Steroid Side Effects

 
 

The action of testosterone can be both beneficial and detrimental to the body. On the plus side, this hormone has a direct impact on the growth of muscle tissues, the production of red blood cells and overall well being of the organism. But it may also negatively effect (among other things) the production of skin oils, growth of body, facial and scalp hair, and the level of both "good" and "bad" cholesterol in the body. In fact, men have a shorter average life span than women, which is believed to be largely due to the cardiovascular defects that this hormone may help bring about. Testosterone will also naturally convert to estrogen in the male body, a hormone with its own unique set of effects. As we have discussed earlier, raising the level of estrogen in men can increase the tendency to notice water retention, fat accumulation, and the development of female tissues in the breast (gynecomastia). Clearly we see that most of the "bad" side effects from steroids are simply those actions of testosterone that we are not looking for when taking a steroid. Raising the level of testosterone in the body will simply enhance both its good and bad properties, but for the most part we are not having "toxic" reactions to these drugs. A notable exception to this is the possibility of liver damage, which is a worry isolated to the use of c17-alpha alkylated oral steroids. Unless the athlete is taking anabolic/androgenic steroids abusively for a very long duration, side effects rarely amount to little more than a nuisance.

One could make a case that periodic steroid use might even be a healthy practice. Clearly a person's physical shape can relate closely to one's overall health and well being. Provided some common sense is paid to health checkups, drug choice, dosage and off-time, how can we say for certain that the user is worse off for doing so? This position is, of course, very difficult to publicly justify with steroid use being so deeply stigmatized. Since this can be a very lengthy discussion, I will save the full health, moral and legal arguments for another time. For now I would like to run down the list of popularly discussed side effects, and include any current treatment/avoidance advice where possible.


 
 


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Steroid information and Reseach

 
         
 

Acne
Rampant acne is one of the more obvious indicators of steroid use. As you know, teenage boys generally endure periods of irritating acne as their testosterone levels begin to peak, but this generally subsides with age. But when taking anabolic/androgenic steroids, an adult will commonly be confronted with this same problem. This is because the sebaceous glands, which secrete oils in the skin, are stimulated by androgens. Increasing the level of such hormones in the skin may therefore enhance the output of oils, often causing acne to develop on the back, shoulders, and face. The use of strongly androgenic steroids in particular can be very troublesome, in some instances resulting in very unsightly blemishes all over the skin. To treat acne, the athlete has a number of options. The most obvious is to be very diligent with washing and topical treatments, so as to remove much of the dirt and oil before the pores become clogged. If this proves insufficient, the prescription acne drug Accutaine® might be a good option. This is a very effective medication that acts on the sebaceous glands, reducing the level of oil secreted. The athlete could also take the ancillary drug Proscar®/Propecia® (finasteride) during steroid treatment, which reduces the conversion of testosterone into DHT, lowering the tendency for androgenic side effects with this hormone. It is of note however that this drug is more effective at warding off hair loss than acne, as it more specifically effects DHT conversion in the prostate and hair follicles. It is also important to note that testosterone is the only steroid that really converts to dihydrotestosterone, and only a few others actually convert to more potent steroids via the 5a-reductase enzyme at all. Many steroids are also potent androgens in their own right, such as Anadrol 50® and Dianabol. As such, they can exert strong androgenic activity in target tissues without Sa-reduction to a more potent compound, which makes Propecia® useless. One can also simply opt take primarily "anabolic" compoiunds, which impart comparable less androgenic activity. For sensitive individuals attempting to build mass, nandrolone would, therefore, be a much better option than testosterone.

Aggression
Aggressive behavior can be one of the scarier sides to steroid use. Men are typically more aggressive than women because of testosterone, and likewise the use of steroids (especially androgens) can increase a person's aggressive tendencies. In some instances this can be a benefit, helping the athlete hit the weights more intensely or perform better in a competition. Many professional powerlifters and bodybuilders take a particular liking to this effect. But on the other hand, there is nothing more unsettling than a grown man, bloated with muscle mass, who cannot control his temper. A steroid user who displays an uncontrollable rage is clearly a danger to himself and others. If an athlete is finding himself getting agitated at minor things during a steroid cycle, he should certainly find a means to keep this from getting out of hand. Remembering to take a couple of deep breaths at such times can be very helpful. If such attempts prove to be ineffective, the offending steroids should be discontinued. The bottom line is that if you lack the maturity and self-control to keep your anger in check, you should not be using steroids.

