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Anabolic-androgenic steroids amongst Kuwaiti males.

Objective: To determine the prevalence use of anabolic-androgenic steroids (AAS) and attitude towards their usage amongst Kuwaiti males. Subject and Methods: Kuwaiti males randomly selected and invited from five regions of Kuwait State, including both urban and rural settings. 32-questions concerning their exercise behavior, body image, income, and education level and use of anabolic-androgenic steroids (AAS) were investigated. SPSS version 16.0 software was used for data analysis. Results: The prevalence of anabolic-androgenic steroids (AAS) use was 12% among Kuwaiti males, 37% of them were young adult under twenty-one years old. Overall 60% of participate believes anabolic-androgenic steroids consumption has limited negative impact on their health on the contrary has positive effect on their physical appearance. Conclusions: This preliminary survey revealed the veracity of anabolic-androgenic steroids abuse amongst young male Kuwaitis, and it is increasing importance to create a national campaign to educate young adults in Kuwait about the impact of anabolic- androgenic steroids (AAS) abuse in the long term and their effects upon health. This could be achieved by: 1) community-based awareness programs, 2) public health prevention programs and, 3) a proper health education curriculum should be implemented in public schools and colleges.


Anabolic steroids which is also called anabolic-androgenic steroids (AAS), are a class of steroid hormones related to the male sex hormone testosterone (androgens) (NIDA, (2006); ACSM, (1987); Fahey, (1998); kuhn, 92002); & Robergs&Roberts, (1997). Steroids increase the protein synthesis and promote the growth of skeletal muscle (anabolic effects) and cause the development of male sexual characteristics (androgenic effects) such as increased body hair, deepening of the voice, and also aggressive behavior)(NIDA, (2006); Fahey, (1998); & Robergs&Roberts, (1997).

Anabolic-androgenic steroids (AAS) are very rarely used medicinally these days as they have been replaced by superior more effective treatment (MRC, (1999). They are used to treat forms of anemia and osteoporosis in rare circumstances (MedicineNet. com, (2005); & Mayo Foundation for medical Education and Research, (2008). As indicated [ACSM], (1987),by using anabolic steroids protein synthesis will increase causing more pronounced muscular tone, however there is no evidence of increase in muscular strength without regular training, and fat mass will decrease.

The use of anabolic-androgenic steroids (AAS), among Olympians, professionals, college, and also high school students has been reported (Kolarov, (2009); Kuwait Pharmacy Inc, (2001-2005); Anderson, Albrecht, & McKeag, (1991). Steroids are also being used in an illegal and unsafe way by athletes attempting to achieve superior performance and also to achieve the success and to have an advantage over their opponents (NIDA, (2006); Verroken, (2001); Thein, them, & landry, (1995). Anabolic androgenic usage became widespread in the athletic community by 1964 and the use of the anabolic androgenic by athletes has been in existence for more than forty years (Thein, thein, & landry, (1995). A rising number of adolescents are using anabolic-androgenic steroids (AAS) agents for non-medical purposes, despite the medical, legal, and ethical issues of non-medical usage of anabolic steroids continue to be discussed (David, (1990). (14) Seventeen percent to twenty percent 17%-20% of intercollegiate athletes' are anabolic steroid users as they indicated in a survey by (Pop, Kate, & Champoux, (1988), where in another study by Buckley et. All (1988). (16) showed that 6.6% are anabolic steroid equal to 500,000 users among male high school seniors. Serious side effects from the use of anabolic steroids have been documented in many studies. Steroids causes an imbalance in natural body system such as the liver, causing toxicity and irreversible damage, some types of cancer, feminizing effect in males "breast tissue growth", heart disease, myocardial infarction, enlarge prostate, deepening in voice and excessive hair growth in females, and premature closure of growth plates-resulting in stunted growth(NIDA, (2008); Koziris, (2000); Williams. (2005); & ffiedl, (1993). Some of the psychological effects are addiction, aggression, depression, mood swings, altered libido, irritability, and general neuroses, sexual arousal, euphoria, confusion(NIDA, (2008); Williams. (2005).

