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Most of the time, when steroids are mentioned, they’re brought up as the reason a particular athlete can run so fast, hit so many home runs, or make so many tackles. They are also claimed to have extraordinarily harsh side effects and for causing severely unforgiving and permanent damage. Everybody´s seen movies like "The Program" where steroids ruin a young athlete´s life, or perhaps "The Aaron Henry Story" on HBO, where a young athlete suffers lifelong problems from his steroid abuse. Most recently, I saw the movie "Spiderman" where the villain, the Green Goblin, admits to having his superhuman strength and psychotic personality from using "performance enhancers"!
I´m here to assure you that those types of horror stories are few and far between, and after consulting with literally hundreds of athletes and bodybuilders, I've almost never heard of anything even remotely resembling the popular "horror stories" we see in the media almost daily. I´ve certainly never seen anyone become Green Goblin-like from using them, either.
By reading this article, coaches, athletes, parents and teachers will learn the truth about anabolic steroid side effects, and will be able to make their own informed decisions regarding them. But I suspect that after reading what I have to say, as well as what the scientific literature says, the question of how bad steroids are will be a different question entirely; the only question remaining will be "why didn´t anyone tell me this before?"
When I initially started research for this piece, I consulted not only real-life athletes who had vast experience with anabolic steroid use, but also scientific and medical journals. The picture that unfolded before me was very different from the one typically painted by the mass media, and certainly much different than the one I found on www.dea.org and www.drugabuse.gov. Honestly, my research on the governmental sites revealed very little useful information. There were numerous unfounded claims, and plenty of talk about money being put into “studies”. In reality, the government "studies" on anabolic steroids were not medical studies at all. They were surveys given to various age groups, on steroid use, in order to generate statistics. There was nothing of medical value or scientific merit on those sites, despite the endless parade of doctors that seemed to be against their use. Here´s an example of one of the more absurd claims made on one of those sites:
"..[steroids] they are dangerous drugs, and when used inappropriately, they can cause a host of severe, long-lasting, and often irreversible negative health consequences. These drugs can stunt the height of growing adolescents, masculinize women, and alter sex characteristics of men. Anabolic steroids can lead to premature heart attacks, strokes, liver tumors, kidney failure and serious psychiatric problems. In addition, because steroids are often injected, users risk contracting or transmitting HIV or hepatitis.."
This is the information found on a government website, in a piece written by a doctor. I´m surprised she didn´t mention turning into the Green Goblin in her list of possible health side effects. As you read what I have to say, I want you to keep this in the back of your head. I want you to remember this claim, made by a medical doctor, as you read the rest of this piece. All of the information here is exactly what has been reported to me by athletes, as well as what is found in credible scientific journals. Review the information and decide for yourself how harmful steroid side effects can be.
The inhibition of natural hormones is likely the most common and probable side effect experienced from the use of anabolic steroids. In almost all cases, taking hormones will send a message to your endocrine system to reduce or stop producing it. This is because your body wants to remain in a very balanced state -- called ‘homeostasis’. To maintain homeostasis, the body seeks to avoid having too much or too little of any particular hormone. In the case of anabolic steroids, the brain signals the testicles to slow down, or even stop producing (depending on the type and amount of steroids taken) testosterone when there is too much circulating. Unfortunately, this happens when any kind of hormone is added into the body, so even if an athlete is not using testosterone, but is using other anabolic steroids, the body will still send this signal 99% of the time. Of course different steroids cause varying degrees of inhibition ranging from total shut down of endogenous (natural) testosterone production, to very mild reductions, where some natural hormones are still being produced and circulating. In almost all cases, this inhibition is over once the steroids aren´t active in the body anymore. In the following charts, we can see a mirror image of the level of activity during steroid (Nandrolone) administration, compared with the level of natural testosterone being produced. In other words, as the level of steroid rises (chart 2), the level of testosterone falls (chart 1), and vice versa.
