Elaborating on why the psychological side effects of testosterone injection are individual dependent: Not everyone get the same amount of motivation and increased goal seeking from the steroid and most people do not experience periods of chronic avolition. Another psychological effect is a potentially drastic increase in aggression which in turn can have negative social consequences. In the case of counterfactual Wedrifid he gets a net improvement in social consequences. He has observed that aggression and anger are a prompt for increased ruthless self-interested goal seeking. Ruthless self-interested goal seeking involves actually bothering to pay attention to social politics. People like people who do social politics well. Most particularly it prevents acting on contempt which is what Wedrifid finds prompts the most hostility and resentment in others. Point is, what is a sanity promoting change in one person may not be in another.
Another important epidemiological question about the use of prescription stimulants for cognitive enhancement concerns the risk of dependence. MPH and d-AMP both have high potential for abuse and addiction related to their effects on brain systems involved in motivation. On the basis of their reanalysis of NSDUH data sets from 2000 to 2002, Kroutil and colleagues (2006) estimated that almost one in 20 nonmedical users of prescription ADHD medications meets criteria for dependence or abuse. This sobering estimate is based on a survey of all nonmedical users. The immediate and long-term risks to individuals seeking cognitive enhancement remain unknown.
While the commentary makes effective arguments — that this isn't cheating, because cheating is based on what the rules are; that this is fair, because hiring a tutor isn't outlawed for being unfair to those who can't afford it; that this isn't unnatural, because humans with computers and antibiotics have been shaping what is natural for millennia; that this isn't drug abuse anymore than taking multivitamins is — the authors seem divorced from reality in the examples they provide of effective stimulant use today.
Organizations, and even entire countries, are struggling with “always working” cultures. Germany and France have adopted rules to stop employees from reading and responding to email after work hours. Several companies have explored banning after-hours email; when one Italian company banned all email for one week, stress levels dropped among employees. This is not a great surprise: A Gallup study found that among those who frequently check email after working hours, about half report having a lot of stress.
The Nature commentary is ivory tower intellectualism at its best. The authors state that society must prepare for the growing demand of such drugs; that healthy adults should be allowed drugs to enhance cognitive ability; that this is "morally equivalent" and no more unnatural than diet, sleep, or the use of computers; that we need an evidence-based approach to evaluate the risks; and that we need legal and ethical policies to ensure fair and equitable use.

Methylphenidate – a benzylpiperidine that had cognitive effects (e.g., working memory, episodic memory, and inhibitory control, aspects of attention, and planning latency) in healthy people.[21][22][23] It also may improve task saliency and performance on tedious tasks.[25] At above optimal doses, methylphenidate had off–target effects that decreased learning.[26]

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