Anabolic-Androgenic Steroids (AAS) in Kuwait

In Kuwait, the Disciplinary Committee of anti-doping which was raised from the Kuwait Olympic Committee issued a decision to ban one of its athletes from the Kuwait Judo' team "AAS user" for two years after he tested positive for the use of steroids. He was using "Lasix stimulant" which contain furosemide, and it prohibited in sport, in the Gulf athletics for Judo which was held in Qatar in August 2008. Athlete uses Lasix occasionally to rid the body of any excess water in order for extra weight loss to happen (KUNA, (2008); & Xinhua News Agency, (2008).

Also it was raised another issue by the national team player, "Waleed Ali" for anti -doping, who was a user of anabolic steroids, where they were taking a sample of Al- Arabi defenders "Mohammed Freeh" and "Ahmed Ibrahim," and Al- Jahra guard "Satam al-Husseini" and the defender, "Hammoud Melfi to subject them for doping examination, after the end of the game. Medical Committee of the Asian Olympic Council and the Kuwaiti Olympic Committee took samples from four players, and choose players randomly, to be sent to Malaysia and Tunisia, for the safety of the players (Sabr electronic newspaper (2012)

A study by Hussain and Al-Shamari conducted in Kuwait among bodybuilders showed that the overall prevalence of anabolic steroids among Kuwaiti bodybuilders was 57.8% with a strong association with older ages, lower education level and longer duration of body building (Hussain, & Al-Shammari, (2008).

In Al-Watan electronic newspaper was indicated that, the Disciplinary Committee of anti-doping banned (8) eight players continue participation in local and international competitions during the period of ineligibility after it was proved the use of anabolic asteroids. Where the head of the committee, added that the results of the analysis showed a growing number of cases of drug abusers for the banned anabolic substances mathematically in Kuwait, where the rate was 9.12 percent of the total number of cases that have been tested for the current sports season, "a proportion is the highest in the Gulf countries and the region (Al-Watan electronic Newspaper, (2013).

Anabolic-Androgenic Steroids (AAS) in Middle Eastern Counties

Bahrain Olympic Committee announced of banning the Bahraini team player "AAS user" for two years after he tested positive for' using anabolic steroids during his participation in the world championship competitions for body building, which were held in South Korean island of Jeju in the month of October of 2007 (Ahmad, 2008). Aldar newspaper, (2008), reported that the anti-doping committee banned AAS user" from Qatar soccer team who was using testosterone at that time of his professionalism with the Al-Arabi team in 2007.

In a study of Al-Falasi et al. (2008) in Al-in district in Emerate, showed that very high prevalence of misuse AS (22%) among gym users and 7% of non-users were planning future use of AS.

Data shown from the 15th Doha Asian games (2006) the final report doping control program number of athletics who were disqualified from the championship competition after positive testing for the anabolic-androgenic steroids (AAS) used during the participation. Fifteen (15) athletes, of which 3 were females and 11, were males (3 weightlifters, 10 body builders, 1 Kayaka player, and 1 football player).

In a meeting of the Gulf Co-operation Council states and Yemen on Anti-Doping, the Asian Olympic Council, which is headquartered in Kuwait, announced on March 12, 2006 the establishment of the Agency's regional counter stimulants against doping in the Gulf Cooperation Council states of the Gulf and Yemen (Al-Dar, (2008); & Almotamar net, 2007).

A study held in Jordan by Tahtamouni, (2008) among colligates students and athletes on the prevalence and risk factors of anabolic-androgenic steroids abuse. The study showed that 4.2% of colligate students are users of anabolic steroids and 26% of athletes are steroids users. The study also showed that students started using steroids when they were on average 15 years old, while athletes when they were between 15 and 18 years old.

Another study was conducted in Jordan showed that 31.6% of the samples are users which involves student, undergraduates, and specialists (Abrahin, et al. (2013).