Anaphylactic Shock
Anaphylactic shock is an allergic reaction to the presence of a foreign protein in the body. It most commonly occurs when an individual has an allergy to things like a specific medication (e.g. penicillin), insect bites, industrial/household chemicals, foods (commonly nuts, shellfish, fruits) and food additives/preservatives (particularly sulfur). With this sometimes-fatal disorder the smooth muscles are stimulated to contract, which may restrict a person's breathing. Symptoms include wheezing, swelling, rash or hives, fever, a notable drop in blood pressure, dizziness, unconsciousness, convulsions or death. This reaction is not really seen with hormonal products like anabolic/androgenic steroids, but this may change with the rampant manufacture of counterfeit pharmaceuticals. Being that there are no quality controls for black market producers, toxins might indeed find their way into some preparations (particularly injectable compounds). My only advice would be to make every attempt to use only legitimately produced drug products, preferably of First World origin. When anaphylactic shock occurs, it is most commonly treated with an injection of epinephrine. Individuals very sensitive to certain insect bites are familiar with this procedure, many of whom keep an allergy kit (for the self administration of epinephrine) close at hand.

Birth Defects
Anabolic/androgenic steroids can have a very pronounced impact on the development of an unborn fetus. Adrenal Genital Syndrome in particular is a very disturbing occurrence, in which a female fetus can develop male-like reproductive organs. Women who are, or plan to become pregnant soon, should never consider the use of anabolic steroids. It would also be the best advice to stay away from these drugs completely for a number of months prior to attempting the conception of a child, so as to ensure the mother has normal hormonal chemistry. Although anabolic/androgenic steroids can reduce sperm count and male fertility, they are not linked to birth defects what taken by someone fathering a child.

Blood Cloning Changes
The use of anabolic/androgenic steroids is shown to increase prothrombin time, or the duration it will take for a blood clot to form. This basically means that while an individual is taking steroids, he/she may notice that it takes slightly longer than usual for a small cut or nosebleed to stop seeping blood. During the course of a normal day this is hardly cause for alarm, but it can lead to more serious trouble if a severe accident occurred, or an unexpected surgery was needed. Realistically, the changes in clotting time are not extremely dramatic, so athletes are usually only concerned with this side effect if planning for a surgery. The clotting changes brought about by anabolic steroids are amplified with the use of medications like Aspirin, Tylenol and especially anticoagulants, so your doctor should be informed of their use (steroids) if undergoing any notable treatment with these types of drugs.

Cancer
Although it is a popular belief that steroids can give you cancer, this is actually a very rare phenomenon. Since anabolic/androgenic steroids are synthetic version of a natural hormone that your body can metabolize quite easily, they usually place a very low level of stress on the organs. In fact, many steroidal compounds are safe to administer to individuals with a diagnosed liver condition, with little adverse effect. The only real exception to this is with the use of c17 alpha alkylated compounds, which due to their chemical alteration are somewhat liver toxic. Ir a small number of cases (primarily with Anadrol 50®), this toxicity has lead to severe liver damage anc subsequently cancer. But we are speaking of a statistically insignificant number in the face millions of athletes whc use steroids. These cases also tended to be very ill patients, not athletes, who were using extremely largt dosages for prolonged periods of time. Steroid opponents will sometimes point out the additional possibility o developing Wilm's Tumor from steroid abuse, which is a very serious form of kidney cancer. Such cases are si rare however, that no direct link between anabolic/androgenic steroid use and this disease has been conclusive! established. Provided the athlete is not abusing methylated oral substances, and is visiting a doctor during heavie cycles, cancer should not be much of a concern.

Cardiovascular Disease
As mentioned earlier, the use of anabolic/androgenic steroids may have an impact on the level of LDL (low density lipoprotein), HDL (high density lipoprotein) and total cholesterol values. As you probably know, HDL is considered the "good" cholesterol since it can act to remove cholesterol deposits from the arteries. LDL has the opposite effect, aiding in the buildup of cholesterol on the artery walls. The general pattern seen with steroid use is a lowering of HDL concentrations, while total and LDL cholesterol numbers increase. The ratio of HDL to LDL values is usually more important than one's total cholesterol count, as these two substances seem to balance each other in the body. If these changes are exacerbated by the long-term use of steroidal compounds, it can clearly be detrimental to the cardiovascular system. This may be additionally heightened by a rise in blood pressure, which is common with the use of strongly aromatizable compounds.

