The use of anabolic steroids is not a new fad. When it became widely known among athletes during the 1950s that steroids could help them build muscle or perhaps enhance their athletic performance, they were used for that purpose.
Initially, the use of steroids was limited to “bodybuilders” and professional athletes, but the practice has now carried over into a widespread segment of society, including young athletes who aspire to someday become professionals.
The problem with the use of steroids is after prolonged use they can cause negative health effects. A greater risk of having a heart attack or stroke has been linked to the use of both injectable and oral steroids. Research has found that the risk of liver damage can occur with the use of most of the oral steroids used for bodybuilding.
What Are Anabolic Steroids?
The term “anabolic steroids” is used to refer to a group of synthetic substances that mimic the effects of male sex hormones such as testosterone. The drugs promote in both males and females the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects).
Therefore, the proper term for these substances should be “anabolic-androgenic steroids”.
Used for Medical Purposes
Anabolic steroids were originally developed in the 1930s to treat hypogonadism, a medical condition in which the testes do not produce enough testosterone. Currently, they are prescribed to treat steroid hormone deficiency, such as delayed puberty and some types of impotence
Sometimes, steroids are prescribed to counteract the wasting away of the body’s muscle mass due to diseases like some cancers and HIV infection.
Abused by Athletes
When early research with animals in the 1930s found that anabolic steroids could facilitate the growth of skeletal muscle, the drugs began to be abused for that purpose by bodybuilders and weightlifters. They later began to be abused by athletes in other sports because of their performance-enhancing capabilities.
Because their use can affect the outcome of sports competitions, anabolic steroids have been banned from use by all amateur and professional sports organisations.
Commonly Abused Steroids
These are some commonly abused steroids:
- Anadrol (oxymetholone)
- Dianabol (methandrostenolone)
- Oxandrin (oxandrolone)
- Winstrol (stanozolol)
- Deca-Durabolin (nandrolone decanoate)
- Depo-Testosterone (testosterone cypionate)
- Durabolin (nandrolone phenylpropionate)
- Equipoise (boldenone undecylenate)
- Tetrahydrogestrinone (THG)
What Are Steroidal Supplements?
Steroidal supplements, promoted as hormone products or alternatives to anabolic steroids, are substances that claim to be converted into testosterone or similar compounds in the body. Many of these products are marketed and labelled as dietary supplements which can increase muscle mass and strength.
The U.S. The Food and Drug Administration (FDA) regularly issues public health advisory warnings about bodybuilding products that are represented to contain steroids or steroid-like substances. The warnings state: “These products are marketed as dietary supplements, they are NOT dietary supplements, but instead are unapproved and misbranded drugs.”
Because these steroid supplement products could increase testosterone levels in the body like anabolic steroids themselves, it is believed that their side effects could also be the same. Little research has been done on the side effects of these supplements, but the FDA warns they can be harmful.
How Are Anabolic Steroids Used?
Depending on the type, anabolic steroids can be taken orally, injected intramuscularly, or applied through the skin as gels or creams. When used for medical purposes, anabolic steroids can be taken by intramuscular or subcutaneous injection, orally, pellet implantation under the skin or by application to the skin via patches or gels.
However, the size of the dosages used by steroid abusers can be much larger than those used for legitimate medical purposes. When steroids are abused for nonmedical purposes they are usually injected or taken orally.
According to researchers, endurance athletes typically use dosages slightly below replacement levels of 5 to 10 mg/day. Sprinters will usually take 1.5 to 2 times replacement levels. Weight lifters and bodybuilders will take 10 to 100 times normal doses.
Women athletes use lower dosages than men, regardless of the sport for which they are training.
Cycling, Stacking, and Pyramiding
People who abuse anabolic steroids sometimes use different methods, or patterns, of usage based on their goals. Athletes may use steroids for a limited period of time to accomplish a specific goal, but bodybuilders may use steroids for long periods of time. They include:
This method involves taking multiple doses over a specific period of time, stopping for a period, and then starting again. Typically, users will take steroids for six weeks to 16 weeks at a time, followed by several weeks of taking low doses or no steroids at all.
