Steroid Side Effects

The action of testosterone can be both beneficial and detrimental to the body. On the plus side, this hormone has a direct impact on the growth of muscle tissues, the production of red blood cells, and overall well-being of the organism. But it may also negatively effect (among other things) the production of skin oils, growth of body, facial and scalp hair, and the level of both “good” and “bad” cholesterol in the body. In fact, men have a shorter average life span than women, which is believed to be largely due to the cardiovascular defects that this hormone may help bring about.Testosterone will also naturally convert to estrogen in the male body, a hormone with its own unique set of effects. As we have discussed earlier, raising the level of estrogen in men can increase the tendency to notice water retention, fat accumulation, and the development of female tissues in the breast (gynecomastia). Clearly we see that most of the”bad”side effects from steroids are simply those actions of testosterone that we are not looking for when taking a steroid. Raising the level of testosterone in the body will simply enhance both its good and bad properties, but for the most part we are not having “toxic” reactions to these drugs. A notable exception to this is the possibility of liver damage, which is a worry isolated to the use of c17-alpha alkylated oral steroids. Unless the athlete is taking anabolic/androgenic steroids abusively for a very long duration, side effects rarely amount to little more than a nuisance.

One could make a case that periodic steroid use might even be a healthy practice. Clearly a person’s physical shape can relate closely to one’s overall health and well-being. Provided some common sense is paid to health checkups, drug choice, dosage, and off-time, how can we say for certain that the user is worse off for doing so? This position is, of course, very difficult to publicly justify with steroid use being so deeply stigmatized. Since this can be a very lengthy discussion, I will save the full health, moral, and legal arguments for another time. For now I would like to run down the list of popularly discussed side effects, and include any current treatment/avoidance advice where possible.

Acne

Rampant acne is one of the more obvious indicators of steroid use. As you know, teenage boys generally endure periods of irritating acne as their testosterone levels begin to peak, but this generally subsides with age. But when taking anabolic/androgenic steroids, an adult will commonly be confronted with this same problem. This is because the sebaceous glands, which secrete oils in the skin, are stimulated by androgens. Increasing the level of such hormones in the skin may therefore enhance the output of oils, often causing acne to develop on the back, shoulders, and face.The use of strongly androgenic steroids in particular can be very troublesome, in some instances resulting in very unsightly blemishes all over the skin.To treat acne, the athlete has a number of options. The most obvious is to be very diligent with washing and topical treatments, so as to remove much of the dirt and oil before the pores become clogged. If this proves insufficient, the prescription acne drug Accutane® might be a good option.This is a very effective medication that acts on the sebaceous glands, reducing the level of oil secreted.The athlete could also take the ancillary drug Proscar®/Propecia® (finasteride) during steroid treatment, which reduces the conversion of testosterone into DHT, lowering the tendency for androgenic side effects with this hormone. It is of note however that this drug is more effective at warding off hair loss than acne, as it more specifically effects DHT conversion in the prostate and hair follicles. It is also important to note that testosterone is the only steroid that really converts to dihydrotestosterone, and only a few others actually convert to more potent steroids via the 5a-reductase enzyme at all. Many steroids are also potent androgens in their own right, such as Anadrol 50® and Dianabol. As such, they can exert strong androgenic activity in target tissues without 5a-reduction to a more potent compound, which makes Propecia® useless. One can also simply opt to take lower doses of primarily “anabolic” compounds, which impart comparable less androgenic activity. For sensitive individuals attempting to build mass, nandrolone would, therefore, be a much better option than testosterone.

Aggression

Aggressive behavior can be one of the scarier sides to steroid use. Men are typically more aggressive than women because of testosterone, and likewise the use of steroids (especially androgens) can increase a person’s aggressive tendencies. In some instances this can be a benefit, helping the athlete hit the weights more intensely or perform better in a competition. Many professional powerlifters and bodybuilders take a particular liking to this effect. But on the other hand, there is nothing more unsettling than a grown man, bloated with muscle mass, who cannot control his temper. A steroid user who displays an uncontrollable rage is clearly a danger to himself and others. If an athlete is finding himself getting agitated at minor things during a steroid cycle, he should certainly find a means to keep this from getting out of hand. Remembering to take a couple of deep breaths at such times can be very helpful. If such attempts prove to be ineffective, the offending steroids should be discontinued. The bottom line is that if you lack the maturity and self-control to keep your anger in check, you should not be using steroids.

Anaphylactic Shock

Anaphylactic shock is an allergic reaction to the presence of a foreign protein in the body. It most commonly occurs when an individual has an allergy to things like a specific medication (e.g., penicillin), insect bites, industrial/household chemicals, foods (commonly nuts, shellfish, fruits), and food additives/preservatives (particularly sulfur). With this sometimes-fatal disorder the smooth muscles are stimulated to contract, which may restrict a person’s breathing. Symptoms include wheezing, swelling, rash or hives, fever, a notable drop in blood pressure, dizziness, unconsciousness, convulsions, or death. This reaction is not really seen with hormonal products like anabolic/androgenic steroids, but this may change with the rampant manufacture of counterfeit pharmaceuticals. Being that there are no quality controls for black market producers, toxins might indeed find their way into some preparations (particularly injectable compounds). My only advice would be to make every attempt to use only legitimately produced drug products, preferably of First World origin. When anaphylactic shock occurs, it is most commonly treated with an injection of epinephrine. Individuals very sensitive to certain insect bites are familiar with this procedure, many of whom keep an allergy kit (for the self administration of epinephrine) close at hand.