Now, as that first chart shows, testosterone levels fell when Nandrolone (an anabolic steroid was administered, but interestingly, the following chart shows an almost identical mirror image, where the Nandrolone levels in the blood rise. What this indicates is that the amount of this particular steroid in the blood is directly and proportionately inhibiting natural testosterone production. Here´s the chart:
Most athletes who use anabolic steroids accept all of this as a necessary price to pay in order to experience the benefits from using steroids. In an effort to combat this, athletes have experimented throughout the years with various compounds to avoid or at least limit this problem. Human Chorionic Gonadotropin, anti-estrogens, and Selective Estrogen Receptor Antagonists (SERMs) are all used during a cycle, or after (or both) with this goal in mind. The following table shows the various hormonal levels of former steroid users who haven´t used them for a year (*called "ex-abusers" by the nice people who funded the test) versus current users (*abusers):
What we see in this chart is not surprising to anyone who is actually familiar with steroids, and not with media-hype. In people studied who haven t used steroids for a year, ALL of their measured hormones (testosterone, estrogen) were within the NORMAL RANGE! Clearly, the effects that steroids have on your hormones are reversible and the horror stories we’ve all read in the media about people who never regained normal hormonal function after one cycle are greatly exaggerated. I think anyone who is familiar with "After School Specials" about steroids will be very surprised at learning this fact. As for "The Aaron Henry Story" on HBO, I can t imagine how he has suffered side effects well into his 40’s when the steroid users in this study were totally fine after one year, and in some cases used more than he did!
(*Journal of Steroid Biochemistry and Molecular Biology. 84 (2003) 369-375)
Liver damage is probably the most sensationalized of all the possible steroid side effects. The media often focuses on this particular problem as if it occurs with every steroid, and in every person who takes them. Nothing could be further than the truth. Most anabolic steroids which are ingested orally pass through the liver, which functions as the body´s filtration system. When something goes through the liver, it is broken down by various enzymes, then passed along into the bloodstream. Most research on orally administered anabolic steroids focus on the fact that liver enzymes are elevated following ingestion. But does this necessarily mean that the liver is being damaged, does it? Of course not. Commonly, studies that focus on steroid toxicity often use absurd doses, or incorrectly focus on liver activity instead of damage. The liver functions as the filter for the human body, it´s going to be activated whenever something (not just a steroid) passes through it. Does that show that steroids damage the liver? Let´s see what the scientists say.
There was an eight-week study done in 1999, which looked at the effects of an 8-week cycle of oral steroids. The steroids examined were Halotestin (Fluoxymesterone), Dianabol (methylandrostanolone), or Winstrol (Stanozolol) on rats at the dose of 2mg/kg-body weight, administered five times a week for 8 weeks. That s almost 200mgs/day of any of those steroids, for a 200lb user. That is, generally speaking, much more than the average person would use on a cycle. In fact, I have never, in my years of researching steroids and speaking with athletes, heard of anybody using even close to 200mgs/day of Halotestin, Winstrol, or Dianabol, ever!
At the end of that study, in vivo, each rat still had liver enzyme levels that were within normal range!
(*Med Sci Sports Exerc. 1999 Feb;31(2):243-50, Rat liver lysosomal and mitochondrial activities are modified by anabolic-androgenic steroids. Molano F, Saborido A, Delgado J, Moran M, Megias A.)
In another study, 16 bodybuilders using steroids were compared to 12 bodybuilders who were not. Then the bodybuilders who had used steroids stopped taking them for three months, at which points, the researchers found that liver enzymes had returned to the same levels as the non users. After only 3 months!
(*Int J Sports Med 1996 Aug;17(6):429-33, Body composition, cardiovascular risk factors and liver function in long-term androgenic-anabolic steroids using bodybuilders three months after drug withdrawal. Hartgens F, Kuipers H, Wijnen JA, Keizer HA.)
We can see from the chart below that ex-steroid users have totally normal liver enzymes one year after they stop using. In fact, for some liver enzymes, even the current users have normal scores!
(*Journal of Steroid Biochemistry and Molecular Biology. 84 (2003) 369-375)
Steroids can lower HDL cholesterol, and raise LDL cholesterol. HDL (high density lipoprotein, commonly referred to as "good cholesterol") helps to protect the arteries by bringing unused cholesterol to the liver where it is broken down. LDL on the other hand has the opposite effect. Some steroids can therefore cause high cholesterol levels with low HDL and high LDL. Some steroids are, of course, very mild on blood lipids, while others are notably harsh. In both cases, however, it is likely that a return to within normal parameters would occur shortly after steroid discontinuation.
The development of gynecomastia or feminization of the breast tissue in males is possible with anabolic steroids. This is due to an excess of estrogen being present in the body, through a process known as "aromatization" whereby androgens like testosterone are converted to estrogen. This excess estrogen then finds its way to the receptors in breast tissue and binds to them. This results in the possibility of female-like breast tissue, which must sometimes be removed by surgery. Most athletes experience itchiness of the nipples, followed by pain. Since this develops over several days, usually, the athlete has more than enough time to discontinue the use of the compounds he´s taking, or to attempt to counteract the breast tissue development while remaining on the cycle. The two most common ways to counteract gynecomastia are the use an anti-estrogen like Nolvadex or Clomiphene Citrate (best taken post-cycle) or Letrozole, a very strong Aromatase Inhibitor (AI)/anti-estrogenic compound is employed during cycle to effectively starve the growth of nourishing estrogen.
