Thursday, February 18, 2010


While numerous side effects are often attributed to the use of anabolic steroid drugs, most remain relatively uncommon. Two examples of this are the adverse effects of high dose steroid use on liver and cardiovascular functions. Such adverse effects are more commonly seen with use of various oral anabolic steroids (AS). Such drugs have been structurally modified to prevent premature breakdown in the liver, but this protection also leads to possible side effects. Still, you rarely hear or read of bodybuilders and other athletes who suffer life-threatening events associated with severe liver or cardiovascular complications while using AS. Actual deaths directly attributable to the drugs are even rarer. The preponderance of published medical literature shows that most of the medical abnormalities induced by steroids, such as lowered levels of protective high density lipoprotein cholesterol (which helps protect against cardiovascular disease onset), as well as elevated liver enzymes, regress when AS use ceases. This is one reason why rational athletes cycle the drugs: to allow any medical abnormalities to return to normal.

Other signs of AS are far more common compared to the relatively rare cases of cardiovascular or liver disease. In fact, physicians are often warned to look for certain signs of steroid use in patients. These signs include a pronounced level of muscular development; premature male pattern baldness in young men and in women; excess stretch marks on the skin; and acne, particularly in certain areas of the body, such as the face, shoulders, chest and back. The skin manifestations of AS use are far more common than internal signs of drug usage. One survey of powerlifters showed that 53% had acne;47% showed increased body hair;27% showed a higher incidence of oily skin and hair; and 20% showed loss of scalp hair. Of these, acne is by far the most common sign of steroid usage, although not everyone who gets acne is using steroids. But when associated with the other signs of steroid use, such as hair loss and excess stretch marks, it is much more suggestive of steroid usage.

When it comes to acne, both oral and injectable forms are equally culpable.One notable problem with AS-induced acne is that it doesn’t always respond to the routine medical treatments for acne, and may persist for an extended time even after all use of AS are stopped. Athletes who continue to use steroids while undergoing treatment for acne often show a delayed healing response, thus suggesting that steroids play a potent role in acne causation.

Glands in the skin called sebaceous glands secrete sebum, which acts as a lubricating factor in the skin. But while AS promote muscular hypertrophy or size increases, they also promote size increases in the sebaceous glands in the skin, which respond by producing larger amounts of sebum. The excess sebum combines with abnormal production of keratin protein in the skin, leading to the formation of comedos, which have nothing to do with comedy, and aren’t the least bit funny. They are, in fact, pre- acne lesions in the skin. The lesions contain larger amounts of skin lipids, including cholesterol and free fatty acids. These fats are like a buffet to the resident bacteria that is normally latent in the skin follicles called propionibacterium acnes or simply P.acnes. Using steroids elevates the skin population of P.acnes, and when their population increases, they produce end products that are extremely inflammatory in the skin follicles, resulting in the inflammation characteristic of acne.

In some bodybuilders and athletes, the usual cases of acne, known as acne vulgaris, progress to a more serious form called acne fulminans. This is ulcerative acne, apparent as ugly red pustules on the skin surface. In many cases, this form of acne can also cause joint pains, particularly in the hips and knees. While many bodybuilders who get acne with steroid use may have a genetic tendency to get acne (explaining why not all bodybuilders who use steroids get acne), others who get acne with AS have no previous history of acne incidence. One such bodybuilder developed acne three weeks after starting use of AS. With ongoing use over the next three months, his initial acne vulgaris progressed to the disfiguring acne fulminans type. He developed extremely tender inflammatory papules(Inflammatory skin lesions), pustules(pus-filled skin lesions), and nodules over his chest, shoulders, and back, with a few pyrogenic granulomas (infected, tumorlike lesions) on his chest. When he got off the steroids, and was treated with various skin drugs, his acne disappeared, but he was left with excessive acne scars. Occasionally, these more serious forms of acne can develop more rapidly even in athletes who never had acne, as was the cases of a javelin thrower and a bodybuilder documented in a 1989 study published in a German medical journal. These spontaneous cases of acne fulminans may result from an immune response to higher levels of P.acnes in the skin increased through use of AS.