Birth Defects

Anabolic/androgenic steroids can have a very pronounced impact on the development of an unborn fetus. Adrenal Genital Syndrome in particular is a very disturbing occurrence, in which a female fetus can develop male-like reproductive organs. Women who are, or plan to become pregnant soon, should never consider the use of anabolic steroids.lt would also be the best advice to stay away from these drugs completely for a number of months prior to attempting the conception of a child, so as to ensure the mother has normal hormonal chemistry. Although anabolic/androgenic steroids can reduce sperm count and male fertility, they are not linked to birth defects when taken by someone fathering a child.

Blood Clotting Changes

The use of anabolic/androgenic steroids is shown to increase prothrombin time, or the duration it will take for a blood clot to form.This basically means that while an individual is taking steroids, he/she may notice that it takes slightly longer than usual for a small cut or nosebleed to stop seeping blood. During the course of a normal day this is hardly cause for alarm, but it can lead to more serious trouble if a severe accident occurred, or an unexpected surgery was needed. Realistically, the changes in clotting time are not extremely dramatic, so athletes are usually only concerned with this side effect if planning for a surgery.The clotting changes brought about by anabolic steroids are amplified with the use of medications like Aspirin,Tylenol, and especially anticoagulants, so your doctor should be informed of their use (steroids) if undergoing any notable treatment with these types of drugs.

Cancer

Although it is a popular belief that steroids can give you cancer, this is actually a very rare phenomenon. Since anabolic/androgenic steroids are synthetic versions of a natural hormone that your body can metabolize quite easily, they usually place a very low level of stress on the organs. In fact, many steroidal compounds are safe to administer to individuals with a diagnosed liver condition, with little adverse effect.The only real exception to this is with the use of c17 alpha alkylated compounds, which due to their chemical alteration are somewhat liver toxic. In a small number of cases (primarily with Anadrol 50®), this toxicity has lead to severe liver damage and subsequently cancer. But we are speaking of a statistically small number in the face of millions of athletes who use steroids. These cases also tended to be very ill patients, not athletes, who were using extremely large dosages for prolonged periods of time. Steroid opponents will sometimes point out the additional possibility of developing Wilm’s Tumor from steroid abuse, which is a very serious form of kidney cancer. Such cases are so rare, however, that no direct link between anabolic/androgenic steroid use and this disease has been conclusively established. Provided the athlete is not abusing methylated oral substances, and is visiting a doctor during heavier cycles, cancer (at least specifically associated with steroid use) probably does not need to be a serious concern.

Cardiovascular Disease

As mentioned earlier, the use of anabolic/androgenic steroids may have an impact on the level of LDL (low density lipoprotein), HDL (high density lipoprotein), and total cholesterol values. As you probably know, HDL is considered the “good” cholesterol, since it can act to remove cholesterol deposits from the arteries. LDL has the opposite effect, aiding in the buildup of cholesterol on the artery walls. The general pattern seen with steroid use is a lowering of HDL concentrations, while total and LDL cholesterol numbers increase.The ratio of HDL to LDL values is usually more important than one’s total cholesterol count, as these two substances seem to balance each other in the body. If these unfavorable changes in ratio are exacerbated by the long-term use of steroidal compounds, it can logically be detrimental to the cardiovascular system.This may be additionally heightened by a rise in blood pressure, which is common with the use of strongly aromatizable compounds.
It is also important to note that due to their structure and form of administration, most 17alpha alkylated oral steroids have a much stronger negative impact on these levels compared to injectable steroids. Using a milder drug like Winstrol® (stanozolol), in hopes HDL level changes will also be mild, may therefore not turn out to be the best option. One study comparing the effect of a weekly injection of 200mg testosterone enanthate vs. only a 6mg daily oral dose of Winstrol® demonstrates this well72. After only six weeks, stanozolol was shown to reduce HDL and HDL-2 (good) cholesterol by an average of 33% and 71% respectively. The HDL reduction (HDL-3 subfraction) with the testosterone group was only an average of 9%. LDL (bad) cholesterol also rose 29% with stanozolol, while it actually dropped 16% with the use of testosterone.Those concerned with cholesterol changes during steroid use may likewise wish to avoid oral steroids, and opt for the use of injectable compounds exclusively.

