Anabolic Steroids Anabolic steroid abuse is a widespread phenomenon not limited to professional and top amateur athletes. High school students are also using anabolic steroids. This fact sheet will help to dispel some of the many misconceptions about anabolic steroid use and abuse. WHAT ARE ANABOLIC STEROIDS AND HOW ARE THEY USED? Anabolic steroids are testosterone or testosterone-like drugs which produce anabolic activity (greater muscular bulk) by increasing protein synthesis and androgenic activity (enhanced secondary sexual characteristics). Natural testosterone is produced in larger quantities in the male, but is also present in the female. It should be noted that doses used by athletes often greatly exceed doses recommended for legitimate medical reasons, causing the potential for even greater negative consequences. Moreover, many athletes will use more than one anabolic steroid simultaneously, a process known as "stacking." Usually, anabolic steroids are taken in cycles, i.e., "on" for three months, then "off" for three months. This practice may be less harmful than continuous use, but it is not totally without dangers. Anabolic steroids are either taken by mouth or injected into a muscle. The "orals," as they are called, are tablets or capsules taken by mouth. These forms are reportedly more toxic to the liver. Often the orals are taken in conjunction with injectable forms. The injectable forms are known as "oils" or "waters". The oils refer to the long-acting types. They are injected into a muscle, usually the buttocks, and the steroid is released slowly over time. Typically, these drugs are injected only a couple of times a week. The "waters" are short-acting forms. Again, these are injected, usually in the buttocks, but they work much faster and are eliminated much more quickly. WHAT HAPPENS WHEN THE BODY GETS TOO MUCH? Since anabolic steroids are synthetic versions of the naturally- occurring male hormone testosterone, they have very similar pharmacological actions and side effects. In mature males, the body secretes 2.5-10 mg. of testosterone each day to promote various body processes. Steroid use often introduces up to an additional 100 mg. of testosterone into the system daily. When levels become too high, the brain shuts down the body's own production of the testosterone, as well as other substances necessary for the proper functioning of the body. Some of the body systems at risk include: Male reproductive system Too much testosterone or related substances (i.e. anabolic steroids) prompts the pituitary gland to stop producing the hormone gonadotropin. This in turn also prevents the production of other intermediate substances which leads to testicular atrophy (decreased size and function), lowered sperm count, sterility (reversible), painful, frequent or prolonged erections and prostate enlargement. When steroid use ceases, the entire testosterone-producing function may remain shut down, possibly leading to a permanent imbalance of hormone. Female reproductive system These side effects are the result of masculinization due to increased testosterone and include enlargement of the clitoris*, uterine atrophy, irregularity or cessation of menstrual cycle, increased body hair*, deepening of the voice*, shrinkage of breast size and masculinization of female fetuses in pregnant women. (*permanent effects) The heart and blood vessels Anabolic steroids cause fluid retention, which can lead to high blood pressure. Steroids also lower high-density lipoproteins (HDLs) in the blood. These HDLs help rid the body of cholesterol. With steroid use, production of cholesterol laden low-density lipoproteins (LDLs) is increased, which has been shown to be a risk factor for cardiovascular disease i.e. heart attack and stroke. Deaths related to cardiovascular problems have been reported in both young and older athletes. Adolescents Bone growth is among the body processes that can shut down with steroid use. Adolescents on anabolic steroids may find their muscles bulking up, but bone growth stops with premature fusion of the epiphysis (growth center) of long bones. The result is permanently stunted growth. There is risk until bones stop growing. WHAT ARE THE PSYCHOLOGICAL EFFECTS? Steroids can affect individuals in many ways, with psychological changes being one of them. There have been a number of clinical studies where the psychological changes with testosterone and/or testosterone-like drug use have been observed by the athlete and/or their peers. Furthermore, in personal interviews, well known athletes who admittedly abused testosterone have unconditionally stated that psychological changes not only occurred, but many times were detrimental to themselves as well as relationships. As proposed in a paper by Pope et al. (see Further Reading section), there is no ethical way to accurately assess the psychological effects of steroid use that mimics the massive doses of several steroids taken simultaneously over prolonged periods. The best alternative, "naturalistic" studies, have