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Steroids and Women
Research shows women use Androgenic Anabolic Steroids (AAS) for reasons that are quite different from those of men, although there is often some overlap. Not only are the reasons different but the risks and side effects associated with female steroid usage are also different than men. AAS is not as dangerous for everyone (men and boys), but definitely is more dangerous for women and girls because the female body is simply not equipped for exogenous male hormone intake.
Steroids are synthetic derivatives of the naturally occurring male hormone testosterone. They possess an anabolic effect (muscle and strength building) and are androgenic, meaning (they affect sexual characteristics). Steroids are used to make men manlier, and for this single reason, steroids are far more potentially harmful for females to use than males. When introduced to the female endocrine system, AAS creates a serious jolt. For example, in sex reassignment treatment (a.k.a. sex changes) the goal is to provide the patient with the opposite gender’s sexual characteristics to the fullest extent. With the exception of the internal and external genitalia, these characteristics are contingent upon the biological effects of the sex steroids given. Therefore, (semi)synthetic sex steroids are indispensable tools in sex reassignment treatment, and the use of cross-gender hormone treatment is necessary to achieve the desired outcome (Hamburger, 1969; Leavitt et al., 1980). Thus, women who abuse AAS will necessarily experience significant changes in their secondary-sexual characteristics including clitoral enlargement, a deepening of the voice, and increased facial hair.
Steroid use by women is not only dangerous, but it’s really unnecessary. Many women believe that since men possess greater testosterone levels, and get bigger and stronger with AAS, that they will require considerably more of these drugs to achieve similar results. Since muscle size and strength does not increase in a manner directly proportionate to the amount of male hormone within the body, the theory is technically false. In fact, studies have shown that women get considerable anabolic benefit out of dosages that are only a fraction of those needed by men. Thus, even those women who detrimentally decide to risk their health by using male hormones have no business taking them in large quantities.
Why do Women Take Androgenic Anabolic Steroids?
There are many reasons. Several female AAS users think their muscles are dysmorphia or have malformation, which means they don’t feel the muscles are big enough and become obsessed with the idea that they need to have a more muscular physique. Usually the women who feel this way, suffer mentally because they constantly have delusions they are too “skinny”, or “to small” or even “fat”, when really they have very average musculature. Muscle Dysmorphia is sometimes referred to as bigorexia nervosa, and is a very specific type of mental disorder a person has with the body. A person would need to be clinically diagnosed as having muscle dysmorphia, because this doesn’t need to be confused with a women wanted to be overly interested in her physical physique or engaging in fitness behaviors that others might consider excessive. A women would need to exhibit symptoms at the type and degree outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Some of the criteria for this disorder are:
- Constantly examining themselves in the mirror
- Becoming distressed if they miss a workout session or one of six meals in a day
- Becoming distressed if they do not receive enough protein per day in their diet
- Taking potentially dangerous anabolic steroids
- Neglecting jobs, relationships, or family because of excessive exercising
- Having delusions of being underweight or below average in musculature
AAS can provide tremendous performance enhancement benefits, and though men outweigh the bulk of such scandals, professional and amateur athletes also administer them for this purpose. Such abuse has gone largely unnoticed in mainstream society. The issue is becoming so prevalent that some organizations have taken very open preventative measures. For example, cafepress.com markets a “Without Steroids” women’s t-shirt to those who remain and support drug free athletics.
Surprisingly, many women use steroids because they feel the need to protect themselves and have been victims of rape. In a National Institute of Drug Abuse (NIDA) study on women weightlifters, twice as many of those who had been raped, reported using anabolic steroids and/or other muscle-building drugs as compared to those who had not been raped. Almost all of the women, who had been raped, increased their bodybuilding activities after their attack in belief that they needed to be bigger and stronger, because this would discourage any future attacks. In another study involving 75 females, 10 reported being raped as their reason for even being the use of AAS because they wanted to increase muscle strength and size (Gruber, Pope; 1999). Of the 10 admitted rape victims, 5 said that prior to the experience they had no intention of ever using steroids because they believed they were a sign of weakness and unwillingness to achieve goals through hard work.