It is also important to note that due to their structure and form of administration, most 17alpha alkylated oral steroids have a much stronger negative impact on these levels compared to injectable steroids. Using a milder drug like Winstrol® (stanozolol), in hopes HDL level changes will also be mild, may therefore not turn out to be the best option. One study comparing the effect of a weekly injection of 200mg testosterone enanthate vs. only a 6mg daily oral dose of Winstrol® demonstrates this well41. After only six weeks, stanozolol was shown to reduce HDL and HDL-2 (good) cholesterol by an average of 33% and 71% respectively. The HDL reduction (HDL-3 subfraction) with the testosterone group was only an average of 9%. LDL (bad) cholesterol also rose 29% with stanozolol, while it actually dropped 16% with the use of testosterone. Those concerned with cholesterol changes during steroid use may likewise wish to avoid oral steroids, and opt for the use of injectable compounds exclusively.

We must also note that estrogens generally have a favorable impact on cholesterol profiles. For example, estrogen replacement therapy in postmenopausal women is regularly linked to a rise in HDL cholesterol and a reduction in LDL values. Likewise the aromatization of testosterone to estradiol may be beneficial in preventing a more dramatic change in serum cholesterol due to the presence of the hormone. A recent study investigated just this question by comparing the effects of testosterone alone (280 mg testosterone enanthate weekly), vs. the same dose combined with an aromatase inhibitor (250mg testolactone 4 times daily)42. Methyltestosterone was also tested in a third group, at a dose of 20mg daily. The results were quite enlightening. The group using only testosterone enanthate showed no significant decrease in HDL cholesterol values over the course of the 12-week study. After only four weeks, the group using testosterone plus an aromatase inhibitor displayed a reduction on average of 25%. The methyltestosterone group noted an HDL reduction of 35% by this point, and also noted an unfavorable rise in LDL cholesterol. This clearly should make us think a little more closely about estrogen maintenance during steroid therapy. Aside from deciding whether or not it is actually necessary in any given circumstance, drug choice may also be an important consideration. For example, the estrogen receptor antagonist Nolvadex® does not seem to exhibit antiestrogenic effects on cholesterol values, and in fact often raises HDL levels. Using this to combat the side effects of estrogen instead of an aromatase inhibitor such as Arimidex® or Cytadren® may therefore be a good idea, particularly for those who are using steroids for longer periods of time.

Since heart disease is one of the top killers worldwide, steroid using athletes (particularly older individuals) should not ignore these risks. If nothing else it is a very good idea to have your blood pressure and cholesterol values measured during each heavy cycle, making sure to discontinue the drugs should a problem become evident. It is also advisable to limit the intake of foods high in saturated fats and cholesterol, which should help minimize the impact of steroid treatment. Since blood pressure and cholesterol levels will usually revert back to their pre-treated norms soon after steroids are withdrawn, long-term damage is not a common worry.

Depression
Obviously steroid use will have an impact on hormone levels in the body, which in turn may result in a change in one's general disposition or mood. On the one hand, we might see very aggressive behavior. But for some people there is also, at times, the other extreme side, depression. This can occur in certain individuals, whom are psychologically sensitive to an imbalance in androgen and estrogen levels. This is most common with male bodybuilders, at times when anabolic/androgenic steroids are discontinued. Given a deeply suppressed endogenous testosterone level, it may take time for one's normal hormonal balance to return. During this period, estrogen levels may be more stable than testosterone, as our bodies can produce it from adrenal hormones. The result may be a protracted window of time where estrogen seems to be the more dominant sex hormone. For some, this window can be filled with feelings of emotional sensitivity, sadness, and lack of motivation (symptoms of depression).

Depression may also occur during the course of a steroid cycle, particularly with the sole use of anabolics. Although these compounds are mild in comparison to androgens, many can still suppress the endogenous production of testosterone. If the testosterone level drops significantly during treatment, the administered anabolics may not provide enough of an androgen level to compensate, and a marked loss of motivation and sense of well-being may result. The best advice when looking to avoid cycle or post-cycle depression is to closely monitor drug intake and withdrawal. The use of a small weekly testosterone dose might prove very effective if added to a mild dieting/anabolic cycle, warding off feelings of boredom and apathy to training. Of course a strong steroid cycle should always be discontinued with the proper use of ancillary drugs (Nolvadex®, Arimidex®, HCG, Clomid® etc.). Although tapering schedules are very common, they are not an effective way to restore endogenous testosterone levels.