provided information on the following psychological changes: Aggression Feelings or irritability and aggression may appear so subtly that the athlete may barely notice, but his friends or family will. Taking anabolic steroids keeps an athlete constantly "on edge." Situations that normally would not disturb the individual can, with steroid use, generate strong feelings of anger and hostility (the "roid rage"). Athletes who take anabolic steroids often have difficulty dealing with people because of these uncontrollable feelings. Users may experience paranoia. Anxiety can disturb sleep patterns. Depression When the athlete discontinues taking the steroids, body size decreases and self-esteem is usually lowered. Due to these changes as well as through other mechanisms (See Addiction and Dependence), depression may occur, often inducing users to take steroids again. Addiction and Dependence Anabolic steroids can also produce psychological addiction. Users may find they have become dependent and experience withdrawal symptoms of severe depression (including suicidal thoughts), insomnia, loss of energy or appetite, sweating, nausea, headaches and craving for anabolic steroids. Withdrawal symptoms will last one to three weeks. Weight loss will also occur. As with any addicting drug, withdrawal should be done under a physician's care. In The Media Recently, an article published in the New England Journal of Medicine has been the subject of attention by several weight lifting magazines (i.e. Joe Weider's Flex). The media has touted the findings in this article as proof that "roid rage" is a myth. This type of journalism can be very misleading. Although minor psychological evaluation was performed secondarily, the objective of the study was not to measure psychological effects (as performed by psychiatric researchers), but to measure muscle growth and strength. This study used testosterone enanthate, a well known androgenic steroid for one short-term treatment at admittedly lower doses than those seen in gyms and as opposed to the common "stacking" regimen, where several steroids are used for a greater number of treatment periods. In addition, this study only used 11 men in the testosterone treated group. Several "naturalistic" studies (with people who are actually abusing steroids) designed to measure psychological effects using much larger numbers of athletes suggest that these changes do occur. Furthermore, within the New England Journal article, the authors stated that with extended use, anabolic steroids have the potential for serious side effects involving the cardiovascular system, prostate, lipid metabolism, and insulin sensitivity. WITH KIDS, HOW DO YOU KNOW? Athletes who use steroids in conjunction with a weight training program can often be identified by their unusually quick muscle and weight gain. Other symptoms and adverse effects: Head: Headaches, hair loss, puffy cheeks Sore throat, unpleasant breath odor, sore tongue Deepening of voice in females Chest: Increased breast tissue on male pectorals Decrease of breast size in female Rapid heart rate, heart attack Skin: Increased oiliness and acne Flushed or yellowish skin Bruising, even with small injuries Increased perspiration Pronounced stretch marks Facial and chest hair on female Rash or hives Psychological effects: Strained relationships with friends and family Hyperactivity (restlessness, insomnia, irritability) Uncharacteristic hostility or aggressive behavior Feelings of frustration and anxiety without provocation Psychotic symptoms (paranoia, delusions, hallucinations) Psychological effects of withdrawal: Severe depression Feelings of inadequacy and weakness as body size decreases Suicidal thoughts Lethargy and listlessness Lack of interest in exercise or sports Inability to maintain normal sexual functions Desire to return to steroid use Genitals and abdomen: Testicles decrease in size Clitoris enlarges Changes in bowel and urinary habits Kidney stones, gallstones, liver tumors Extremities: Joint stiffness, pain, swelling Increased chance of injury to muscles, tendons, and ligaments Stunted growth in adolescents HOW CAN PARENTS HELP? Typically, athletes who take steroids are ambitious and want to make their friends and families proud of them. Parents are an important source of emotional support for their children. Let your aspiring athletes know you are proud of them and praise their accomplishments, no matter what the level, win or lose. Be there if they come to you for help. HOW CAN COACHES HELP? Coaches are under great pressure to produce winning teams. Requests to "bulk up", "get stronger" or "speed up" without proper guidance may be misinterpreted by athletes to include steroid use. The athlete's efforts and integrity must be valued more than winning. As teachers, friends and models for young athletes, coaches are in an excellent position to communicate these values to young people while encouraging safe methods of improving speed, strength and technique.

written by Joe Maxxell