Can Testosterone cause “roid-rage?”

This morning while at work, I received the CNN breaking news alert on my phone “Oscar Pistorius leaves jail after bail”. For anyone who hasn’t been following the story, Pistorius is a South African sprint runner (and Olympic champion) who is being charged with the murder of his girlfriend Reeva Steenkamp on 14 February. The prosecution claim police found two boxes of the hormone testosterone, needles and 38-calibre ammunition in the athlete’s bedroom. His defense however says “No, it was a herbal remedy”.

While the jury is still out on what exactly the substance actually is, let’s discuss whether testosterone is actually capable of making a human fatally aggressive.

A little background on Testosterone

Testosterone is a steroid hormone found naturally in most animals. It is the principal male sex hormone in males with their daily production being about 8 times more than females. In men, it is the key hormone that develops male reproductive tissues (i.e testicles) it also promotes secondary sexual characteristics such as increased muscle, deepening of the voice, increased bone mass, and the growth of body hair.

Some male bodies have little or no internal testosterone production; this condition is known as hypogonadism. As a result, they have to go through a process known as hormone replacement therapy (HRT) or testosterone replacement therapy (TRT) where they take extra testosterone to restore and maintain their serum testosterone levels in the normal range.

Dosage forms of TRT include transdermal gels or patches, injectable depots and oral therapy.

Illegal Athletic use

Synthetic testosterone can be used by athletes as a performance enhancing agent, but it is considered illegal to do so in most countries. They are usually called “anabolic steroids”, and because they directly increase production of muscle protein, they are taken to enhance muscle development, strength, or endurance. As a result, muscle fibers become larger and repair faster than the average person’s which gives them an advantage during sport performances.

So can testosterone really cause a “roid-rage”?

“Roid rage” is a term given to people who act in very aggressive or hostile manner after taking large doses, usually on a regular basis, of anabolic steroids, sometimes nicknamed as roids.

According to Dr. Sack, M.D., CEO of Promises Treatment Centers in Los Angeles; research has shown a correlation between high testosterone levels and aggressive behavior in men. “Testosterone increases dopamine activity in the brain as well as receptor responses to dopamine,” Dr. Sack explains. “Dopamine makes you irritable, paranoid, and hostile when it’s too high.”

As a result, “Certain men who are taking high doses of steroids—about five to ten percent—become very irritable and aggressive, developing ‘roid rage’… they can go off for no reason and become impulsive.” However, even if Pistorius was influenced by steroids, Dr. Sack says it probably wouldn’t have clouded his judgment. “It’s hard to say what he was thinking at the time, but when people talk about whether someone was mentally competent, the issue is – were they able to evaluate what was going on? and were they able to make decisions based on that information?,” he says. “It would be a stretch to say someone in a ‘roid rage’ wasn’t competent in a legal sense. They’re not usually delusional or having hallucinations; they’re just really agitated.”

There have been several clinical studies assessing roid rage, and it does turn out that people who are most likely to experience it are also most likely, prior to steroid use, to be extremely angry, hostile or violent. This suggests that roid rage may most occur in those who are already at risk for violent behavior. These studies further suggest that roid rage is not a suitable legal defense for committing violent acts, since the person who claims it as a defense may have already had tendencies toward violence.

Overall the theory of “roid-rage” looks like it will remain just that…a theory, rather than a fact.