Antique Illustration. Copyright has expired on this artwork. From my own archives, digitally restored.

'roid age

Weight lifters’ brains reveal one unexpected side effect of steroids

Long-term use of performance-boosting substances can make brains look old beyond their years.

mikroman6/Moment/Getty Images

If a scientist scanned your brain, what do you think it would show? If you’ve ever taken steroids, the answer may not be what you expect.

Androgenic anabolic steroids — the kinds of drugs athletes, weight lifters, and even recreational exercisers may take in the hopes of building lean muscle mass and improving their athletic performance — have been linked to a plethora of health risks, including diminished testosterone production, psychiatric issues, and cardiovascular problems. But there’s more.

Now, a study published this week in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging reveals powerful evidence that long-term use of these drugs can accelerate brain aging to the extent that your brain looks demonstrably older than your biological age on brain scans.

Here’s the background — That steroids harm health isn’t a new idea, but these drugs’ effects on the brain and cognitive abilities are “understudied,” according to this paper’s authors. This study is the largest of its kind to date, but as Astrid Bjørnebekk, the study’s lead author and leader of Oslo University Hospital’s Anabolic Androgenic Steroid Research Group, tells Inverse, “there are few studies that have looked into AAS [anabolic androgenic steroid] use and brain aging, so there is a lot to be learned.”

High doses of certain common anabolic steroids appear to have toxic effects on animal brain cells and even lead to cell death. And some of the better-studied health impacts of steroid use, such as cardiovascular problems, hypogonadism, and insulin sensitivity, are connected to cognitive impairment later in life.

Studies that have looked directly at the brains of anabolic steroid users suggest these drugs may be linked to psychiatric and cognitive issues, reduced connectivity in some parts of the brain, and changes to brain volume and density in certain regions.

Though steroids offer bodybuilders a shortcut; the drugs may cause serious side effects.Andrew Stawicki/Toronto Star/Getty Images

Cognitive testing of long-term steroid users has also revealed problems with pattern recognition, difficulty establishing the relationships between objects, cognitive processing speed, memory, executive function, and problem-solving abilities. “All these findings are in the same direction and suggest long-term consequences on brain health,” along with the new study’s results, says Bjørnebekk.

What they found — Among the androgenic anabolic steroid users included in this study, those who had used steroids for more than 10 years and met the criteria for being “dependent” on these substances, their MRI brain scans revealed a worrying trend: Their brains looked older than their true biological age.

To come to this conclusion, the researchers first trained machine-learning algorithms to guess the “brain age” of participants using a dataset composed of the brain scans of almost 2,000 healthy males of different ages. Then, they ran the brain scans of each of the 130 male weight lifters who used anabolic steroids long-term and the 99 male weight lifters who had not used steroids through the computer model to predict their brain age.

The difference between the predicted age based on the brain scan and the individual’s actual age was deemed the “brain age gap.”

The gap between the age predicted by images of the brain and the actual age of participants, or “brain age gap,” was more pronounced among long-time users of anabolic steroids than in short term and non-users.Biological Psychiatry: Cognitive Neuroscience and Neuroimaging/Bjørnebekk et al.

The “brain age gap” was larger for long-term, dependent steroid users than non-users. And the longer the weight lifters had used steroids, the bigger the gap — in other words, the aging process seemed to accelerate with extended use of steroids.

The researchers controlled for confounding factors like cognitive ability and depression. They found that while steroid users were more likely to be prescribed psychiatric medication like antidepressants, this didn’t affect accelerated brain aging findings.

Why it matters — As the brain ages, some areas change in thickness, volume, and surface area — an older-looking brain is associated with cognitive impairment, mortality, and a host of other problems.

Unfortunately, the study doesn’t pinpoint if one steroid is worse than another, and as Bjørnebekk says, “We do not know the exact practical effects yet,” but she hopes to study these next. Weight lifters and other athletes may use a combination or a variety of androgenic anabolic steroids, making it difficult to single out the culprit for cognitive risks. Not to mention, it’s hard to recruit study participants who are engaging in drug use that could put their professional — and personal — lives at risk to delve further into the link.

In general, drug use and addiction are also associated with older-looking brains. On the other hand, in one study, brains appear “younger” than biological age among people who are more educated and take regular exercise. Notably, in this study, the brains of steroid users who quit did not differ much from the healthy participants in the control group, suggesting that recovery is possible.

Apart from serving as a warning to those considering taking anabolic steroids, the findings of this study strengthen the case that long-term anabolic steroid use really does lead to measurable cognitive changes. Healthcare providers may be able to use these findings to prevent and treat steroid use.

High-dose long-term use of anabolic-androgenic steroids (AAS) may cause a range of adverse effects, including brain and cognitive abnormalities. We performed age prediction based on brain scans to test whether prolonged AAS use is associated with accentuated brain aging.
T1-weighted MRI (3D MPRAGE) scans were obtained from male weightlifters with a history of prolonged (n=130) or no (n=99) AAS use. We trained machine learning models on combinations of regional brain volumes, cortical thickness and surface area in an independent training set of 1838 healthy males (18-92 years) and predicted brain age for each participant in our study. Including cross-sectional and longitudinal (mean interval 3.5 years, n=76) MRI data, we used linear mixed effects (LME) models to compare the gap between chronological age and predicted brain age (the brain age gap, BAG) between the two groups, and tested for group differences in the rate of change in BAG. We tested for associations between apparent brain aging and AAS use duration, pattern of administration and dependence.
AAS users had higher BAG compared to weightlifting controls, which was associated with dependency and longer history of use. Group differences in BAG could not be explained by other substance use, general cognitive abilities or depression. While longitudinal analysis revealed no evidence of increased brain aging in the overall AAS group, accelerated brain aging was seen with longer AAS exposure.
The findings suggest that long-term high dose AAS use may have adverse effects on brain aging, potentially linked to dependency and exaggerated use of AAS.