Besides promoting acne, the stimulation of sebaceous glands by AS can also result on other skin diseases. These include rosacea, epidermoid cysts, seborrheic dermatitis, and oily skin and hair. A 1992 report associated the use of AS with the onset of tinea versicolor, a fungal skin disease sensitive to sun exposure. The excess sebum in the skin fostered by steroid usage provides an ideal environment for the growth of the fungus that causes tinea, namely Malassezia furfur.

As noted earlier, striae distensae, also known as stretch marks, are also common in steroid users, although they do appear in those who don’t use steroids. While steroids promote the growth of muscles throughout the body, the most dramatic increases are seen in the neck, chest, shoulders, and upper arms. These are also the areas where stretch marks are most commonly seen. Stretch marks result when the expansion of the skin isn’t proportional to the increase of the size of the underlying muscle tissue. Steroids add to this effect by interfering with the formation of collagen, a primary skin structural protein, resulting in decreased skin elasticity, and thus a higher tendency to produce stretch marks. While muscle size may recede when steroid usage is stopped, the stretch marks that have developed remain. Various treatments are offered to minimize stretch mark formation, although there is as yet no proven cure.

Another type of scar tissue that can form on the skin with steroid usage are keloids. Keloids are an overgrowth of scar tissue on the skin, and are more common in people with darker skin. One study found increased keloid formation in bodybuilders and a hockey player who had used both injectable and oral AS.

None of the involved athletes had any previous history of keloid formation. While the keloids remained on the skin after they stopped using steroids, no new lesions developed. The keloids formed through use of steroids may be related to excessive collagen formation in the skin promoted by steroids, since the keloids are largely composed of collagen as is most other forms of scar tissue. Indeed, one study did find decreased breakdown and increased formation of type-1 collagen in those who used large doses of AS.

Besides promoting various skin diseases, steroids can worsen or increase the incidence of pre-existing skin conditions. As noted earlier, athletes being treated for acne often stop responding to normal treatment regimes if they also continue to use AS. Some cases of comparatively benign acne can progress to the disfiguring inflammatory types through using high dose AS regimes. Psoriasis is an autoimmune disease in which for unknown reasons, immune cells attack skin cells resulting in red, scaly patches on the skin. One bodybuilder had controlled his psoriasis condition thorough the use of a topical cream. But when he began using steroids, his condition considerably deteriorated. The condition eventually resulted in his psoriasis becoming resistant to treatment. But when he stopped using AS, the psoriasis stabilized and again responded to simple skin cream treatment.

Another case involved a 24-year-old man with a condition called familial angiolipomas, which are fatty tumors of the skin. When he began using AS, he experienced an acute onset of 40 new tumors in his skin. Over the next two years, the tumors increased in size as he continued to use steroids. Analysis of this man’s fat cells showed that the cells had androgen receptors, indicating that the steroids may have reacted with androgen receptors in the fatty tumors, explaining their proliferation and growth. Research also points to a link between AS and a strange condition called hereditary coproporphyria. Among the effects of this disease caused by a genetic lack of a certain enzyme, are purple urine and an increased sensitivity to sunlight. In one case, blisters formed on the face and hands of a weightlifter who had previously not suffered from any symptoms of the disease. They manifested, however, when he began using AS. When he stopped using the drug, the conditioned declined, as did his sensitivity to light.

Bodybuilders who inject steroids under non-sterile conditions often get bacterial and sterile abscesses, particularly in the glute area. This can result after using contaminated vials and syringes. Repeatedly injecting the same area can lead to localized inflammation and oil-induced granuloma, which is a tumorlike mass caused by local inflammation. Those who are ultra stupid share needles, which can result in hepatitis transmission, as well as HIV.

Bodybuilders who use large doses of oral steroids often get a transient form of liver inflammation characterized by elevated liver enzymes. The problem here related to acne treatment is that some of the drugs provided to treat more serious forms of acne, such as isotretinoin and tetracycline, are more dangerous when there are existing liver problems, since both drugs also impose stress on the liver. Using these drugs along with oral AS can worsen or amplify the effects of the steroids in the liver.