Even though the professionals point out the use anabolic-androgenic steroids (AAS) are harmful, there is very little data and /or no shown study on anabolic use in Kuwait. In order to develop a comprehensive prevention program, it is very important to understand not only the prevalence of anabolic steroids but also the attitude and believes toward using them which influences the behavior.


In November of 2007 researchers invited members of sport clubs selected from five regions in Kuwait City to participate in the study. The five regions are" Hawally, Salmiya, Jahra, Bnaid-Alqar and Fahaheel". In "Hawally five (5) clubs were selected, Salmiya were five (5), Jahra were three (3), Bnaid-Allqar were five (5), & Fahaheel were five (5). In total twenty-three (23) clubs were used in this study. Those clubs were all male club for weight lifting and fitness. In November 2007, over three thousand male were selected and invited from five regions that included both urban and rural setting. Participants were asked to answer the 32-item questionnaires.

The researchers asked 2000 men who agreed to participate and were asked to complete survey questionnaire by one week returning them to the person who is responsible for collecting. Data collected started from 1st of November 2007 to 1st of December 2007. The number of participates who returned our survey was 1708 males, just over half of the original selected sample.


For this study, a cross-sectional design aimed to determine the prevalence of anabolic steroids among Kuwaiti males. Furthermore, investigate anabolic-androgenic steroids (AAS) users and non-users opinion, attitudes, and environmental influences. The instrument used in this study was a proprietary developed based on a careful review of the available literature, interviews and discussions with young people and adults in Kuwait. A pilot study earlier showed a (0.81) coefficients of the opinion-items, and (0.79) coefficients of all items.

The study used anonymous multiple-choices, and yes or no questionnaire which is created by the researchers to investigate the prevalence of steroids use among Kuwaitis. The questionnaire was based on the participates opinions and beliefs regarding the use and health problems from using the AAS. Also other questions regarding their daily exercise and training were asked. The questionnaire was divided into four parts: demographic questions, active live and exercise, the use of AAS, and opinions of the use of AAS. The questionnaire sought information about age, income, education, and anabolic steroid use.

Data collection

Participants were asked in each club to participate in the questionnaire. Samples were invited to visit the research assistant at Kuwait university", to answer the questionnaire". The research assistant will supervise the completion of the questionnaire. Participants were asked to complete individually and anonymously the questionnaire. The assistant researchers' collect the questionnaire to return them to the researchers in the Kuwait University where they were analyzed.

Descriptive statistics such as percentage, mean, range and standard error of the mean were used. Confidence intervals on proportions and the differences in proportions were also calculated. The samples t-test was used to test for significant differences between means. Statistical comparisons of users' age, frequency of AAS abuse and the use of one type or more of AAS between low and high income athletes were performed by t-test. The same was done for unemployed and employed samples. Data was analyzed where applicable using SPSS Statistical Package for the Social Sciences A significance level of P < 0.05 was considered acceptable.


The study response rate was 51.7% (1708), descriptive analysis and illustration of demographic differences among participants presented in Table 1. The study sample median age 19 years, the anabolic-androgenic steroids (AAS), users' median age 18, age ranges from 17 years to 35 years old. More than half of the participants (83.7%) were single, (14.9%) were married and (1.5%) were divorced (table 1). Over half (65%) of all respondents were unemployed or students, and (35%) working or in a job. Over half of the participants 59.5 % (n = 1017) were college graduates, 26.6% (n = 454) high school graduates and 13.7% (n = 234) middle school graduates.

Prevalence of Steroids

Participants were asked if they ever used anabolic-androgenic steroids (AAS) or not; anabolic-androgenic steroids (AAS). users and non-users were asked about the age at which they began to use anabolic-androgenic steroids (AAS) and whether or not if they used it daily, also, the reason for using anabolic steroids. The prevalence of anabolic-androgenic steroids (AAS) users among the participants (1708) was 11.8% (202). All anabolic steroids users were asked their age when first time started using steroids, a 27.7% (56) while they were 17 years of age, a 37.5% (76) of anabolic-androgenic steroids (AAS) users stated the first time they used anabolic agents was when they were 18 years. 34.7% (70) participants started the consumption of anabolic-androgenic steroids (AAS) at the age of 19 years old. (Table 1)

