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Anabolic Steroid Side Effects- Part 1
By: guest5 Date: June 5, 2019, 12:51 pm
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By Mauro DiPasquale, M.D.
As used by most athletes, the side effects of anabolic steroid
use appear to be minimal. Even in those using large doses for
prolonged periods of time, clinical evidence shows that any of
the short term side effects are mostly reversible. As well, some
of the more serious side effects such as hepatic toxicity and
increased serum cholesterol, can be minimized by proper
monitoring, changes in lifestyle, and if indicated, medication.
The absence of significant side effects to the long term use of
low to moderate amounts of testosterone and some anabolic
steroids has been shown in a series of clinical studies
investigating the use of anabolic steroids and testosterone as
male contraceptive agents. A considerable amount of research has
been and is being carried out by the World Health Organization
and independent researchers using combinations of testosterone,
anabolic steroids (especially 19-nortestosterone) (1•2),
medroxyprogesterone acetate and methyltestosterone (3),
Gonadotropin Hormone Releasing Hormone agonists and antagonists.
Several of these combinations have proven to significantly
reduce the sperm count with no significant short or long term
side effects (at least for as long as the various studies ran).
In these studies, normal sperm production resumed shortly after
discontinuation of the various compounds.
In general, anabolic steroid side effects can be separated into
two groups. One group consists of side effects that are an
exaggeration of the expected pharmacological properties of the
anabolic steroids. Potential hormonally related side effects of
anabolic
steroids in men include gynecomastia, fluid retention, acne,
changes in libido, oligospermia and increased aggressiveness.
In women amenorrhea and other menstrual irregularities occur
commonly. As well there is a possibility of virilizing effects
from the use of anabolic steroids. Some of these effects, such
as coarsening and eventually deepening of the voice, hirsutism,
male pattern baldness, reduction of breast size, and clitoral
enlargement, may or may not be partially reversed by the
discontinuation of anabolic steroids and if needed the use of
androgen antagonists such as cyproterone acetate.
In most men, however, once the anabolic steroids are
discontinued, the hormonal parameters invariably return to
normal, except perhaps in those athletes who have used large
amounts of anabolic steroids for prolonged periods of time. In
some of these athletes
testicular atrophy and refractiveness of the
hypothalamic-pituitary-testicular axis. Occasionally the serum
testosterone fails to returns to normal, and long term
replacement therapy is necessary.
The other group of side effects are those which are not usually
thought of as related to either the anabolic or androgenic
properties of these compounds. These side effects, while
controversial as to the role that anabolic steroids have in
their genesis and development, result in more than just cosmetic
changes, and include changes in serum cholesterol,
cardiovascular disease, prostatic cancer, kidney dysfunction,
disturbances in carbohydrate metabolism, emotional disturbances,
increased incidence of musculoskeletal injuries, cerebrovascular
accidents, and hepatic dysfunction (with rare instances of
hepatic cirrhosis), hepatocellular carcinoma and peliosis
hepatitis. This second group of side effects, while posing a
serious threat to the athlete, has often been misrepresented and
sensationalized in both the media and some of the scientific
literature. As noted earlier we need better controlled long term
studies to accurately determine the risk involved in the
prolonged use of anabolic steroids.
To put these potentially life-threatening side effects in
perspective, I have found it useful to compare the side effects
of anabolic steroids to the side effects of oral contraceptives,
especially prior to the 1980's when larger dosages of hormones
were used. In general, the side effects of using low to moderate
dosages of anabolic steroids are comparable to those seen in
women using oral contraceptives. The risks inherent in this
universally used and accepted method of contraception, which are
well outlined in the Report on Oral Contraceptives, 1985 by the
Special Advisory Committee on Reproductive Physiology to the
Health Protection Branch, Health and Welfare, Canada, parallel
in many ways the risks inherent in anabolic steroid use,
although, of course, there are differences since it is mainly
the male athletes who use anabolic steroids (although use among
women is increasing in the power sports such as weightlifting,
powerlifting, bodybuilding, and the track and field events that
require explosive strength).
A search of the recent literature shows that the use of oral
contraceptives is associated with similar side effects, such as
hepatic disease, including hepatic cell adenomas and cancer of
the liver (5•6) and changes in serum cholesterol. Even peliosis
hepatitis, described primarily in patients on androgenic steroid
medication and patients with tuberculosis, has recently been
reported as a possible complication of the long-term use of oral
contraceptives (7).
We can also separate side effects into the short term and long
term consequences of using anabolic steroids. While many of the
short term consequences are clinically clear (especially those
resulting in changes in the female secondary sexual
characteristics, and in feminization of the male) the long term
consequences are more elusive. There is some speculation that
chronic use of anabolic steroids may, in those genetically
susceptible, cause hepatic cirrhosis, peliosis hepatitis,
primary hepatoma, atherosclerosis and cardiac disease, diabetes,
prostatic cancer, and cerebral vascular accidents.
There is, however, no solid clinical or experimental evidence to
show that the use of anabolic steroids by healthy athletes has
any effect on longevity, or that prolonged use leads to diseases
of the various organs and systems mentioned above. I find it
interesting that while substantial amounts of anabolic steroids
have been used by athletes for over three decades, we are not
seeing any significant long term effects on athletes who have
used anabolic steroids in the fifties, sixties and seventies.
However, the changing pattern of anabolic steroids use over the
past decade - anabolic steroids are being more widely, at higher
dosages and for longer periods of time - may yet reveal more
severe problems in the long term. There are some studies in
progress now that may shed some light on the long term
consequences of anabolic steroid use. One study, announced in
1987, proposed to examine football players and power lifters for
possible long-term sequelae from anabolic steroid use in 1970s
competition (8).
1- Schurmeyer T; Beliltien L; Knuth U A; Nieschl.aq B.
Reversible azoospermia induced by the anabolic steroid
19-nortestosterone. Lancet . 1:417-420. Feb 25 1984 . LG Bn.
2 Schurmeyer T; Belkien L; Knuth U A; Ni eschlaq 8. Reversible
azoospemia induced by the anabolic steroid 19-nortestosterone.
Lancet . 1:417-420. Feb 25 1984.
3 Bashin J; Rachlis V; Robert B; Khai.t Z. caubined use of oral
medroxyproqesterone acetate and methyltestosterone in a male
contraceptive trial program. Contraception. 21:365-379. Apr 1980
.
4 Thomas DB. Steroid hormones and medications that al.ter cancer
risks. Cancer (United States) Oct 15 1988, 62 (8 Supp1)
p1755-67.
5 Forman D; Vincent TJ; Do11 R. Cancer of the 1iver and the use
of oral. contraceptives. Br Med J [C1in Res] May 24 1986, 292
(6532) p1357-61.
6 Christoherson ; Mays BT; Barrows G. A study of steroid-related
liver tumors. Am J Surq Patho1 Mar 1977, 1 (1) p31-41.
7 Janssens AR; Kreun.i.nq J; Ruiter DJ; Kroon JIM; Grond AJ.
Generalized hepatiti after lonq-term use of oral contraceptives.
Am J Gaatroenterol (United States) May 1988, 83 (5) p572-5.
8 Cowart vs. JAMA (Uni.ted States) Jun 12 1987, 257 (22) p3021,
3025,
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