Adolescent use of anabolic-androgenic steroids (AAS) is linked primarily with problem behaviour, including marijuana (cannabis) use, and only secondarily with participation in strength sports and disordered eating.

This somewhat surprising conclusion emerged from a nationally representative survey of Norwegian youngsters, attracting responses from 8,058 subjects aged 15-22.

Participants were asked whether they had ever been offered AAS, whether they had ever used them and whether they had used them in the preceding 12 months. They were also questioned about their involvement with sport, their attitudes to food, weight and physical appearance and their behaviour: there were five measures of 'problem' behaviour, including conduct, sexual involvement and use of other drugs.

Key results were as follows:

a. 430 subjects (5.1%) had been offered AAS at some time;
b. 72 (0.8%) had used AAS at some time;
c. 31 (0.34%) users had taken the drug during the preceding 12 months;
d. Those competing at high levels were most likely to have been offered AAS and slightly more likely to have used them.

Recent users of AAS were more often male, participated more in power sports, had more conduct problems, used other illicit drugs more often, had better self-perceived romantic appeal, and trained more often in private gyms than past users. When these variables were analysed for their power in predicting current rather than past use the only significant factors were involvement in power sports and current use of marijuana.

Use of AAS at any time was predicted by gender (mostly boys), being offered or having used marijuana, disordered eating, conduct problems of 'overt non-destructive type' (eg fighting, bullying) and involvement in power sports.

'Three explanations for AAS use were contrasted: body image and eating problems, involvement in power sports and problem behaviour,' explain the authors. 'Analyses showed that AAS use was first and foremost associated with types of problem behaviour (ie drug [marijuana] involvement and aggressive-type conduct problems). In addition, involvement in power sports and disordered eating were É associated with lifetime use.
'Recent AAS users were more often current marijuana users than were previous AAS users. A substantial proportion of Norwegian adolescents (5.1%) had been offered AAS, and they differed little from those who had actually used the substances except that the AAS users more often used such illegal substances as marijuana.
'Marijuana possibly functions as a gateway drug for AAS in the Norwegian context, making the choice of experimenting with yet another illegal substance easier.'
The prevalence of adolescent AAS use in Norway is substantially lower than for other western societies, including the US, Canada, Australia and Sweden. This may be explained by the relative unpopularity of strength events in Norway.

The researchers warn against generalising their findings to other cultures, where the use of marijuana as well as AAS is more frequent and therefore less marginalised. 'However, although the types of behaviour associated with AAS may be different in other countries, the conclusion may still hold that AAS use in the general adolescent population is first and foremost another type of behaviour problem and secondly related to power sports and appearance.'

J Stud Alcohol 2001 Jan 62(1) p5-13

Isabel Walker