The initiation and progression of breast development involves a variety of pituitary (and ovarian, in women) hormones, as well as various local mediators. As you can see in the following chart, testosterone has the ability to aromatize (convert to estrogen), and eventually become part of the cascade of hormones that contribute to the development of breast tissue:
(GYNECOMASTIA: ETIOLOGY, DIAGNOSIS, AND TREATMENT Chapter 14 - Ronald S. Swerdloff, MD, Jason Ng, MD, and Gladys E. Palomeno, MD, March 1, 2004)
Anabolic steroids can cause the development of acne. However, the extent to which it is experienced can be due to a number of varying factors, with the particular steroids and exact dosages used being primary. The skin´s sebaceous glands have a particularly high affinity to Dihydrotestosterone, which is an androgen the body naturally produces from testosterone via the enzyme 5-alpha Reductase. Increased sebaceous gland activity promotes oily skin which can combine with bacteria and dead skin (normal wear and tear) eventually causing pores to become clogged more quickly than the body can cleanse them. This of course, is preventable by using only particular steroids, cleansing the skin regularly, and perhaps using a topical anti-androgen.
(1. Am J Clin Dermatol. 2002;3(8):571-8. 2. Clin Dermatol. 2004 Sep-Oct;22(5):419-28. 3. Pol Merkuriusz Lek. 2004 May;16(95):490-2.)
Increased aggressiveness is often claimed to occur with anabolic steroid use. Although it´s highly rare (less than 5%), significant psychiatric symptoms have been found in some steroid users, including aggression and increased violence, mania, and even psychosis. However, it must be noted that in the studies performed there was no control group, making their results spurious at best. It can be logically assumed that naturally aggressive people (those with certain aggressive traits) are simply more inclined to use steroids, which further skews any research results. Can steroids enhance such aggressiveness? Possibly. Can steroids be to blame for anti-social, psychotic, "roid-rage" type of behaviors? Probably not. The evidence just isn´t there to support that such theories.
In fact, a landmark study was performed which examined different doses of testosterone administration on men aged 20-50, who had a variety of experience with steroids from having used them previously to not at all prior to the study. A variety of psychological tests were performed at the outset of the study as well as at the end. It was found was that no participant in the study had become violent as a result of the testosterone injections they had been receiving, although some said they felt more aggressive. This clearly indicates that there is a high level of control over possible violent or aggressive behavior that can result from steroid use. The researchers also noted that in terms of the psychological tests performed, some subjects showed little or no response to testosterone, with regards to psychological measures, while others experienced significant changes. Thus, general temperament clearly plays a large role in how one responds psychologically to steroid administration. In addition, when this study was compared with others, similar results were found:
Out of 109 cases studied, only 5 people exhibited Psychological (Manic or Hypomanic) effects. (*Archives of General Psychiatry, Volume 57, February 2000.)
Steroids can possibly cause men to start balding if they have a genetic predisposition towards Male Pattern Baldness. The gene for baldness is thought to reside in the X (male) chromosome exclusively, so a good general indication of whether someone is genetically predisposed towards being bald is to look at the men on their mothers side. Chances are that if the majority of them are bald, then the person will be carrying that gene too. The reason steroids can cause premature balding is that the scalp reacts to Dihydrotestosterone (DHT) quite strongly, and many steroids can either convert to DHT or are derived from it. Some anti-baldness medications can prevent this, such as Finasteride and Dutesteride. This is, of course, merely a cosmetic effect, and poses no real health issues. It could be catastrophic to a potential career with any one of a number of 80´s rock bands, but other than that, I can´t really see any real problems associated with hair loss; especially since it can be avoided when proper steps are taken and certain steroids are avoided.
Anabolic steroids have been linked with cardiovascular issues. Part of this may be due to their effects on Blood Lipids (see above). But some of it is due to the fact that many steroid users have been found to have enlarged ventricles. This is actually very common in bodybuilders as well as powerlifters and other types of athletes, and is more indicative of the effect of weight training on the heart, rather than solely steroid use.