Gynecomastia
Gynecomastia is the medical term for the development of female breast tissues in the male body. This occurs when the male is presented with an unusually high level of estrogen, particularly with the use of strong aromatizing androgens such as testosterone and Dianabol. The excess estrogen can act upon receptors in the breast and stimulate the growth of mammary tissues. If left unchecked, this can lead to an actual obvious and unsightly tissue growth under the nipple area, in many cases taking on a very feminine appearance. To fight this side effect during steroid therapy, many find it necessary the use some form of estrogen maintenance medication. This includes an estrogen antagonist such as Clomid® or Nolvadex®, which blocks estrogen from attaching to and activating receptors in the breast and other tissues, or an aromatase inhibitor such as Femara® or Arimidex®, which blocks the enzyme responsible for the conversion of androgens to estrogens. Aromatase inhibitors like this are currently the most effective options, but also the most costly.

It is worth noting however, that many believe a slightly elevated estrogen level may help the athlete achieve a more pronounced muscle mass gain during a cycle (see: Estrogen Aromatization). With this in mind many athletes decide to use anti-estrogens only when it is necessary to block gynecomastia. It is of course still a good idea to always keep an anti-estrogen on-hand when administering an aromatizable steroid, so that it is readily accessible should trouble become evident. Puffiness or swelling under the nipple is one of the first signs of pending gynecomastia, often accompanied by pain or soreness in this region (an effect termed gynecodynea). This is a clear indicator that some type of anti-estrogen is needed. If the swelling progresses into small, marble like lumps, action absolutely must be taken immediately to treat it. Otherwise, if the steroids are continued at this point without ancillary drug use, the user will likely be stuck with unsightly tissue growth that can only be removed with a surgical procedure.

It is also important to mention that progestins seem to augment the stimulatory effect of estrogens on mammary tissue growth. There appears to be a strong synergy between these two hormones here, such that gynecomastia might even be able to occur with the help of progestins, without excessive estrogen levels being necessary. Since many anabolic steroids, particularly those derived from nandrolone, are known to have progestational activity, we must not be lulled into a false sense of security. Even a low estrogen producer like Deca can potentially cause gyno in certain cases, again fostering the need to keep anti-estrogens close at hand if you are very sensitive to this side effect.

Hair loss
The use of highly androgenic steroids can negatively impact the growth of scalp hair. In fact, the most common form of male pattern hair loss is directly linked to the level of androgens in such tissues, most specifically the stronger DHT metabolite of testosterone. The technical term for this type of hair loss is androgenetic alopecia, which refers to the interplay of both the male androgenic hormones and a genetic predisposition in bringing about this condition. Those who suffer from this disorder are shown to posses finer hair follicles and higher levels of DHT in comparison to a normal, hairy scalp. But since there is a genetic factor involved, many individuals will not ever see signs of this side-effect, even with heavy steroid use. Clearly those individuals who are suffering from (or have a familial predisposition for) this type of hair loss should be very cautious when using the stronger drugs like testosterone, Anadrol 50®, Halotestin® and Dianabol.

In many instances, the renewal of lost hair can be very difficult, so avoiding this side-effect before it occurs is the best advice. For those who need to worry, the decision should probably be made to either stick with milder substances (Deca-Durabolin® most favored), or use the ancillary drug Propecia®/Proscar® (finasteride) when taking testosterone, methyltestosterone or Halotestin. Propecia® is a very effective hair loss medication, which inhibits the 5-alpha reductase enzyme specifically in the hair follicles and prostate. However, it offers us little benefit with drugs that are highly androgenic without Salpha reduction, the most notable offenders being Anadrol 50® and Dianabol. We must also remember that all anabolic/androgenic steroids activate the androgen receptor, and can, likewise, all promote hair loss given the right dosage and conditions.

Headaches
Athletes sometimes report an increased frequency of headaches when using anabolic/androgenic steroids. This seems to be most common during heavier bulking cycles, when an individual is utilizing strongly estrogenic compounds. One should not simply take an aspirin and ignore this problem, as it is may indicate a more troubling side effect of steroid use, high blood pressure. Since high blood pressure invites a number of unwanted health risks, monitoring it on a regular schedule is important during heavy steroid use, especially if the individual is experiencing headaches. Some athletes choose to lower their blood pressure in such cases with a prescription medication like Catapres, but most find this an appropriate time to discontinue steroid use. Milder anabolics, which generally display little or no ability to convert to estrogen, are also more acceptable options for individuals sensitive to blood pressure increases. Less seriously, many headaches are due to simple strain on the neck and scalp muscles. The athlete may be lifting with much more intensity during a steroid cycle, and as a result may place added strain on these muscles. In this case, a short break from training, and some general rest, will often take care of the problem. Of course if anyone is experiencing a very serious or persistent headache, a visit to the doctor may be in order.

