The actions and side effects of Anabolic Steroids in sport and social abuse

Anabol ic steroids (AS) derived from testosterone have both anabolic (muscle and strength enhanc ing) and androgen ic (pr imary and secondary sexual) effects. Efforts to limit the androgenic while enhancing the anabolic effects have not been successful. Alterations to the structure of testosterone, so as to improve the pharmacokinetics of AS, have resul ted in drugs, which are oral ly active, have a longer plasma half life and may be administered as depot injections. Therapeutic doses of AS produce statistically significant effects on strength and athletic performance in well-controlled scientific and clinical trials. At low, therapeutic doses, diet and an intensive training regime are equally important in producing a statistically significant increase in strength. Higher doses 6-7000mg per week are regular ly administered in spor t and produce the greatest increases in muscle strength erythropoiesis and lean body mass. Patterns of steroid abuse can be complex, reflecting a desire to minimise side effects, and avoid detection. AS side effects are of many types. AS increase sal t and water retent ion leading to an expans ion of the blood volume, but effects of steroids on blood pressure are equivocal and most cardiovascular side effects appear to be reversible. Abuse of AS causes an increase in blood triglyceride and cholesterol levels and this is associated with a decline in High Density Lipoproteins (HDLs) and an increase in the Low Densi ty (LDL) type. Though these effects are reversible they are associated with an increased r isk of both acute and c h r o n i c c a r d i o v a s c u l a r pa tho l ogy . The mos t ser ious irreversible anabolic steroid side effects are associated with carc inomas mainly of the liver, prostate and kidney. Hepatic carcinomas are strongly associated with abuse of the orally active 17alpha methyl subst i tuted steroids, which also produce a reversible jaundice. In males, anabolic steroid abuse causes suppression of LH and FSH release leading to inhibit ion of testosterone production often accompanied by testicular atrophy, and azoospermia. High, chronic doses of the drugs may also cause moderate to severe feminis ing effects in the form of gynaecomastia. Male secondary sexual characteristics are a side effect of AS abuse in women. Increased insulin resistance and elevated fasting blood glucose levels are the commonest non-gonadal endocrine side effects of AS. AS abuse leads to contradictory, complex, behavioural, and psychiatr ic changes. Increased frequency of mental illness, in anabolic steroid abusers including paranoid schizophrenia, mania and d e p r e s s i o n has been repo r ted . Phys i ca l and psychological dependency occur amongst some anabolic steroid abusers and severe psychiatr ic disorders can appear upon withdrawal, leading in a few cases to criminality and even suicide. We need more studies on the long-term effects of AS. The implications of the past 50 years of AS abuse will be discussed in the review.