Negative Side Effects
As stated earlier, the female body is simply not equipped for the administration of AAS. Steroids are very powerful messengers that signal cells to behave in very specific ways, many of which never become outwardly visible, making the exact extent of the harm unknown to the female user. Although type, dosage, and duration play significant roles in the severity of negative effects, even a one-time cycle (use over a specific time period) at very low doses can cause irreversible damage even well after the cycle is completed. (See: “Excerpt fro a true story”)
Adverse physical conditions can and do occur in women using anabolic steroids. Virilization is the development of male secondary sexual characteristics. This set of anatomical structures and features unique to males and females that are not directly related (and therefore secondary) to the production of sex cells. Most virilization is produced by androgens, any natural or synthetic compound (including steroids) that stimulates or controls the development and maintenance of masculine characteristics. Some negative side effects of taking steroids are permanent and others can go away, at least partially, when the drug is discontinued. Some of these side effects can include, but aren’t limited to, deepening of the voice, increased body hair (including the growth of dark facial hair), loss of scalp hair, liver or kidney damage, oily skin, acne, facial pore enlargement, clitoral enlargement, decreased breast size, and increased levels of LDL cholesterol.
While very few studies have evaluated the relationship of androgens to aggression or violent behavior, those that have done so note a correlation between testosterone levels and observed aggression (Grimes, J. 2003). Scientists have attempted to test the strength of this association by administering high steroid doses and placebos to human volunteers. These subjects were then asking to report on their behavioral symptoms over periods of days and weeks. Three out of four of the high dose studies produced greater feelings of irritability and aggression in relation to the placebo group, but the effects appear to be highly variable across individuals. The fourth study did not have a significant effect. One possible explanation, according to the researchers, is that some but not all anabolic steroids increase irritability and aggression.
A woman on AAS can experience mild to moderate mental instability. A recent study suggests that the mood and behavioral effects seen during AAS abuse may result from secondary hormonal changes. Aggressive instances are often labeled as “Roid Rage”, which is characterized as overly irritable reactions, sometimes violent, that would normally be deemed as small life stressors. This can be accompanied by severe mood swings and can be clinically related to hypomania (part of the manic-depressive cycle), which is bipolar disorder or paranoia.
Women can also suffer from withdrawal symptoms when coming off the steroids, which include such symptoms as psychosis, depression, listlessness, apathy, loss of appetite, and feelings of anxiety. Women can become forgetful, distracted, and sometimes even confused about what she is doing or how she is behaving. Most importantly, she won’t understand why such things are happening to her.
Women can have testosterone levels around 30 times greater than normal when taking steroids. They will have a decrease in sex-hormone binding globulin, SHBG – a protein in the liver. (Malarkey, Strauss, Leizman, Liggett, Demers; 1991). This will also cause a decrease in follicle-stimulating hormones, a decrease in circulating HDL -cholesterol, and a decrease in thyroid binding proteins. These ever changing hormone levels weaken and endanger a women’s immune system, making her far more susceptible to infectious disease and even the common cold.
One study cited the possibility that AAS might inhibit the immunonodulatory and anti-viral activities of androgens like DHEA. This acts on adrenal glands to induce the production of corticosteroids and dehydroepiandrosterone. (Hughes, Rady, Smith; 1998). This particular study also indicated steroids significantly inhibited the production of corticotrophin in blood lymphocytes immediately following a viral infection. Simply stated, they can cause the prevention of antibodies during sickness and lead to altered immune reactions.