This term refers masculinization, or development of male sexual characteristics that females could potentially suffer from steroid use. This side effect on women is often reversible after steroids are discontinued. Some typical signs of virilization are the development of a deeper voice, hirsuitism (growth of excess body hair), enlargement of external genitalia (clitoral enlargement), and possible male pattern baldness, or acne on the face or body. This is all dependent, of course, on the compounds used as well as the dosages employed. Personally, I have witnessed the most permanent of these effects to be the deepening of the voice due to the hypertrophy (growth) of the vocal chords. This is typically the most unwelcome side effect, as it makes it very obvious when a woman is using steroids. Of course, if this begins, the best course of action is to cease taking all steroids immediately. There are several ways to reverse this effect, the most common being to undergo a medical procedure known as vocal chord scraping. And yes, it´s exactly what it sounds like.
The use of some steroids can possibly stunt the growth potential of still maturing children, teens and young adults. This is only possible with certain steroids, and not with others. In fact, certain steroids have been used in clinical settings to improve growth rates in children. It is probable that the premature closure of the epiphysial cartilage, which is most likely caused by aromatizable steroids, will lead to a possible growth inhibiting effect, and could ultimately result in a shorter adult height. This is most likely an irreversible side effect, as the growth plates would have fused and can not "re-open". Anavar (Oxandrolone) has been used to improve the height of growth stunted children, and it is probable that most other DHT-derived steroids could also be used for this purpose as could certain anti-estrogens.
In 99.9% of humans, the process of bone elongation ends at around the mid to late teen years. At this point, the growth plates are obliterated and disappear, after which no more elongation (typified by an increase in limb length, i.e. height) can take place. Elongation of the bone occurs here and at a second epiphysis at the end. The proliferation of the cartilage happens very quickly, actually fast enough to keep ahead of the bone generation that´s "chasing" it, called ossification, which is just the replacement of cartilage by bone. As long as the cartilage growth "stays ahead" of the bone, you grow taller, as bone replaces cartilage. When the bone finally catches the cartilage (because the cartilage slows its growth rate, not the bone), it ossifies, and "seals" the growth plate.
Here´s a growth plate picture, enhanced by radioactive dye (GP= Growth Plate), so you can sort of see the bone "catching" up with the cartilage.
(Human Anatomy and Physiology, 6th Edition, John W. Hole jr., Wm. C. Brown Publishers.)
Once again, this is only a possible side effect, but steroids can potentially cause enlargement of the prostate. The media-perpetuated claim of possible prostate cancer seems to be wholly unfounded, according to most research. In many cases, this enlargement is quickly remedied upon cessation of anabolic steroid use. The first period of prostate prostate growth, occurs during puberty and occurs as a result of the testicular secretion of androgens. Then, much later on in life, there is often a second stage of growth. Although this was originally deemed to be a result of Dihydrotestosterone’s actions in the body, it is more likely due to estrogen combined with a small amount of either DHT or Testosterone. Thus, it’s not hard to imagine that taking steroids can potentially cause this type of prostate enlargement and cause trouble for a steroid taking athlete. Typically, a product such as Finasteride or Dutesteride is taken to avoid this problem, with a high degree of success.
This problem is possibly the most easily remedied of all steroid side effects. It’s very common for steroid using athletes attempting to gain maximum bulk to abstain from all aerobic activity. This causes the body to work much harder to circulate blood. The typical water and sodium retention induced by certain steroids can also contribute to this side effect. If blood pressure is measured regularly to ensure that the value is not higher than 140/90, there should be no problems.
Certain anabolic steroid usage may place greater strain on the kidneys. Since kidneys are involved in the filtration and excretion processes, when a foreign substance is administered, they necessarily work harder. Some steroid users have noticed very dark urine while on a cycle, and this is indicative of the kidneys working overtime to accomplish their goal. One of the major offenders of this seems to be Trenbolone, which turns the user’s urine a very dark color. This problem is alleviated when enough water is consumed daily. Also, even though I know you’re probably getting sick of hearing this from me, the possibility of side effects is dependant on the dosage and type of administered compounds. Some steroids (Nandrolones) are even used to help treat people with kidney problems! So clearly, they aren’t as bad as they’re made out to be with regards to possible negative kidney-related side effects.