We must also note that estrogens generally have a favorable impact on cholesterol profiles. For example, estrogen replacement therapy in postmenopausal women is regularly linked to a rise in HDL cholesterol and a reduction in LDL values. Likewise the aromatization of testosterone to estradiol may be beneficial in preventing a more dramatic change in serum cholesterol due to the presence of the hormone. A recent study investigated just this question by comparing the effects of testosterone alone (280 mg testosterone enanthate weekly), vs. the same dose combined with an aromatase inhibitor (250mg testolactone 4 times daily)73. Methyltestosterone was also tested in a third group, at a dose of 20mg daily. The results were quite enlightening.The group using only testosterone enanthate showed no significant decrease in HDL cholesterol values over the course of the 12-week study. After only four weeks, the group using testosterone plus an aromatase inhibitor displayed a reduction on average of 25%. The methyltestosterone group noted an HDL reduction of 35% by this point, and also noted an unfavorable rise in LDL cholesterol.This clearly should make us think a little more closely about estrogen maintenance during steroid therapy. Aside from deciding whether or not it is actually necessary in any given circumstance, drug choice may also be an important consideration. For example, the estrogen receptor antagonist Nolvadex® does not seem to exhibit anti-estrogenic effects on cholesterol values, and in fact often raises HDL levels. Using this to combat the side effects of estrogen instead of an aromatase inhibitor such as Arimidex® or Cytadren® may therefore be a good idea, particularly for those who are using steroids for longer periods of time.

Since heart disease is one of the top killers worldwide, steroid-using athletes (particularly older individuals) should not ignore these risks. If nothing else, it is a very good idea to have your blood pressure and cholesterol values measured during each cycle, making sure to discontinue the drugs if a problem becomes evident. It is also advisable to limit the intake of foods high in saturated fats and cholesterol while on cycle, which should help minimize (a small bit anyway, as diet is not an effective way of controlling this side effect) the impact of steroid treatment. Since blood pressure and cholesterol levels will usually revert back to their pre-treated norms soon after steroids are withdrawn, long-term damage is not a common worry with short-term use.

Depression

Obviously steroid use will have an impact on hormone levels in the body, which in turn may result in a change in one’s general disposition or mood. On the one hand, we might see very aggressive behavior. But for some people there is also, at times, the other extreme side, depression.This can occur in individuals who are psychologically sensitive to an imbalance in androgen and estrogen levels. This is most common with male bodybuilders, at times when anabolic/androgenic steroids are discontinued. Given a deeply suppressed endogenous testosterone level, it may take time for one’s normal hormonal balance to return. During this period, estrogen levels may be more stable than testosterone, as our bodies can produce it from adrenal hormones.The result may be a protracted window of time in which estrogen seems to be the more dominant sex hormone. For some, this window can be filled with feelings of emotional sensitivity, sadness, and lack of motivation (symptoms of depression).
Depression may also occur during the course of a steroid cycle, particularly with the sole use of anabolics. Although these compounds are mild in comparison to androgens, many can still suppress the endogenous production of testosterone. If the testosterone level drops significantly during treatment, the administered anabolics may not provide enough of an androgen level to compensate, and a marked loss of motivation and sense of well-being may result.The best advice when looking to avoid cycle or post-cycle depression is to closely monitor drug intake and withdrawal.The use of a small weekly testosterone dose might prove very effective if added to a mild dieting/anabolic cycle, warding off feelings of boredom and apathy to training. Of course a strong steroid cycle should always be discontinued with the proper use of ancillary drugs (Nolvadex®, Arimidex®, HCG,Clomid®, etc.). Although tapering schedules are very common, they are not an effective way to restore endogenous testosterone levels.

Gynecomastia

Gynecomastia is the medical term for the development of female breast tissues in the male body. This occurs when the male is presented with an unusually high level of estrogen, particularly with the use of strong aromatizing androgens such as testosterone and Dianabol. The excess estrogen can act upon receptors in the breast and stimulate the growth of mammary tissues. If left unchecked, this can lead to an actual obvious and unsightly tissue growth under the nipple area, in many cases taking on a very feminine appearance.To fight this side effect during steroid therapy, many find it necessary to use some form of estrogen maintenance medication. This includes an estrogen antagonist such as Clomid® or Nolvadex®, which blocks estrogen from attaching to and activating receptors in the breast and other tissues, or an aromatase inhibitor such as Femara® or Arimidex®, which blocks the enzyme responsible for the conversion of androgens to estrogens. Aromatase inhibitors like this are currently the most effective options, but also the most costly.
It is worth noting, however, that many believe a slightly elevated estrogen level may help the athlete achieve a more pronounced muscle mass gain during a cycle (see: Estrogen Aromatization). With this in mind many athletes decide to use anti-estrogens only when it is necessary to block gynecomastia. It is of course still a good idea to always keep an anti- estrogen on-hand when administering an aromatizable steroid, so that it is readily accessible should trouble become evident. Puffiness or swelling under the nipple is one of the first signs of pending gynecomastia, often accompanied by pain or soreness in this region (an effect termed gynecodynea).This is a clear indicator that some type of anti-estrogen is needed. If the swelling progresses into small, marble-like lumps, action absolutely must be taken immediately to treat it. Otherwise, if the steroids are continued at this point without ancillary drug use, the user will likely be stuck with unsightly tissue growth that can only be removed with a surgical procedure.

