- Amino Acids
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Dangers of Steroid Abuse (health risks, prison, and death)
For all those readers that are tired of the same old repetitive laundry list of steroid horrors that you’ve all seen before, this article will not be the same and nor will it be some type of medical journal article that only a small percentage of you can comprehend. Whenever a study refers to a medical term, disease, or procedure that’s unfamiliar, it will try to be defined. It is important for readers to fully understand the science behind the facts regarding several very real dangers faced when using anabolic androgenic steroids (AAS).
Unfortunately, the youth of today are acquiring and taking AAS without any knowledge of the associated dangers. Although the short-term adverse physical effects are fairly well known, many users cycle and supplement AAS in such a way that they simply don’t suffer from negative side effects. With that said, users fail to realize the seriousness of taking these drugs and how harmful the long-term physiological and psychological effects, and even severe legal consequences can be.
Do Adolescents Really Use Steroids?
The answer to this question is rather blunt but simple, YES. According to the Center of Disease Control and Prevention’s (CDC) Youth Risk Behavior Surveillance, the percentage of students who reported lifetime steroid use increased during 1991 – 2003 (2.7% - 6.1%) and then decreased during 2003 – 2005 (6.1% - 4.0%). Although the declining trend is somewhat comforting, and the figures don’t seem staggering, they are still somewhat misleading. Let’s take a look at these numbers a little closer. The U.S. Census Bureau reports a total population of just over 301 million people, and of that number, the National Center for Education Statistics estimates 16.5 million or 5.4% are public or private school children between the 9th and 12th grade. Using the CDC’s 4% current lifetime user’s statistic, we have an estimated 660,000 students (14 to 17 years of age) who’ve admitted to steroid use as of 2005. The fact is, our 4% figure though reported in 2006 only used data through early 2005, which was just prior to any professional sports scandals and subsequent resurgence of steroid popularity. The main thing trying to be conveyed in this article is “the use of steroids among children is a REALLY BIG PROBLEM!”
Steroid users can be vulnerable to a host of physiological side effects. This would be dealing with the functions and activities of living organisms. More specifically, it concerns the organs, tissues, and cells, as well as the chemical reactions between them. Physiological side effects are serious and if left untreated can take your life.
Some of the systems AAS usage directly impacts:
Gonad Effects: Testosterone is essential for the production of sperm, the maintenance of the male sex drive, erectile potency, and the function of the prostate gland and other reproductive structures. The natural production of testosterone is controlled by another set of hormones called gonadotrophins, which are released from the pituitary gland in the brain. AAS can throw this delicate system out of balance which could result in gonadotrophin suppression and can cause testicular atrophy (shrunken testicles), impotence, decreased sex drive, decreased mental and physical activity, infertility due to decreased sperm production, and bone loss (1, 2, 3). Trying to reverse the effects of these varies and is largely dependent on the type, combination, duration, and amount of AAS taken. Some studies suggest restoration of hormonal balance after discontinuation of AAS use allows testicular function to return to normal (4, 5), whereas other studies have shown the persistence of hormonal abnormalities even after discontinuation (6, 7).
Skeletal-Muscular Injury: In spite of the apparent positive effects of AAS on bone and muscle strength, alterations in connective tissue structure induced by AAS usage have been associated with a weakening of the tendons. More evidence suggests AAS can lead to abnormal growth or development (dysplasia) of collagen fibrils, resulting in an overall decrease in tendon strength (8). The risk of tricep tendon rupture, a very uncommon injury, is also increased with AAS use (9). This is often seen with Winstrol a.k.a. Stanozolol usage, and is more pronounced in athletes who participate in sports which usually require hard starts and stops, such as track or baseball. Even though there are not abundant amounts of clinical information on this topic, in the gym the rumor is that “Winstrol weakens joints”.
