Steroids Information

Studies have shown anabolic steroid users tend to be mostly middle class heterosexual men with a median age of 27. Most users do not compete in any sports. Anabolic steroid users often are stereotyped as uneducated or ‘muscle heads’ by popular media and culture however studies on steroid users have shown them to be the most educated drug users out of all users of controlled drugs.[37] Anabolic steroid users also tend to research the drugs they are taking more than any other group of users of controlled substances. Moreover anabolic steroid users tend to be disillusioned by the portrayal of anabolic steroids as “deadly” in the media and in politics.[38]

Anabolic steroids have been used by men and women in many different kinds of professional sports (cricket, track and field, weightlifting, bodybuilding, shot put, cycling, baseball, wrestling, mixed martial arts, boxing, football, etc.) to attain a competitive edge or to assist in recovery from injury. Steroids used to obtain competitive advantage are prohibited by the rules of the governing bodies of many sports.

Anabolic steroid use also seems to occur among adolescents especially by those in sports. It has been suggested that the prevalence of use among High school students in the United States may be as high as 2.7%.[39] Male students used more than female students and those who participated in sports used more often than those who did not on average.

It is extremely difficult to determine what percent of the population in general have actually used anabolic steroids, but the number seems to be fairly low. The demographics of steroid users tend to be mostly males between the ages 15-25 and noncompetitive bodybuilders and non-athletes who use for cosmetic reasons.[40]
^ Eastley, Tony (Jan 18 2006). Steroid study debunks user stereotypes. abc.net.au. Retrieved on February 24, 2007.
^ Tanner, SM; Miller DW, Alongi C (1995). “Anabolic steroid use by adolescents: prevalence, motives, and knowledge of risks.”. Clin J Sport Med. 5 (2): 108-115. PMID 2199753. Retrieved on 2006-11-24. 
^ Andrew, Parkinson; Nick A. Evans (2006). “Anabolic Androgenic Steroids: A Survey of 500 Users”. Medicine & Science in Sports & Exercise 38 (4): 644-651. Retrieved on 2006-11-24.

Medical uses of Steroids
 
Various anabolic steroids and related compounds.Anabolic steroids were tried by physicians for many purposes from the discovery of synthetic testosterone in the 1930s to the 1950s with varying success. One of the initial medical uses of steroids was treatment of chronic wasting, such as was experienced by Nazi concentration camp prisoners and prisoners of war. During World War II, German scientists worked on synthesizing other anabolic steroids, and ran experiments on human prisoners, as well as with their own soldiers. They had hoped to increase the aggressive tendencies of their troops. Adolf Hitler’s own physician reported that Hitler had been given testosterone derivative injections to treat various ailments.[31]

Bone marrow stimulation: For decades, anabolic steroids were the mainstay of therapy for hypoplastic anemias not due to nutrient deficiency, especially aplastic anemia. Anabolic steroids are slowly being replaced by synthetic protein hormones (such as epoetin alfa) that selectively stimulate growth of blood cell precursors.
Growth stimulation: Anabolic steroids were used heavily by pediatric endocrinologists for children with growth failure from the 1960s through the 1980s. Availability of synthetic growth hormone and increasing social stigmatization of anabolic steroids led to discontinuation of this use.
Stimulation of appetite and preservation and increase of muscle mass: Anabolic steroids have been given to people with chronic wasting conditions such as cancer and AIDS.[32][33]
Induction of male puberty: Androgens are given to many boys distressed about extreme delay of puberty. Testosterone is now nearly the only androgen used for this purpose but synthetic anabolic steroids were often used prior to the 1980s.
Testosterone enanthate may prove to be a useful, safe, reversible, effective method of male hormonal contraception in the near future.[34][35]
Used for age related problems in elderly people. Anabolic steroids have been shown to help in many age related problems in the elderly.[36]
Used in hormone replacement therapy for men with low levels of testosterone. (see hypogonadism)
Used for gender dysmorphia: whereby secondary male characteristics (puberty) are initiated in female-to-male diagnosed patients. Most commonly used testosterone derivatives are Sustanon and Testosterone Enanthate which cause the voice to deepen, increased bone and muscle mass, facial hair, increased levels of red blood cells and clitoral enlargement.