Cardiovascular risk factors include the alteration or diminishing of glucose tolerance and hyperinsulinism, which means becomes resistant to insulin, or a change in lipoproteins, which means carrying cholesterol in the blood, a fraction of which can cause cardiovascular disease and atherosclerosis, deposition of fatty substances onto inner walls of arteries causing blockage. These increased triglyceride levels, can cause hypertension, abnormally high blood pressure, or changes in her myocardium, middle muscular layer of the heart wall, and increased concentration levels of several different clotting factors. Cardiomyopathy, a typical chronic disorder of the heart muscle, which may involve hypertrophy and obstructive damage to the heart, myocardial infarction which is the localized death of the myocardium tissue usually leading to heart failure, heart attack, stroke, and cerebro-vascular accidents have all been causes in deaths where AAS abuse was implicated. Of course the liver, the body’s primary filtration system will come under attack as it has to accommodate the increased toxicity. Among the liver problems promoted are holestatic jaundice, which is failure of bile flow that causes yellowish pigmentation of skin, tissues, and body fluids, peliosis hepatic, blood-filled cysts that develop on liver, hepatocellular hyperplasia, unusual increase of an epithelial parenchymatous cell called hepatocytes in the liver, and cancer. Secondary filters such as the kidneys and gallbladder also become more susceptible to disease.
The musculoskeletal system can be threatened within the female and male teens when using steroids. One such threat is the fusing of growth plates between bones, which effectively reduces one’s potential height resulting in shortened stature. If muscle strength is increased too rapidly for tendons and ligaments to keep up, both are weakened to the point of rupture, and experience increased healing times. Another skeletal threat, which is particular to women, is that of osteoporosis which can be a result due to a steroid’s exhaustion of a woman’s blood circulating calcium, as well as other mineral levels. When this occurs, the body begins to leech stored calcium deposits directly from the bones leaving them brittle.
Reproductive system problems are a given as the delicate balance of the women’s hypothalamus-pituitary-gonadal axis becomes skewed due to the increases in circulating testosterone and diminished estrogen activity. Additionally, the stark decline in estrogen and progesterone can result in the inhibition of follicle formation, ovulation, and an irregular menstrual cycle, which can lead to amenorrhea, absence or suppression of the menstrual cycle. A study conducted with 9 female weightlifters showed all but 2 had menstrual abnormalities (Malarkey et al.;1991). Women can also run very high risks of developing cervical and/or endometrical cancer and uterine atrophy from extended use of use AAS. A pregnant woman using steroids can literally damage her unborn child by delaying the development of fetus growth, or increasing the chances of pseudohermanphroditism, both male and female physical body and character traits.
Infection is usually gotten by abusers who actually inject AAS. There are many dangers surrounding the choice to inject steroids, such as unsanitary techniques by not swabbing the site, or sharing and reusing needles. Not to mention, some steroids are prepared and manufactured illegally and under less than sterile conditions. All of these contributing factors put any abuser at a risk for acquiring life threatening viral infections, such as HIV and hepatitis B & C. Abusers can also potentially develop infective endocarditis, a bacterial illness which causes a potentially fatal inflammation of the inner lining of the heart. Any bacterial infection often manifests into an abscess formation near or at the infection site, causing pain, which can be unbearable.
Additional Hazards for Bodybuilders
In January of 2000, McLean Hospital released a landmark study. Hospital researchers from the tiny town of Belmont , MA, eight miles west of Boston , cited widespread AAS and other performance-enhancing drugs in many women bodybuilders. Although this may not exactly seem like groundbreaking news, the study further uncovered evidence that many female bodybuilders suffer from eating disorders, as well as several other body image and psychiatric disorders.
The study, believed to be the first in-depth look at AAS use in female bodybuilders, was published in Psychotherapy and Psychosomatics. It involved 75 female athletes who competed in at least one bodybuilding or fitness contest, or who had lifted weights in the gym five days or more per week for at least two years. As part of the investigational study, participants, mostly from the Boston area received psychiatric and medical evaluations. Of the 75 subjects, 25 reported current or past steroid use. Women in both the steroid using and non-steroid using groups reported use of other performance enhancing drugs such as ephedrine, which are used by 20 of the 25 steroid users and 21 of the 50 non-users.
