Wednesday, February 17, 2010


Much of the past medical literature published in relation to anabolic steroid usage in sports and bodybuilding isn’t relevant. These past studies often involved dosages that had no resemblance to what was used by athletes in the real world. Such conservative study designs were based on medical ethics, in the sense that no one really knew the possible health effects of using dosages of drugs that far exceeded commonly prescribed therapeutic dosages. This explains such past findings that ingesting oral anabolic steroid drugs don’t build muscle. Of course they don’t--when the dose involves one tablet a day of Dianabol! The end of the controversy about the efficacy of anabolic steroids in relation of developing muscular size and strength came with the 1996 publication of a study in the New England Journal of Medicine. That study clearly showed that using 600 milligrams of weekly testosterone injections boosted muscular gains, especially when combined with weight-training. This,of course, came as no surprise to anyone in the bodybuilding world. But it did change the opinions of medical professionals, who were now forced to accept the indisputable fact that steroids do work when used in significant dosages.
While doctors don’t deny that steroids do aid muscular growth, they still warn of the significant health risks linked to the use of steroids. This is particularly true, they warn, in light of the extreme dosages commonly used in athletic drug regimes. While the average man produces about 9 milligrams of testosterone daily in his body, many athletes inject themselves with over 1,000 milligrams of testosterone a week. Surely there is a price to pay for such pharmaceutical extravagance--or is there?

Scientists now realize that designing studies about the health effects of anabolic steroids using doses commonly prescribed in medical practice bears little or no relationship to the effects produced by real world athletic doses. But they are still limited by medical ethics to limit the doses of steroids used in studies. Thus, the latest trend among researchers who study the health and performance effects of anabolic studies is to publish “observational” studies. An observational study is one in which the researchers don’t supply any drugs, but allow the study subjects to use their own drugs in any amount the subjects desire. The study subjects allow the researchers to monitor them through various medical testing procedures. In this way, researchers can obtain a more accurate view of what happens when athletic doses of anabolic steroid and other drugs are used.

A recent study published by a group of Italian researchers is an example of such observational studies. The study provided an interesting overview of the long-term effects of anabolic steroids (AS), since it featured 20 male bodybuilders who had never previously used any type of anabolic steroid drug. The study lasted 2 years, and involved extensive physical evaluations of the bodybuilders every 6 months during the course of the study. The bodybuilders provided all of the their own drugs, which included various injectable and oral steroids,as well as other drugs such as clenbuterol, Cytodren, Nolvadex, HCG, thyroid, insulin, and aromatase-blocking drugs. On the average, 10 drugs were used during a cycle.In short, the cycles and drugs used matched that commonly used in athletic and bodybuilding circles.

At the start of the study, the bodybuilders received counseling about the possible risks and side effects linked to steroid usage. This caused 2 of the men to immediately withdraw from the study. During the course of the study, 7 other men withdrew for various reasons, some involving perceived adverse mental effects (aggression, depression), sexual dysfunction, family problems, and being unable to attend scheduled medical exams. All the subjects consumed a high protein diet, and increased their protein intake after starting the drugs. They also consumed various nutritional supplements, such as creatine, amino acids, and others.

The study results showed that gynecomastia or male breast development occurred in 5 subjects, producing notable pain in 2, but only one subject showed clinical relevance, assuming this means that they needed surgery to correct the gyno. Levels of estrogen, which is the usual cause of gyno, increased during the study, since many AS are converted into estrogen in the body, but this increase was considered clinically insignificant since the levels varied in the subjects.

A common side effect of steroid use, especially long-term, is shrinkage of the testicles. Sure enough, 16 of the 20 subjects showed this side effect. A semen analysis after 2 years showed a decrease in sperm count, but no reduction in sperm motility (movement) or morphology (shape), both of which can adversely affect fertility. Despite this, the fertility index showed a significant reduction, likely due to the lower than normal sperm count.Two of the bodybuilders showed no sperm production, while another 2 showed low sperm counts not consistent with fertility. Many bodybuilders use HCG to prevent these effects, but only 8 out of 20 of the study subjects used HCG.

An interesting effect was an increase in insulin sensitivity, along with a drop in plasma glucose and insulin levels in the bodybuilders. While some studies show that AS produces insulin resistance, this didn’t prove true in this study. The study authors think that the effect may have been caused by added muscle and decreased bodyfat, a combination proven to boost insulin sensitivity. Oral steroids are known to lower a protective cholesterol-carrier in the blood called high density lipoprotein (HDL), and this occurred in this study, with an average drop in HDL of 26%.

