Anabolic-Androgenic Steroid Use and Involvement in Violent Behavior in a Nationally Representative Sample of Young Adult Males in the United States

Abstract

We examined the effects of anabolic-androgenic steroid use on serious violent behavior. Multivariate models based on data from the National Longitudinal Study of Adolescent Health (N = 6823) were used to examine the association between lifetime and past-year self-reported anabolic-androgenic steroid use and involvement in violent acts. Compared with individuals who did not use steroids, young adult males who used anabolic-androgenic steroids reported greater involvement in violent behaviors after we controlled for the effects of key demographic variables, previous violent behavior, and polydrug use.

Anabolic-androgenic steroids are muscle-building synthetic compounds closely related to male sex hormones and legally available only by prescription. Although attention has focused on professional athletes, evidence from national surveys indicates that adolescents and young adults also are using these substances.¹ The dramatic physical changes and resultant consequences of anabolic-androgenic steroid use are well documented; however, the behavioral and emotional effects of steroid use, although of interest,^2–6 have not been as thoroughly researched. Elevations in testosterone stemming from anabolic-androgenic steroid abuse have led researchers to examine purported links to aggressive and violent behaviors, and several studies have shown an association between anabolic-androgenic steroid use and increased aggression and violence^4,5,7–12 including homicide.¹³ Some reports, however, have failed to identify links to aggressive behavior.^14–16

We examined the empirical relation between anabolic-androgenic steroid use and involvement in different types of violent behavior (e.g., shooting or stabbing someone) in a nationally representative sample of young adult males. We hypothesized that respondents who used anabolic-androgenic steroids would self-report greater involvement in a variety of violent acts after we controlled for substance use and demographic factors.

METHODS

We analyzed data from the National Longitudinal Study of Adolescent Health (Add Health). Detailed information about the Add Health data and the sampling design is available elsewhere.^17,18 Briefly, the Add Health is a nationally representative sample of American students who were enrolled in 7th through 12th grade in 1994. Three waves of data were collected (2 in adolescence and 1 in early adulthood) on more than 20 000 participants. In total, the data span nearly 7 years of human development.

We measured anabolic-androgenic steroid use in 2 ways. First, during wave 3 interviews, respondents were asked whether they had ever used anabolic-androgenic steroids during their life (0 = no; 1 = yes). Second, during wave 3 interviews, respondents were asked whether they had used anabolic-androgenic steroids or other performance-enhancing drugs during the previous 12 months (0 = no; 1 = yes). Overall, 2.6% of the males had used anabolic-androgenic steroids at least once in their life, and 2.3% had used anabolic-androgenic steroids in the previous year. The prevalence rates were much lower for females (0.9% for lifetime use and 0.4% for previous year); thus, we restricted the analyses to males only.

The dependent variable was self-reported violent behavior assessed through 8 questions asked at wave 3. This scale is similar to violence measures used previously¹⁹ and captures involvement in acts of serious violence, such as physical fighting (α = .67). Three sets of control variables were also included. First, a 7-item wave-2 violent behavior scale (α = .74) was included to help control for underlying antisocial propensities. Second, a wave-3 polydrug-use scale was included to help isolate the effect of steroids from that of other drugs (α = .61). Third, models also were adjusted for age (measured in years) and race (0 = White; 1 = minority).

We examined the association between anabolic-androgenic steroid use and violent delinquency by estimating negative binomial regression equations to take into account the severe skewness of the dependent variable (skewness statistic = 4.56).

RESULTS

Table 1 provides estimates of the relation between lifetime anabolic-androgenic steroid use and violence. Model 1 shows that males who had used anabolic-androgenic steroids at least once in their life reported greater involvement in violent behavior compared with males who reported never using anabolic-androgenic steroids. This association remained even after we controlled for violence at wave 2 (model 2), polydrug use at wave 3 (model 3), and the combined effect of both measures (model 4).