It is also important to mention that progestins seem to augment the stimulatory effect of estrogens on mammary tissue growth.There appears to be a strong synergy between these two hormones here, such that gynecomastia might even be able to occur with the help of progestins, without excessive estrogen levels being necessary. Since many anabolic steroids, particularly those derived from nandrolone, are known to have progestational activity, we must not be lulled into a false sense of security. Even a low estrogen producer like Deca can potentially cause gyno in certain cases, again fostering the need to keep anti-estrogens close at hand if you are very sensitive to this side effect.

Hair Loss

The use of highly androgenic steroids can negatively impact the growth of scalp hair. In fact, the most common form of male pattern hair loss is directly linked to the level of androgens in such tissues, most specifically the stronger DHT metabolite of testosterone. The technical term for this type of hair loss is androgenetic alopecia, which refers to the interplay of both the male androgenic hormones and a genetic predisposition in bringing about this condition.Those who suffer from this disorder are shown to posses finer hair follicles and higher levels of DHT in comparison to a normal, hairy scalp. But since there is a genetic factor involved, many individuals will not ever see signs of this side-effect, even with heavy steroid use. Clearly those individuals who are suffering from (or have a familial predisposition for) this type of hair loss should be very cautious when using the stronger drugs like testosterone, Anadrol 50®, Halotestin®, and Dianabol.

In many instances, the renewal of lost hair can be very difficult, so avoiding this side-effect before it occurs is the best advice. For those who need to worry, the decision should probably be made to either stick with milder substances (Deca-Durabolin® most favored), or use the ancillary drug Propecia®/Proscar® (finasteride) when taking testosterone, methyltestosterone, or Halotestin. Propecia® is a very effective hair loss medication, which inhibits the 5-alpha reductase enzyme specifically in the hair follicles and prostate. However, it offers us little benefit with drugs that are highly androgenic without 5alpha reduction, the most notable offenders being Anadrol 50® and Dianabol. We must also remember that all anabolic/androgenic steroids activate the androgen receptor, and can, likewise, all promote hair loss given the right dosage and conditions.

Headaches

Athletes sometimes report an increased frequency of headaches when using anabolic/androgenic steroids.This seems to be most common during heavier bulking cycles, when an individual is utilizing strongly estrogenic compounds. One should not simply take an aspirin and ignore this problem, as it may indicate a more troubling side effect of steroid use, high blood pressure. Since high blood pressure invites a number of unwanted health risks, monitoring it on a regular schedule is important during heavy steroid use, especially if the individual is experiencing headaches. Some athletes choose to lower their blood pressure in such cases with a prescription medication like Catapres, but most find this an appropriate time to discontinue steroid use. Milder anabolics, which generally display little or no ability to convert to estrogen, are also more acceptable options for individuals sensitive to blood pressure increases. Less seriously, many headaches are due to simple strain on the neck and scalp muscles. The athlete may be lifting with much more intensity during a steroid cycle, and as a result may place added strain on these muscles. In this case, a short break from training, and some general rest, will often take care of the problem. Of course if anyone is experiencing a very serious or persistent headache, a visit to the doctor may be in order.

High Blood Pressure/Hypertension

Athletes using anabolic/androgenic steroids will commonly notice a rise in blood pressure during treatment. High blood pressure is most often associated with the use of steroids that have a high affinity for estrogen conversion, such as testosterone and Dianabol. As estrogen builds in the body, the level of water and salt retention will typically elevate and lead to increased blood pressure.This may be further amplified by the added stress of intense weight training and rapid weight gain. Since hypertension (high blood pressure) can place a great deal of stress on the body, this side effect should not be ignored. If it is left untreated, high blood pressure can increase the likelihood for heart disease, stroke, or kidney failure. Warning signs that one may be suffering from hypertension include an increased tendency to develop headaches, insomnia, or breathing difficulties. In many instances these symptoms do not become evident until BP is seriously elevated, so a lack of these signs is no guarantee that the user is safe. Obtaining your blood pressure reading is a very quick and easy procedure (either at a doctor’s office, pharmacy,or home); steroid-using athletes should certainly be monitoring BP values during stronger cycles so as to avoid potential problems.
If an individual’s blood pressure values are becoming notably elevated, some action should/must betaken to control it.The most obvious is to avoid the continued use of the offending steroids, or at least to substitute them with milder, non- aromatizing compounds. It is also of note that although aromatizing steroids are typically involved, non-aromatizing androgens like Halotestin® ortrenbolone are occasionally also linked to high blood pressure, so these are perhaps not the ideal alternatives in such a situation. The athlete also has the option of seeking the benefit of high blood pressure medications such as diuretics, which can dramatically lower water and salt retention. Catapres (clonidine HCL) is also a popular medication among athletes, because in addition to its blood pressure lowering properties, it has also been documented to raise the body’s output of growth hormone.
Immune System Changes

