The topic of anabolic steroid use frequently appears in the news, either as the focus of a sports doping scandal or in connection to some heinous act. The media loves discussing anabolic steroids (AAS), as it is a visceral buzzword that creates a headline, even in the absence of a newsworthy event. There has been a recent rash of news reports linking AAS to a variety of tragedies. In New York State, a young man’s death is being attributed to AAS use despite a lack of supportive medical evidence. In a suburb near Atlanta, the apparent murder-suicide of WWE wrestler Chris Benoit and his family was initially white-washed by the media as a direct consequence of his monitored use of legally obtained testosterone and possibly growth hormone. Benoit was later found to suffer from brain injury consistent with repetitive head injury; the medical examiner did not attribute the events to AAS use, nor did he find dramatically elevated concentrations of testosterone in Benoit’s urine sample. Numerous other athletes and sports celebrities have suffered an ignoble outing due to the release of confidential medical records.On September 24, 2007, the United States Drug Enforcement Agency (DEA), in conjunction with several other federal agencies and in cooperation with nine foreign governments, announced the results of an investigation that has been ongoing for nearly two years and promises to continue to develop over the next year, if not longer. Called Operation Raw Deal, this investigation sought to trace the import of Chinese-sourced AAS or chemical precursors and growth hormone into the United States. Once the destinations of these imports were determined, agents then sought evidence that the chemicals were being used in the manufacture and/or distribution of a controlled substance. It would be interesting to learn if Raw Deal refers to AAS precursor sales or the 1986 Arnold Schwarzenegger movie of the same title. Certain media reports have attributed some measure of the pressure to reduce the Chinese manufacture of performance-enhancing drugs or drug precursors to the upcoming 2008 Summer Olympics to be held in Beijing, China. A similar DEA action against the import of Mexican AAS of 21 months duration had culminated in the arrest of four individuals during December 2005; 2,000 customers were identified according to the DEA news release.
Thus far, 143 warrants have been served in Operation Raw Deal, resulting in the arrest of over 120 people. Though the DEA was generous in providing press releases regarding Operation Raw Deal, front-page news coverage of the action lasted only one day, with the exception of local coverage in cities where the actual arrests occurred. In comparison, the DUI arrest of Kiefer Sutherland remained prominent on the Google News website for days. There have been hints that clientele lists of the alleged AAS distributors would be released, something the media desperately craves, as the identities of the people so far detained are as bland as the white pages of the phone book. There have been reports of teachers, police and firefighters obtaining AAS, but nobody who “matters” insofar as public interest goes.One is led to wonder, if AAS cause such furor every time they are mentioned in relation to sports doping or teen use, why did Operation Raw Deal fail to hold national interest? Some feel it is because nobody really cares who is using AAS as long as they are not being rewarded for the use. If it is a personal choice and doesn’t harm others, why would it matter if a bunch of “nobodies” use the drugs? The argument is made that allowing AAS to be used provides the wrong example to impressionable children and promotes crime, particularly violent crime.So far, the people involved are nobody special, just a bunch of “average Joes.” In fact, there were not even many people involved in any kind of sport, including bodybuilding. These facts seem dismaying, since all the press about AAS use has focused on celebrity athletes or student athletes, but they are in agreement with several studies, including one recently published in the Journal of the International Society of Sports Nutrition, which surveyed nearly 2,000 AAS users.
If celebrities and athletes are not using AAS, are criminals? There have certainly been allegations of “roid rage,” a concept that is neither accepted as a clinical diagnosis nor as a criminal defense. Again, the threatening image of a muscular freak, driven mad with drug-induced lust or rage, strikes a visceral chord and plays well to the scare tactics of public opinion manipulators. Yet, in the 120 “Raw Deal” arrests, less than 80 guns were seized and no violent resistance was reported. In fact, the only injury noted related to Raw Deal was the suicide of one of the arrestees after his release on bond. Sadly, there are no tracking data on AAS as a component of crime. An extensive search of the many federal agencies appointed with the task of tracking criminal data failed to find any that maintained a database of AAS-related crimes, other than distribution or possession. [A detailed list of the agencies contacted precedes the references.] Certainly, there is no shortage of agencies and such data is maintained for drugs of abuse; the server capacity and clerical resources are available, as this would simply be another category of drug to monitor. Why then is there a lack of any data relating AAS to crime, especially violent crime, when AAS use is notable enough to be included in a Presidential State of the Union Address?Some suggest that any association between AAS and criminal violence has been grossly, almost maliciously, inflamed. Seemingly, AAS do not have a strong presence in real world crime, even in locales that are central to the international drug trafficking outlined by the DEA. In commenting upon local arrests related to Operation Raw Deal and a local operation code-named “Juice Box,” one Columbia (MO) detective commented, “It’s the kind of thing, the people who are doing steroids are not the type of people kicking in people’s doors and shooting each other over it,” he said. “It’s not a very visible market.” This real world observation from a police sergeant located at an AAS distribution nexus contradicts the