Steroids Consumptions

Twelve (5.9%) of the anabolic-androgenic steroids (AAS) users indicated their monthly income was less than 100 KD, nine out of twelve (4.5%) of the users, who indicated that they spend more than their income on anabolic-androgenic steroids (AAS). Ninety four (46.5%) of the steroid users had monthly income between (100-250KD). Twenty (9.9%) of ninety four spent more than one hundred fifty Kuwaiti Dinars on anabolic steroids. Overall, 45 (22.3%) out of 202 users spend more than one hundred fifty Kuwaiti Dinars. (Table 2)

More than half of participants indicated they used anabolic-androgenic steroids (AAS) for bodybuilding (59.1%), also, they are involve in daily bodybuilding exercise, (11.8%) stated anabolic enhanced their appearance and that they were using steroids to improve their outward appearance, where (29.1%) said it was only for attraction.

Of 202 users, 66 (32.7%) indicated that the people are encouraged by coaches, where 118 (58.4%) were encouraged by friends to use anabolic steroids. Clubs were shown to be the highest in encouraging people to use steroids 146 (72.3%). A 69.3% (n = 140) of steroids users indicated the anabolic-androgenic steroids (AAS), products are readily available and easy to obtain, 80.7 % (n = 163) stated they know people who use anabolic steroids daily.

Anabolic-androgenic steroids (AAS) users from the sample were asked some questions about knowledge, beliefs and opinions regarding anabolic-androgenic steroids (AAS) use. A (73.6%) indicated that anabolic steroids sometimes harm the body. Most of anabolic-androgenic steroids (AAS) users agree that a steroid affect the body strength (90.3%), and increases their performance (66.1%), and users believed anabolic-androgenic steroids (AAS) used impacted their muscles strength (75.2%). A 65% of user indicated positive effect on their reproductive system.

Steroids Type

All respondents of anabolic-androgenic steroids (AAS) users indicated they usually taking oral substance indicting over twenty-five types of steroid were available, among these steroids type were; Growth Hormone (GH), Nolvadex, Amineptine, Deca, Dianabol, Ephedrine, Flyboy, Winstrol, Testosterone, Drive, Primoline, Stallone, Primobqlan, Nandrolone, Sastanon, amifepramone, bromantan, Amiphenazole, Etafedrine, Ethamivan, Terbutaline, Clenbuterol, Danazol, Bumbuterol, Salmeterol, Trenbolone, Depo-testosterone, and Anavar.

Opinion about Anabolic-androgenic steroids

Anabolic-androgenic steroids users and non-users were asked about their opinion and attitudes toward their physical appearance, health concern, and sport involvement. An independent t-test indicated a statistically significant difference in attitudes of anabolic-androgenic steroids (AAS) users and anabolic-androgenic steroids (AAS) non-users. As anticipated, the anabolic-androgenic steroids (AAS) users had more positive attitude toward taking anabolic-androgenic steroids (AAS). Likewise, both users and non-users believed consumption of anabolic-androgenic steroids (AAS) had limited health impact (Table 3).

In this study, users were grouped into those who young adults ([less than] 21 years), middle-age adult (22-27 years), and (>28). About 35.6% young adults were (AAS) users and 87.6% (AAS) non-users, [chi square] test statistic indicated anabolic-androgenic steroids (AAS) more concerned about their physical appearance ([chi square] = 28.36, p<0.05 for users and [chi square] = 34.361, p<0.05 for non-users). More likely young adult users dissatisfied with the self-image Pearson chi-square ([chi square] = 6.32, p<0.05 for users and [chi square] = 1.94, p<0.05 for non-users).

All respondents were asked questions regarding their inspiration to use anabolic-androgenic steroids (AAS). Almost all of these AAS-users (80%) had been supported by club personal and more than half by their friends (53.5%) beside 76 % indicated it is easy to obtain anabolic-androgenic steroids (AAS) Table 4.


