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Anabolic steroid abuse

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Anabolic steroid abuse is the drug abuse of anabolic steroids(AAS). Since their discovery, the drugs have been widely used as an ergogenic aid to improve performance in sports, to improve one's physical appearance, as self-medication to recover from injury, and as an anti-aging aid. Use of anabolic steroids for purposes other than treating medical conditions is controversial and, in some cases, illegal. Major sports organizations have moved to ban the use of anabolic steroids. There is a wide range of health concerns for users. Legislation in many countries restricts and criminalizes AAS possession and trade. A political counter current has formed in some of these countries.[citation needed].

Adverse effects

Anabolic steroids can cause many adverse effects. Most of these side effects are dose dependent, the most common being elevated blood pressure, especially in those with hypertension,[1] and harmful cholesterol levels: some steroids cause an increase in bad cholesterol and a decrease in good cholesterol.[2] Anabolic steroids such as testosterone also increase the risk of cardiovascular disease,[3] or coronary artery disease[4][5] in men with high risk of bad cholesterol. Acne is fairly common among anabolic steroid users, mostly due to increases in testosterone stimulating the sebaceous glands.[6][7] Conversion of testosterone to dihydrotestosterone (DHT) can accelerate the rate of premature baldness for those who are genetically predisposed.

Other side effects can include alterations in the structure of the heart, with the induction of an unfavorable enlargement and thickening of the left ventricle, which impairs its contraction and relaxation.[8] Possible effects of these alterations in the heart are hypertension, cardiac arrhythmias, heart attacks, and sudden cardiac death.[9] These changes are also seen in non-drug using athletes, but steroid use may accelerate this process.[10][11] However, both the connection between changes in the structure of the left ventricle and decreased cardiac function, as well as the connection to steroid use have been disputed.[12][13]

High doses of oral anabolic steroid compounds can cause liver damage as the steroids are metabolized (17-alpha-alkylated) in the digestive system to increase their bioavailability and stability.[14] When high doses of such steroids are used for long periods, the liver damage may be severe and lead to liver cancer.[15][16]

There are also gender-specific side effects of anabolic steroids. Development of breast tissue in males, a condition called gynecomastia (which is usually caused by high levels of circulating estrogen), may arise because of increased conversion of testosterone to estrogen by the enzyme aromatase.[17] Reduced sexual function and temporary infertility can also occur in males.[18][19][20] Another male-specific side effect which can occur is testicular atrophy, caused by the suppression of natural testosterone levels, which inhibits production of sperm (most of the mass of the testes is developing sperm). This side effect is temporary: the size of the testicles usually returns to normal within a few weeks of discontinuing anabolic steroid use as normal production of sperm resumes.[21] Female-specific side effects include increases in body hair, deepening of the voice, enlarged clitoris, and temporary decreases in menstrual cycles. When taken during pregnancy, anabolic steroids can affect fetal development by causing the development of male features in the female fetus and female features in the male fetus.[22]

A number of severe side effects can occur if adolescents use anabolic steroids. For example, the steroids may prematurely stop the lengthening of bones (premature epiphyseal fusion through increased levels of estrogen metabolites), resulting in stunted growth. Other effects include, but are not limited to, accelerated bone maturation, increased frequency and duration of erections, and premature sexual development. Anabolic steroid use in adolescence is also correlated with poorer attitudes related to health.[23]

Steroid receptor

The human androgen receptor bound to testosterone.[24] The protein is shown as a ribbon diagram in red, green and blue, with the steroid shown in black.