High Blood Pressure/Hypertension
Athletes using anabolic/androgenic steroids will commonly notice a rise in blood pressure during treatment. High blood pressure is most often associated with the use of steroids that have a high affinity for estrogen conversion, such as testosterone and Dianabol. As estrogen builds in the body, the level of water and salt retention will typically elevate and lead to increased blood pressure. This may be further amplified by the added stress of intense weight training and rapid weight gain. Since hypertension (high blood pressure) can place a great deal of stress on the body, this side effect should not be ignored. If it is left untreated, high blood pressure can increase the likelihood for heart disease, stroke or kidney failure. Warning signs that one may be suffering from hypertension include an increased tendency to develop headaches, insomnia or breathing difficulties. In many instances these symptoms do not become evident until BP is seriously elevated, so a lack of these signs is no guarantee that the user is safe. Obtaining your blood pressure reading is a very quick and easy procedure (either at a doctors office, pharmacy or home); steroid-using athletes should certainly be monitoring BP values during stronger cycles so as to avoid potential problems.
If an individual's blood pressure values are becoming notably elevated, some action should/must be taken to control it. The most obvious is to avoid the continued use of the offending steroids, or at least to substitute them with milder, non-aromatizing compounds. It is also of note that although aromatizing steroids are typically involved, nonaromatizing androgens like Halotestin® or trenbolone are occasionally also linked to high blood pressure, so these are perhaps not the ideal alternatives in such a situation. The athlete also has the option of seeking the benefit of high blood pressure medications such as diuretics, which can dramatically lower water and salt retention. Catapres (clonidine HCL) is also a popular medication among athletes, because in addition to its blood pressure lowering properties, it has also been documented to raise the body's output of growth hormone.

Immune System Changes
The use of anabolic/androgenic steroids has been shown to produce changes in the body that may impact an individual's immune system. These changes can be both good and bad for the user. For instance, during steroid treatment, many athletes find they are less susceptible to viral illnesses. New studies involving the use of compounds like oxandrolone and Deca-Durabolin® with HIV+ patients seem to support this claim, clearly showing that these drugs can have a beneficial effect on the immune system. Such therapies are, in fact, catching on in recent years, and many doctors are now less reluctant to prescribe these drugs to their ill patients. But just as a person may be less apt to notice illness during steroid treatment, the discontinuance of steroids can produce a rebound effect in which the immune system is less able to fight off pathogens. This most likely coincides with the rebound activity/production of cortisol, a catabolic hormone in the body, which may act to suppress immune system functioning. When the administered steroids are withdrawn, an androgen deficient state is often endured until the body is able to rebalance hormone production. Since testosterone and cortisol seem counter each other's activity in many ways, the absence of a normal androgen level may place cortisol in an unusually active state. During this period of imbalance, cortisol will not only be stripping the body of muscle mass, but may also cause the athlete to be more susceptible to colds, flu, etc. The proper use of ancillary drugs (anti-estrogens, testosterone stimulating drugs) is the most common suggestion for helping to avoid this problem, which will hopefully allow the user to restore a proper balance of hormones once the steroids are removed.

We also cannot ignore the other possibility that steroids could actually increase cortisol levels in the body during treatment. Termed hypercortisolemia, this effect is a common occurrence with anabolic/androgenic steroid therapy. This is because anabolic/androgenic steroids may interfere with the ability for the body to clear corticosteroids from circulation, due to the fact that in their respective pathways of metabolism these hormones share certain enzymes. When overloaded with androgens competing for the same enzymes, cortisol may be broken down at a slower rate, and levels of this hormone will in turn begin to build. Due to their strong tendency to inhibit the activity of the Sbeta hydroxysteroid dehydrogenase enzyme, oral c17 alpha alkylated orals may be particularly troublesome in regards to elevated cortisol levels, as again this is a common pathway for corticosteroid metabolism. Though an elevated cortisol level is not a common concern during typical steroid cycles, problems can certainly become evident when these drugs are used at very high doses or for prolonged periods of time. This, of course, may lead to the athlete becoming "run-down" and more susceptible to illness, as well as foster a more over-trained and static (less anabolic) state of metabolism.

