Side Effects of Anabolic Steroids

As we all know, to make a significant change in your physique and muscles it takes a lot of efforts in terms of nutrition and exercise. But for few anabolic steroids offer shortcut. They help gain muscles in short term but such unregulated and illegal use of anabolic steroids can lead to serious side effects.

1. What are Anabolic Steroids?

Anabolic steroids are group of hormones that involve testosterone as well as synthetic derivatives of testosterone (1). Testosterone is a male sex hormone secreted by testicles. It plays a significant role in the development of secondary male sexual characteristics and normal growth.

Since testosterone is quickly metabolized in the body. So, various synthetic derivatives of testosterone with a longer half-life are used to mimic its effects.

Some of the popular Anabolic Steroids are Nandrolone, Oxandrolone, Oxymetholone, and Stanozolol, etc.

Anabolic steroids are commonly known as Androgenic Anabolic Steroids (AAS). Androgenic means involved in development of sexual characteristics and anabolic means involved in tissue growth (2).

Since the separation of both of the properties of steroids hasn’t been possible so far, they are known as Androgenic anabolic steroids. Thus when consumed steroids affect both sexual characteristics and tissue growth (2)

After administration into the body anabolic steroids bind to specific receptors, become active and exert their function.

Steroids under medical supervision are used to treat various conditions such as anemia, breast cancer, malnutrition, HIV, Inflammation and testosterone deficiency.

Anabolic steroids are also abused by people to gain muscles, strength, and stamina. To achieve these effects dosage 10 to 100 times of normal are taken which leads to serious side effects (3).

There are also cases where steroids are fed to livestock to increase muscle mass and to racehorses to increase stamina and strength.

2. Legal Status of Steroids

Steroids are legal to use when taken under medical supervision and prescribed by a medical practitioner to treat a medical conditions.

Steroid use is illegal when administered or purchased without a prescription.

The use of anabolic steroids to improve physical performance, gain muscles, stamina is banned in many countries.

The national anti-doping agency in India has banned the use of such substances and can lead to disqualification of the athlete from competition and ban from participating in any future competition (4) (5).

But, nowadays even fitness enthusiasts or gym-goers who are not participating in any competition are also abusing these steroids. The illegal use of steroids has now gripped the younger and unaware generation too.

People who seek social validation, likes on social media, want to have a better physique are falling easily for these shortcuts.

In many cases, people who are consuming these steroids are not even aware of their actual nature and their side effects.

3. Types of Anabolic Steroids

Anabolic steroids are majorly available in the form of injections, oral or creams. I will refrain from citing examples of these steroids.

4. How do Anabolic Steroids work?

The simple mechanism of action of Anabolic steroid is as follows-

Anabolic steroids work by increasing muscle protein synthesis, inhibiting protein breakdown, and increasing lean muscle mass and, body mass. Steroids increase the release of growth hormones, increase performance and recovery by decreasing protein breakdown (1) (6). They act as a natural male hormone but are taken at almost 100 times more concentration. This huge concentration possibly speeds up the normal muscle-building process.

At the cellular level it works as follows-

Anabolic steroids are carried to the cytoplasm of the target tissue and bind to the androgenic receptor. The androgenic receptor then carries it to the cell nucleus. In the nucleus, steroid binds to a specific sequence of chromosomal DNA. Upon which it stimulates mRNA to synthesize genes that increase protein synthesis (6).

Anabolic steroids also increase the uptake of amino acids from the blood, stimulate the formation of new muscle fibers resulting in increased muscle mass and strength (1) (17).

Anabolic steroids also interfere with glucocorticoid receptors thus inhibiting protein breakdown (7).

Illegal administration of anabolic steroids is similar to making illegal modifications to a car. It may increase the performance of a single aspect, but damages the overall vehicle and the experience.

The above modification surely increased the length of the vehicle but at the same time affected handling, stability, mileage, and safety.

5. Side effects of Anabolic steroids

A picture is worth a thousand words (1), I am sure after looking at the long list of side effects of anabolic steroids you will want to stay away from them.

*supraphysiological dosage: dosage higher than normal.

Although the diagram suggests positive effects of anabolic steroids at normal dosage, we must keep in mind that steroids are administered at higher dosage by abusers.

As the picture states anabolic steroids have very few positive effects but a long list of side effects of anabolic steroids on both males and females, their various systems, and organs.

The common and self-reported side effects of anabolic steroids include an increase in the sex drive, acne, increased body hair, aggressive behavior (6).