Study author Amanda Gruber, MD, and researcher at McLean Hospital’s Biological Psychiatry Laboratory exclaimed, "Bodybuilding can be a dangerous activity for women who have or are at risk of developing eating or body image disorders because the bodybuilding community accepts as normal the compulsive dieting, self-preoccupation and concomitant substance abuse that are associated with these disorders." According to Gruber and Harrison Pope, MD, PhD, chief of McLean ’s Biological Psychiatry Laboratory, the paper’s second author, “One of the most interesting findings of the study was the high prevalence of eating disorders and other psychiatric disorders in women bodybuilders in general. The first syndrome, dubbed by the researchers as "eating disorder, bodybuilder type (ED, BT)," is characterized by rigid adherence to a high-calorie, high-protein, low-fat diet eaten at regularly scheduled intervals. ED, BT was found in 55 of the 75 study subjects. Nontraditional gender role, the second syndrome identified in 55 of 75 study subjects, is characterized by a strong preference for stereotypical masculine clothing, occupations and games or pastimes, and a strong preference for male friends.” Sixty-five out of the 75 study subjects reported extreme dissatisfaction with their bodies in accord with the early described syndrome called "muscle dysmorphia" in which even bodybuilders in top physical condition feel small and weak. Gruber states, "These patterns of eating behavior, gender role behavior and body image disorder caused profound effects on the social and occupational functioning of women bodybuilders. We encountered women who held degrees in law, medicine or business, yet had abandoned these careers to pursue an all-consuming lifestyle of rigorous dieting and spending many hours at the gym," said Gruber.
When it comes to bodybuilding, if a woman doesn’t train hard and follow a regular program, using proper technique and doing so consistently over time, the use of anabolic drugs will only make a difference in her sexuality, not her figure or competitive potential.
- Albert, S. The Journal of Clinical Endocrinology and Metabolism, Feb. 6, 2004 ; vol 89: pp 695-701
- American College of Sports Medicine Position statement on the use and abuse of anabolic/androgenic steroids in sports. Med Sci Sports Exerc 1987; 19:534-539
- AnabolicSteroid.com, I Am A Women Who Used Steroids And Lost A Precious Gift. http://www.anabolicsteroids.org/womenfemalessteroids.html
- Grimes, J. Hormones and Behavior, Nov. 2003; vol 44: pp 271-280
- Gruber AJ, Pope HG Jr. Compulsive weight lifting and anabolic drug abuse among women rape victims. Comprehensive Psychiatry 40(4):273–277, 1999
- Hamburger, C. (1969). Endocrine treatment of male and female transsexualism. In: Transsexualism and sex reassignment. Green, R. & Money, J. (eds), Baltimore, Johns Hopkins University Press, 291-307
- Kraemer, William J., Varying Weight Training Intensity Increases Growth Hormone In Women. American Physiology Society, December 4, 2006
- Malarkey, W.B., Strauss, R.H., Leizman, D.J., Liggett, M., Demers, L.M. (1991) Endocrine effects in female weight lifters who self-administer testosterone and anabolic steroids. American Journal of Obstetrics and Gynecology, 165, 1385-1390
- National Institute on Drug Abuse (NIDA). Research Report Series - Anabolic Steroid Abuse. Why do people abuse anabolic steroids?
- Patrick J. Bird, Ph.D., Steroid Effects on Female Bodybuilders, University of Florida Health and Human Performance
- Silver, M.D. Use of Ergogenic Aids by Athletes. J. Am. Acad. Ortho. Surg., January 1, 2001 ; 9(1): 61 - 70
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- Sutton, Linda, ANABOLIC STEROIDS: Not Just For Men Anymore, Vanderbilt University
- US Department of Health and Human Services. Physical Activity and Health: A Report from the Surgeon General. Atlanta , GA : US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996
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