Friday, April 5, 2013

Steroid Side Effects— Recent Research by Jerry Brainum

    Much of the medical literature on anabolic steroid use in sports and bodybuilding isn’t relevant. Studies often involved dosages that bear no resemblance to what was used by real-world athletes. Conservative study designs were based on medical ethics, in that no one really knew the possible health effects of using amounts that far exceeded what’s commonly prescribed for therapeutic purposes. That explains the claims that anabolic steroids don’t build muscle. Of course they don’t—when the dose is one tablet a day of Dianabol.
    The end of the controversy about the role of anabolic steroids in developing muscular size and strength came with the 1996 publication of a study in the New England Journal of Medicine. It clearly showed that 600 milligrams of weekly testosterone injections boosted muscular gains, especially when combined with weight training. That, of course, came as no surprise to anyone in the bodybuilding world. It did, however, change the opinions of medical professionals, who were forced to accept the indisputable fact that steroids work when used in significant amounts.
    While doctors no longer deny that steroids aid muscular growth, they still warn of significant health risks linked to the use of steroids—especially in light of the extreme amounts commonly used by athletes. While the average man produces about nine milligrams of testosterone daily, many athletes inject themselves with more than 1,000 milligrams a week. Surely there’s a price to pay for such pharmaceutical extravagance—or is there?
    Scientists are constrained by medical ethics to limit the doses of steroids that they administer to subjects in their studies. Thus, the latest trend among researchers who investigate the health and performance effects of anabolic steroids is the “observational” study. The researchers don’t supply any drugs but observe subjects who use their own. The subjects permit the researchers to monitor them via various medical tests. It gives a more accurate view of the impact of athletic doses of anabolic steroids and other drugs.
    A recent observational study published by a group of Italian researchers provided an interesting overview of the long-term effects of anabolic steroids because it featured 20 male bodybuilders who’d never previously used them. It lasted two years and involved extensive physical evaluations of the subjects every six months. The bodybuilders provided their own drugs, which included injectable and oral steroids as well as other drugs commonly used in athletic and bodybuilding circles—clenbuterol; Cytodren; Nolvadex; human chorionic gonadotropin, a.k.a. hCG; thyroid; insulin and aromatase-blockers. On the average, 10 drugs were used during a cycle.
     At the start of the study the bodybuilders received counseling about possible risks and side effects linked to steroid use. That caused two of the men to immediately withdraw from the experiment. Subsequently, seven other men withdrew for various reasons, some involving adverse mental effects such as aggression and depression, sexual dysfunction, family problems and inability to attend scheduled medical exams. The subjects all ate a high-protein diet and increased their protein intake after starting the drugs. They also used such nutritional supplements as creatine and amino acids.
    Gynecomastia, or male breast development, occurred in five subjects, producing notable pain in two. Only one subject showed “clinical relevance”—presumably he needed surgery to correct the gyno. Measures of estrogen, the usual cause of gyno, increased in the subjects—not surprising, as many anabolic steroids are converted into estrogen—but it was considered clinically insignificant because the measures varied among the subjects.
   A common side effect of long-term steroid use is shrinkage of the testicles. Sure enough, 16 of the 20 subjects experienced that. A semen analysis after two years showed a drop in sperm count and fertility but no reduction in sperm motility or shape, both of which can also adversely affect fertility. Two of the bodybuilders showed no sperm production, while another two had counts not consistent with fertility. Many bodybuilders use hCG to prevent those effects, but only eight of the 20 subjects used hCG.
    The bodybuilders also experienced an increase in insulin sensitivity, along with a drop in plasma glucose and insulin. While some studies have found that anabolic steroids produce insulin resistance, that didn’t prove true here.The authors think that’s because of the added muscle and decreased bodyfat, a combination proven to boost insulin sensitivity. Oral steroids lower high-density lipoprotein,a protective cholesterol carrier in the blood, and in this study there was an average drop of 26 percent in the subjects.
    Free T3, or active thyroid hormone, and TSH, which stimulates thyroid hormone release, were both elevated, but thyroid levels remained within normal limits. A surprising finding was a drop in plasma insulinlike growth factor 1. IGF-1 usually rises when testosterone does. The authors speculate that the suppression of gonad function induced by the anabolic steroids may also have suppressed the IGF-1. Gonadotropin often drops during steroid use, as in this study. The suppression of luteinizing hormone by higher estrogen levels is thought to be mainly responsible for the loss of testicle size. Interestingly, even the bodybuilders in the study who used HCG and Nolvadex, both of which help prevent estrogen rise and luteinizing hormone 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. That points to liver inflammation and possibly liver damage. Most cases of liver impairment as a result of anabolic steroid use reported in the medical literature involve hospitalized patients on long-term anabolic steroid therapy. Complicating the picture is the fact that some liver enzymes increase in those engaged in the kind of exercise that causes muscle damage, such as typical bodybuilding workouts. The same enzymes found in the liver also show up in muscle and are released into the blood when muscles are damaged.
    At the beginning of the study the bodybuilders had liver enzymes at the higher range of normal, likely because of their training. Most of those values remained steady during the two years of the study, although the liver enzymes in two of the bodybuilders doubled, which was thought to be related to their use of oral steroids. Despite that, their enzymes were still considered in the normal range. Ultrasounds revealed no adverse structural changes in the liver or any evidence of incipient tumors. Most of the bodybuilders had slightly enlarged livers and more liver fat than usual at the start of the study, but that was attributed to long-term high-protein intake and wasn’t considered pathological. The authors suggest that reports of liver toxicity induced by anabolic steroids are probably overestimated.
     Testosterone and anabolic steroids increase the production of red blood cells by stimulating EPO, a hormone made in the kidneys that facilitates red cell production. In this study the bodybuilders had increased hemoglobin—the protein in red blood cells—but the hematocrit, or density of red cells, remained within normal limits. What’s called humoral immunity, or immune factors in the body, represented by B cells, wasn’t affected. Cellular immunity, which among other things protects against viral infections and tumor formation, was decreased by steroids but remained within normal range.
    The heart, as a muscle, enlarges with stimulation just as skeletal muscle does, and the left ventricle is its primary pumping chamber. Past studies have indicated adverse changes in the heart, such as an increase in left-ventricular-wall thickness and mass. That particular change, often called “athlete’s heart,” is also a by-product of exercise. Some research has found that steroids interfere with the diastolic phase, or the filling of the heart with blood, which can dangerously disturb normal heart rhythm. Examinations of heart tissue have revealed microscopic damage and scar-tissue formation. Many such changes, however, depend on length of use and dose, with those using high doses for longer periods being more susceptible to heart damage. In this study echocardiograms of the bodybuilders’ hearts revealed no structural abnormalities.
By and large, the adverse effects of anabolic steroid use revert to normal when drug use stops. That explains why you rarely hear about bodybuilders and athletes dropping dead from steroids. There are, however, exceptions. Genetics may make large doses of steroids particularly dangerous for some people, and it’s difficult to predict precisely who is susceptible. That’s one reason it’s absolutely essential for anyone either using steroids or contemplating it to undergo regular medical evaluation.

Bonetti, A., et al. Side effects of anabolic androgenic steroid abuse. Int J Sports Med.2008;29:679-97.

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

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