Of muscles and mania

by Eleanor Grant

Intrigued when two men with no history of mental illness had to be hospitalized for psychotic episodes while taking steroids, psychiatrists Harrison G. Pope Jr. and David L. Katz wondered whether there might be a connection. They recruited 41 steroid-using bodybuilders and athletes from Boston- and Los Angeles-area gyms and interviewed the 39 men and two women exhaustively about their lives.

Of those interviewed, 12 percent reported overtly psychotic symptoms. One man heard nonexistent voices for five weeks; another was convinced that his friends were robbing him blind. Another 10 percent described symptoms the researchers call “subthreshold psychotic.” One bodybuilder, for example, was convinced that he could fall from a third-floor window without harm.

One-third of the steroid users showed major mood swings, and 12 percent experienced manic episodes. One bodybuilder twice bought expensive sports cars while on steroids, only to have to sell them later. Another deliberately drove an old car into a tree at 40 miles per hour while his friend videotaped the crash. Increased irritability and aggression in everyday situations were even more common.

Surprisingly, not one of the bodybuilders reported such behavior before taking steroids. Many were shocked by their bizarre actions. “Most said it was absolutely uncharacteristic,” Katz notes.

Many of the steroid users reported some physiological difficulties as well, such as hair loss, acne, testicular atrophy and breast swelling. Overall, however, “the psychiatric problems were far more pronounced than the physical ones,” according to Pope. Fortunately, the psychotic and manic symptoms disappeared promptly when steroid use was discontinued.

Why steroids would have such a disturbing effect on behavior is unclear. Most steroids taken by athletes are synthetic variations of the natural hormone testosterone, long associated with male aggression. But the exact biochemical mechanism involved remains a mystery.

Despite its largely illegal status–an estimated 80 percent of athletes’ steroids are obtained on the black market–steroid use is common among bodybuilders. Many of those Pope and Katz interviewed put steroid use among competitive bodybuilders at 100 percent. And bodybuilders aren’t the only ones. “Every professional football player I know takes them, with some position-related exceptions,” says Maj. Jim Wright, an exercise physiologist for the U.S. Army.

Pope, himself a bodybuilder who does not use steroids, believes that despite more rigorous testing and crackdowns on suppliers, the use of these potent drugs will continue unabated in sports in which power and aggression are at a premium. “It’s an illusion to think we can put a stop to it,” he says. “But the public needs to know that it goes on, and that there are dangers involved.”