dramatic claims of the media and public officials. A search for more objective investigations into possible relationships between AAS use and crime showed very limited results. Perhaps one of the finest reviews in the U.S. was written in 2001 for the Department of Energy (DOE), oddly enough. Though the report held the bias of looking for signs of AAS use in DOE employees and applicants for the purpose of promoting personnel security (avoiding violence or crime in the workplace), it provided a thorough review of the topic from that side of the issue. One telling comment in the report stated, “The most consistent finding in human and animal studies following AAS use has been increased aggression. In addition, human studies have shown a decrease in tolerance especially in situations involving provocation. These traits in some individuals could result in a potentially violent outburst. While it is true that these effects are not experienced by all AAS users, the increased frequency found in a small, but significant, subpopulation of the estimated one million AAS users in the United States is cause for concern.”One aspect of this comment, one universally expressed in reports on the effect of AAS on behavior, that escapes scrutiny is the assumed confluence of aggression with violence. As pointed out by forensic psychologist Jason Cohen, the association of AAS with aggression relies heavily upon animal studies, which often confuse social dominance with aggression. Further, the expression of aggression in humans is much more complex due to the cognitive abilities of man (thinking about the appropriateness of a response or the consequences). While certain classes of criminals may have higher levels of natural testosterone than the normal population, so too do high-level executives, attorneys and many other men with high social status.While researchers have done little to study any possible association between AAS use and criminal violence, the issue has been more thoroughly examined in Australia and Sweden. Several papers from Australian researchers have supported the argument that AAS use is associated with violent behavior and crime. Perhaps the most definitive research on the area comes from Sweden, led most prominently by Professor Ingemar Thiblin of the Department of Forensic Medicine at Uppsala University. AAS use is fairly prevalent in the Scandinavian countries. Within the last 15 years, authorities became aware of AAS use among criminals and speculated that AAS use might lead to criminal behavior, especially violent crime. A 1998 study by Isacsson et al looked at the rate of AAS use among criminals convicted of violent crimes in Sweden and failed to show any correlation, as all 50 subjects who provided a voluntary sample were negative and 16 prisoners refused to cooperate. Thiblin’s research then emerged, first reporting on eight suicides in young men with a history of AAS use. Current AAS use or the recent discontinuation of a cycle was present in the cases, with signs of depression or (hypo)-mania; four of the subjects had recently committed acts of violence. Acknowledging that an association is not proof of cause, Thiblin suggested that long-term AAS use may lead to psychiatric conflict in predisposed individuals, increasing the risk of suicide. Of course, as Thiblin notes in a later article, the prevalence of long-term use of AAS is very low, so it is near impossible to ascertain any relationship between illicit AAS use and any adverse effect.Pursuing that line of research, Thiblin examined a set of individuals who were known by law agencies to have used AAS and discovered a trend toward anti-social behavior and criminal violence. A later autopsy series found that among 52 dead AAS users, nearly 80 percent also used other illicit drugs and AAS users died 10 to 15 years younger than heroin or amphetamine users; the cause of death was often violent (suicide or homicide). Next, a seven-year review was undertaken to determine the prevalence of criminal behavior among AAS users. Initially, AAS use was associated with a higher rate of being convicted of a weapons offense or fraud; there was no increase in violent crimes against persons or property. However, when the group was filtered to remove AAS users who had been referred from substance abuse centers, suggesting they used other illicit drugs, there was no increase in fraud charges and crimes against property were actually lower among AAS users. A later study noted that while AAS users were no more likely to commit crimes of violence, they still committed crimes of violence at a rate similar to other illicit drug users. With much of the evidence for or against the argument that AAS use is associated with criminal violence being anecdotal (meaning it is people guessing based upon behavior they have noticed), and an inability to clearly define a relationship between AAS use and criminal violence, it is impossible to state definitively what role, if any, AAS use has in crimes of violence. To further understand the issue, questions were posed to a number of experts in the field, including Professor Ingemar Thiblin of Sweden. All of the experts were gracious with their time and provided insightful responses. They include: Professor Ingemar Thiblin, Uppsala University, Sweden; Dr. Steven Karch, assistant medical examiner of the city and county of San Francisco and noted author of several texts on drug abuse; criminal defense attorney Rick Collins, author of Legal Muscle and noted legal expert; forensic psychologist Jason Cohen, PsyD (candidate); and Jack Darkes, PhD, clinical psychologist and associate professor at the University of South Florida.The questions poised to the panel and representative responses follow:Is there any identified causative or permissive association between AAS and criminal violence?
• Universally, the group responded “No.” Professor Thiblin expanded on the response, adding, “This association is still restricted to anecdotal data. Most professionals who treat or in other ways meet users of AAS are of the opinion that AAS may increase the risk for violent crime in a minority of certain predisposed individuals and that alcohol and/or BZ is an important contributing/triggering factor.”

