Health Consequences Of Steroid Use
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The undesirable physical health consequences that are most often associated with abuse of anabolic steroids include the following:
Physical appearance
Oily skin and acne, which can cause scarring, are among the most
frequently observed side effects of steroid use among athletes. Another is changes in hair patterns, such as increased body hair growth
and an acceleration in male pattern baldness in those predisposed to
it. Breast enlargement (gynecomastia) in men or shrinkage of breast
tissue in women are side effects considered by most to be unwanted.
Many of these effects are permanent and, not surprisingly, distressing to the individual, although none is considered a serious risk
to life or limb. The most serious threat to appearance is the very real
possibility that chronic steroid use, especially prior to puberty or in
early adolescence, could cause the premature closure of the growth
plates of the long bones so that adult stature is significantly shorter than nature intended.
Muscle and bone injuries
So far, the musculoskeletal injuries sustained by steroid users cannot
be distinguished from those seen in strength athletes with extraordinary muscle development who do not use steroids. Animal studies
suggest that the risk of tendon rupture may be increased in steroid
users, however. There are several anecdotal reports of injuries in
athletes whose muscle mass exceeded the strength of the attachment
to bone. The most common type of injury that athletes sustain is damage to the ligaments and tendons.
Infertility
The reversible effect of steroid administration on male fertility has been studied for more than 20 years with a thought to using anabolic
steroids as a male contraceptive. Taking synthetic sex hormones disrupts the normal hormonal process. Many steroid users report an
increase in libido initially, but diminished sex drive is associated with prolonged use. Most men who self-administer high doses of steroids
become infertile during the period of use and for some time afterwards, perhaps six months or more. Infertility cannot be reliably
produced in all males, and not all steroids are equally effective. Several researchers believe there is a risk of sterility with prolonged
use at high dosage levels, but no case has ever been reliably documented. A common problem related to the infertility issue is a
significant reduction in the size of the testicles as a result of steroid use.
Heart disease
There are good reasons to believe that long-term abuse of anabolic
steroids increases the incidence of heart disease, even though that fact has not yet been demonstrated unequivocally. Several known
bodily changes in steroid users could explain this possible increased risk of heart disease.
- Lipid levels
- The use of anabolic steroids causes a reduction in the serum level of
a type of blood fat known as HDLC (high-density lipoprotein cholesterol), probably because the steroids stimulate a liver enzyme that
regulates fats in the blood. This reduction of the so-called "good cholesterol" is clinically significant and has been identified as a major
risk factor for heart disease and stroke in epidemiological studies of
men who are not steroid users. This reduction appears to be reversible; HDLC levels begin to recover within about a month after steroid use is discontinued.
Although this depression of HDLC has been documented in a number of studies of athletes taking steroids, it's not an inevitable
consequence because not all steroids produce the effect to the same extent. Oral steroids have a significantly more pronounced negative
impact on HDLC levels, probably because of their overall stressful impact upon the liver. A few studies have reported an increase in total
cholesterol but most do not. It appears that the decrease in circulating HDLC is offset by an increase in low-density lipoprotein cholesterol (LDLC) so that the total cholesterol level remains the same.
- Glucose tolerance
- Some anabolic steroids can cause glucose intolerance which, like
blood fat changes, is considered a risk factor for heart disease in itself. These steroids can also impair the body's mechanism for regulating
the amount of insulin so that too much is produced. Researchers have
suggested that testosterone and steroids increase the risk of heart disease through an effect on insulin.
- Blood pressure
- There have been claims that steroids cause high blood pressure, but
this claim appears to be exaggerated, based on a few studies that
demonstrated increases in blood pressure that were of little or no clinical significance.
- Heart tissue
- The effects of testosterone on the heart muscle of animals were first
described more than 60 years ago, and evidence that anabolic steroids alter myocardial performance in animals was presented more
than 40 years ago. These animal studies showed that the heart has androgen receptors and that anabolic steroids can cause cardiac dysfunction.