Kidney Stress/Damage
Since your kidneys are involved in the filtration and removal of byproducts from the body, the administration of steroidal compounds (which are largely excreted in the urine) may cause them some strain. Actual kidney damage is most likely to occur when the steroid user is suffering from severe high blood pressure, as this state can place an undue amount of stress on these organs. There is actually evidence to suggest that steroid use can be linked to the onset of Wilm's Tumor in adults, which is a rapidly growing kidney tumor normally seen in children and infants. However, such cases are so rare that no conclusive link has been established. Obviously the kidneys are vital to one's heath, so the possibility of any kind of damage (although low) should not be ignored during heavy steroid treatment. If the user is noticing a darkening of color (in some cases a distinguishable amount of blood), or pain/difficulty when urinating, kidneys strain might be a legitimate concern. Other warning signs include pain in the lower back (particularly in the kidney areas), fever and edema (swelling). If organ damage is feared, the administered steroidal compounds should be discontinued immediately, and the doctor paid a visit to rule out any serious trouble.
Since kidney stress/damage is generally associated with the use of stronger aromatizing compounds such as testosterone and Dianabol (which often raise blood pressure), individuals sensitive to high blood pressure/kidney stress should avoid such compounds until health concerns are safely addressed. If steroid use is still necessitated by the individual, it may be a good idea to avoid the stronger compounds and opt for one of the milder anabolics. Primobolan®, Anavar and Winstrol®, for example, do not convert to estrogen at all, and may be acceptable options. Also favorable drugs in this regard are Deca-Durabolin® and Equipoise®, which have only a low tendency to convert to estrogen.

Liver Stress/Damage
Liver stress/damage is not a side-effect of steroid use in general, but is specifically associated with the use of c17 alpha alkylated compounds. As mentioned earlier, these structures contain chemical alterations that enable them to be administered orally. In surviving a first pass by the liver, these compounds place some level of stress on the organ. In some instances, this has led to severe damage, even fatal liver cancer. The disease peliosis hepatitis is one worry, which is an often life-threatening condition where the liver develops blood-filled cysts. Liver cancer (hepatic carcinoma) has also been noted in certain cases. While these very serious complications have occurred on certain occasions where liver-toxic compounds were prescribed for extended periods, it is important to stress that this is not very common with steroid using athletes. Most of the documented cases of liver cancer have in fact been in clinical situations, particularly with the use of the powerful oral androgen Anadrol 50® (oxymetholone). This may be directly related to the high dosage of this preparation, as Anadrol 50® contains a whopping 50mg of active steroid per tablet. This is a considerable jump from other oral preparations, most of which contain 5mg or less of a substance. With one Anadrol 50® tablet, the liver will therefore have to process (roughly) the equivalent of 10 Dianabol tablets. This obvious stress is further amplified when we look at the unusually high dosage schedule for ill patients receiving this medication. With Anadrol 50®, the manufacturer's recommendations may call for the use of as many as 8 or 10 tablets daily. This is a far greater amount than most athletes would ever think of consuming, with three or four tablets per day being considered the upper limit of safety. It is also important to note that the actual number of cases involving liver damage have been few, and have not been a significant enough of a problem to warrant discontinuing this compound. Methyltestosterone, the first steroid shown to cause liver trouble, is also still available as a prescription drug in this country. The average recreational steroid user who takes toxic orals at moderate dosages for relatively short periods is therefore unlikely to face devastating liver damage.

Although severe liver damage may occur before the onset of noticeable symptoms, it is common to notice jaundice during the early stages of such injury. Jaundice is characterized by the buildup of bilirubin in the body, which in this case will usually result from the obstruction of bile ducts in the liver. The individual will typically notice a yellowing of the skin and eye whites as this colored substance builds in the body tissues, a clear sign to terminate the use of any c17 alpha alkylated steroids. In most instances, the immediate withdrawal of these compounds is sufficient to reverse and prevent any further damage. Of course, the athlete should avoid using orals for an extended period of time, if not indefinitely, should jaundice occur repeatedly during treatment. It is also a good idea to visit your physician during oral treatment in order to monitor liver enzyme values. Since liver stress will be reflected in your enzyme counts well before jaundice is noticed, this can remove much of the worry with oral steroid treatment.