While the other common side effects included fluid retention, increased blood pressure, lack of sleep, increased irritability, increased appetite, a state of feeling of well-being, depression, loss of head hair, and gynecomastia.

These side effects are reported by male subjects participating in AAS abuse studies.

Other side effects include (8) (9)

Mental side effects:

1. Jealousy
2. Irritability
3. Delusion
4. Impaired judgment
5. Mania

Long term side effects:

1. Kidney failure
2. Liver damage
3. Risk of heart failure
4. Increased risk of blood clots

Side effects in Men:

1. Shrinking of testicles
2. Decreased sperm count
3. Loss of head hair
4. Gynecomastia (development of breasts)
5. Prostate cancer

Side effects in women:

1. Growth of facial hair
2. Decreased breast size
3. Changes in the menstrual cycle
4. Enlarged clitoris
5. Deepening of voice

In teens:

1. Underdeveloped growth
2. Underdeveloped height

• • Effects of Anabolic Steroids on Reproductive system:

Anabolic hormones being derivatives of the male sex hormone testosterone exert significant action on the reproductive system.

The external administration of anabolic hormones disturbs the body’s feedback mechanism affecting the normal production of testosterone in the body.

Anabolic hormones suppress the hormones testosterone and gonadotropins, hormones that play important role in sexual functions. Suppression of gonadotropins results in the shrinking of testicles and a decrease in semen production and quality (6).

Reports suggest that the administration of a higher dosage of steroids, as seen in athletes can lead to infertility within months.

Studies show that after discontinuation of steroid use it takes about 4-6 months for the reproductive system to restore to normal. Some reports suggest that it may even take more than a year. Although the recovery period can vary depending on the dosage taken and duration of abuse.

Administration of a high amount of steroids leads to conversion of AAS to estrogen. Estrogen is a sex hormone that plays important part in development and maintenance of female characteristics and reproductive system. This conversion from AAS to estrogen in male athletes causes gynecomastia, which is often accompanied by pain (7).

• • Effects of Anabolic Steroids on the heart:

External administration of anabolic steroids in higher doses can cause various defects in the heart (6).

It has been suggested that prolonged use of anabolic steroids can lead to significant changes in heart structure and function. Studies performed in steroid users showed structural changes in various sections of the heart as compared to non-users (6).

Animal studies clearly show that even short-term usage of steroids affects cardiac function and structure.

• • Effects of Anabolic Steroids on the liver:

Sever abuse of Anabolic steroids can lead to liver damage and toxicity. This liver toxicity is caused by AAS induced oxidative stress (10).

The extent of liver damage largely depends on the administered dosage and strength of steroids used (12).

A study 5 week study performed in rats showed that upon administration of AAS the markers of liver necrosis in the blood increased. Meaning just 5-week use of steroids in rats led to the death of liver cells.

The most reported effects of steroid administration are the formation of cysts and blood-filled cavities in the liver (13). Another common side effect of steroid administration on the liver is decreased bile flow. The decreased bile flow to the liver can cause retention of substances in the body which are generally excreted in the form of bile (13).

Bilirubin, Cholesterol, amino acids, steroids, enzymes, heavy metals, externally administered drugs and harmful lipophilic substances are excreted through bile.

The above effects were observed when steroids were administered in higher dosage.

• • Effects of Anabolic Steroids on Kidneys and urinary system:

Prolonged administration of steroids has direct toxic effects on the urinary system including changes in kidney structure. Steroids directly affect the glomerular cells, the cells which carry out blood filtration (14).

Animal studies show that only three months of steroid administration led to structural changes in the kidney (15).

The administration of steroids also increases oxidative stress in kidneys due to decreased anti-oxidative enzyme activity (14). The increased oxidative stress in kidneys can lead to glomerular cell damage.

The extensive damage to the glomerular cells can ultimately lead to kidney failure.

Besides this, anabolic steroids also show various withdrawal symptoms (6). It is reported that as soon as the use of steroids is stopped the subjects start losing muscle mass and physique gained due to the use of steroids (16). The fear of losing gains and desire to maintain physique leads to the continual use of anabolic steroids and further increases the risk of long-term side effects.

Conclusion

The use of anabolic steroids for muscle gain, to improve performance and strength is illegal. The use of a steroid for this purpose requires using a much higher dose than normal levels. The use of steroids at higher dosage leads to serious side effects on mental health, various organs, body systems, and even untimely death.

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