Anabolika

Anabolic steroids (singular anabolic steroid) are substances that promote the build-up of the body's own tissue (predominantly through increased protein synthesis) and ensure a muscle-building-friendly metabolic state (so-called anabolic effect). Substances with anabolic effects include in particular selective androgen receptor modulators (SARMs), anabolic androgenic steroids, β2-sympathomimetics (e.g. clenbuterol), growth hormones (hGH) and insulin.

In common parlance, the term anabolic steroids is often equated with anabolic androgenic steroids. Anabolic steroids belong to the group of image and performance enhancing drugs (IPEDs), which are often used to improve appearance and performance in fitness, and include many other substances used in the context.

The recommendations for non-medical use of anabolic steroids are mainly based on anecdotes from other users and underground books. The recommendations vary widely, both in terms of duration of use and the type, number and amount of substances to be used.

It is important to know that anabolic steroids have side effects even if they are dosed therapeutically - this also applies to testosterone. The dosages often deviate considerably from medical use and exceed it many times over. The many different anabolic steroids (and other active substances) are often combined with each other: On the one hand to achieve synergistic effects and reduce side effects, on the other hand to accelerate regeneration. Not all of the drugs are intended for human use. Some of the drugs do not have a marketing authorisation (any more); other drugs are substances from veterinary medicine or research. Every consumption therefore has consequences for the body, which in certain cases cannot be reversed.

The side effects of anabolic steroids can be very complex, far-reaching and long-lasting. Acute side effects that are often accepted by users include acne, testicular shrinkage, infertility, hair loss, abscesses from the injections and painful enlargement of the male mammary gland. Significant psychological side effects are mood swings, changes in sexual sensation and sexual behaviour, as well as depression and even suicidal tendencies, especially when stopping anabolic steroids. Other side effects of consumption, on the other hand, often show no symptoms for a long time and thus often go unnoticed, such as the "silent killers" high blood pressure, enlargement of the heart, cardiac arrhythmia, thickening of the blood, liver and kidney damage. Long-term consequences of consumption can be a heart attack or stroke as well as certain cancers. The number of unreported cases of death caused by anabolic steroids is probably high.

Many anabolic steroid users develop a dependency. In the case of anabolic androgenic steroids, this is 25-40%. Only a minority of them manage to stop using them.

Such a dependence fulfils all the criteria of a substance use disorder, which are also evident, for example, in alcohol or cocaine dependence. The criteria of a dependence include: Development of tolerance, withdrawal symptoms, craving, dose increases, the conscious acceptance of health risks through continued use, unsuccessful attempts to stop and the neglect of other duties in favour of use.

At the same time, however, there are also major differences in the use of anabolic steroids compared to psychoactive substances such as alcohol or cocaine. For example, the hoped-for reward effect only occurs with a delay, i.e. the desired effect on body image usually occurs with a delay of weeks or months. Other effects on psychological well-being, such as increased drive and libido, however, occur earlier. How exactly anabolic steroid dependence develops has not yet been conclusively clarified; psychological and physical aspects that can lead to this development of dependence are discussed in the specialist literature.

Dependence on anabolic steroids - as with other psychoactive substances - depends on many factors that can vary from person to person: E.g. a hereditary predisposition, personal environmental factors as well as social factors. According to a report by the World Commission on Drug Policy, the dependence potential of anabolic steroids can be compared to that of MDMA/ecstasy, cannabis or amphetamines (speed).

When stopping anabolic steroids, strong withdrawal symptoms often occur. These are caused by the hormonal disorders associated with anabolic steroid use. Possible withdrawal symptoms are listlessness, listlessness, depressive phases, erectile dysfunction and libido disorders.

When discontinuing anabolic steroids, special attention must be paid to the development of suicidal tendencies: The extent and length of this "down" depends on many factors and often cannot be predicted. During such a "down", people often start using anabolic steroids again, which makes it easy to slip back into dependence. Discontinuation should be carried out under medical supervision in the case of suicidal symptoms, whereby adequate therapy can alleviate the symptoms and the hormonal axis recovers more quickly.

The medical care and professional ethical rules of sportsmen and women are subject to strict legal requirements of the Professional Code of Conduct of the FMH (StaO) and the associated Annex 5. The prohibition of doping under criminal law is enshrined in the Sports Promotion Act (SpoFöG) and the associated ordinance (SpoFöV).

These laws apply both to the medical advice and care of "sportspeople in general" (all those who engage in sporting activities, e.g. in the gym, as well as participants in "non-regulated competitive sport") and to the sports medicine activities of doctors in advising and treating licensed athletes of a sports federation or club affiliated to Swiss Olympic in particular, including all participants in "regulated competitive sport".

The fight against doping in Switzerland is based on a prohibition under criminal law and a prohibition under disciplinary law by the sports associations and prohibits all forms of doping by the medical profession. Furthermore, doctors are prohibited from assisting a person in committing an above-mentioned act (so-called complicity), e.g. the medical care and support of a patient who wishes to take doping substances in the future.

According to the legal provision, however, only the doctor's conduct for the purpose of doping is punishable. The medical support of anabolic steroid users or patients with anabolic steroid dependence (current use) within the framework of the medical care offered by Arud, on the other hand, is for the purpose of combating addiction. In the context of such evidence-based treatment, a psychological diagnosis is the underlying disorder that causes secondary anabolic steroid use or maintains its use. A somatic diagnosis is again indicated due to medically indicated circumstances.

Regular use of anabolic steroids is associated with considerable physical and psychological risks and has a considerable potential for dependence. Consumption is very widespread in Switzerland and there are as yet no specialised medical care services. It is urgently indicated to make the established harm reduction measures and the very well functioning integrated care approaches of addiction medicine accessible to this population. People with anabolic steroid use are exposed to numerous stigmatisations in the regular health care system and most doctors often do not have much experience with this use, which leads to a large gap in medical care for these users. Furthermore, the medical care of athletes is subject to strict legal requirements, which currently limits holistic care by doctors under criminal law.