Prostate Enlargement
Prostate cancer is currently one of the most common forms of cancer in males. Benign prostate enlargement (a swelling of prostate tissues often interfering with urine flow) can precede/coincide this cancer, and is clearly an important medical concern for men who are aging. Prostate complications are believed to be primarily dependent on androgenic hormones; particularly the strong testosterone metabolite DHT in normal situations, much in the same way estrogen is linked to breast cancer in women. Although the connection between prostate enlargement/cancer and steroid use is not fully established, the use of steroids may theoretically aggravate such conditions by raising the level of androgens in the body. It is, therefore, a good idea for older athletes to limit/avoid the intake of strong 5-alpha reducible androgens like testosterone, methyltestosterone and Halotestin, or otherwise use Proscar® (finasteride), which was specifically designed to inhibit the 5-alpha reductase enzyme in scalp and prostate tissues. This may be an effective preventative measure for older athletes who insist on using these compounds. However, drugs like Dianabol, Anadrol 50® and Proviron, which do not convert to DHT yet are still potent androgens, are not effected by its use. It is also important to mention that not only androgens, but also estrogens, are necessary for the advancement of this condition. It appears that the two work synergistically to stimulate benign prostatic growth, such that one without the other would not be enough to cause it. It has, therefore, been suggested that a non-aromatizable compound like DHT may be a safer option for older men looking for androgen replacement therapy than testosterone. Anti-estrogens might even turn out to be more effective at treating BPH than a drug like finasteride, which is used to lower androgenic activity in the prostate. Estrogen suppression is easier to accomplish in males, and should be accompanied with less side effects. It would also be very sound advice, regardless of steroid use, for individuals over 40 to have a physician check the prostate on a regular basis.

Sexual Dysfunction
The functioning of the male reproductive system depends greatly on the level of androgenic hormones in the body. Therefore, the use of synthetic male hormones may have a dramatic impact on an individual's sexual wellness. On one extreme, we may see a man's libido and erection frequency become significantly heightened. This is most commonly seen with the use of strongly androgenic steroids, which seem to have the most dramatic stimulating impact on this system. In some instances, this can reach the point of becoming problematic, although more often than not, the athlete is simply much more active and sexually aggressive during the intake of steroids.
On the other extreme, we may also see a lack of sexual interest, possibly to the point of impotency. This occurs mainly when androgenic hormones are very low. This will often happen after a steroid cycle is discontinued, as the endogenous production of testosterone is commonly suppressed during the cycle. Removing the androgen (from an outside source) leaves the body with little natural testosterone until this imbalance is corrected. The loss of its' metabolite DHT is particularly troubling, as this hormone may have a strong affect on the reproductive system that may not be apparent with other less androgenic hormones. Therefore, it is a very good idea to use testosterone-stimulating drugs like HCG and/or Clomid®/Nolvadex® when coming off of a strong cycle, so as to reduce the impact of steroid withdrawal. Impotency/sexual apathy may also occur during the course of a steroid cycle, particularly when it is based strictly on anabolic compounds. Since all "anabolics" can suppress the manufacture of testosterone in the body, the administered drugs may not be androgenic enough to properly compensate for the testosterone loss. In such a case, the user might opt to include a small androgen dosage (perhaps a weekly testosterone injection), or again reverse/prevent the androgen suppression with the use of a medication like HCG.

It is also interesting to note that it is not always simply an androgen vs. anabolic issue. People will often respond very differently to an equal dose of the same drug. While one individual may notice sexual disinterest or impotency, another may become extremely aggressive. It is, therefore, difficult to predict how someone will react to a particular drug before having used it.

Stunted Growth
Many anabolic/androgenic steroids have the potential to impact an individual's stature if taken during adolescence. Specifically, steroids can stunt growth by stimulating the epiphyseal plates in a person's long bones to prematurely fuse. Once these plates are fused, future linear growth is not possible. Even if the individual avoids steroid use subsequently, the damage is irreversible and he/she can be stuck at the same height forever. Not even the use of growth hormone can reverse this, as this powerful hormone can only thicken bones when used during adulthood. Interestingly enough, it is not the steroids themselves, but the buildup of estrogen that causes the epiphyseal plates to fuse. Women are shorter than men on average because of this effect of estrogen, and likewise the use of steroids that readily convert to estrogen can prematurely suppress/halt a person's growth. In fact, the use of steroids like Anavar, Winstrol® and Primobolan® (which do not convert to estrogen) can actually increase one's height if taken during adolescence, as their anabolic effects will promote the retention of calcium in the bones. This would also hold true for non-aromatizing androgens such as trenbolone, Proviron® and Halotestin®. It is still good common sense to advise adolescents to avoid steroid use, at least until their bodies are fully mature and steroid use will have a less dramatic impact.