The use of anabolic/androgenic steroids has been shown to produce changes in the body that may impact an individual’s immune system. These changes can be both good and bad for the user. For instance, during steroid treatment, many athletes find they are less susceptible to viral illnesses. New studies involving the use of compounds like oxandrolone and Deca-Durabolin® with HIV+ patients seem to support this claim, clearly showing that these drugs can have a beneficial effect on the immune system. Such therapies are, in fact, catching on in recent years, and many doctors are now less reluctant to prescribe these drugs to their ill patients. But just as a person may be less apt to notice illness during steroid treatment, the discontinuance of steroids can produce a rebound effect in which the immune system is less able to fight off pathogens.This most likely coincides with the rebound activity/production of Cortisol, a catabolic hormone in the body, which may act to suppress immune system functioning. When the administered steroids are withdrawn, an androgen deficient state is often endured until the body is able to rebalance hormone production. Since testosterone and Cortisol seem to counter each other’s activity in many ways, the absence of a normal androgen level may place Cortisol in an unusually active state. During this period of imbalance, Cortisol will not only be stripping the body of muscle mass, but may also cause the athlete to be more susceptible to colds, flu, etc. The proper use of ancillary drugs (anti-estrogens, testosterone stimulating drugs) is the most common suggestion for helping to avoid this problem, which will hopefully allow the user to restore a proper balance of hormones once the steroids are removed.

We also cannot ignore the other possibility that steroids could actually increase Cortisol levels in the body during treatment.Termed hypercortisolemia,this effect is a common occurrence with anabolic/androgenic steroid therapy.This is because anabolic/androgenic steroids may interfere with the ability for the body to clear corticosteroids from circulation, due to the fact that in their respective pathways of metabolism these hormones share certain enzymes. When overloaded with androgens competing for the same enzymes, Cortisol may be broken down at a slower rate, and levels of this hormone will in turn begin to build. Due to their strong tendency to inhibit the activity of the 3beta hydroxysteroid dehydrogenase enzyme, oral c17 alpha alkylated orals may be particularly troublesome in regards to elevated Cortisol levels, as again this is a common pathway for corticosteroid metabolism.Though an elevated Cortisol level is not a common concern during typical steroid cycles, problems can certainly become evident when these drugs are used at very high doses or for prolonged periods of time.This, of course, may lead to the athlete becoming “run-down” and more susceptible to illness, as well as foster a more over-trained and static (less anabolic) state of metabolism.

Kidney Stress/Damage

Since your kidneys are involved in the filtration and removal of byproducts from the body, the administration of steroidal compounds (which are largely excreted in the urine) may cause them some strain. Actual kidney damage is most likely to occur when the steroid user is suffering from severe high blood pressure, as this state can place an undue amount of stress on these organs.There is actually evidence to suggest that steroid use can be linked to the onset of Wilm’s Tumor in adults, which is a rapidly growing kidney tumor normally seen in children and infants. However, such cases are so rare that no conclusive link has been established. Obviously the kidneys are vital to one’s heath, so the possibility of any kind of damage (although low) should not be ignored during heavy steroid treatment. If the user is noticing a darkening of color (in some cases a distinguishable amount of blood), or pain/difficulty when urinating, kidney strain might be a legitimate concern. Other warning signs include pain in the lower back (particularly in the kidney areas), fever, and edema (swelling). If organ damage is feared, the administered steroidal compounds should be discontinued immediately, and the doctor paid a visit to rule out any serious trouble.
Since kidney stress/damage is generally associated with the use of stronger aromatizing compounds such as testosterone and Dianabol (which often raise blood pressure), individuals sensitive to high blood pressure/kidney stress should avoid such compounds until health concerns are safely addressed. If steroid use is still necessitated by the individual, it may be a good idea to avoid the stronger compounds and opt for one of the milder anabolics. Primobolan®, Anavar, and Winstrol®, for example, do not convert to estrogen at all, and may be acceptable options. Also favorable drugs in this regard are Deca-Durabolin® and Equipoise®, which have only a low tendency to convert to estrogen.

