The actions and side effects of Anabolic Steroids in sport and social abuse
- Alan James George1
© Société d’Andrologie de Langue Française 2003
Received: 15 July 2003
Accepted: 15 September 2003
The Erratum to this article has been published in Andrologie 2004 14:BF03035476
Anabolic steroids (AS) derived from testosterone have both anabolic (muscle and strength enhancing) and androgenic (primary and secondary sexual) effects. Efforts to limit the androgenic while enhancing the anabolic effects have not been successful. Alterations to the structure of testosterone, so as to improve the pharmacokinetics of AS, have resulted in drugs, which are orally active, have a longer plasma half life and may be administered as depot injections. Therapeutic doses of AS produce statistically significant effects on strength and athletic performance in well-controlled scientific and clinical trials. At low, therapeutic doses, diet and an intensive training regime are equally important in producing a statistically significant increase in strength. Higher doses 6–7000mg per week are regularly administered in sport and produce the greatest increases in muscle strength erythropoiesis and lean body mass. Patterns of steroid abuse can be complex, reflecting a desire to minimise side effects, and avoid detection. AS side effects are of many types. AS increase salt and water retention leading to an expansion of the blood volume, but effects of steroids on blood pressure are equivocal and most cardiovascular side effects appear to be reversible.
Abuse of AS causes an increase in blood triglyceride and cholesterol levels and this is associated with a decline in High Density Lipoproteins (HDLs) and an increase in the Low Density (LDL) type. Though these effects are reversible they are associated with an increased risk of both acute and chronic cardiovascular pathology. The most serious irreversible anabolic steroid side effects are associated with carcinomas-mainly of the liver, prostate and kidney. Hepatic carcinomas are strongly associated with abuse of the orally active 17alpha methyl substituted steroids, which also produce a reversible jaundice. In males, anabolic steroid abuse causes suppression of LH and FSH release leading to inhibition of testosterone production often accompanied by testicular atrophy, and azoospermia. High, chronic doses of the drugs may also cause moderate to severe feminising effects in the form of gynaecomastia. Male secondary sexual characteristics are a side effect of AS abuse in women. Increased insulin resistance and elevated fasting blood glucose levels are the commonest non-gonadal endocrine side effects of AS.
AS abuse leads to contradictory, complex, behavioural, and psychiatric changes. Increased frequency of mental illness, in anabolic steroid abusers including paranoid schizophrenia, mania and depression has been reported. Physical and psychological dependency occur amongst some anabolic steroid abusers and severe psychiatric disorders can appear upon withdrawal, leading in a few cases to criminality and even suicide. We need more studies on the long-term effects of AS. The implications of the past 50 years of AS abuse will be discussed in the review.