See also

See also


  1. Grace F, Sculthorpe N, Baker J, Davies B (2003). Blood pressure and rate pressure product response in males using high-dose anabolic-androgenic steroids (AAS). J Sci Med Sport 6 (3): 307-12.
  2. Tokar, Steve Liver Damage And Increased Heart Attack Risk Caused By Anabolic Steroid Use. University of California - San Francisco. URL accessed on 2007-04-24.
  3. Barrett-Connor E (1995). Testosterone and risk factors for cardiovascular disease in men. Diabete Metab 21 (3): 156-61.
  4. Bagatell C, Knopp R, Vale W, Rivier J, Bremner W (1992). Physiologic testosterone levels in normal men suppress high-density lipoprotein cholesterol levels. Ann Intern Med 116 (12 Pt 1): 967-73.
  5. Mewis C, Spyridopoulos I, Kühlkamp V, Seipel L (1996). Manifestation of severe coronary heart disease after anabolic drug abuse. Clinical cardiology 19 (2): 153-5.
  6. Hartgens F, Kuipers H (2004). Effects of androgenic-anabolic steroids in athletes. Sports Med 34 (8): 513-54.
  7. Melnik B, Jansen T, Grabbe S (2007). Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 5 (2): 110-7.
  8. De Piccoli B, Giada F, Benettin A, Sartori F, Piccolo E (1991). Anabolic steroid use in body builders: an echocardiographic study of left ventricle morphology and function. Int J Sports Med 12 (4): 408-12.
  9. Sullivan ML, Martinez CM, Gallagher EJ (1999). Atrial fibrillation and anabolic steroids. The Journal of emergency medicine 17 (5): 851-7.
  10. Dickerman RD, Schaller F, McConathy WJ (1998). Left ventricular wall thickening does occur in elite power athletes with or without anabolic steroid Use. Cardiology 90 (2): 145-8.
  11. George KP, Wolfe LA, Burggraf GW (1991). The 'athletic heart syndrome'. A critical review. Sports medicine (Auckland, N.Z.) 11 (5): 300-30.
  12. Dickerman R, Schaller F, Zachariah N, McConathy W (1997). Left ventricular size and function in elite bodybuilders using anabolic steroids. Clin J Sport Med 7 (2): 90-3.
  13. Salke RC, Rowland TW, Burke EJ (1985). Left ventricular size and function in body builders using anabolic steroids. Medicine and science in sports and exercise 17 (6): 701-4.
  14. Yamamoto Y, Moore R, Hess H, Guo G, Gonzalez F, Korach K, Maronpot R, Negishi M (2006). Estrogen receptor alpha mediates 17alpha-ethynylestradiol causing hepatotoxicity. J Biol Chem 281 (24): 16625-31.
  15. Socas L, Zumbado M, Pérez-Luzardo O, et al (2005). Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature. British journal of sports medicine 39 (5): e27.
  16. Velazquez I, Alter BP (2004). Androgens and liver tumors: Fanconi's anemia and non-Fanconi's conditions. Am. J. Hematol. 77 (3): 257-67.
  17. Marcus R, Korenman S. Estrogens and the human male. Annu Rev Med 27: 357-70. PMID 779604.
  18. Hoffman JR, Ratamess NA (June 1, 2006). Medical Issues Associated with Anabolic Steroid Use: Are they Exaggerated?. Journal of Sports Science and Medicine.
  19. Meriggiola M, Costantino A, Bremner W, Morselli-Labate A (2002). Higher testosterone dose impairs sperm suppression induced by a combined androgen-progestin regimen. J. Androl. 23 (5): 684-90.
  20. Matsumoto A (1990). Effects of chronic testosterone administration in normal men: safety and efficacy of high dosage testosterone and parallel dose-dependent suppression of luteinizing hormone, follicle-stimulating hormone, and sperm production. J. Clin. Endocrinol. Metab. 70 (1): 282-7.
  21. Alén M, Reinilä M, Vihko R (1985). Response of serum hormones to androgen administration in power athletes. Medicine and science in sports and exercise 17 (3): 354-9.
  22. Manikkam M, Crespi E, Doop D, et al (2004). Fetal programming: prenatal testosterone excess leads to fetal growth retardation and postnatal catch-up growth in sheep. Endocrinology 145 (2): 790-8.
  23. Irving L, Wall M, Neumark-Sztainer D, Story M (2002). Steroid use among adolescents: findings from Project EAT. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 30 (4): 243-52.
  24. Pereira de Jésus-Tran K, Côté PL, Cantin L, Blanchet J, Labrie F, Breton R (2006). Comparison of crystal structures of human androgen receptor ligand-binding domain complexed with various agonists reveals molecular determinants responsible for binding affinity. Protein Sci. 15 (5): 987-99.

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