TABLE 1.

Effect of Lifetime Anabolic-Androgenic Steroid Use on Violent Behavior Among Young Adult Males: National Longitudinal Study of Adolescent Health, United States, 1994–2002

	Model 1 (n = 6823)		Model 2 (n = 5158)		Model 3 (n = 6789)		Model 4 (n = 5134)
	b (SE)	z	b (SE)	z	b (SE)	z	b (SE)	z
Lifetime steroid user	1.12* (0.16)	6.96	1.19* (0.17)	6.91	0.87* (0.16)	5.58	0.98* (0.17)	5.86
Age	−0.15* (0.02)	−9.72	−0.15* (0.02)	−7.99	−0.13* (0.02)	−8.21	−0.13* (0.02)	−7.19
Race	0.20* (0.06)	3.39	0.15 (0.05)	2.30	0.36* (0.06)	6.31	0.31* (0.06)	4.79
Previous violent behavior			0.17* (0.01)	12.51			0.15* (0.01)	11.72
Polydrug use					0.35* (0.02)	14.80	0.29* (0.03)	11.15

Note. Model 1 estimated the baseline effect that steroid use has on wave-3 violence. Model 2 introduced a measure of previous violent behavior (measured at wave 2) as a statistical control. Model 3 introduced a measure of polydrug use as a statistical control. Model 4 estimated the effect of steroid use on wave-3 violence after we controlled for both previous violent behavior (measured at wave 2) and polydrug use.

* P ≤ .001.

Table 2 provides estimates of the relation between past-year anabolic-androgenic steroid use and violence. Males who used anabolic-androgenic steroids in the previous year scored significantly higher on the violence scale in comparison with males who had not used anabolic-androgenic steroids in the previous year, after the effects of wave-2 violence (model 2), polydrug use at wave 3 (model 3), and the combined effect of both measures (model 4) were controlled.

TABLE 2.

Effect of Past-Year Anabolic-Androgenic Steroid Use on Violent Behavior Among Young Adult Males: National Longitudinal Study of Adolescent Health, United States,1994–2002

	Model 1 (n = 6822)		Model 2 (n = 5157)		Model 3 (n = 6788)		Model 4 (n = 5133)
	b (SE)	z	b (SE)	z	b (SE)	z	b (SE)	z
Past-year steroid user	1.25* (0.17)	7.27	1.19* (0.19)	6.31	0.93* (0.17)	5.55	0.91* (0.19)	4.90
Age	−0.15* (0.02)	−9.53	−0.15* (0.02)	−8.21	−0.13* (0.02)	−8.52	−0.14* (0.02)	−7.35
Race	0.19* (0.06)	3.27	0.14 (0.06)	2.20	0.36* (0.06)	6.21	0.30* (0.06)	4.69
Previous violent behavior			0.16* (0.01)	12.32			0.15* (0.01)	11.55
Polydrug use					0.35* (0.02)	14.55	0.29* (0.03)	11.06

Note. Model 1 estimated the baseline effect that steroid use has on wave-3 violence. Model 2 introduced a measure of previous violent behavior (measured at wave 2) as a statistical control. Model 3 introduced a measure of polydrug use as a statistical control. Model 4 estimated the effect of steroid use on wave-3 violence after we controlled for both previous violent behavior (measured at wave 2) and polydrug use.

* P ≤ .001.

DISCUSSION

Our results suggest that the use of anabolic-androgenic steroids is related to heightened levels of violent behaviors. However, limitations must be considered. First, the measures of anabolic-androgenic steroid use were based on self-reports, not on direct measures as have been used by previous researchers.⁸ Another limitation of our study was that the measures of violent behavior were drawn from self-reports, which necessarily raises the question of whether the reports were reliable and accurate. With these limitations in mind, the current research suggests that the media attention and public concern surrounding anabolic-androgenic steroid use may be justified given its association with violence among males in the United States.