Possible Exacerbation of Tics by Androgenic Steroids

Abstract

A variety of physical and psychological sequelae have been reported among athletes using high doses of androgenic steroids to enhance their performance.^{1 2 3} We have recently evaluated two athletes with a history of Gilles de la Tourette's syndrome who reported that their tic symptoms worsened during periods of steroid use. In the first case, a well-proportioned 22-year-old man presented with moderate-to-severe motor and phonic tics. He reported that his tic symptoms had worsened inexplicably over the previous 10 months. His history revealed a 10-year course of benign motor and phonic tics that had largely disappeared by the age of 20. According to the patient, his tics suddenly worsened over a period of two to three weeks, with the emergence of frequent head jerks, shoulder shrugging, and throat clearing. Further inquiries revealed that the exacerbation of the tics had occurred during the latter stages of a several-week "cycle" of parenterally administered anabolic steroids (stanozolol and methandrostenolone). In the second case, a muscular 36-year-old man presented with a similar history of tic symptoms, which had worsened dramatically during a "cycle" of parenteral testosterone administration. In both cases, the exacerbation of the symptoms coincided with an altered mental state, described as "a sense of power and invincibility" associated with heightened aggressiveness and a diminished tolerance for frustration.