Is there any specific type of AAS associated with criminal violence?
• None of the panel was able to answer due to the absence of relevant clinical data. Professor Thiblin noted, “There are also observations that certain individuals take AAS with the intention to become aggressive in a coming fight. In Sweden, this way of taking AAS has been observed among neo-Nazistic groups and football hooligans.” He identified Cheque drops (mibolerone) as the favored aggression booster. It stands to reason that fast-acting, highly androgenic orals or sublinguals that are alpha-akylated would be the most likely to affect behavior in the short-term. Over the long-term, any AAS may affect behavior, though some might actually decrease aggression and possibly violence, such as stanozolol.

Is the relationship (AAS and criminal violence) dose-dependent?
• Again, a lack of research disallows any concrete response, but Dr. Darkes answered, “…it has been reported that symptoms and serum steroid levels are not correlated. It is likely that, in the real world, there is some dose-dependent relationship…but it is also likely that certain types of individuals might use larger doses and hence confound the relationship.” One issue that has not been addressed in the literature is the concept of expectancy, which is the subject’s expectation to become more intimidating or aggressive when ingesting an intoxicant, most commonly alcohol.

Does violence depend upon a latent (hidden) or overt (obvious) personality disorder, psychoses or neuroses?
• The lack of published studies and relative rarity of recognized AAS use in criminal violence limited the response, but again, Professor Thiblin contributed, “In our studies all AAS-using violent offenders but one were burdened by psychiatric disorders, such as borderline PD, antisocial PD, ‘immature personality,’ ‘severe compulsive strategies,’ etc.” This leads to question, would an otherwise stable person become violent while using AAS? The possibility always remains, but the point made by Professor Thiblin emphasizes the need for qualified screening of AAS users if the practice is to be allowed.

Is the relationship, if present, confounded by polypharmacy? (use of many drugs, including street drugs like)
• Dr. Karch’s response, “OF COURSE,” was brief, to the point and accurate. AAS may act as neurosteroids and affect certain pathways directly or in a permissive manner. Compound the potential mood-altering effect with the sedatives, alcohol, stimulants or other drugs and the situation becomes unpredictable. This coincides with Professor Thiblin’s observations, “Indeed. Multiple substance abuse, both chronic and acute, is present in the vast majority of the case that we have seen, which is cases of either violent crime or premature death.”

If surveys are correct, estimating several million current and former users of anabolic steroids, with 3 percent to 7 percent of high school seniors having been exposed to the drugs, what can be said about the paucity of anabolic steroid-related violent crime?
• Dr. Karch raised the point that AAS-related violent crime may be unrecognized or not reported. In part, he notes that prisoners are not screened for AAS use due to the expense. Professor Thiblin provided a detailed response, stating:

1.    The figures report lifetime prevalence, which is not relevant for “persons at risk,” since most adverse effects appear to be related to long-term use in high doses.
2.    The prevalence figures are probably exaggerated by persons mistaking various food supplements for AAS.
3.    It appears as reasonably to believe that only a small fraction of those who take AAS are vulnerable for the central effects of these compounds. Perhaps this figure is in the vicinity of that for corticosteroids, which is about 5 percent.

Should the roles of expectancy, high-risk behavior, sociopathic behavior, illicit trafficking, etc. be more fully discussed in the literature?
• The panel agreed these issues are all relevant. Professor Thiblin already noted the use of Cheque Drops by various thug groups prior to brawls. Dr. Darkes commented, “There is ample evidence that the same factors that influence use and use-related behavior in other drugs are also likely operating in AAS use and its behavioral effects. We know, for instance, that those who become most aggressive after drinking alcohol are those who were more aggressive prior to drinking. We know that those who are more prone to aggression and expect alcohol to make them more aggressive will drink more and become more aggressive after they drink.”

Does any concurrence of anabolic steroid use and violent crime confirm a causal relationship?
• Typically, the panel challenged this thinking. Dr. Karch warns against the logical fallacy. “Post-hoc, ergo-propter hoc,” meaning an event preceding an action is not necessarily the cause of the action. However, Professor Thiblin added, “Depends on how strict you are about the methodology. If you can accept so called case-cross over design, there appears to be a causal relationship. We have reported cases in which various kinds of criminal activity were strictly related to on-phase AAS use. However, there is need for more such studies before a causal relationship can be concluded. It is also important to consider that many AAS-users become depressed during off-phase, which certainly may explain a low criminal activity.”

Is muscle mass and aggression via anabolic steroid doping sought for functional purposes…as in, does the crime or criminal intent predate the use of anabolic steroids?
• Professor Thiblin noted this in the Cheque Drops example, and several reports suggest that certain functionaries in criminal organization may use AAS to be more intimidating or lethal, such as the example of “torpedoes” or enforcers in Norway.

