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Anabolic steroids: what you need to know?

Last reviewed by: Aleksey Portnov , medical expert, on 18.06.2018

Anabolic steroids are used to improve physical performance and muscle growth. If they are taken for a long time in high doses and without medical supervision, they can cause eccentric and irrational behavior and a wide range of somatic side effects.

Anabolic steroids include testosterone and other drugs that are pharmacologically similar to testosterone and cause muscle growth. Anabolic steroids have androgenic effects (eg, hair growth, libido, aggressiveness) and anabolic effects (eg, increased protein absorption, changes in muscle mass). Androgenic effects can not be separated from anabolic, but some anabolic steroids have been synthesized to minimize androgenic effects.

Testosterone is rapidly destroyed in the liver; tableted testosterone is inactivated too quickly to be effective, and injectable testosterone must be modified (eg through esterification) to delay absorption and delay decay. Analogs modified via 17-b-alkylation are often effective for oral administration, but may cause more side effects. There are also preparations for the introduction through the skin.

Side effects differ depending on the dose and the drug. In physiological doses for substitution therapy (for example, methyltestosterone 10-50 mg / day or its analogs), side effects are little pronounced. Athletes can use 10-50 times higher doses. In high doses, some effects are noticeable, while others are not apparent. There is uncertainty, as most studies involve patients who can not accurately name the consumed dose, and also buy drugs on the black market, many of which are counterfeit and contain (contrary to the label) various substances in different concentrations.

Side Effects of Anabolic Steroids

Strongly expressed

  • Erythrocytosis
  • Disrupted lipid profile (decreased HDL, increased LDL)
  • Hepatic disorders (hepatitis, adenoma)
  • Mood disorders (at high doses)
  • Androgenic effects: acne, hair loss on the head, masculinity and hirsutism in women
  • Gonadal suppression (decreased sperm quality, testicular atrophy)
  • Gynecomastia
  • Premature closure of the epiphyses

Moderate

  • Hypertension / hypertrophy of the left ventricle
  • The aggravation of prostatic hypertrophy and pre-existing carcinoma
  • Carcinoma of the liver
  • Slightly expressed
  • Increased risk of sudden death in athletes
  • Significant mood disorders in low doses
  • Primarily for 17-b-alkylated preparations.

HDL - high density lipoproteins, LDL - low density lipoproteins, LVH - left ventricular hypertrophy.

In clinical practice, anabolic steroids are used to treat low testosterone levels. In addition, given that anabolic steroids possess an anti-catabolic effect and improve protein uptake, they are sometimes prescribed in burned, bedridden and other weakened patients to prevent muscle atrophy. Some doctors prescribe these drugs to patients with exhaustion against AIDS and cancer. However, there is insufficient data to recommend such treatment, and information on how androgens affect the underlying disease. It is believed that testosterone is effective in the treatment of injuries and muscle damage, although there is no evidence to support this opinion.

Anabolic steroids are abused to increase muscle mass and strength; these effects are enhanced if combined with enhanced training and appropriate diet. There is no direct indication that anabolic steroids increase stamina or speed, but there is clear single information that athletes taking anabolic steroids can perform more frequent high-intensity loads. Muscle hypertrophy is definitely expressed.

The incidence of anabolic steroids over the course of their lives ranges from 0.5 to 5% of the population, differing significantly in different groups (for example, higher rates among bodybuilders and competing athletes). In the United States, the prevalence of use is 6-11% among boys, students in the upper grades, and about 2.5% among girls of college age.

Athletes can take steroids for a certain period of time, stop, and then resume again (as, for example, in cycling) several times a year. It is believed that the intermittent administration of drugs can normalize the levels of endogenous testosterone, sperm counts, hypothalamic-pituitary-gonadal relationships. There is some evidence that such a cyclic administration reduces adverse effects and the need to increase the dose to achieve the desired effect.

Athletes often use a lot of drugs at the same time (called overdraft) and various methods of administration (oral, intramuscular, transdermal). Increasing the dose during the cycle (multistage) can lead to a physiological dose exceeding the 5-100 times. Overlay and multistage lead to an increase in receptor coagulation and minimization of side effects, but this advantage is not proved.

Symptoms and signs

The most characteristic sign is a rapid increase in muscle mass. The degree and severity of the increase directly depends on the dose taken. In patients taking physiological doses, there is a slow and insignificant increase in muscle mass; in receiving megadoses, the increase in non-fatty body weight can reach several pounds per month. There is an increase in the energy level and libido (in men), but this is more difficult to detect.

Psychological effects (usually when taking very large doses) are usually seen by the family: pronounced mood swings, irrational behavior, increased aggressiveness, irritability, increased libido, depression.

Frequent complaints are increased acne and gynecomastia, and in women - the effects of muscularisation. Some effects can be irreversible (for example, alopecia, clitoral enlargement, hirsutism, lowering of the voice). In addition, the size of the breast may decrease, the mucous membrane of the vagina may be atrophied, menstruation may be disturbed or ceased, the libido may increase or decrease less often, aggression and appetite may increase.

Diagnosis, prognosis and treatment

Urine tests usually identify those who use anabolic steroids. Metabolites of anabolic steroids can be detected in the urine up to 6 months (and even longer for some types of anabolic steroids) after cessation of their consumption.

Doctors who supervise adolescents and young people should be vigilant about signs of steroid abuse and explain possible risks to patients. Education for anabolic steroids should begin in middle school.

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