Liver Stress/Damage

Liver stress/damage is not a side-effect of steroid use in general, but is specifically associated with the use of c17 alpha alkylated compounds. As mentioned earlier, these structures contain chemical alterations that enable them to be administered orally. In surviving a first pass by the liver, these compounds place some level of stress on the organ. In some instances, this has led to severe damage, even fatal liver cancer.The disease peliosis hepatitis is one worry, which is an often life-threatening condition in which the liver develops blood-filled cysts. Liver cancer (hepatic carcinoma) has also been noted in certain cases. While these very serious complications have occurred on certain occasions where liver-toxic compounds were prescribed for extended periods, it is important to stress that this is not very common with steroid-using athletes. Most of the documented cases of liver cancer have in fact been in clinical situations, particularly with the use of the powerful oral androgen Anadrol 50® (oxymetholone). This may be directly related to the high dosage of this preparation, as Anadrol 50® contains a whopping 50mg of active steroid per tablet.This is a considerable jump from other oral preparations, most of which contain 5mg or less of a substance. With one Anadrol 50® tablet, the liver will therefore have to process (roughly) the equivalent of 10 Dianabol tablets.This obvious stress is further amplified when we look at the unusually high dosage schedule for ill patients receiving this medication. With Anadrol 50®, the manufacturer’s recommendations may call for the use of as many as 8 or 10 tablets daily.This is a far greater amount than most athletes would ever think of consuming, with three or four tablets per day being considered the upper limit of safety. It is also important to note that the actual number of cases involving liver damage have been few, and have not been a significant enough of a problem to warrant discontinuing this compound. Methyltestosterone, the first steroid shown to cause liver trouble, is also still available as a prescription drug in this country.The average recreational steroid user who takes toxic orals at moderate dosages for relatively short periods is therefore unlikely to face devastating liver damage.
Although severe liver damage may occur before the onset of noticeable symptoms, it is common to notice jaundice during the early stages of such injury. Jaundice is characterized by the buildup of bilirubin in the body, which in this case will usually result from the obstruction of bile ducts in the liver. The individual will typically notice a yellowing of the skin and eye whites as this colored substance builds in the body tissues, a clear sign to terminate the use of any c17 alpha alkylated steroids. In most instances, the immediate withdrawal of these compounds is sufficient to reverse and prevent any further damage. Of course, the athlete should avoid using orals for an extended period of time, if not indefinitely, should jaundice occur repeatedly during treatment. It is also a good idea to visit your physician during oral treatment in order to monitor liver enzyme values. Since liver stress will be reflected in your enzyme counts well before jaundice is noticed, this can remove much of the worry with oral steroid treatment.

Prostate Enlargement

Prostate cancer is currently one of the most common forms of cancer in males. Benign prostate enlargement (a swelling of prostate tissues often interfering with urine flow) can precede/coincide this cancer, and is clearly an important medical concern for men who are aging. Prostate complications are believed to be primarily dependent on androgenic hormones; particularly the strong testosterone metabolite DHT in normal situations, much in the same way estrogen is linked to breast cancer in women. Although the connection between prostate enlargement/cancer and steroid use is not fully established, the use of steroids may theoretically aggravate such conditions by raising the level of androgens in the body. It is, therefore, a good idea for older athletes to limit/avoid the intake of strong 5-alpha reducible androgens like testosterone, methyltestosterone, and Halotestin, or otherwise use Proscar® (finasteride), which was specifically designed to inhibit the 5-alpha reductase enzyme in scalp and prostate tissues. This may be an effective preventative measure for older athletes who insist on using these compounds. Drugs like Dianabol, Anadrol 50®, and Proviron, however, which do not convert to DHT yet are still potent androgens, are not effected by its use. It is also important to mention that not only androgens, but also estrogens, are believed necessary for the advancement of this condition. It appears that the two work synergistically to stimulate prostatic tissue growth, such that one without the other would not be enough to cause it. It has, therefore, been suggested that a non-aromatizable compound like DHT may be a safer option for older men looking for androgen replacement therapy than testosterone. MENT is also being looked at as an androgen replacement option for the same reason. Anti-estrogens might even turn out to be more effective at treating BPH than a drug like finasteride, which is used to lower androgenic activity in the prostate. Estrogen suppression is easier to accomplish in males, and should be accompanied with less side effects.lt would also be very sound advice, regardless of steroid use, for individuals over 40 to have a physician check the prostate on a regular basis, and never consider self-administering steroids if prostate health is compromised.

Sexual Dysfunction

The functioning of the male reproductive system depends greatly on the level of androgenic hormones in the body. Therefore, the use of synthetic male hormones may have a dramatic impact on an individual’s sexual wellness. On one extreme, we may see a man’s libido and erection frequency become significantly heightened.This is most commonly seen with the use of strongly androgenic steroids, which seem to have the most dramatic stimulating impact on this system. In some instances, this can reach the point of becoming problematic, although more often than not, the athlete is simply much more active and sexually aggressive during the intake of steroids.

On the other extreme, we may also see a lack of sexual interest, possibly to the point of impotency.This occurs mainly when androgenic hormones are very low. This will often happen after a steroid cycle is discontinued, as the endogenous production of testosterone is commonly suppressed during the cycle. Removing the androgen (from an outside source) leaves the body with little natural testosterone until this imbalance is corrected. The loss of its metabolite DHT is particularly troubling, as this hormone may have a strong effect on the reproductive system that may not be apparent with other less androgenic hormones. Therefore, it is a very good idea to use testosterone-stimulating drugs like HCG and/or Clomid®/Nolvadex® when coming off of a strong cycle, so as to reduce the impact of steroid withdrawal. Impotency/sexual apathy may also occur during the course of a steroid cycle, particularly when it is based strictly on anabolic compounds.

Since all “anabolics” can suppress the manufacture of testosterone in the body, the administered drugs may not be androgenic enough to properly compensate for the testosterone loss. In such a case, the user might opt to include a small androgen dosage (perhaps a weekly testosterone injection), or again reverse/prevent the androgen suppression with the use of a medication like HCG.

It is also interesting to note that it is not always simply an androgen vs. anabolic issue. People will often respond very differently to an equal dose of the same drug. While one individual may notice sexual disinterest or impotency, another may become extremely aggressive. It is, therefore, difficult to predict how someone will react to a particular drug before having used it.

