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Anabolic steroids are often used to increase physical performance and muscle growth. When used inappropriately, for long periods at high dosages and without medical supervision, they can lead to unstable and irrational behavior and a wide range of physical side effects.

Anabolic steroids include testosterone and any drugs chemically and pharmacologically associated with testosterone that promote muscle growth; There are numerous drugs of this kind. Anabolic steroids are used in clinical practice with hypogonadism to treat men with low testosterone levels . In addition, since anabolic steroids are anti-catabolic and improve protein utilization, they are sometimes prescribed to burn patients bedridden or debilitated patients to prevent muscle wasting.

Some doctors prescribe anabolic steroids to patients who are AIDS depleted or have cancer. However, there is little data to recommend such therapy, and few guidelines on how additional androgens can affect the development of underlying diseases. Testosterone has earned a reputation for its benefits in healing wounds and damaged muscles, although there is little evidence to support these claims.

Anabolic steroids are sold in UK illegally to increase muscle mass and strength; resistance training and a certain diet can enhance these effects. There is no direct evidence that anabolic steroids increase stamina or speed, but substantial indirect evidence suggests that athletes taking them can perform high-intensity workouts more often. Muscle hypertrophy is unambiguous.

Estimates of the intravital morbidity from abuse of anabolic steroids range from 0.5 to 5% of the population, but the subpopulations vary significantly (for example, higher rates in bodybuilders and professional athletes). In the United States, the announced application rate is between 6 and 11% among high school students, including an unexpected number of non-athletes, and about 2.5% among high school students.

Pathophysiology

Anabolic steroids have androgenic effects (e.g., changes in hair or libido, aggressiveness) and anabolic effects (e.g., increased protein intake, increased muscle mass). Androgenic effects cannot be separated from anabolic, but some anabolic steroids have been synthesized in order to minimize androgenic effects.

Testosterone is rapidly degraded in the liver; oral testosterone is inactivated too quickly to be effective, and injectable testosterone must be altered (for example, by esterification) to slow absorption or stop cleavage. Analogs modified by 17-alpha-alkylation are often effective when taken orally, but side effects may increase. Transdermal drugs are also available.

Chronic effects

Side effects vary significantly depending on the dosage and preparation. Some adverse effects are observed at dosages of physiological substitution (for example, methyltestosterone from 10 to 50 mg / day or its equivalent). Athletes can apply dosages in this range 10-50 times. At high dosages, some effects are clearly manifested, others are ambiguous (see Adverse effects of anabolic steroids ).

Uncertainty exists because most studies include drug addicts who are unable to indicate the exact dosage and use the black market for drugs, many of which are counterfeit and contain (despite labeling) different dosages and substances.

Athletes take steroids for a certain period, stop taking them, and then resume (cycling) several times a year. Periodic discontinuation of drugs is believed to normalize endogenous testosterone levels , sperm count and hypothalamic-pituitary-gonadal axis. A popular opinion shows that cycling can reduce the harmful effects and the need to increase the dose of the drug to achieve the desired effect.

Athletes often use many drugs at the same time (in practice, it is called “styling”) and alternative routes of administration (inside, IM or transdermal). Increasing the dose through the cycle (“pyramid”) can lead to dosages 5-100 times higher than physiological doses. “Laying” and “pyramids” aim to increase receptor binding to minimize adverse effects, but these benefits have not been proven.

Clinical manifestations

The most characteristic feature is a rapid increase in muscle mass. The rate and degree of increase are directly related to the doses taken. In patients taking physiological doses, growth is slow and often imperceptible; those taking huge doses can increase muscle mass by several pounds per month. It is difficult to identify an increase in energy consumption levels and the level of libido (in men).

Family members often observe psychological effects (usually only at very high doses):

• Wide and erratic mood swings
• Irrational behavior
• Increased Aggression (“Rage Steroid”)
• Irritability
• Increased libido
• Depression

Enhanced acne is common in both sexes; there is an increase, and less often a decrease in libido; aggressiveness and appetite may increase. In men, gynecomastia, testicular atrophy, and decreased fertility may occur. Virilizing effects are common among women (e.g., alopecia, clitoral enlargement, hirsutism, deepening of the voice). In addition, breast size may decrease; The vaginal mucosa may atrophy and menstruation may change or stop. Virilization and gynecomastia can become irreversible.

Diagnostics

• Urinalysis

Users of anabolic steroids are usually identified using a urinalysis. Metabolites of anabolic steroids can be detected in urine for up to 6 months. (even longer for some types of anabolic steroids) after taking the drugs.

Exogenously taken testosterone is indistinguishable from endogenous testosterone . However, when high testosterone levels are detected, the ratio between testosterone and epitestosterone (an endogenous steroid that is chemically nearly identical to testosterone ) is measured. Normal ratio < 6: 1; during the use of exogenous testosterone, the ratio becomes higher.

Treatment

• Cessation of use

The main treatment is discontinuation. Although physical dependence is not observed, psychological dependence may exist, especially among competing bodybuilders. Gynecomastia may require surgical reduction.

Prevention

Doctors dealing with adolescents and young people should be alert to signs of steroid abuse and educate patients about their risks. Anabolic steroid management training should begin at the beginning of high school. Programs that teach alternative, healthy ways to increase muscle size and increase productivity through proper nutrition and strength training can help. An explanation of both the risks and the benefits of using anabolic steroids seems to be a more effective way of informing adolescents about the negative effects of illicit steroid use.