Are you aware of any database that tracks anabolic steroid related crimes, other than possession/distribution?
• None of the panel was aware of any database, similar to my efforts in contacting several federal agencies.

Is the level of concern sufficient to detract resources and attention from other crime prevention/law enforcement endeavors (methamphetamine, cocaine/crack, heroin, prescription drug abuse, etc)?
• Professor Thiblin noted the level of concern in Sweden to be very low, but building. In the U.S., political pressures may be behind some of the prosecutorial zeal. Rick Collins stated, “Apparently it is. Our President once took time out of his State of the Union address to denounce steroids. Congress and many states have decried the evils of steroids and have toughened the laws. The U.S. Sentencing Commission has stiffened the federal penalties for trafficking. Hey, the recent headlines about “Operation Dumbbell” here in New York prove that the police were willing to divert financial resources and lots of work hours toward a massive steroid sting operation targeting gear sellers in two health clubs.” He later emphasized that law enforcement should not ignore any black-market drug dealing, though the prominence and menace of other illicit drugs would seem to be of greater social relevance.


Have the Anabolic Steroid Controlled Substance Acts of 1990 and 2004 created/amplified criminal problems relating to anabolic steroid use/distribution by diverting the supply through traditional street drug trafficking, increasing prices, decreasing quality control and introducing greater risk of adulterated products?
• Rick Collins has tracked this issue from its inception. “Absolutely. I reached that conclusion in researching my book Legal Muscle, and I presented a whole chapter specifically addressing that point. It’s ironic that classifying steroids as controlled substances actually reduced the controls that best reduce the potential harms associated with these drugs. Aside from the points you made, the Anabolic Steroid Control Acts have retarded medical research and chilled beneficial applications of these medications. AIDS survival researcher and author Michael Mooney has blamed these laws for needless deaths and suffering.”


Clearly, in the issue of AAS and criminal violence, nothing is clear. Though the experts agree for the most part that AAS are not the cause or even a component of most criminal violence and that most AAS users do not perform violent acts as a result of their AAS use, there remains the risk that in a small segment of users— perhaps 5 percent or so— AAS may reduce the threshold for violence or trigger an aggressive response that results in injury. Further, there may be a clear intent to use AAS to promote one’s criminal/violent prowess, such as in the example of Cheque Drops or the Norwegian crime enforcers. In such cases, criminal activity is the goal of AAS use, not the result or an unintended consequence.There is a belief, counter to popular opinion, that the laws and professional regulations relating to AAS use, prescribing practices and distribution have hindered clinical research and the development of guidelines in the use of drugs that enhance performance, improve body composition (increase muscle mass or decrease fat mass) and possibly promote health. Instead, the prohibitionist approach has increased illicit demand and jeopardized AAS users by subjecting them to drugs of questionable purity and sterility, in addition to driving otherwise law-abiding citizens to black-market channels. There is a strong demand for research in this area, a demand that sadly will not be met, as there is no political pressure or financial incentive to pursue this field of study.  Research in the field of AAS risks is primarily anecdotal and with the exception of the work of Shalendar Bhasin, et al, very few controlled studies on physical benefits of supraphysiologic testosterone administration have been published. Perhaps most distressing is the near absence of controlled psychological assessments relating to the use of supraphysiologic testosterone or any of the related but distinct synthetic AAS. Findings in the greater research, including animal studies, suggest that certain AAS could be used to promote physical ability without promoting aggression. It is also possible that aromatase inhibition may suppress some of the propensity towards aggression or violence seen in certain AAS-using individuals.
At this point, nothing definite can be said of the relationship between AAS and criminal violence at the individual level. Some people are prone to violence in the absence of AAS, and the permissive or anxiolytic effects of androgens on certain brain pathways may increase the risk of violence in such people. The vast majority of AAS users do not appear to engage in acts of criminal violence during periods of use. AAS are not inconsequential hormones and it is folly to approach the entire class of drugs as being identical in effect. The public good has not been served by disallowing the medical community from participating in AAS research and developing guidelines related to consumer demand. Operations Raw Deal and Gear Grinder are important steps in blocking the black market trade in AAS, but without providing a legal alternative, it merely diverts the flow to another, as yet unrecognized route of distribution. Unfortunately, the establishment of a legal alternative is unlikely to occur until legislators and the media can separate the concept of AAS therapy from sports doping and high-risk adolescent behavior.

Federal agencies contacted:
Alcohol, Tobacco & Firearms
Bureau of Justice Statistics
Bureau of Prisons
Department of Justice
Drug Enforcement Administration, St. Louis
Federal Bureau of Investigations
National Center for Health Statistics
National Institute of Drug Abuse


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