Stunted Growth

Many anabolic/androgenic steroids have the potential to impact an individual’s stature if taken during adolescence. Specifically, steroids can stunt growth by stimulating the epiphyseal plates in a person’s long bones to prematurely fuse. Once these plates are fused, future linear growth is not possible. Even if the individual avoids steroid use subsequently, the damage is irreversible and he/she can be stuck at the same height forever. Not even the use of growth hormone can reverse this, as this powerful hormone can only thicken bones when used during adulthood. Interestingly enough, it is not the steroids themselves, but the buildup of estrogen that causes the epiphyseal plates to fuse. Women are shorter than men on average because of this effect of estrogen, and likewise the use of steroids that readily convert to estrogen can prematurely suppress/halt a person’s growth. In fact, the use of steroids like Anavar,Winstrol®,and Primobolan® (which do not convert to estrogen) can actually increase one’s height if taken during adolescence, as their anabolic effects will promote the retention of calcium in the bones. This would also hold true for non-aromatizing androgens such as trenbolone, Proviron®, and Halotestin®. It is still good common sense to advise adolescents to avoid steroid use, at least until their bodies are fully mature and steroid use will have a less dramatic impact.

Testicular Atrophy

The human body always prefers to remain in a very balanced hormonal state, a tendency known as homeostasis. When the administration of androgens from an outside source causes a surplus of hormone, it will cause the body to stop manufacturing its own testosterone. Specifically, this happens via a feedback mechanism where the hypothalamus detects a high level of sex steroids (including androgens, progestins, and estrogens) and shuts off the release of GnRH (Gonadotropin Releasing Hormone, formerly referred to as luteinizing hormone releasing hormone).This, in turn, causes the pituitary to stop releasing luteinizing hormone and FSH (follicle stimulating hormone), the two hormones (primarily LH) that stimulate the Leydig’s cells in the testes to release testosterone (negative feedback inhibition has been demonstrated at the pituitary level as well). Without stimulation by LH and FSH, the testes will be in a state of production limbo, and may shrink from inactivity. In extreme cases the steroid user can notice testicles that are unusually and frighteningly small. However, this effect is temporary, and once the drugs are removed (and hormone levels rebalanced) the testicles should return to their original size. Many regular steroid users find this side effect quite troubling, and use HCG during a steroid cycle in order to try to maintain testicular activity (and size) during treatment. The more estrogenic androgens (testosterone, Anadrol 50®, and Dianabol) are most dramatic in this regard, and are not the best choices for individuals who seriously want to avoid testicle shrinkage. Non-aromatizing anabolics would be a better option, however, be warned that all steroids will suppress the production of testosterone if taken at an anabolidy effective dosage (yes, even Anavarand Primobolan®).

Water and Salt Retention

Many anabolic/androgenic steroids can increase the amount of water and sodium stored in body tissues. In some instances, steroid-induced water retention can bring about a very bloated appearance to the body (hands, arms, face, etc.), which will also reduce the visibility of muscle features (loss of definition). Athletes often ignore this side effect, particularly during bulking cycles when the excess water stored in the muscles, joints, and connective tissues will help to improve an individual’s overall strength. With the use of many strong androgens, water retention can account for much of the initial strength and body weight gain during steroid treatment, with “water-weight”sometimes amounting to ten or more pounds.
Assessing Steroid Safety: Studies with Reai-World Dosages

If you so much as mention anabolic steroids to the average person, you usually get some cross looks in response. State that you are actually considering a cycle, and you are likely to be lectured about the tremendous heath risks you are about to undertake; how your hair might fall out and testicles disappear, or your body eaten away by cancer. Or maybe you will just lose you mind to uncontrolled fits of psychotic rage, or suffer a life-threatening heart attack. You’ll probably hear something like,”Is all that really worth it… to build a little more muscle?” Clearly, the American public has been given a very strong message about steroids: stay far away from them, they are DEADLY! You can’t convince too many people that smoking a joint will REALLY cause a 16-year-old kid to pull out his dad’s gun and shoot his friend in the face, but, for some reason, the “over the top” anti-drug message with steroids seems to have worked. Most people are terrified of them.

Those actually taking anabolic steroids usually see things very differently. They believe the dangers are terribly exaggerated in the media. In fact, these athletes will routinely point out that the medical literature for the past 50 years fails to make much note of any serious consequences of steroid use, with most clinical studies looking quite favorably on these drugs. Steroid opponents, on the other hand, will still make sure you know that bodybuilders take much larger doses of steroids than those used in medical situations, and, therefore, are in much greater danger than the patients using them. Who is right? Is that occasional cycle really a serious health risk? In this section I would like to touch on this debate by looking closely at three medical studies that were published recently.They concern not small clinical doses, but a level of steroid usage that any recreational bodybuilder would recognize as sufficient for building muscle. Many markers of safety are assessed in these papers, giving us a fairly good indication of what dangers, realistically, are presented.