Testicular Atrophy
The human body always prefers to remain in a very balanced hormonal state, a tendency known as homeostasis. When the administration of androgens from an outside source causes a surplus of hormone, it will cause the body to stop manufacturing its own testosterone. Specifically, this happens via a feedback mechanism where the hypothalamus detects a high level of sex steroids (including androgens, progestins and estrogens) and shuts off the release of GnRH (Gonadotropin Releasing Hormone, formerly referred to as luteinizing hormone releasing hormone). This, in turn, causes the pituitary to stop releasing luteinizing hormone and FSH (follicle stimulating hormone), the two hormones (primarily LH) that stimulate the Leydig's cells in the testes to release testosterone (negative feedback inhibition has been demonstrated at the pituitary level as well). Without stimulation by LH and FSH, the testes will be in a state of production limbo, and may shrink from inactivity. In extreme cases the steroid user can notice testicles that are unusually and frighteningly small. However, this effect is temporary, and once the drugs are removed (and hormone levels rebalanced) the testicles should return to their original size. Many regular steroid users find this side-effect quite troubling, and use HCG during a steroid cycle in order to try to maintain testicular activity (and size) during treatment. The more estrogenic androgens (testosterone, Anadrol 50® and Dianabol) are most dramatic in this regard, and are therefore poor choices for individuals who seriously want to avoid testicle shrinkage. Non-aromatizing anabolics would be a better option, however be warned that all steroids will have an impact on the production of testosterone if taken at an anabolically effective dosage (yes, even Anavar and Primobolan®).

Testosterone
The Hypothalamic-Pituitary-Testicular Axis: The hypothalamus releases Gonadotropin Releasing Hormone, which stimulates the pituitary to release luteinizing hormone and follicle stimulating hormone. This promotes the release of testosterone from the testes. Testosterone, as well as estrogens and progestins, in turn cause negative feedback inhibition at the hypothalamus (and to some extent the pituitary).

Water and Salt Retention
Many anabolic/androgenic steroids can increase the amount of water and sodium stored in body tissues. In some instances, steroid induced water retention can bring about a very bloated appearance to the body (hands, arms, face etc.), which will also reduce the visibility of muscle features (loss of definition). Athletes often ignore this side effect, particularly during bulking cycles when the excess water stored in the muscles, joints and connective tissues will help to improve an individual's overall strength. With the use of many strong androgens, water retention can account for much of the initial strength and body weight gain during steroid treatment, with "water-weight" sometimes amounting to ten or more pounds.

Although water retention may not be the most unwelcome side effect during a bulking cycle (greater strength and mass), it can lead to dangerous problems such as high blood pressure and kidney damage. The body is clearly under more strain when dealing with an unusually high level of water, so athletes should not simply ignore this. Water retention is most specifically associated with the presence of estrogen in the body, and is therefore common with the use of aromatizing compounds (such as testosterone and Dianabol). If water retention becomes an obvious problem during a cycle, the use of an anti-estrogen (Nolvadex®, Proviron®) may help minimize it. An antiaromatase like Arimidex® is, in fact, the most effective option, a drug that inhibits the conversion of testosterone to estrogen. Sometimes the athlete will alternately opt to use a diuretic, which can rapidly shed the water so as to achieve a more comfortable/attractive physique in a short period of time. This is a common practice when preparing for a competition, as diuretic use allows the user a great level of control over water stores. Of course, discontinuing the offending compounds, or substituting them with a milder anabolic would be the simplest option for recreational steroid users.

Virilization
Since anabolic/androgenic steroids are synthetic male hormones, they can produce a number of undesirable changes when introduced into the female body. This includes the possibility of "virilization", which refers to the tendency for women to develop masculine characteristics when taking these drugs. Virilization symptoms include a deepening or hoarsening of the voice, changes in skin texture, acne, menstrual irregularities, increased libido, hair loss (scalp), body/facial/pubic hair growth and an enlargement of the clitoris. In extreme cases the female genitalia can become very disfigured, and may actually take on a penis-like appearance. Clearly, women must be very careful when considering the use of steroids, especially since most virilization symptoms are irreversible. The stronger androgenic compounds should be off-limits, with cautious female athletes restricting themselves to the use of only mild anabolics such as Winstrol®, Primobolan®, Anavar and Durabolin® (the shorter acting nandrolone). Nandrolone is actually the preferred hormone, as it displays the lowest level of androgenic to anabolic activity. Since even these milder anabolics have the potential to cause problems, users should additionally remember to be conservative with drug dosages and duration of intake. After each cycle a notable break from treatment would be a good idea as well, so that the body has sufficient time to reestablish a hormonal balance.

 
 

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