There is far more involved in acne cause and treatment that was discussed here, including new information related to nutrition and acne onset. But that will have to await a separate feature.

Book review: Anabolic Pharmacology

While interest in the effects of anabolic steroids and other anabolic drugs are at a zenith,likely the result of the extensive publicity about drug usage in sports, the information on such drugs is often misinterpreted or downright wrong. This is particularly true on the Internet. Countless self-appointed Internet steroid gurus dispense information that is based on nothing more than supposition and anecdotal evidence,neither of which have any relationship to true science. While the results of such questionable information can result in a lack of expected effects, in other cases this level of misinformation can prove hazardous to health, or even deadly.

One antidote to such misinformation is to read sources of information about anabolic steroids and other anabolic drugs that have a basis in reality in that they accrue from a study of the available scientific literature on the subject. I’ve reviewed a number of excellent steroid books in this column over the years based on my assessment of their value to readers. My most recent entry into this domain of knowledge is a new book titled, Anabolic Pharmacology, which sounds a bit like this column.

The book was written by “Seth Roberts,” which admittedly is a pen name on the part of the author. Roberts claims to hold combined bachelor’s degrees in chemistry and pharmacology. He was a pharmacologist in the pharmaceutical industry, where he worked in drug discovery and development. His areas of interest include obesity, muscle wasting, cardiovascular and renal physiology, and hematology. In addition, he has had a personal interest in anabolic pharmacology for over 20 years, which led to the writing of this book.

As to his motivation for the publication of Anabolic Pharmacology, Roberts feels that other books on the subject rely too much on anecdotal information, resulting in the perpetuation of widespread misinformation that he refers to as “bro-lore”. He also was motivated to provide information not contained in the other books in this genre that are known to researchers, but not understood by the “AAS-using community,” as he put it to me. While Roberts goes into extensive detail in discussing the often esoteric mechanisms behind anabolic drugs, he also admits that he left out other information that would have proven too obtuse to the non-scientist. He also points out that an advantage of his book over others is that it takes a more objective and scientific view of anabolics not seen in other texts because of a lack of the science background he possesses. Roberts took over 10 years to write this book, and the level of information attests to this truth.

The book does indeed offer revelations about various anabolic drugs not seen in similar books on the topic. For example, when discussing a particular AS called mibolerone, trade name, Cheque drops, which was a veterinary drug administered to dogs, he alludes that boxer Mike Tyson (although Tyson isn’t specically named in the book) may have been using this drug when the infamous ear-biting incidents occured during Iron Mike’s match with Evander Holyfield.Cheque drops were known to promote extreme aggression in some users. Another of the many interesting facts related by Roberts is that getting off aromatase-inhibiting drugs, such as Arimidex, may increase estrogen response through various mechanisms that he fully explains in the book. Indeed, Roberts also notes that high dose steroid regimes often displace estrogen from the steroid-binding protein in the blood, which can result in gynecomastia and other estrogen-related effects. This effect isn’t blocked by aromatase-inhibiting drugs. Taking large doses of the drug Clomid, which many athletes use to kick start lagging testosterone levels after a drug cycle, may paradoxically stimulate estrogen receptors, leading to lowered testosterone levels. While the drug, Nolvadex, is often used to block the effects of estrogen by bodybuilders using steroids, Roberts says that another similar drug, naloxifene, is far superior to Nolvadex in this regard, although it is also considerably more expensive.

These are just a small sample of the fascinating data discussed by Roberts in his book. I learned quite a bit about the relationships of various enzymes to steroid physiology, as well as some of the lesser known effects of the drugs themselves. He also discusses health effects of the drugs, dosing regimes, and prohormones, even suggesting some new possibilities in this regard, although judging by recent government crackdowns in that area, getting into the prohormone industry these days is extremely ill-advised to say the least. Anabolic Pharmacology is an informative and easily understood reference book sure to delight anyone with even a passing interest in the true mechanisms and effect of these drugs. You can obtain the book at

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

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