Steroids Side Effects
According to the Merriam Webster dictionary, anabolic steroids are ‘drugs derived from testosterone (the male sex hormone), typically prescribed to promote growth or to help repair tissues that are weakened by severe illness or aging. At times anabolic steroids are also given to stimulate appetite’. In recent times, there is a lot of discussion and analysis about these drugs and much of it, unfortunately, centers around the negative aspects. Typically, it is the ‘potentially serious’ side effects of anabolic steroids that are the most common subject of any discussion about these drugs. Steroids have been demonized to such an extent that the very term is now beginning to be associated with undesirable consequences. While it is true that anabolic steroids may have certain side effects, it is equally true that, just like many other pharmacological products, these have several incredible benefits to offer as well.
A Balanced Approach
Maintaining a balanced approach is very important in any discussion about anabolic steroids. It is practical to weigh the benefits of these drugs against their potential side effects before making any conclusion about whether or not they should be used. In this respect, the very first fact to note is that in most of the cases the side effects arise only when the steroid is misused or abused. When a drug is not being used in the way it should there is a great likelihood of side effects, even potentially fatal ones, arising. A report in the bbc.co.uk website reveals how taking too much of a very common OTC analgesic like paracetamol may be fatal, if the user has not followed dosage instructions accurately. Clearly, side effects arising from misuse or overdose are not limited to steroids alone but to all type of drugs.
The second point to note is that it is not a certainty that side effects will arise whenever any individual ingests anabolic steroids. In fact, steroids only have ‘potential’ side effects, which mean that there is a chance you may not face any side effects from its use at all. Among those who do experience side effects, all may not be impacted to the degree and in the same way.
There are several conditions for which physicians recommend a course of steroids as the most effective treatment. For instance, steroids may be prescribed for those suffering from steroid hormone deficiency as well as serious ailments like cancer or AIDS. For the latter, the steroids work to combat the loss of lean muscle mass that is a typical development in an individual with either of these diseases. Physicians may also recommend anabolic steroids to treat specific types of anemia, some kinds of breast cancer and hereditary conditions like angioedema. In fact, it has been found that anabolic steroid may also have a positive impact on the treatment of other ailments such as Turner’s Syndrome, certain blood clotting diseases, and growth related problems .
In other words, steroids are NOT the same as ‘street drugs’ that are ingested illegally and that put the individual at immense risk. Steroids are, in fact, commonly prescribed by doctors worldwide to address specific problems and excellent results have been derived from their use for such ailments/conditions.
From a clinical perspective, it is imperative that anabolic steroids are viewed in a balanced manner so that their benefits may be enjoyed while side effects are kept at bay or at the very least kept to a minimum. There is a general view that anabolic steroids cause a range of problems arising from fluid retention in addition to specific detrimental effects for male, female, and adolescent users. In this regard it is important to understand that the side effects of steroid use are generally categorized into:
It is also critical to point out here that not all anabolic steroids have the same kind of effects. Some may have a specific impact that is not shared by other kinds of steroids. Also there is no research that proves that all anabolic steroid users do suffer side effects and that they experience the same degree of these effects. It is possible for an individual to use these drugs without experiencing any of these detrimental effects at all.
The Question of Intensity of Side Effects
Another critical question that needs to be raised at this point is – where there are side effects, is it possible to address them successfully?
Many of the side effects linked to anabolic steroid use are reversible. Many others may be minordevelopments that can easily be ignored in face of the benefits derived from the use of the drug. For example, for a user who is witnessing a steady gain in muscle strength after a serious illness through steroid use, a slight increase in acne over a few weeks is definitely a side effect that can be ignored. It should be kept in mind that in surveys proclaiming the harmful effects of steroid use, there is seldom any indication as to what percentage of the users faced serious, debilitating or life threatening side effects. Generally, all users experiencing side effects are clubbed together and this presents a skewed and inaccurate picture of the impact of using these drugs.
To give the reader a clear and accurate picture of the facts, these points need to be set out clearly at this stage. Different factors including the individual’s physical condition and existing ailments impact the side effects that arise from anabolic steroid use. All anabolic steroids do not have the same kind or the same intensity of side effects. Not all steroid users will experience all the side effects that other users do. It is definitely possible that the use of steroids does not result in any side effects at all.
What are the Factors Impacting Side Effects?
