Turinabol and the psyche: mood, aggression, sleep

In the sports environment Turinabol has a reputation as a "mild" steroid that supposedly does not affect the psyche. This reputation rests more on anecdotes than on data. The editorial team examined what is known about the effect of anabolic steroids on mood, aggression and sleep, why the reactions are so individual, and what of this can cautiously be transferred to Turinabol.

Androgens and the brain: basic mechanisms

Androgen receptors are present in many areas of the brain, in particular the amygdala, hypothalamus and prefrontal cortex — structures associated with emotions, motivation, threat response and self-control. Therefore a change in androgen levels inevitably affects behavior, though very differently in different people.

Part of testosterone's effects on the brain is realized through its conversion into estradiol. Turinabol, thanks to the chlorine atom at position 4, does not aromatize, so its action is limited to androgen receptors and indirect effects. At the same time it suppresses one's own testosterone, and hence also one's own estradiol. How this affects mood has not been reliably studied.

Anabolic steroids can also affect neurotransmitter systems — serotonergic, dopaminergic, GABAergic — which has been described mostly in animal experiments. The review by Piacentino and co-authors (2015) emphasizes that these mechanisms are complex, and transferring them directly to humans is difficult.

An important methodological note: there are no targeted studies of the psychiatric effects of Turinabol in the modern scientific sense. Documents of the GDR doping program (Franke, Berendonk, 1997) mention, in particular, changes in libido and behavior in athletes, but these are archival observations, not controlled studies.

Mood and aggression: what studies show

The most cited controlled study on this topic was conducted by Pope, Kouri and Hudson (2000). Healthy men received supraphysiological doses of testosterone cypionate or placebo in a double-blind crossover design. In most participants no noticeable psychiatric changes arose, but in a small proportion pronounced manic or hypomanic symptoms developed and aggressiveness increased in laboratory tests.

This result explains the "gym" experience well: some people notice no changes, others become irritable, impulsive, confrontational. The reaction is idiosyncratic, that is, it depends on individual characteristics, and it cannot be predicted in advance.

Observational studies among users of anabolic steroids record an increased frequency of irritability, aggressive behavior, hypomania and depressive symptoms compared with those who do not use steroids (Kanayama et al., 2008). However, in these studies it is difficult to separate the influence of the drugs from personality traits, use of other substances and lifestyle.

For Turinabol there are no data that would prove it is "safer for the psyche" than other androgens. The belief in its "mildness" is rather a subjective comparison with other drugs than an established fact.

Sleep and recovery of the nervous system

Sleep is one of the least studied aspects of the effect of anabolic steroids. Users often report difficulties falling asleep, shallow sleep and night awakenings, but there are no controlled studies for Turinabol specifically.

It is known that high doses of androgens in a medical context can worsen obstructive sleep apnea. The Endocrine Society clinical guidelines on testosterone therapy (Bhasin et al., 2018) point to untreated severe apnea as a situation requiring caution when prescribing testosterone.

Sleep is closely linked to emotional regulation. Sleep deprivation in itself increases irritability and worsens self-control, so sleep disturbance can intensify the behavioral changes attributed to the drug. The result is a vicious circle: worse sleep — more irritability — worse recovery.

Additional factors that worsen sleep in athletes are late intense workouts, caffeine and stimulants in pre-workout complexes, and a harsh caloric deficit. They should be taken into account before linking insomnia to one specific substance.

Withdrawal, depression and dependence

The period after stopping anabolic steroids is considered the most vulnerable for the psyche. One's own testosterone is still suppressed, muscle mass decreases, and against this background depressive symptoms can develop — from apathy to clinically significant depression.

Kanayama and co-authors describe that in some users a dependence on anabolic steroids forms. It manifests as prolonged use despite harm, an inability to stop and a resumption of use to avoid the unpleasant symptoms of withdrawal and loss of form.

Closely related to dependence is muscle dysmorphia — a condition in which a person constantly considers themselves insufficiently muscular regardless of their actual size. It can precede steroid use and sustain it.

In the Endocrine Society scientific statement (Pope et al., 2014) it is emphasized that the psychiatric consequences of anabolic steroids are an underestimated public health problem and require the attention of doctors, who often do not ask patients about such drugs.

When to seek help

It is worth turning to a doctor or psychologist if you or those close to you notice persistent changes in behavior. It is especially important not to ignore symptoms in the period after withdrawal, when a person may explain their state as "ordinary fatigue."

• outbursts of anger that were not there before, conflicts in the family or at work;
• low mood, apathy, hopelessness for more than two weeks;
• thoughts of self-harm or suicide — a reason to seek help immediately (a psychological support line or the emergency service 103);
• prolonged insomnia that does not go away after normalizing the routine;
• an inability to stop use despite the desire to.

It is important to tell the doctor honestly about the use of the drugs: this changes both the diagnosis and the treatment approach. Often help requires the cooperation of a psychiatrist and an endocrinologist.

Editorial conclusions

Anabolic steroids affect the brain through androgen receptors and neurotransmitter systems. Controlled studies show that in most people the changes are moderate, but in some pronounced irritability, aggression or hypomania develop.

Turinabol's reputation as "psychologically mild" is not confirmed by studies. Especially vulnerable is the period after withdrawal, when the risk of depression and dependence rises.

We also recommend reading our materials on Turinabol and the kidneys, on muscle dysmorphia, and on recovery of the hormonal system after anabolic steroids.

References

1. Pope HG Jr, Kouri EM, Hudson JI. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: a randomized controlled trial. Arch Gen Psychiatry. 2000;57(2):133–140.
2. Kanayama G, Hudson JI, Pope HG Jr. Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: a looming public health concern? Drug Alcohol Depend. 2008;98(1–2):1–12.
3. Piacentino D, Kotzalidis GD, Del Casale A, et al. Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review. Curr Neuropharmacol. 2015;13(1):101–121.
4. Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341–375.
5. Franke WW, Berendonk B. Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government. Clin Chem. 1997;43(7):1262–1279.
6. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744.