In relation to hormones, free T3, or active thyroid hormone and TSH, which stimulates thyroid hormone release, both elevated, but thyroid levels remained within normal limits. A surprising finding was a drop in plasma insulinlike growth factor-1 (IGF-1). This is surprising because IGF-1 usually rises with higher testosterone levels. The study authors speculate that the suppression of gonadal function induced by the AS may also have suppressed the IGF-1 levels. Gonadotropin levels, such as LH and FSH secreted from the pituitary gland in the brain, are often suppressed during steroid use, and this also occurred in this study. The suppression of luteinizing hormone (LH) by higher estrogen levels produced as a result of conversion of some AS into estrogen, is thought to be mainly responsible for the loss of testicular volume frequently encountered among steroid users. Interestingly, even the bodybuilders in the study who used HCG and Nolvadex, both of which are used to prevent the estrogen rise and LH suppression, still showed gonadotropin suppression. The good news is that no changes in prostate gland volume or size occurred in any of the bodybuilders.

Liver enzymes, which offer a picture of liver function, are frequently affected by high doses of oral steroids. Such a scenario points to a liver inflammation caused by the oral steroids. In a worst-case scenario, this can eventually result in liver damage, but rarely does in athletic steroid users. Most cases of liver impairment as a result of anabolic steroid usage reported in the medical literature involve hospitalized medical patients on long-term anabolic steroid therapy. Complicating the picture is the fact that certain liver enzymes commonly are elevated by those engaged in intense exercise that results in muscle damage--such as typical bodybuilding workouts. The same enzymes found in the liver also exist in muscle, and are released into the blood when muscles are damaged.

In this study, the bodybuilders showed liver enzymes at the higher range of normal, likely because of their training, at the start of the study. Most of these values remained steady during the 2-year course of the study, although 2 of the bodybuilders showed a 2-fold rise in liver enzymes, thought to be related to their use of oral steroids. Despite this, their enzyme levels were still considered in the normal range. Ultrasound tests of the bodybuilders showed no adverse structural changes in the liver, nor any evidence of incipient tumors. Most of the bodybuilders, however, did show slightly enlarged livers and more liver fat than usual at the start of the study, but this was attributed to a long-term high protein intake, and wasn’t considered pathological. The study authors suggest that reports of liver toxicity induced by AS are probably overestimated.

Testosterone and anabolic steroids are known to increase the production of red blood cells or erythrocytes. The usual mechanism for this involves a stimulation of EPO, a hormone made in the kidneys that promotes red cell production. In this study, the bodybuilders did show increased hemoglobin (protein in red blood cells) levels, but the hematocrit or viscosity of the blood remained within normal limits, even after 2 years on steroids. As for immune factors in the body, humoral immunity, represented by B cells, wasn’t affected by steroid usage. Cellular immunity, which among other things protects against virus infections and tumor formation, was decreased by steroids, but remained within normal ranges.

Echocardiogram images of the bodybuilder’s hearts revealed no structural abnormalities. Past studies have indicated adverse changes in the heart, such as an increase in left ventricular wall thickness and mass. This particular change in heart structure, often called “athlete’s heart,” is also considered a byproduct of exercise. The heart, being a muscle, enlarges with stimulation similarly to skeletal muscle, and the left ventricle is the primary pumping chamber of the heart. Other studies show that steroids interfere with the diastolic phase, or the filling of the heart with blood. This could result in a dangerous disturbance in normal heart rhythm. Past cellular studies of heart tissue from heavy steroid users showed microscopic damage and scar tissue formation. Much of these possible adverse changes, however, depend on time and dosage, with those using high doses for longer periods more susceptible to these possible adverse heart changes.

Another important aspect to consider is that most of the adverse effects caused by anabolic steroid use revert to normal when drug usage stops. This explains why you rarely hear about bodybuilders and athletes dropping dead from steroid usage. There are, however, always exceptions to the rule. Pre-existing, genetic scenarios may make using large doses of steroids particularly dangerous for some people. It’s difficult to predict precisely who would be susceptible to such adverse effects. This is one reason why it’s absolutely essential for anyone either using or contemplating steroid usage to undergo regular medical evaluations.

©,2013 Jerry Brainum. Any reprinting in any type of media, including electronic and foreign is expressly prohibited.

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