^ Grunfeld, C; Kotler DP, Dobs A, Glesby M, Bhasin S (2006 March). Oxandrolone in the treatment of HIV-associated weight loss in men: a randomized, double-blind, placebo-controlled study.. J Acquir Immune Defic Syndr.
^ Berger, JR; Pall L, Hall CD, Simpson DM, Berry PS, Dudley R. (1996 December). Oxandrolone in AIDS-wasting myopathy.. AIDS.
^ Matsumoto, AM (1990 Jan). “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. 1 (70): 282-7. PMID 2104626. Retrieved on 2007-02-05. 
^ Aribarg, A; Sukcharoen N, Chanprasit Y, Ngeamvijawat J, Kriangsinyos R. (1996 Oct). “Suppression of spermatogenesis by testosterone enanthate in Thai men.”. J Med Assoc Thai. 10 (79): 624-9.. PMID 8996996. Retrieved on 2007-02-05. 

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.

Anabolic steroids are androgenic and therefore produce androgenic effects in the body. Androgens stimulate myogenesis which is the formation of muscular tissue. Androgens are known to cause hypertrophy of both types (I and II) of muscle fibers however the mechanism of this is not completely understood and there are a few accepted mechanisms through which this may occur. It’s widely understood that supraphysiological doses of testosterone in non-hypogonadal men promotes nitrogen density and increases fat free mass (muscle mass) while at the same time decreasing fat, particularly abdominal fat. The increase in muscle mass is mostly skeletal muscle increases and are likely caused by an increase in the synthesis of muscle proteins or possibly a decline in the breakdown in muscle proteins.[6] It has also been hypothesized[7] that androgens regulate body composition by promoting the commitment of mesenchymal pluripotent cells into myogenic lineages and inhibiting their differentiation into adipogenic lineages. However, androgens may also play an anticatabolic role in inhibiting skeletal muscle atrophy through antiglucocorticoid action independent of the androgen receptor.[8]

The mechanisms of action differ depending on the specific anabolic steroid. Different types of anabolic steroids bind to the androgen receptor to varying degrees depending on their chemical structure. Anabolic steroids such as methandrostenolone do not bind strongly to the androgen receptor and instead directly affect protein synthesis or glycogenolysis: while steroids such as oxandrolone bind tightly to the androgen receptor and act mostly on transcription.

- Brodsky, IG; P Balagopal and KS Nair (1996). Effects of testosterone replacement on muscle mass and muscle protein synthesis in hypogonadal men–a clinical research center study. Journal of Clinical Endocrinology & Metabolism, Vol 81, 3469-3475.
- Singh, Rajan; Jorge N. Artaza, Wayne E. Taylor, Nestor F. Gonzalez-Cadavid and Shalender Bhasin (2003 Nov). “Androgens Stimulate Myogenic Differentiation and Inhibit Adipogenesis in C3H 10T1/2 Pluripotent Cells through an Androgen Receptor-Mediated Pathway.”. Endocrinology. 11 (144): 5081-8. DOI:10.1210/en.2003-0741. PMID 12960001. Retrieved on 2007-02-07. 
- Hickson, RC; Czerwinski SM, Falduto MT, Young AP. (1990 June). “Glucocorticoid antagonism by exercise and androgenic-anabolic steroids.”. Med Sci Sports Exerc. 22 (3): 331-340. PMID 2199753. Retrieved on 2006-11-24. 

History of Anabolic Steroids

Further information: War on Drugs, Controlled Substances Act
Comments on professional athletes in ancient Greece suggest that a wide variety of natural steroidal substances were used to promote androgenic and anabolic growth. These may have ranged from testicular extracts to plant materials. Traditional medicine in general, in the West as well as in contemporary Asian medicine, has a wide pharmacopeia of substances intended to promote virility and masculine traits, though not entirely oriented towards muscle growth and athletic ability so much as sexual performance. In Chinese traditional medicine substances such as deer antler, tiger bone, bear gall bladder, ginseng and other roots and much more were all primarily consumed and were thought to bolster the male organism, though there is no scientific evidence such potions have any effect.

Modern pharmaceutical anabolic steroids are believed to have been inadvertently discovered by German scientists in the early 1930s, but at the time the discovery was not considered significant enough to warrant further study. The first known reference to an anabolic steroid in a US weightlifting/bodybuilding magazine is testosterone propionate in a letter to the editor in Strength and Health magazine in 1938. In the 1950s, scientific interest was rekindled, and methandrostenolone (Dianabol) was approved for use in the United States by the federal Food and Drug Administration in 1958 after promising trials had been conducted in other countries.

