.4 ± 6.7 (1.5–11.0)	0.8 ± 1.4 (0.0–1.0)	<0.001*

Mean ± Standard Deviation (IQR).

^aAAS, anabolic-androgenic steroids.

*: Mann Whitney U Test.

Table 3. Distribution of depression and anxiety scores of the anabolic-androgenic steroid users and the control.

	AAS^a user group		Control group		p value
	n	%	n	%
Beck Anxiety Inventory scores
Normal (<8)	18	72	25	100	0.010*
Mild anxiety symptoms (8–15)	7	28	0	0
Moderate anxiety symptoms (16–25)	0	0	0	0
Severe anxiety symptoms (26–63)	0	0	0	0
Beck Depression Inventory scores
Normal (<10)	18	72	25	100	0.012*
Mild depressive symptoms (10–16)	4	16	0	0
Moderate depressive symptoms (17–29)	3	12	0	0
Severe depressive symptoms (30–63)	0	0	0	0

^aAAS, anabolic-androgenic steroids.

* Fisher Exact Testing.

Figure 1. The correlation graph between LDH (lactate dehydrogenase) and BAI (Beck Anxiety Inventory) scores.

Figure 2. The correlation graph between BAI (Beck Anxiety Inventory) scores, BDI (Beck Depression Inventory) scores, and creatinine.

Figure 3. The correlation graph between estradiol and BDI (Beck Depression Inventory) scores.

Figure 4. Receiver operating characteristic (ROC) curve of creatinine (sensitivity: 85.7% and specificity: 87.8%, AUC: 0.853).

Table 4. Regression analysis results for beck anxiety Inventory score.

	B (%95 CI)	Beta	t	p	Zero-order	Partial
Constant				<0.001
Creatinine	10.319 (4.940–15.699)	0.470	3.859	<0.001	0.544	0.491
LDH	6.375 (1.345–12.404)	0.259	2.127	0.039	0.393	0.296

B: Unstandardized Coefficient, Beta: Standardized Coefficient.

LDH: lactate dehydrogenase.

Table 5. Regression analysis results for beck depression Inventory score.

	B (%95 CI)	Beta	t	p	Zero-order	Partial
Constant				<0.001
Creatinine	16.973 (8.728–25.219)	0.497	4.141	<0.001	0.601	0.517
Eastridol	0.137 (0.015-0.258)	0.272	2.266	0.028	0.463	0.314

B: Unstandardized Coefficient, Beta: Standardized Coefficient.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [B.K.], upon reasonable request.