Athletes who know they are going to be tested – for example, during a specific event or competition – will time their cycle in hopes of passing the drug test. Cycling is also used to try to minimise the undesirable side effects of steroids use.
Athletes do Cycling to –
- Ensure peak performance during competition
- Prevent detection of steroid use
- Reduction of adverse effects
- Reduction of tolerance development
When abusers combine different types of steroids—such as those taken orally as well as those injected—it is called stacking. The idea behind the practice is that the different kinds interact to produce a greater effect.
Many users try stacking in hopes of increasing the effectiveness of the combination of steroids, but there is no scientific evidence to back that theory up.
- Injectables may be stacked with oral preparations
- Short-acting steroids may be stacked with longer-acting steroids
- Stacking is never done in medical practice
In this method, users start with low doses then increase the dosage or the frequency until they reach a peak at mid-cycle. Then they gradually reduce the dosage or frequency down to zero. Typically, the pyramid cycle will last six to 12 weeks. This is usually followed by a cycle when the user continues to train or exercise without taking steroids.
Pyramid users believe the method gives the body time to adjust to the high dosages and the drug-free period allows the body’s hormonal system time to recuperate. But again, the theory is not supported by scientific research.
What Are the Health Effects of Steroid Abuse?
The negative side effects linked to anabolic steroid abuse can range from those that are mildly annoying to those that can be life-threatening. Steroid abusers report experiencing health effects that range from developing acne problems to having heart attacks and liver cancer.
Some Effects Show Up Years Later
The prevalence of life-threatening effects of steroid abuse seems to be very low from case studies, but the NIDA reports that serious adverse effects may be underreported and underrecognized because they sometimes do not appear until years after the abuse.
Anabolic steroid abuse can affect many different bodily systems.
The following are some of those effects.
Hormonal System Effects
The disruption that steroid abuse causes to the body’s normal production of hormones can cause some changes that are reversible and some changes that are irreversible. Reduced sperm production and shrinking of the testicles are two changes that can be reversed once the steroids are no longer used.
Male-pattern baldness and breast development (gynecomastia) in men are two of the side effects of steroid abuse that cannot be reversed. One study found that a majority of male bodybuilders experienced testicular atrophy and/or gynecomastia.
Women who abuse anabolic steroids can experience masculinization. Their voices can become deeper, their breast size and body fat can decrease, the clitoris can become enlarged and the skin can become coarse. Women can lose scalp hair, but experience excessive growth of body hair.
With long-term steroid abuse, some of these changes in women can become irreversible, particularly the deepened voice.
Short-Term Physical & Mental Effects of Steroid Abuse
According to the latest research available regarding anabolic steroids, there are several physical and mental effects of steroid abuse on males and females.7
Short-term adverse effects in men may include:
- Abnormal liver function
- Bleeding (usually nose)
- Decreased HDL cholesterol levels
- Decreased semen volume
- Decreased sperm production and motility
- Elevated blood pressure
- Enlargement of the breast (gynecomastia)
- Fluid retention leading to swelling
- Frequent or continuing erections
- Increased LDL cholesterol levels
- Prostate enlargement
- Shrinkage of the testicles
- Skin tissue damage at the site of injection
Short-term adverse effects in prepubertal boys may include:
- Decrease in the total height achieved
- Fluid retention leading to swelling
- Increased frequency of penile erections
- Painful, prolonged penile erections
- Penis enlargement
- Precocious sexual development
Short-term adverse effects in women:
- Decreased breast size
- Deepening of the voice
- Enlargement of the clitoris
- Fluid retention leading to swelling
- Increased body and facial hair growth
- Male pattern baldness
- Menstrual irregularities (missed or no periods)
- Oily skin
- Tissue damage at injection site
Long-Term Consequences of Anabolic Steroid Abuse
There is a limited amount of scientific research about the long-term effects of anabolic steroid abuse on men or women. The “possible” long-term effects listed below come mostly from case studies.