Nowadays the use of anabolic-androgenic steroids (AAS) is widening, no longer just for competing athletes, they are used to increase performance, but also for other reasons such as attraction and physical appearance (NIDA, (2006). As known now, anabolic steroids use is becoming a trend for males for displaying their muscles without full knowledge of the potential side effects of the anabolic agents. Anabolic steroids are now available readily to the younger population (Faigenbaum et al. (1998). A study of Hussain and Al-Shammari (2008) Indicated that knowledge of anabolic steroids was low among anabolic steroids-using bodybuilders regarding side effect.

As indicated by the owner of the Challenge club, people do not care about the side effects of the anabolic steroids, where they believe the use of anabolic steroids in the right way will not have any side effects for their body in the long run. Our study showed that (21.2%) of the samples indicated that anabolic steroids sometimes harm the body. Al-falasi, et al. (2008) indicated that 59% of the samples had heard about AS. However, specific areas of knowledge were inadequate, which reflects the lack of public awareness about the health hazards of AS. They added that 59% of all users believed that the benefits from using AS outweigh the risk. Anabolic steroids are now very easily obtained in clubs, by coaches, friends, and for business.

Obtaining anabolic steroids in Kuwait is very easy. People of younger ages indicated the use of anabolic steroids. Of the 1708 that responded to the survey, 24.8% of the anabolic steroids users were between the ages of 16-18 years old. A recent study by Buckley et al. (1988); Terney (1990) & Yesalis e. et al. (1993) indicated that some high school students use anabolic steroids at younger ages before they even enter high school. Study by tanner, (tanner; Miller. & Alongi, (1995) showed that 54% of adolescents are using anabolic steroids starting at [greater than or equal to] 14 years of age, where in another study by Nutter it was indicated that ~3% of students who are between 12 and 16 years of age had used or were currently using anabolic steroids

No rules have been applied in Kuwait regarding the testing of athletes for the use of anabolic agents, even though it is prohibited for personal and sports involvement. More than half of the population indicated that they know people who use anabolic steroids (71.9%), which mean the use of steroids is increasing in Kuwait among young people due to of the encouragement of friends and coaches where it is pressured onto the client to use anabolic steroids.

Clubs have a strong influence on young people about the anabolic steroids use. More than half of the samples (67.6%) indicated that clubs have strong influences on their clients. Even though large numbers of the samples are non- workers or under age can't work (65%) they dependent someone else, they spend most or all of their money/ allowance on purchasing anabolic steroids.


If anabolic steroids continue to be used in this way by the young population in Kuwait there will be noticeable long term effects in the future. The effects will be detrimental to family life causing problems such as infertility, aggression and depression amongst young males. Also the long-term damage to internal organs of the user leading to hospital referrals and the cost of treatment all need to be considered. As yet no studies have been carried out in this field. The question needing to be asked is; what can be done to prevent these long- term effects? For example a national campaign to educate people about the use of steroids and their long and short-term effects, also education in schools and colleges in physical education classes.

We need to strengthen adolescent and youth public health relations to focus on health promotion and prevention of risky behaviors, such as the use of A AS. Another action that could be taken is to conduct a national situation analysis on socioeconomic and behavioral determinants of AAS use. The government could also take a stance and review legislation and policies to control access and use of AAS by adolescents and young people.

Steroid use can be controlled if we make the young people know the harmful and deadly side effects that can occur from taking steroids and this should be included in every teacher's curriculum because it is a topic that continues in the news such as TVs', Radios which will definitely impact our society in positive way.

In conclusion the use of steroids may lead to short-term benefits for the athletes but the consequences of long- term use by far outweigh their benefits and this is the message that people need to receive. Further studies are required on the involvement of health clubs in the encouragement of steroids use amongst clients.


