Anabolic steroids are drugs that are pharmacologically or chemically related to testosterone; they are commonly used to promote muscle growth and improve physical performance. These substances exhibit both androgenic and anabolic effects.
The anabolic and androgenic effects of anabolic steroids cannot be completely separated, but some synthetic preparations are designed to minimize the androgenic effects.
Androgenic Effects of Testosterone
- Deepened voice
- Pattern baldness
- Increased growth of body hair
- Enlargement of penis or clitoris
- Heightened libido
- Aggressiveness
- Changes in breast tissue (decrease in females, gynecomastia in males)
Anabolic Effects of Testosterone
- Increased utilization of protein
- Decreased body fat stores
- Increased muscle mass
- Increased energy and strength
Anabolic steroids are used clinically to treat several conditions. At physiologic “replacement” doses, they have few adverse effects. The use of anabolic steroids by athletes for performance enhancement is illegal.
Clinical Uses of Anabolic Steroids
In the medical arena, anabolic steroids are used in situations where maintenance of muscle mass or protein sparing is desirable, or in cases of testosterone deficiency:
- Male hypogonadism
- Burn patients
- Cancer
- Bedridden or immobilized individuals
- AIDS
- Trauma
Illicit Use of Anabolic Steroids
Unfortunately, illicit use of anabolic steroids is relatively widespread. In the US, the reported use of anabolic steroids among high school-aged males is 6 to 11%. Among females in the same age group, the rate of use is approximately 2.5%. Surprisingly, many users are non-athletes. (Merck Manual, 18th Edition. 2006;1691.)
Athletes may routinely use up to 50 times the physiologic dose of anabolic steroids. When engaging in “stacking” (using several different steroids simultaneously) or “pyramiding” (using increasing doses through a cycle), doses may be as high as 100 times the physiologic dose.
At higher doses, the adverse effects of anabolic steroids become more prevalent. Some of these side effects are well-documented, while others are equivocal.
Adverse Effects of Anabolic Steroids
Well-documented
- Abnormal lipid profile (decreased HDL cholesterol, increased LDL)
- Erythrocytosis (abnormally high production of red blood cells)
- Liver abnormalities (adenoma, peliosis hepatitis)
- Mood disorders, usually only associated with very high doses (“roid rage,” depression, irritability, erratic or irrational behavior)
- Androgenic effects (acne, baldness, virilization--possibly irreversible-- in females)
- Gonadal suppression (decreased sperm count, testicular atrophy)
- Gynecomastia in males
- Premature closure of bone growth centers in adolescents
Equivocal or Poorly-documented
- Hypertension
- Left ventricular hypertrophy (enlarged heart)
- Liver cancer
- Worsening of prostatic hypertrophy or prostate cancer
- Increased risk of sudden death in athletes
- Mood disorders with low doses
Anabolic Steroids and Aging
Anabolic steroids are finding use in the intriguing—and controversial—area of anti-aging medicine. Essentially, this is the practice of “replacing” those hormones that normally decline as humans grow older.
Physicians who espouse anti-aging therapy contend that it isn’t really “normal” for, say, testosterone or growth hormone levels to decrease as people age. Since human life expectancy is gradually increasing, they feel it is reasonable to supplement those hormones that will maintain muscle mass, strength, and energy levels, thus improving the likelihood for extended independent living.
Anti-aging proponents also cite the unlikelihood of adverse events when physiologic doses of anabolic steroids are administered.
Opponents of anti-aging therapies point to the potential for adverse side effects and possible health problems (e.g., abnormal cholesterol profiles or metabolic syndrome) with the chronic use of anabolic steroids in an aging population. (Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004 Jan 29;350(5):482-92)
While it is clear that young people with otherwise normal hormone levels should eschew anabolic steroids, it will take time to settle the debate surrounding their use in anti-aging and other spheres.
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