Steroids: Physiological effects
Last modified: Saturday, 20. June 2009 - 3:38 pm
Oral AASs are rapidly absorbed and result in an increased AAS concentration in the bloodstream within a few hours, although it is several days before the AAS completely passes through the system. Intravenous AAS solutions are absorbed more slowly. Athletes who use large doses of AASs and strength train do get larger and stronger muscles. One study involving 21 male weight trainers showed greater strength and body weight and increased muscle girth when compared to the group without AAS. Another study showed the trunk and legs of 16 bodybuilders on AASs experienced the most significant increase. While the composition of the muscle fibers does not differ, it appears that AAS users form new and larger muscle fibers. The increase in lean body mass and body weight continues for at least a short time after AAS use stops. However, AAS use is linked to a number of adverse side effects, which range from acne to life-threatening heart attacks and liver cancer. While most side effects, are reversible when the user stops taking the drug, some are permanent. Certain side effects occur due to some of the testosterone being chemically changed in the body to the female hormone estrogen. This leads to higher than normal estrogen levels — and potential side effects.
Harmful side effects
Hormonal effects. Steroid use alters the normal production of hormones, raising the blood levels to many times the amount naturally produced. This change in the body’s hormonal balance can cause both reversible and irreversible effects in many parts of the body. Males can experience enlarged prostate glands, which makes urination difficult. A shrinking in testes (called testicular atrophy), lowered sperm production, and sterility has resulted from AAS use. In a 2001 study by J. Torres-Calleja published in Life Sciences, eight of 15 bodybuilders using AAS had below-normal sperm counts, and three had no sperm. The average sperm counts for the control group, 15 bodybuilders not on AAS, were within normal limits. Luckily, these changes are reversible, although one case of prostate cancer has been reported. Irreversible changes in males include breast enlargement, called gynecomastia, painful breast lumps, and baldness. In one study of male bodybuilders, more than half experienced testicular atrophy and gynecomastia. In fact, the number one visit to physicians for AAS users is gynecomastia. In severe cases, AAS users with enlarged breasts resort to surgical treatment that involves liposuction, a cosmetic surgery in which excess fatty tissue is removed. However, this is not without risks. A review of 20 patients surgically treated for AAS-induced gynecomastia showed six had complications or recurrence of the gynecomastia.
Children or adolescents taking AASs before or during puberty can seriously stunt their height. The artificially high sex hormone levels found in AASs can initiate the characteristics of male puberty. Normally, rising levels of testosterone trigger bone growth, but when hormones reach certain levels they signal a halt in bone growth. The high levels in AAS use can prematurely end the growth of the long bones, which results in shorter adult heights than would normally occur.
In women who take AASs, the surge in male hormones exerts a profound effect on a delicate hormonal balance. Due to the higher testosterone levels from AAS use, breast size and body fat decrease, skin becomes coarse, voice deepens, and the clitoris enlarges. Menstrual periods become irregular and sterility may result. Also, women may develop excessive hair growth on the chest and face but lose scalp hair. As steroid use continues, some of these effects may be permanent. For both sexes, increases and decreases in sex drive have both been reported.
Cardiovascular and liver effects. Steroid use has been linked to cardiovascular diseases (CVD), including heart attacks and strokes in athletes younger than 30. Although studies are required to determine how much of this is due to a genetic propensity for CVD, changes in cholesterol levels of AAS users have been noted. One study that analyzed the blood of AAS-using bodybuilders found high calcium and cholesterol levels in a significant number of them. Research has been published that shows AASs, particularly the oral or 17-alkylated compounds, decrease the level of high-density lipopro-tein (HDL), which is referred to as the good cholesterol because it is thought to protect against heart disease. Some research has also shown increased levels of low-density lipoproteins (LDL) or bad cholesterol. Studies are mixed as to whether the lowered HDL level from AAS use leads to CVD.