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Kuwait University
Table 1. Prevalence Distribution of AAS in Sample

                            Users      Non-Users      Total

Education level           N     %      N      %      N      %

Elementary                0     0      1     0.5     7     0.4

Middle                   40    19.8   278    18.5   318    18.6

High school              64    31.7   595    39.5   659    38.6

College/University       98    48.5   626    41.5   724    42.4

Social Status

Single                   190   94.1   1358   90.2   1548   90.6

Married                  12    5.9    138    9.2    150    8.8

Divorce                   0     .0     10    0.6     10    0.6


Young Adult              72    35.6   1320   87.6   1392   81.5
([less than or
equal to]21 years)

Middle-age Adult         78    38.7   150    10.0   228    13.3
(22-27 years)

Adult                    52    25.7    36    2.4     88    5.2
(28 [greater than
or equal to]years)

Weight (BMI) (1)

Underweight              20    9.9    231    15.3   251    14.7

Healthy weight           154   76.2   769    51.1   923    54.0

Overweight               28    13.9   360    23.9   388    22.7

Obese                     0     .0    146    9.7    146    8.6

Sport Activities (2)

Aerobics                 12    6.1    104    7.9    116    7.7

Resistance training      92    46.9   386    29.4   478    31.6

Team sport                6    3.1    397    30.2   403    26.7

Individual competition   30    15.3    48    3.6     78    5.2

Power sport              56    28.6   380    28.9   436    28.8

1) This classification was based on adults aged [less than or equal
to]20 years old, (Centers for Disease Control, 2002). Underweight
(BMI <18.5 Kg/[m.sup.2]), Healthy weight was defined as (BMI; 18.5/
24.9, kg/[m.sup.2]), Overweight (BMI > 25 Kg/[m.sup.2]), Obesity (BMI
> 30 Kg/[m.sup.2])

2) (6) AAS Users and (191) non-users did not report any sport

Table 2. Monthly income and spending among anabolic steroid users

                                 Monthly Income

Monthly                  100-250     251-500
Spending     >100 KD       KD          KD       < 500 KD     Total

>100 KD         3          54          21          4       82(40.6%)

100-150 KD      3          20          46          6       75(37.1%)

< 150 KD        6          20          11          8       45(22.3%)

Total        12(5.9%)   94(46.5%)   78(38.6%)   18(8.9%)   202(100%)

Table 3. Opinion about Anabolic-Androgenic Steroids (AAS)

                                 Users         Non-users
Steroids (AAS)                 M      SD       M      SD        t

I care about my physical      1.64   0.845   1.21    0.404   10.749 *

I am happy with my physical   2.44   0.697   1.893   0.858   8.599 *

Increase my body strength     1.51   0.825   1.33    0.600   3.759 *

Increase my athletics         1.63   0.893   1.29    0.712   4.184 *

Increase my muscle strength   1.47   0.799   1.10    0.303   4.793 *
& size

Impact my reproductive        1.99   0.754   1.65    0.778   5.916 *

Impact my general health      1.23   0.427   1.56    0.875    8.855

Scale: l = strongly disagree, 2 = disagree, 3 = neither disagree nor
agree, 4 = agree, 5= strongly agree. * p < 0.05

Table 4. Environmental influence

                    Users         Non-users
I know people
Use AAS           N       %       N       %     [chi square

Yes              180    89.1    1022    67.9      37.08 *
No               20      9.9     400    26.6
I am not sure     2       1      84      5.6

Easy to obtain AAS

Yes              154    76.2    1007    66.9     25.838 *
No               48     23.8     198    13.1
I am not sure     0       0      301    20.0

Friends encourage you to use AAS

Yes              108    53.5     437    29.0      35.00 *
No               56     27.7     648    43.0
Sometime         38     18.8     421    28.0

Coach encourage you to use AAS

Yes              60     29.7     377    25.0       2.76
No               82     40.6     608    40.4
Sometime         60     29.7     521    34.6

Club personal encourage you to use AAS

Yes              162    80.2     588    39.2     114.64 *
No               30     14.9     542    35.9
Sometime         10      4.9     376    24.9

Note: * p<0.01, Significance level of pairwise difference between
users and non-users
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Author:Mohammad, Heyam
Publication:College Student Journal
Article Type:Report
Geographic Code:7KUWA
Date:Mar 1, 2014
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