Enlargement of the heart (cardiomegaly) is not always a bad thing. Exercise itself causes an increase in heart size that is not dangerous
but represents a physical adaptation by the heart muscle to increase the blood supply to meet increased physical demands. With each
beat of a normal heart, the main pumping chamber (left ventricle) ejects between 50 and 80 percent of the blood in the chamber,
depending on the activity level. This is called the ejection fraction. When the heart becomes larger because of disease or drug use, its
efficiency diminishes; the ejection fraction may fall below 40 percent, which means that the heart pump is no longer efficient. When this
happens, the individual will have fatigue and shortness of breath
and be unable to sustain a high level of physical activity.
In 1988, the first case of cardiomyopathy (a medical term referring to heart disease) and stroke (cerebrovascular accident) associated
with anabolic steroids was reported. Since then, other case reports have indicated that using anabolic steroids can cause this unhealthy
enlargement and weakening of the main pumping chamber.
Stroke and heart attack
Steroid abuse has emerged as a possible cause of thrombotic stroke,
the kind caused by a blood clot. The medical literature contains several case reports of athletes and one of a young man who secretly
increased his intake of a form of testosterone that had been prescribed to help him mature (a legitimate use of the drug) that had this
kind of stroke. In addition, several cases of stroke have been reported in Japanese men who received large doses of anabolic steroids as
treatment for a type of anemia. Although no direct evidence exists,
the clinical circumstances of these case reports is suspicious and suggests a possible relationship between steroid use and the risk of
stroke. If a causal relationship does exist, it could represent the first evidence that steroids have potentially life-threatening short-term effects.
Prostate diseases
Women who take oral contraceptives, which also are sex hormones,
have a slightly greater risk of breast cancer. The parallel in men may
be a higher risk of prostate cancer as a result of taking steroids.
Although it usually is a disease of older men, prostate cancer is the
second leading cause of cancer death (after lung cancer) in American
men. If steroids increase the risk, it is a matter of serious concern.
Physicians know that prostate cancer is negatively affected by the
male hormone testosterone; standard treatment for this disease already includes reducing or blocking testosterone within the body.
One case report describes a bodybuilder who had prostate cancer at
the early age of 40 years. It is quite possible that today's steroid abusers will face a higher risk for prostate cancer as they age.
Liver disease and cancer
Steroids definitely have a strong negative effect on liver function, which is not surprising because the liver is the principal site where
steroids are cleared from the body. Virtually all changes in the structure of the liver have been associated with the use of a type of
oral steroids known as 17 alpha-alkylated steroids. When steroids are taken by mouth, the liver is exposed to the full dose of the drug
before it is distributed in the circulation. This exposure can be particularly dangerous in individuals who already have poor liver
function from other causes. Anabolic steroid abuse can harm the liver in several ways.
- Jaundice
- Blockage of the bile flow, which causes jaundice (yellowing of the
skin and the whites of the eyes), has been seen in patients with serious diseases who are being treated with anabolic steroids. The first
suggestion that some anabolic steroids might cause liver problems came when physicians tried to use methyltestosterone (an anabolic
steroid) to treat the severe itching associated with obstructive jaundice. Most patients with jaundice got worse. Although athletes have
used steroids that have been associated with bile flow blockage and jaundice, most probably stop taking steroids when jaundice occurs.
For these reasons and the fact there have been only a few documented clinical cases of jaundice in athletes, almost no information exists
about this condition in healthy individuals.
- Peliosis hepatis
- Peliosis hepatis is a potentially life-threatening condition in which
blood-filled cysts develop in the liver. Before the development of steroids, this condition was seen almost exclusively in patients with
pulmonary tuberculosis. Now, more than 70 cases of peliosis have
been reported in association with intake of male hormones. The reason that this condition is so dangerous is that it is not easily
diagnosed and patients often have no symptoms. If the cysts rupture, the patient can die, with little or no warning, from internal hemorrhage.
- Liver tumors
- Taking anabolic steroids increases the risk of liver tumors. The type
of tumor seen most often behaves more like a noncancerous, or benign, type of liver tumor. These benign tumors can still be life
threatening, however. At least several of the steroid-related tumors were diagnosed because the tumors ruptured and caused serious or
fatal internal bleeding. There is one report of a hepatocellular carcinoma in a steroid-using athlete who died from this metastatic cancer.
Another athlete who used steroids died from internal hemorrhage after a type of tumor called an adenoma ruptured. A third patient also
had an adenoma but survived after it was removed surgically.
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