Throughout the ’50s, ’60s, ’70s and even ’80s there was doubt that anabolic steroids were anything more than a placebo effect. In a 1972 study,[1] participants were informed they would receive injections of anabolic steroids on a daily basis, but instead had actually been given placebo. They reportedly could not tell the difference, and the perceived performance enhancement was similar to that of subjects taking the real anabolic compounds. This study had many flaws including inconsistent controls and insignificant doses. According to Geraline Lin, a researcher for the National Institute on Drug Abuse, at the time of the books’ publishing in 1996, the results of the study remained unchallenged for 18 years.[2] In the 1996 study mentioned above which was founded by the NIH it examined the effect of high doses of testosterone enanthate (600 mg/week intramuscularly for 10 weeks). The results showed a clear increase in muscle mass and decrease in fat mass in those who took the testosterone opposed to the placebo. No adverse reactions were noted.[3]

In the late 1980s the U.S. Congress had been considering placing anabolic steroids under the controlled substance act due to recent controversy over Ben Johnson’s victory at the 1988 summer Olympics in Seoul. During deliberations the AMA, DEA, FDA as well as the NIDA all opposed listing anabolic steroids as controlled substances citing the fact that use of these hormones simply doesn’t lead to the physical or psychological dependence required for scheduling under the Controlled substance act. However the U.S. Congress in the Anabolic Steroid Control Act of 1990 placed anabolic steroids into Schedule III of the Controlled substance act (CSA). The CSA defines anabolic steroids as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promotes muscle growth. By the early 1990s after anabolic steroids were scheduled in the United States several pharmaceutical companies stopped manufacturing or marketing the products in the United States, including Ciba, Searle, Syntex and others.

In addition, an entire market for counterfeit drugs emerged at this time. Never seen in the previous 30 years of their availability on the U.S. market, computers and scanning technology made the ease of counterfeiting legitimate products by utilizing their original label design, and the market was flooded with products that contained everything from mere vegetable oil to toxic substances which unsuspecting users injected into themselves, of which some died as a result of blood poisoning, methanol poisoning or subcutaneous abscess.

On January 20, 2005, the Anabolic Steroid Control Act of 2004 took effect, amending the Controlled Substance Act to place both anabolic steroids and prohormones on a list of controlled substances, making possession of the banned substances without a prescription a federal crime.[4]

References
- Medicine and Science in Sports, Anabolic steroids: the physiological effects of placebos. (Ariel & Saville, 1972). 
- Lin, Geraline (1996). Anabolic Steroid Abuse ISBN 0-7881-2969-4 
- a b Bhasin, S; Woodhouse L, Casaburi R, Singh AB, Bhasin D, Berman N, Chen X, Yarasheski KE, Magliano L, Dzekov C, Dzekov J, Bross R, Phillips J, Sinha-Hikim I, Shen R, Storer TW (2001 Dec). “Testosterone dose-response relationships in healthy young men.”. Am J Physiol Endocrinol Metab 6 (281): E1172-81. PMID 11701431. Retrieved on 2007-02-07.  
- News from DEA, Congressional Testimony, 03/16/04. Retrieved on 2006-10-05.

Anabolic androgenic steroids are a class of natural and synthetic steroid hormones that promote cell growth and division, resulting in growth of several types of tissues, especially muscle and bone. Different anabolic androgenic steroids have varying combinations of androgenic and anabolic properties, and are often referred to in medical texts as AAS (anabolic/androgenic steroids). Anabolism is the metabolic process that builds larger molecules from smaller ones.

Anabolic steroids were first discovered in the early 1930s and have since been used for numerous medical purposes including stimulation of bone growth, appetite, puberty, and muscle growth. The most widespread use of anabolic steroids is their use for chronic wasting conditions, such as cancer and AIDS. Anabolic steroids can produce numerous physiological effects including increases in protein synthesis, muscle mass, strength, appetite and bone growth. Anabolic steroids have also been associated with numerous side effects when administered in excessive doses and these include elevated cholesterol (increase in LDL, decreased HDL levels), acne, elevated blood pressure, hepatotoxicity, and alterations in left ventricle morphology.

Today anabolic steroids are controversial because of their widespread use in competitive sports and their associated side effects. While there are numerous health issues associated with excessive anabolic steroid use, public understanding of the true risks remains limited. Anabolic steroids are controlled in a few countries including the United States, where they are listed as Schedule III in the Controlled Substances Act, as well as Canada and Britain who also have laws controlling their use and distribution.

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