Cholesterol & Lipoproteins: Recreational users and patients receiving AAS therapy often experience fluctuations in lipid profiles. Palatini et al. (10) compared 14 non-AAS using bodybuilders to 10 AAS users. At study completion, the bodybuilders taking AAS had lower HDL (high density lipoprotein) cholesterol, which is the good kind, and elevated concentrations of LDL (low density lipoprotein), the bad kind. Similarly, weekly administration of Nandrolone Decanoate a.k.a. Deca Durabolin (200 mg/wk) to 14 hemodialysis patients resulted in a significant decrease in HDL (11).
Everything we digest passes through the liver twice and this process contributes to overall liver toxicity. This is one of the reasons AAS users prefer to inject intramuscularly (into the muscle), because this method will divert the first liver pass and go directly into the bloodstream. The first liver pass filters nutrients in preparation for the bloodstream and the second liver pass serves as maintenance to cleanse for the blood. Oral steroids, known as 17aas, have been modified at the 17th position (hence the nickname) in order to survive the first liver pass in tact. This will allow their properties to function as intended once inside the bloodstream (12, 13, 14). Testosterone (T), when compared to other AAS, tends to have less of an effect on lipid profiles. Thompson et al. (15) in their six week cross-over trial of 11 male weight lifters, found administering of oral Winstrol at a dose of 6mg/d resulted in a more adverse lipid profile than a much greater and stronger intramuscular injection of T (200 mg/wk). Serum HDL levels decreased by 33% during Winstrol treatment compared with a decline of 9% during T administration (15).
Cardiovascular: Studies are conducted on certain animals, mostly monkeys and mice, because of our distinct physiological similarities. T has been known to induce hypertension in animals for more than six decades (16). Animal studies have shown that AAS increases water and inhibits the conversion mechanism which makes corticosterone, resulting in hypertension in rats (17). This matters to the studies because fluid retention, a traditional AAS side effect, is a known contributing factor to hypertension. Autoradiographic (a kind of X-ray), and biochemical analyses (cell sample examinations) of the hearts of female rhesus monkeys and baboons indicate that arterial and ventricular heart cells contain androgen receptors, a primary absorption site for AAS. The presence of this receptor suggests sex steroid hormones may affect heart function directly and may explain some of the peculiar differences in heart disease between men and women (18).
Cardiomegaly (an enlarged heart) has been reported in the preclinical studies of AAS (19, 20), and electron microscopy (an imaging technique that makes the picture larger and brighter) shows disintegration and swelling of the heart tissue when AAS are given in conjunction with physical training (21). The risk of arteriosclerosis (a progressive narrowing and hardening of the arteries) may also be increased with AAS use, as shown by an increase in aortic elastin and collagen content (additional and potentially obstructive materials within heart valves) with T administration to male rats. Another study of male athletes found significantly greater cardiovascular risk factors in AAS users than nonusers (22). Similar to the earlier citation, AAS users in this study also had high total cholesterol/HDL ratio, higher low density lipoprotein levels, and lower HDL levels compared to nonusers.
Hard evidence of cardiovascular morbidity (death caused by heart of artery problems) associated with AAS use, has been difficult to come by. This is mostly due to the high level of secrecy observed by athletes and bodybuilders who use AAS. Even under controlled, medically supervised conditions for patients undergoing therapeutic AAS treatment, there were 16 reported cases of morbid circulatory events (death caused by heart of artery problems) between 1976 and 1993 (23). These were prescribed drugs and dosages, under the routinely monitored care of licensed, board certified physicians.
Hepatic: Studies have linked various abnormal liver function tests with the use of AAS (24, 25, 26). Jaundice (the yellowing of the skin and whites of the eyes frequently due to liver problems) occasionally occurs in patients due to hepatotoxicity (chemically caused liver toxicity or damage). Cholestatic hepatitis is a condition where bile cannot flow from the liver to the duodenum (a hollow jointed tube) and connecting the stomach to the jejunum (the central of the three divisions of the small intestine) has also been reported with the use of 17aas (27). If jaundice occurs, it generally develops after 2-5 months of therapy of in AAS users on higher dosages or longer cycles of harsh orals like Dianabol (Methandrosenolone) or Andriol (Testosterone Undecanoate).