600mg/wk of Testosterone

The first is a testosterone dose-response study published in the American Journal of Physiology Endocrinology and Metabolism in July of 2001, which looked at the effects of various doses of testosterone enanthate on body composition, muscle size, strength, power, sexual and cognitive functions, and various markers of health74.61 normal men, ages 18-35, participated in this investigation.They were divided into five groups, with each receiving weekly injections of 25,50,125, 300, or 600 milligrams for a period of 20 weeks. This treatment period was preceded by a control (no drug) period of 4 weeks, and followed by a recovery period of 16 weeks. Markers of strength and lean body mass gains were the greatest with larger doses of testosterone, with the 600mg group gaining slightly over 17 pounds of fat-free mass on average over the 20 weeks of steroid therapy.There were no significant changes in prostate-specific antigen (PSA), liver enzymes (liver stress), sexual activity, or cognitive functioning at any dose. The only negative trait noted was a slight HDL (good) cholesterol reduction in all groups except those taking 25mg.The worst reduction of 9 points was noted in the 600mg group, which still averaged 34 points after 20 weeks of treatment. All groups, except this one, remained in the normal reference range for males (40-59 points).

600mg/wk of Nandrolone

Next we look at a study conducted with HIV+ men, which charted the lean-mass-building effects of nandrolone decanoate75.30 people participated in this investigation, with each given the same (high) weekly dose of this drug. Half underwent resistance training so that two groups (trained and untrained) were formed.The dosing schedule was quite formidable, beginning with 200mg on the first week, 400mg on the second, and 600mg for the remaining 10 weeks of peak therapy. Doses were slowly reduced from weeks 13 to 16 to withdraw patients slowly from the drug. Potential negative metabolic changes were looked at closely, including cholesterol and lipid levels (including subfractions of HDL and LDL), triglycerides, insulin sensitivity, and fasting glucose levels. Even with the high dosages used here, no negative changes were noted in total or LDL cholesterol, triglycerides, or insulin sensitivity. In fact, the group also undergoing resistance exercise noticed significant improvements in LDL particle size distribution, lipoprotein(a) levels, and triglyceride values, which all indicate improved cardiovascular disease risk. Carbohydrate metabolism was also significantly improved in this group.The only negative impact noted during this study was a reduction in HDL (good) cholesterol values similar to that noted with the testosterone study, with an 8-10 point reduction noted between both groups.

100mg/day of Anadrol

Lastly, we find a study looking at the potent oral steroid oxymetholone (Anadrol)76.This steroid is thought to be one of the most dangerous ones around by bodybuilders, who as a group seem to treat it with both a lot of respect and caution. It is not common to find them exceeding the doses and intake durations of this investigation, making it a very good representation of real-world Anadrol usage.This study involves 31 elderly men, between the ages of 65 and 80.The men were divided into three groups, with each taking 50mg,100mg,or placebo daily for a 12-week period. Changes in lean body mass and strength were measured, as well as common markers of safety including total, LDL and HDL cholesterol levels, serum triglycerides, PSA (prostate-specific antigen), and liver enzymes. Muscle mass and strength gains were again relative to the dosage taken, with the end results being similar to those noted with 20 weeks of testosterone enanthate therapy at 125mg or 300mg per week (about 6.4 and 12 lb of lean body mass gained for the 50mg and 100mg doses respectively). There were no significant changes in PSA, total or LDL cholesterol values, or fasting triglycerides; however, there was a significant reduction in HDL cholesterol values (reduced 19 and 23 points for the 50mg and 100mg groups respectively). Liver enzymes (transaminases AST and ALT) increased only in the 100mg group, but the changes were not dramatic, and were not accompanied by hepatic enlargement or the development of any serious liver condition.
Adding It All Up

One hundred and twenty one men participated in these three studies, which involved the use of moderate to high doses of steroids for periods of three to five months. It may be shocking to most of the staunch opponents of steroid use, but all of the men participating were still alive at the conclusion of their respective investigations. An unbiased assessment of the metabolic changes and health risks does not seem to reveal any short-term significant dangers.The main negative impact of steroid use in all three cases was a reduction in good (HDL) cholesterol values, which is a legitimate concern when it comes to assessing one’s risk for developing cardiovascular disease. It is uncertain, however, if a short-lived increase in this particular risk factor will relate to any tangible damage to one’s health. It is also unknown how much (if any) this may be offset by the other positive metabolic changes that were seen to accompany combined steroid use and exercise.
Logic would seem to suggest that the periodic use of steroids, under parameters similar to these studies, should entail relatively minimal risks to health overall. At the very least, it is extremely difficult to argue that an isolated cycle with a moderate drug dose is tantamount to playing Russian roulette with your body, as most media campaigns against the use of these drugs would seem to suggest. But make no mistake, at the same time it does make clear that even with moderate use, steroids can have negative effects that would (logically) be detrimental if carried into long-term use. There is little doubt that decades of steroid use has contributed to many deaths by cardiovascular disease, but will never be linked to these deaths officially (just like “Fast Food” won’t be listed as the cause of a death).The bottom line here is sane respect for these drugs. They can be used safely and responsibly, and are most certainly not as dangerous as the media usually portrays them to be. But they can also be misused and abused as well.

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