Long-term consequences of anabolic steroid abuse in men and women may include:
- Adverse cardiovascular effects
- Cancer of the prostate (men only)
- Liver cancer
- Liver dysfunction
- Liver tumours
Other potential risks faced by anabolic steroid abusers in men and women:
- Hepatitis infections
- HIV infection (needle sharing)
- Skin infections
- Violent trauma
Anabolic steroid abuse in male children can cause stunted growth. Normally, the rising levels of testosterone and other sex hormones trigger the growth spurt that takes place during puberty. It also provides the signals to tell the bones to stop growing. When steroid abuse artificially increases these sex hormone levels it can prematurely signal the bones to stop growing.
Because steroid abuse can change the levels of lipoproteins that carry cholesterol in the blood, abusers can develop cardiovascular diseases.
Steroid use, particularly oral steroids, has been shown to reduce the level of high-density lipoprotein (“good cholesterol”) and increase the level of low-density lipoprotein (“bad cholesterol”), resulting in the increased risk for atherosclerosis, which can cause heart attack and stroke.
Steroid abuse can also increase the risk of blood clots forming in the blood vessels. Effects of steroid abuse on the cardiovascular system include:
- Decreases in HDL
- Enlargement of the heart’s left ventricle
- Heart attacks
- High blood pressure
- Increased blood clotting
- Increases in LDL
- Spasms of the coronary arteries
Research has found that anabolic steroid abuse can cause tumours to form in the liver. Steroids can also cause a rare condition known as peliosis hepatis, in which blood-filled cysts form in the liver. Internal bleeding can occur when either the tumours or the cysts rupture.
Side effects of steroid abuse on the liver include:
- Peliosis hepatis
Effects of steroid abuse on the skin can include:
- Fluid retention
- Oily scalp and skin
- Severe acne and cysts
Because some who abuse steroids inject the drugs and use non-sterile injection techniques or share contaminated needles with other abusers, they are at increased risk for developing HIV and hepatitis B and C like all other injection drug users.
What Effects Do Anabolic Steroids Have on Behaviour?
Anger, Hostility, Aggression or Violent Behaviour
According to steroid abuse researchers, anger, irritability, hostility, aggression and/or violent behaviour:
- Increased likelihood with higher doses
- Minor provocations evoke exaggerated responses
- Occurs in some but not all anabolic steroid users
- Presents danger to law enforcement
- Presents danger to spouse, family, and friends
- Unpredictable who will respond
Psychological Effects of Steroid Abuse
There have been some reports of psychotic and manic reactions in both men and women who abuse anabolic steroids, but these have been rare occurrences and researchers believe they have most likely occurred in users with prior mental illness.
It is not known scientifically to what extent anabolic steroid use has on violence and behavioural disorders. The prevalence of extreme cases of violence among steroid abusers appears to be low, but as with the health effects, extreme violence could be underreported or underrecognized.
Some other psychological effects of steroid abuse that have been reported include:
- Hallucinations and delusions
- Manic behaviour
- Mood swings
Are Anabolic Steroids Addictive?
Some individuals who abuse anabolic steroids can develop patterns of behaviour that are typical symptoms of people who are addicted. Those behaviours include continuing use despite negative consequences, spending excessive time and effort in obtaining drugs, and experiencing withdrawal symptoms when they stop using.
Some anabolic steroid users continue using the drugs despite experiencing physical problems and problems in their social relationships. The percentage of those who continue to use it in spite of negative consequences is not known.
Classic Addiction Symptoms
Many steroid abusers spend large amounts of time and money to obtain the drugs they use. When they stop taking steroids, users can experience withdrawal symptoms that can include mood swings, restlessness, loss of appetite, and craving for steroids.
Other withdrawal symptoms reported in case studies of people coming off anabolic steroids use include
- Decreased sex drive
- Difficulty concentrating
- Fatigue (extreme tiredness)
- Feelings of anxiety
- Muscle and joint pain
One of the most serious withdrawal symptoms associated with stopping steroid use is depression because it can sometimes lead to suicide attempts. Research reveals that if untreated, depression associated with anabolic steroid withdrawal can persist for a year or longer after the use of the drug stops.