Steroids: Bigger Is Not Better
Anabolic steroids are synthetically-produced derivatives of testosterone, a natural hormone that, among other things, promotes muscle growth. There are a number of different types of manufactured steroids. The official name for this type of steroid is androgenic anabolic steroid, or in English, "a drug that promotes protein synthesis (anabolic) and leads to masculine secondary sexual characteristics (androgenic)."
To understand how anabolic steroids work, it helps to know how testosterone works. Testosterone is a male sex hormone (although women also produce it) that serves two basic purposes. During the first stage of puberty, young men produce an increased amount of testosterone for a number of months. During this stage, the bulk of the male physical maturation process occurs including bone growth, deepening of voice, and development of facial and body hair. Testosterone also maintains the male reproductive system and helps to produce larger body size and muscle mass.
Androgenic steroids are prescribed by physicians for therapeutic treatment of conditions where testosterone (or its effects) need to be added or replaced. Anabolic steroids are designed to copy the muscle-building effects of testosterone but with fewer of the accompanying "masculinization" effects.
Users of anabolic steroids can be divided into two groups:
- Those who use them for medical purposes
- Those who use them to enhance their strength and athletic ability, and/or enhance their physical appearance by adding muscle mass
Anabolic steroids are prescribed for a small number of legitimate medical purposes. These include the treatment of:
- Males who are unable to produce sufficient amounts of testosterone due to pituitary malfunctions or loss of their testes. (However, these men are most commonly treated with testosterone.)
- Persons with a rare genetic condition known as hereditary angioneurotic edema. Both males and females with this condition are given anabolic steroids.
- Persons with decreased muscle mass due to HIV, cancer, and/or surgery.
Athletes and Body Enhancers
As far back as the 1950s, athletes have been using anabolic steroids. The reason is simple: the use of these drugs in conjunction with intense physical training increases the body's overall muscle mass, lowers the body's percentage of fat, and thus, enhances body strength. These effects occur in both men and women.
Though many people equate anabolic steroid use with a limited number of athletes such as weight lifters and football players, the fact is that anabolic steroid use can be found among all types of athletes. Since their use was banned in Olympic athletes, testing has detected at least one instance of anabolic steroid use among athletes in every Olympic sport except figure skating and women's field hockey.
Moreover, many people now use anabolic steroids to help enhance their physical appearance. In recent years, this use has become more pronounced among young people. This is especially troubling because the potentially dangerous side effects of using anabolic steroids are heightened in adolescents.
Dangerous Side Effects
The potentially dangerous side effects of anabolic steroid use are numerous. Men run the risk of testicular shrinkage, reduced sperm count, impotence, baldness, and enlarged prostate. Women can suffer from masculinization effects such as deepened voice or the growth of facial hair, cessation of menstruation, enlargement of genitals, and reduction of breast size. Both sexes run the risk of serious medical problems, including high blood pressure and liver damage. Both heart attacks and strokes have been described in young persons taking these substances.
Finally, there is the belief held by some that both men and women may be susceptible to so-called "'roid rage"—sudden pronounced outbursts of anger due to their anabolic steroid use. Furthermore, depression after quitting steroid use can also occur. There is considerable animal evidence and some human evidence that the use of anabolic steroids during adolescence can have long acting effects on the developing brain that may influence behavior and mental health into adulthood.
As mentioned, adolescents are at an even greater risk from anabolic steroid use. In addition to the above dangers, young adolescents who use steroids (those who are still growing) run the risk of suffering irreversible stunting of their growth. Indeed, this danger is so significant that steroids are prescribed for children only with great caution and expert medical supervision.
As if the dangers inherent in using anabolic steroids were not enough, the manner in which abusers of these drugs acquire and administer them only serves to increase the dangers. Due to the difficulty in acquiring non-medically prescribed anabolic steroids, a black market for the drugs has developed. As a result, tainted drugs and/or drugs of uncertain potency are sometimes sold to users. In addition to being taken orally, anabolic steroids can also (and in some cases must) be injected. Since some users reuse or share needles, this creates a danger of transferring blood-born diseases such as HIV/AIDS and hepatitis.
The way that some users manage their intake of anabolic steroids is particularly unsafe. Some users "cycle" their intake, taking anabolic steroids on and off for one- to six-month periods. Some who compete in regulated sports do this in the hopes of avoiding detection. Hoping to increase the effect of the drug, many users "megadose," sometimes taking hundreds of milligrams of the drug per day when the medically prescribed dose would be much lower. Others partake in "stacking"—taking many different types of anabolic steroids at the same time, sometimes in combination with other drugs such as stimulants, painkillers, and/or other hormones. This may further increase the risks associated with using anabolic steroids.
Some signs of anabolic steroid use include:
- Puffy face
- Severe acne (on face, chest, upper back, and thighs)
- Increased weight gain over a short period of time
- Yellowing of skin and/or eyes
- Spotted, dark skin
- Profuse sweating
- Hair loss (in men)
By themselves none of these signs indicate that someone is taking anabolic steroids, but they could alert parents and coaches to the possibility that drug abuse is occurring. There are a few medical conditions in youth for which medical prescription of testosterone is appropriate and indicated – proper use of testosterone should cause none of the physical signs listed above. The non-medically authorized use of anabolic steroids poses grave danger. Possession and distribution of anabolic steroids for non-medical purposes is illegal under federal law because steroids are classified as a Schedule III drug under the Controlled Substances Act.
So, the intelligent conclusion is simple: unless anabolic steroids have been medically prescribed for you, don't take them. This is one case where bigger is not better. Especially since consistent hard work with resistance training will provide most of the muscle mass that steroids do.
National Institute on Drug Abuse
Partnership for a Drug-Free America
Association Against Steroid Abuse
Casavant MJ, Blake K, Griffith J, Yates A, Copley LM. Consequences of use of anabolic androgenic steroids. ediatr Clin North Am. 2007 Aug;54(4):677-90.
Hall RC, Hall RC. Abuse of supraphysiologic doses of anabolic steroids. South Med J. 2005 May;98(5):550-5.
Sato SM, Schulz KM, Sisk CL, Wood RI. Adolescents and androgens, receptors and rewards. Horm Behav. 2008 May;53(5):647-58.
Last reviewed July 2008 by Lawrence Frisch, MD, MPH
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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