In the majority of the patients tested, there is an elevation in transaminases (important enzymes in the production of various amino acids), with levels normalizing after a few weeks of discontinuation (28). In athletes, extreme care should be taken giving liver function tests because the breakdown of skeletal muscle during this intense training can also result in elevated transaminases. With that being said, liver values should not be the sole determinant of AAS abuse (29). Some steroid users will combine very harsh and extremely mild oral steroids, such as Andriol and Anavar (Oxandrolone), but HIV/Aids research informs us that combinations such as these can lead to a concentration of harmful levels.
Peliosis hepatic (a disorder in which multiple blood-filled cystic spaces randomly ravage the liver) has also been reported with the use of AAS (30, 31, 32, 33). There have also been isolated reports of AAS use resulting in carcinomas (any spreading cancer that arises from epithelial or compound layers of cells, that invade the surrounding tissue and organs) of the liver (34, 35, 36, 37). The majority of patients experiencing these conditions were taking compounds for approximately one to seven years, usually at high doses and/or untraditional combinations of 17aas (38, 39, 40, 41).
Psychiatric: The effects of T on human aggression are controversial. Anecdotal evidence supports the claim the AAS use results in a typical “roid rage” phenomenon, during which athletes experience an increase in aggression and irritability. The scientific validity of this assertion is questionable in consideration of the fact that virtually all evidence supporting this behavior is based on either case reports or studies that correlate (as byproducts of studies that sought other findings) (42). A few well-controlled studies have demonstrated an association between AAS use and feelings of aggression, alertness, irritability, anxiety, suspiciousness, and other types of mood overactive behaviors (43, 44, 45). On the other hand, these results have been contradicted by further studies that found “absolutely no” evidence of aggressive behavior even when supraphysiological (this word means amounts greater than normally found in the body) doses of T were administered (46).
Wang et al. (47) recently reported that T administration to hypogonadal men (those with a defect in the reproductive system) resulted in a significant decrease in anger, sadness, irritability, and nervousness along with increased sense of well-being, energy, and friendliness. Sorting through all this research, it appears more likely that increased aggression is partly a product of the type, amount and combination of substances used, and mostly a product of the user’s personality and predisposition.
Laws and Penalties: There are major concerns over the growing amount of illegal AAS abuse by teenagers and many of the long-term side effects just discussed throughout this article. This led Congress in 1991 to place the entire AAS class of drugs into Schedule III of the Controlled Substances Act (CSA). Under this legislation, AAS are defined as any drug or hormonal substance, chemically and pharmacologically related to T (other than estrogens, progestins, and corticosteroids) that promotes muscle growth. The possession or sale of AAS without a valid prescription is illegal. Since 1991, simple possession of illegally obtained AAS carrys a maximum penalty of one year in prison and a minimum fine of $1,000 if this is an individual’s first drug offense. The maximum penalty for AAS trafficking (selling, distributing, or possessing enough to be a suspect) is five years in prison and a fine of $250,000 if this is the individual’s first felony drug offense. If this is the second felony drug offense, the maximum period of imprisonment and the maximum fine both double. While the above listed penalties are for federal offenses, individual states have also implemented fines and penalties for illegal use of AAS. State executive offices have also recognized the seriousness of AAS abuse and other drugs of abuse in schools. For example, the State of Virginia enacted a law that will allow student drug testing as a legitimate school drug prevention program (48, 49).
The International Olympic Committee (IOC), National Collegiate Athletic Association (NCAA), and many professional sports leagues (e.g. Major League Baseball, National Basketball Association, National Football League, and National Hockey League) have banned the use of steroids by athletes, both because of their potentially dangerous side effects and because they give the user an unfair competitive advantage. Since the now infamous Mark McGuire incident, the IOC, the NCAA, and NFL have also banned the use of steroid precursors (e.g. androstenedione) by athletes for the same reason steroids were banned. The IOC and professional sports leagues use urine testing to detect steroid use in both in and out of competition (48, 49).
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