The intensity and kind of side effects that may be experienced by an individual who is taking anabolic steroids depends on various factors as listed below:
The side effects experienced from use of anabolic steroids may vary according to the age, gender, and overall health of the user. For example, a person who is prone to psychological problems may suffer mood swings or other similar side effects of steroid use to a greater degree than an individual with no such existing issues. Another aspect to consider is that the appearance of side effects may vary with age. Even in the same individual, fewer side effects may be seen at a younger age. As the individual grows older, changes take place in the body which also changes the way they react to the steroid. Extremely young or old individuals may not be able to tolerate a sudden shift in androgen concentration that is brought about by the use of anabolic steroids.
Gender specific differences are also found to affect the degree and number of side effects experienced from steroid use. For instance, in women, steroid use may lead to reduction of the breast, facial hair growth, and lowering/deepening of the voice. Men may experience gynecomastia as a result of increased levels of circulating estrogens and erectile dysfunction.
The DNA of each individual is distinct and unique and this blueprint also determines to a great extent how the individual responds to any drug including anabolic steroids. In fact, an interesting point to note is that an individual who aspires to gain strength, improve musculature, or add on weight cannot do so merely because of ingesting anabolic steroids. The drug only supports the process if the individual’s genetic make-up makes this outcome possible. The side effects experienced by various people are heavily influenced by their genetics.
The form in which the steroid is taken impacts the kind of side effects that may be experienced. Oral steroids pass through the body’s digestive system. Any side effects pertaining to liver damage may arise only when the individual uses these kinds of oral steroids. Those steroids that are injected do not enter the digestive system and, as such, are not acted upon by the liver at all. For example, steroids like testosterone cypionate and testosterone enanthate are believed to have negligible adverse impact on the liver
It has been found that the side effects may be diminished or eliminated when the anabolic steroid is not used on a continuous basis for a long duration. Many athletes prefer to ‘cycle’ the steroids – taking it regularly for a fixed period and then avoiding it entirely for the succeeding period. While it is advisable to keep the steroid cycles short there is little doubt that the best results are achieved by steroid use over long duration, which presents substantial temptation to misuse the drug. Typically, many beginners adopt an 8 week cycle followed by an 8 week off cycle when the steroid is completely avoided. Keep in mind that the longer the cycle the better the effects, but longer cycles also come with increased risks.
The type of steroid used also makes a difference to the kind and degree of side effects experienced. Typically, different steroids are ingested with the objective of gaining different outcomes. This is a clear indication that each of these drugs acts on our body in different ways, perhaps even act on different organs of the body. Evidently, in such case there is no reason to believe that all these steroids should cause similar side effects.
A Detailed Look at Potential Side Effects
It is commonly believed that the use of Anabolic Steroids causes several side effects in both men as well as women apart from gender and age specific ones. Let us first look at the general side effects these drugs are typically associated with and discern the seriousness of the problem.
Anabolic steroids are believed to cause severe damage to the liver and impair its functioning to a great extent. While it is true that liver damage may be witnessed with anabolic steroid use, it is equally true that not all forms of these drugs result in these impairments. When modification of testosterone is done by esterification (resulting in products like testosterone cypionate) the virilizing effect is retained. However, here the duration of action is improved. For oral administration, the C-17 position alkylation is usually carried out. This alters the ‘potency to masculinizing effects’ equation in the drug. These androgenic steroids (the C-27 alkylated kind) have been found to cause liver injury mainly because they pass through the digestive system, causing the liver to undergo immense strain in processing them.
It is critical to note that esterified testosterones are not believed to cause liver injuries or damage. Their use over a long duration may heighten the individual’s risk of developing nodular transformation and hepatic tumors. But even this takes place at a much slower pace than with the C-17 alkylated steroids. In fact, in an Encyclopedia of Sports Medicine and Science article that cautions against the use of anabolic steroids, it is mentioned that there are ‘strong indications’ that benign tumors of the liver may be caused by 17-alpha-alkyl anabolic steroids. However, these tumors reverse once the individual ceases to ingest the steroid .
In a NLM report discussing the issue of hepatoxicity associated with anabolic steroid use, it is stated that data regarding the frequency of cholestasis arising due to the use of androgenic steroids is extensive. The report goes on to say the following:
In general, it is believed that prolonged use of anabolic steroids may put the individual at high risk of developing hepatoxicity in general and cholestasis in particular. Those already exhibiting Fanconi’s Syndrome, iron overload, or chronic Hepatitis C may be more susceptible to developing this kind of liver damage. Typically, reversal of the condition is possible with the withdrawal of the steroid although complete recovery may require long convalesce in severe cases of cholestasis.