There is a large amount of data indicating that anabolic steroids may have some effect(s) on modulating the immune system. As with most potential side effects, this is largely dose and compound dependent. There is strong evidence that different analogues impact the immune system in differing ways. Testosterone and certain analogues have been shown to be possibly immunosuppressive, while Nandrolone and still other compounds have demonstrated immunostimulating properties. Both, however, have been found to be beneficial when given to AIDS patients, who clearly have an already compromised immune system. This is because the increase in lean body mass that those steroids can provide is consistent with an enhanced ability to fight off infections, enhanced survival rates, and a better quality of life.
(1.Int J Immunopharmacol. 1995 Nov;17(11):857-63. 2. J Steroid Biochem Mol Biol. 1990 Sep;37(1):71-6 3. AIDS. 1996 Jun;10(7):745-52. 4. Journal of Neuroimmunology 83 1998, 162-67.)
As expressed above in ‘Virilization’ steroids typically cause an increase in body hair growth. In a manner very similar to adolescence, the period when hair sprouts in places it formerly wasn’t due to the exposure of unusually high amounts of sex hormones, steroids serve as a synthetic initiator. Quite simply put, the rapid influx of sex hormones stimulates body hair development. This side effect is occurs in both males and females, and the hair growth can appear anywhere on the body with the exception of the head (where the opposite effect is sometimes seen due to the large number of DHT receptors). In women, this hair growth most often increases in traditionally manly locations on the body such as the face and back, but also increases on the legs, armpits, pubic region, arms, torso, hands/knuckles and feet. Although steroid discontinuation, reverses the irregular growth, it does not reverse or thin any hair grown during steroid administration. For men, such hair growth is barely noticeable except among the decisively less hairy members of the population, and even then it doesn’t really present a problem.
Effects of androgenic-anabolic steroids in athletes. Hartgens F, Kuipers H., Sports Med. 2004;34(8):513-54.
Bloating, a.k.a. excess water retention is a very likely side effect of specific anabolic steroids. Generally speaking short-ester testosterone (Testosterone Propionate) and DHT-derived steroids (with the exception of Dianabol) do not cause significant bloating. Some 19-Nors, Dianabol, and medium to long-ester testosterones have a greater aromatization rate and excess estrogen typically (but not always) equates to greater muscle blurring water retention. For this reason such steroids are often included within bulking cycles and avoided during cutting cycles. Also contributing to the bloating are moderate to high levels of sodium, sugar, and synthetic sweetners like those found in diet drinks.
It's true that estrogen is required for optimal muscle development, which often makes bloating is an acceptable side effect during off-season training. Thus, there are periods of training during which athletes and bodybuilders are less concerned with, and affected by bloating. However, when seconds count, success is measured in inches, and muscular presentation readiness is of great importance, bloating is often off-set in numerous ways. Firstly, the above high propensity for bloating steroids and food sources are avoided. Secondly, with regard to steroid use AIs and SERMs (anti-estrogenics explained earlier) are employed to reduce estrogenic activity, and thereby promote lean, bloat-free physiques. The third weapon against bloat used by the athlete comes in the form of diuretics which flush extra fluids from the body. Some are mild (mostly mineral & herbal), others (mostly prescription) can be harsh, but both should be used respectfully to prevent debilitating cramping which can hinder both performance and presentation.
Psychological characteristics of adolescent steroid users. Burnett KF, Kleiman ME., Adolescence. 1994 Spring;29(113):81-9., Counseling Psychology Program, School of Education, University of Miami, Coral Gables, Florida 33124.
Temporary sterility is a common side effect of steroids in both males and females. In fact, anabolic steroids are so proficient at this that they have actually been studied and approved by the World Health Organization as a male contraceptive possibility. Steroids do this by disrupting the various hormones in women which potentiate the ability to have regular menstrual cycles. In men, steroids lower Follicle Stimulating Hormone (FSH) to the point where normal production of sperm is not possible. This isn´t to say that nobody on a cycle has every conceived; quite the opposite, actually. There' ve been legions of "happy accidents" reported to me by athletes who were on cycles and thought they couldn´t possibly conceive.
Sterility caused by steroids is temporary, of course, and reverses post-cycle. This reversal is typically sped up by the post-cycle therapy which often involves the use of SERMs such as Nolvadex or Clomid , and/or Human Chorionic Gonadotropin.
(1. Fertil Steril. 2004 Jan;81(1):226. 2. Urology. 2000 Oct 1;56(4):669.3. J Clin Endocrinol Metab. 1985 Oct;61(4):746-52 4. Fertil Steril. 1994 May;61(5):911-4. 5. Andrologia. 1985 Sep-Oct;17(5):497-501 6. Urol Clin North Am. 1986 Aug;13(3):455-63.)