Additionally, AAS users experience lower triglyceride levels than non-users. High triglyceride levels are also associated with heart disease. Low HDL levels and high LDL levels increase the risk of atherosclerosis, the condition where fatty substances are deposited on the inner walls of arteries. The disruption in blood flow can cause a stroke when blood is prevented from reaching the brain, or a heart attack when blood does not reach the heart muscle. Cholesterol levels return to normal when AAS use stops. The potential development of blood clots also increases with AAS use, which can disrupt blood flow. The changes in cholesterol levels appear to return to the person’s baseline levels after AAS discontinuation.
Another possible adverse effect is an increase in blood pressure, which also returns to normal when AAS use stops. Some studies also show that those taking AASs can develop an enlarged heart. One 2001 study reported that 10 bodybuilders on AAS had larger left heart ventricles, the heart’s primary pumping chamber, compared to 10 bodybuilders who were not taking AASs. It does appear that enlarged ventricles also routinely occur in AAS-free athletes who intensively resistance-train as part of the body’s physiological response to weight lifting. Anabolic steroid use probably accelerates the process. As of early 2002, studies do not show evidence that this leads to heart problems.
As mentioned, the 17-alkylated AASs are more toxic to the liver than the other forms. With AAS use, the liver releases higher levels of some enzymes into the bloodstream. However, some researchers have found that all bodybuilders, both those taking and not taking AASs, experience higher enzyme levels due to the muscle damage that occurs in the sport. Bilirubin, the substance that causes the yellow skin and eyes, called jaundice, is also increased, and has been reported in users. A 2000 study by Yesalis showed that up to 17% of patients treated medically with 17-alkylated AASs developed jaundice. Jaundice usually disappears after anabolic steroids are discontinued. AAS use has been linked with a rare condition called peliosis hepatis, in which little sacs of blood form in the liver. Lastly, liver tumors may occur in 1-3% of patients or users who have taken high doses of 17-alkylated AAS for more than two years. Other rare liver tumors have occurred with other types of AASs. Although more than half of the tumors disappeared with AAS stoppage, others were cancerous and/or resulted in death.
Other effects. The most common skin side effect with steroid use is acne, which is reversible, and occurred in 48% of AAS users in one study. Cysts, and oily hair and skin have also been reported. Other possible effects include small increases in the number of red blood cells, and a worsening of pre-existing conditions such as sleep apnea, a condition where people stop breathing during sleep; and muscle twitches called tics.
People who inject AASs are at higher risk for infections because of nonsterile injection techniques or sharing contaminated needles. In the United States, half of AAS users administer their compounds by needle and one-fourth of adolescent AAS users share needles, placing them at high risk. Products manufactured illegally may also have been prepared with nonsterile methods, which increase the potential of developing viral infections such as HIV, and hepatitis B or C. Bacterial infections can result at injection sites or in the body as infective endocarditis, a bacterial illness that causes a serious inflammation of the inner lining of the heart.
Long-term health effects
Overall, the incidence of life-threatening effects appears to be low, but this may be due to a failure to recognize and report negative effects. Most data on the long-term effects of AAS come from individual case studies rather than formal larger studies. Problems that may persist after usage stops in men are breast development (gyneocomastia) and male-pattern baldness. The situation for women is more serious. The side effects of excessive body hair, skin coarsening, male pattern baldness, and voice deepening are often irreversible. As mentioned, the stunting of normal growth in young AAS users may be permanent.
Increased mortality among AAS users is another possibility. In 2000 a study was published that analyzed 62 male high-ranking competitive powerlifters in Finland who were strongly suspected to have used AASs for several years. Following them for 12 years, nearly 13% had died compared to 3.1% in a control population of powerlifters. Suicide and heart attacks were the most common reasons. The Finnish authors identified three significant issues as causing early disease or death: negative effects on the cardiovascular system, effects on mental health, and a possible increase in the incidence of tumors. Probable causes were AAS use and other concurrent drug use. In fact, another study named the use of AASs with other drugs as a probable cause of increased death rates. Animal studies also demonstrate higher mortality. One study exposed laboratory mice to steroid doses comparable to human AAS doses for one-fifth of their life span. The result was a higher death rate among those given the highest dose than those given a low dose or no steroids. The average life span of the mice receiving the low dose was also shorter than the AAS-free group.