Cardio-Vascular Side Effects
There is widespread belief that steroid use leads to cardio-vascular disease of various kinds. Research shows that steroids do bring about alterations in lipid metabolism, primarily increase in LDL and decrease in HDL. However, researchers have not uncovered specific underlying mechanisms that are established by steroid use and that increase the risk of life threatening arrhythmia . In effect, the risk of cardiovascular disease, characterized by an increase in bad cholesterol may be enhanced by steroid use if:
The drug is abused/used in a manner not in accordance with prescribed or safe dosage
The drug is used without respite for a long period
The individual has other underlying health problems that already place him at high risk for such illnesses
The drug is taken in a form and using a method that increases risk of such ailments
In general it has been found that oral steroids are more likely to prove detrimental to cardiovascular health than injectable forms of non C-17 alkyl steroids. In this regard it is important to point out that estrogen is actually known to have a positive effect on cholesterol levels, enhancing HDL levels, and keeping LDL levels under control. It is when aromatase inhibitors in ancillary compounds come into play during the steroid cycles that the individual is at risk of cardio-vascular diseases owing to estrogen levels being subdued. Further, it has been seen that when the individual is committed to a healthy diet that supports desired cholesterol levels during the steroid cycle, the risk of cardiovascular disease arising from steroid use can be kept under control.
Heart enlargement is another cardiovascular side effect that is attributed to steroid use. This muscle tissue typically enlarges when physical training is intensified just as many other muscle groups enlarge and expand at this time. If the steroid is being taken to help weight gain or strength training regimen, it may be inaccurate to attribute the heart enlargement to steroids alone. Exercising can cause both concentric remodeling and eccentric remodeling depending on the kind of activity that is being carried out.
Another critical point to note is that there is no scientific evidence to link heart failure directly to steroid use. Heart enlargement is also reversible and this muscle gradually shifts back to its pre-steroid, pre-exercise size once the individual has halted exercising and steroid use.
Blood pressure fluctuations are another common side effect attributed to steroid use. However, this may be linked to the water retention that increased estrogen levels cause. Blood pressure change arising from such conditions is easily rectified by the use of aromatase inhibitor. An alternative is to use steroids that do not get converted into estrogen. It is critical to understand that in those individuals who experience blood pressure fluctuations, these changes are moderate. Many AAS users also benefit in this regard by switching to a low sodium diet without simple sugars or carbs.
In a report published on the IronMan website , there is specific mention of how blood pressure fluctuations are a risk to consider with high-dose steroid regimens. The report goes on to mention how, in testosterone deficient individuals, steroid treatment may actually prevent high blood pressure.
Impact on the Human Brain
It has long been believed that anabolic steroids have a long-term adverse impact on the human brain. Researchers have maintained that these drugs affect the neurotransmitter systems within our brain. Terms like ‘roid rage’ are often associated with steroid and steroid users so much so that when a well built, muscular individual exhibits aggressive behavior it is often automatically assumed that he is acting under the influence of steroids. Several reports have been circulated on how steroid use contributes to moodiness, depression, aggression, mood swings, and other similar issues.
In research on the long-term impact of steroids on the brain, the effect of steroid nandrolone decanoate on the dopaminergic and serotonergic systems of the brain was observed. In the dopamine system, complete reversal of the effects of the steroid took place when about 5 times the duration of the dosing period has passed. In the serotonin system, this took about 6 times the duration of the dosage period.
The conclusion drawn was that the changes caused by the steroid to the CNS are reversible provided sufficient time is allowed between cycles . Based on this research, the risk of sustaining long-term brain damage from steroid use appears to arise when the individual fails to allow enough time for the neurotransmitter circuits to shift back to baseline levels. Starting a new cycle soon after the previous one may place the individual at high risk. Those who have been using steroids for years to achieve body building, weight gain, or other objectives place immense importance on allowing sufficient time gaps between cycles to avoid these problems. Another research paper had statistics showing that about 21% of the participating Anabolic Androgenic Steroids (AAS) users reported marked psychiatric effects.
Even among sportspersons, there are many who believe that regular use of AAS heightens the risk of degenerative brain disease that is caused by repeated head trauma sustained by the individual during sports activities. Recent research has revealed that there is no scientific evidence to prove that use of steroids by athletes creates long-term damage arising from mild traumatic brain injury or MTBI . The study proved that no difference can be detected in effects of brain trauma among those using steroids and those who do not.
