Steroids Information

Minimization of steroid side effects

Further information: Steroid cycle, Post-cycle therapy
Typically, bodybuilders, athletes and sportsmen who use anabolic steroids try to minimize the negative side effects. For example, users may increase their amount of cardiovascular exercise to help negate the effects of left ventricle hypertrophy.[26] Some androgens will aromatise and convert to estrogen, potentially causing some combination of the side effects listed above. During a steroid cycle users tend to take an aromatase inhibitor and/or a SERM; these drugs affect aromatisation and estrogen receptor binding respectively. The SERM tamoxifen, is of particular interest as it prevents binding to the estrogen receptor in the breast, reducing the risk of gynecomastia.[27]

Furthermore, to combat the natural testosterone suppression and to restore proper HPTA function, what is known as ‘post-cycle therapy’ (PCT) is self prescribed. PCT takes place after the course of anabolic steroids. It typically consists of a combination of the following drugs, depending on which protocol is used:

A SERM such as clomiphene citrate and/or tamoxifen citrate (this is the primary PCT drug).[28]
An aromatase inhibitor such as anastrozole.[29]
Human chorionic gonadotropin, hCG (this has become less common as it is now more often used throughout the cycle rather than after).
The aim of PCT is to return the body’s endogenous hormonal balance to its original state within the shortest space of time. People prone to premature hair loss that can be exacerbated by steroid use, have been known to take the prescription drug finasteride for prolonged periods of time. Finasteride reduces the conversion of testosterone to DHT, the latter having much higher potency for alopecia. Finasteride is useless in the cases when steroid is not converted into a more androgenic derivative.[30] Since anabolic steroids can be toxic to the liver or can cause increases in blood pressure or cholesterol, many users consider it ideal to get frequent blood work tests and blood pressure tests to make sure their blood pressure or cholesterol are still within normal levels. Since anabolic steroids can increase cholesterol they increase the risk for heart attack in users.

^ Kokkinos, Peter F.; Puneet Narayan, M.D., John A. Colleran, D.O., Andreas Pittaras, M.D., Aldo Notargiacomo, B.S., Domenic Reda, M.S., and Vasilios Papademetriou, M.D. (1995). “Effects of Regular Exercise on Blood Pressure and Left Ventricular Hypertrophy in African-American Men with Severe Hypertension”. New England Journal of Medicine 333: 1462-1467. Retrieved on 2006-11-24. 
^ Medras, M; Tworowska U (2001). “[Treatment strategies of withdrawal from long-term use of anabolic-androgenic steroids]” 11 (66): 535-538. PMID 11899857. Retrieved on 2006-11-24. 
^ Dony, JM; Smals AG, Rolland R, Fauser BC, Thomas CM. (1985 Jul-Aug). “Effect of lower versus higher doses of tamoxifen on pituitary-gonadal function and sperm indices in oligozoospermic men.”. Andrologia. 17 (4): 369-78. PMID 3931502. Retrieved on 2007-02-04. 
^ Plourde, Paul V.; Edward O. Reiter, Hann-Chang Jou, Paul E. Desrochers, Stephen D. Rubin, Barry B. Bercu, Frank B. Diamond, Jr. and Philippe F. Backeljauw Members of the AstraZeneca Gynecomastia Study (2004). “Safety and Efficacy of Anastrozole for the Treatment of Pubertal Gynecomastia: A Randomized, Double-Blind, Placebo-Controlled Trial”. The Journal of Clinical Endocrinology & Metabolism 89 (9): 4428-4433. PMID 15356042. Retrieved on 2007-02-04. 

Possible unwanted side effects of steroids
Anabolic steroids can cause many unwanted side effects. Most of the side effects are dose dependent and are caused by the chemical reactions of the hormones such as androgens metabolizing into other hormones which can interact with steroid receptors in including the estrogen, progesterone, and glucocorticoid receptors, producing additional (usually) unwanted effects. The most common side effects are elevated blood pressure especially in hypertensives,[12] Increases in cholesterol levels due to the fact that some steroids can cause an increase in LDL and decreased HDL levels.[13] This drug can also cause an increase in risk of cardiovascular disease[14] or coronary artery disease[15] in men with high risk of bad cholesterol. Acne is fairly common among anabolic steroid users, mostly due to the increases in testosterone which can cause stimulation of the sebaceous gland.[16][17] Testosterones conversion to DHT (Dihydrotestosterone) can accelerate the rate of premature baldness for who are genetically predisposed. Other side effects can include altered left ventricle Morphology; Steroids can induce an unfavorable enlargement and thickening of the left ventricle, which loses its diastolic properties with the mass increase.[18] However the negative relation of left ventricle morphology to decreased cardiac function has been disputed.[19] Also hepatotoxicity which can be caused by particularly by high doses of oral anabolic steroid compounds that are 17-alpha-alkylated to increase their bioavailability and stability in the digestive system.[20]

There are also side effects that are particular to sex and can include development of breast tissue in males, a condition called gynecomastia. This is usually caused by high levels of circulating estrogen; the result of the increased conversion of testosterone to estrogen via an aromatase enzyme.[21] Reduced sexual function and temporary infertility can also occur in males.[22][23][24] Another male specific steroid side effect which can occur is testicular atrophy which is a temporary side effect that is due to decreases in natural testosterone levels inhibiting spermatogenesis. As most of the mass of the testes is developing sperm, the size of the testicles usually returns to normal within a few weeks of discontinuing anabolic steroid use when spermatogenesis resumes.[25] Female specific side effects that can occur include increases in body hair, deepening of the voice, enlarged clitoris (clitoral hypertrophy), as well as temporary decreases in menstrual cycles. A number of severe side effects can occur if adolescents use anabolic steroids which include but are not limited to stunted growth; Abuse of the agents may prematurely stop the lengthening of bones (premature epiphyseal fusion through increased levels of estrogen metabolites), accelerated bone maturation, increased frequency and duration of erections, precocious sexual development and development of extreme secondary sexual characteristics (hypervirilization), Phallic enlargement (hypergonadism or megalophallus) as well as increases in body hair.

Anabolic androgenic steroids produce anabolic and virilizing (also known as androgenic) effects. Most anabolic steroids work in two simultaneous ways. First, they work by binding to the androgen receptor and increasing protein synthesis. Second, they also reduce recovery time by blocking the effects of the stress hormone, cortisol, on muscle tissue. As a result, catabolism of the body’s muscle mass is greatly reduced. Some examples of the anabolic effects of these hormones include increased protein synthesis from amino acids, increased muscle mass and strength,[10][11][3] increased appetite, increased bone remodeling and growth, as well as stimulation of bone marrow increasing production of red blood cells. Some examples of the virilizing/androgenic effects include growth of the clitoris (clitoral hypertrophy) in females and the penis in male children (the adult penis does not grow indefinitely even when exposed to high doses of androgens), increased growth of androgen-sensitive hair (pubic, beard, chest, and limb hair), increased vocal cord size, deepening the voice, increased libido, suppression of endogenous sex hormones, as well as impaired spermatogenesis.