Intracellular and extracellular water retention may be increased within the body with anabolic steroid use. This can result in increased blood pressure owing to excessive water in the circulatory system. It can also contribute to a bloated and puffy look to the physique owing to the water present subcutaneously. The use of aromatase inhibitors to limit the estrogen in the body in conjunction with a low sodium diet may resolve these problems.
An increase in sebum production and secretion caused by the binding of steroids to androgen receptors underlying the skin may give rise to acne. The steroid may enlarge the sebaceous glands which also exacerbates the problem. It is a fact that not all steroid users experience this problem, nor is the intensity of the problem the same across steroid users. Topical androgens are commonly used to reduce acne caused by steroid use. The problem also clears up once the steroid is discontinued.
Gender Specific Side Effects
Apart from general symptoms like acne, moodiness, cardiovascular impact and others, steroids are also believed to have some gender specific side effects. These include:
Hormonal imbalance and build-up of estrogen often cause this problem where the male’s chest begins to develop breasts similar to a woman. This is a common problem for older males who are using AAS since hormonal changes are already taking place in their bodies owing to age. The problem may not have any physically debilitating impact but the psychological and emotional effect is substantial. However, many men have found that using a Selective Estrogen Receptor Modulator or SERM helps immensely with this problem. In fact it is commonly believed that this is one of the most easily avoided side effects and innumerable AAS users supplement their steroids with SERMs and get good results. The severity of the problem is heavily dependent on the individual’s sensitivity to the steroid. That is why the same steroid may be used without any such side effects by several men while just a few experience gynecomastia.
Gynecomastia progresses through different stages and halting the process at an early stage enables complete reversal. However, if the individual has allowed the problem to grow, then surgery may be the only remedy.
All AAS products suppress the endogenous testosterone production by the HPTA negative feedback loop. A visible effect of this shutdown is the reduction in the size of the testes. Roughly half of all AAS users experience this temporary and reversible impact of the use of these drugs. An important point to note here is that some AAS products have less of a suppressive impact than others. In general, this problem is rectified by undergoing a Post Cycle Therapy where a testosterone production stimulating compound is ingested for a cycle.
Use of AAS over a prolonged period can result in the shrinkage of the breasts leading to a more masculine chest. Although the degree of reduction is highly dependent on the type of AAS used, its duration of use and dosage, there is evidence to show that this may be a significant side effect of steroid use. Unlike many of the other side effects, breast size reduction may not always be reversible and it may remain even after the use of the steroid has been stopped entirely.
An androgenic effect of steroid use, dysphonia causes the deepening of the voice in female users. Although this may take place in males as well, the impact is far more evident and intensified in women. In addition, just as the male reproductive organ is impacted by AAS use, the female organ also undergoes changes, albeit of a different kind. Clitoromegaly is a side effect of ASS use that results in the enlargement of the clitoris.
Typically, use of AAS products that have high androgenic strength rating place the user at high risk of developing these side effects. One effective way to avoid this issue is to ingest steroids that are not strong androgens. Ensuring that cycles are as short as possible and that the total dosage is within safe limits often suffices to keep this side effect away. Dysphonia and Clitoromegaly are both reversible if the problem is detected at an early stage and the steroid use stopped immediately.
Hormonal action of AAS products often result in menstrual cycle changes as well. The menstrual cycle may become more frequent or infrequent as a consequence of AAS use. Although complete recovery is possible when the steroid is no long being taken, this may take time depending on the kind of AAS product used, the duration of use, and the dosage.
Age Specific Side Effects
This is a serious concern mainly because of the increasing number of younger athletes and school going sports enthusiasts who are exhibiting a keenness for steroid use. Stunted growth is a side effect of the use of this drug that has far reaching consequences for young users. AAS causes premature fusion of growth plates preventing the individual from growing any further. Since growth may take place up to the age of 24, experts and physicians alike caution against taking steroids if the individual is below this age. Research has proven that Estrogen is the main culprit behind the stunted growth. So, steroids that aromatize into estrogen or that act as estrogens may result in the closure of growth plates in younger users. However, non-estrogen steroids are not completely safe either. It is advised that young persons below the age of 24 do not use steroids unless prescribed as treatment for a specific health condition.
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