Steroids are a man-made version of chemicals known as hormones that are made naturally in the human body.
There’s a wide range of steroids, but the most popular is testosterone. This hormone and its derivates are often known as anabolic steroids.
Some people use anabolic steroids irresponsibly to increase muscle size. Others use them because they really need them due to a low level of testosterone.
This short review of anabolic steroids includes important considerations of substance abuse and how to use them properly.
What are anabolic steroids?
As mentioned above, steroids are the name of a wide array of molecules. They are all active and have in common a molecular configuration consisting of four carbon rings. Steroids are not always the same and do not perform the same function always. Thus, we can divide them into different types.
The most essential steroids are corticosteroids and sex hormones. The adrenal cortex releases corticosteroids. Sex hormones are either released by the ovaries or the testicles. The latter is also known as androgenic steroids because they are behind the typical appearance of a man. Another name usually given to testosterone is anabolic steroid because it has an anabolic effect.
Contrary to a catabolic effect, anabolic androgenic steroids (AAS) help your body creating new tissue. After binding with the androgen receptor, they trigger and stimulate protein synthesis. By doing so, these steroid hormones help to build muscle, bone tissue, and other structures (1).
More important still, testosterone is the male hormone. It is required for an adequate sexual function, and to trigger puberty in boys.
Why do people use them?
People use anabolic steroids for many reasons. Not all of them are actually recommended.
Too often, people look for illegal anabolic steroids and misuse them. They don’t have a prescription because they do not really need them.
Instead, they use them to improve athletic performance or increase muscle mass. Some people can use them to burn fat, too. That’s because this hormone is associated with an increase in fat metabolism (2).
Others use testosterone because they think they need it. They believe they have low testosterone levels without actually measuring them. Or maybe they did measure them but were not even near the lower threshold to start testosterone replacement therapy.
However, many other patients fulfill the criteria for AAS use. Medically speaking, anabolic steroid use should be reserved to (3):
- Boys who didn’t naturally trigger their puberty
- Older men who have deficient testosterone levels
- As a part of fertility therapy for patients with low testosterone levels
- Masculinizing hormone therapy in transgender patients
These uses are more appropriate, but still need constant monitoring to prevent side effects.
Types of anabolic steroids
There are several types of anabolic steroids. Natural anabolic steroids are two: testosterone and dihydrotestosterone DHT. The former is the hormone as-synthesized and release by the testis. The latter is an improved and more active version of testosterone.
Other synthetic substances also share the same functions of testosterone. They are divided into several groups and subtypes. Some of them are better for medicinal use. Others are better for cutting of physical performance. But what they have in common is a similar structure. And even though they are better for this or that, they do perform the same functions to a certain degree.
According to their structures and primary functions, each variant of synthetic testosterone can be used differently. For example, nandrolone decanoate is commonly known as Deca-Durabolin. It is very useful to treat patients with osteoporosis, wasting syndrome, and anemia caused by hormonal imbalances.
But you have other “pure” testosterone substances. They work almost exactly as natural testosterone. One example is testosterone cypionate. This one is more useful for patients with hypogonadism. These patients do not synthesize their own testosterone. Thus, they need the complete set of functions offered by a non-modified testosterone molecule.
Initially, all of these steroids had to be injected. It was the only way to get them into the circulatory system without the breakdown of nutrients in the gut and their metabolism by the liver. But new formulations allow us to have oral steroids and even steroids in cream or gel. Some of them can also be implanted under the skin or administered sublingually (4).
Leaving aside steroid abusers, medical uses of steroids are limited to the bullet points considered above. These drugs are commonly used by patients who have very low testosterone levels. And even patients with a low testosterone level are not always steroid users.
Not all of them suffer from hypogonadism, which is a clear indication of steroid treatment. They need to fulfill a series of tests, and doctors need to evaluate their signs and symptoms.
After a full assessment, doctors will make a decision based on clinical findings and international recommendations. In older adults especially, the androgenic effects of testosterone can be used to reduce skeletal muscle wasting and prevent osteoporosis (4).
Another common medical use is in young boys with delayed puberty. This particular use is even more controversial, and there are specific criteria to fulfill.
Doctors need to measure testosterone levels several times. Patients need to wait a considerable time to make sure puberty is not triggered naturally. And sometimes, genetic exams are made to rule out Klinefelter syndrome and similar issues (4).
What are the side effects of anabolic steroids?
Steroid abuse works similarly to any other drug abuse. Side effects appear if you take a drug, you don’t need and use an excessive dose. Sometimes you get side effects even if you use the drug responsibly and at the right dosage. In the case of anabolic steroids, the most common side effects are as follows (4,5):
- Acne: This side effect is due to an increase in the production of sebaceous glands. The oily substance they produce creates a clog and the ideal conditions for infection. Acne may appear in the face but also the back and other parts of the body.
- Baldness: This is due to the conversion of testosterone into DHT in the scalp. For an unknown reason, DHT destroys the hair follicles and causes male pattern baldness.
- Increased facial hair: This can be disturbing for women who receive testosterone for medical purposes. This use is not widespread, though, and should be considered very carefully.
- Breast enlargement: An excess of testosterone is transformed into estrogens. These are female hormones and may cause breast enlargements in men. This usually happens at very high doses of anabolic steroids.
- Pain at the site of injection: This is a common side effect in injected testosterone. The location of injection may also look reddened due to an increase in vascularity.
- Skin rash where patches are placed: Patients with a severe rash should consider an allergy to patches, and some would even need to discontinue this form of administration.
On the other hand, we also have to consider severe side effects. They are not as common, but need to be addressed right away (4,6):
- Swelling and rapid weight gain: Steroids cause water retention. This effect is secondary in the case of testosterone but still can happen. So, notify at once if you notice swelling of the lower extremities. Severe water retention is also associated with rapid weight gain.
- Ongoing penile erections: This is called priapism, and it is an emergency. It is not only an ongoing erection. It is also painful and sometimes associated with a change in the color of the penis.
- Liver injury: A very high dose and combining steroids with other drugs can cause liver injury. This is more common in oral steroid users.
- Testicular atrophy: This is one of the worst complications of anabolic steroids. Anabolic steroid misuse causes an alteration in the regulation of testosterone. The testicle believes there’s enough testosterone around and stops synthesizing by itself. After a while, it gets lazy and becomes atrophied and smaller than normal. This is a cause of AAS dependence because it literally stops producing testosterone by itself.
To prevent anabolic steroid addiction and other problems, some people use dietary supplements instead.
Actually, before testosterone replacement therapy (TRT), it is recommended to try natural remedies that boost your capacity to synthesize testosterone. They are safer and do not have the same adverse events.
Anabolic steroid abuse can cause several health risks and increase your chance of disease. AAS abuse and use without monitoring can cause the following health problems (4,6):
- An increased cardiovascular risk: These patients have a higher risk of high blood pressure and heart disease. Thus, they should be carefully controlled to prevent any adverse outcomes.
- An increase in hemoglobin and hematocrit: By increasing hemoglobin, anabolic steroids can prevent anemia. But an overly high level can thicken the blood and increase the risk of stroke and heart attack.
- An imbalance in cholesterol levels: Anabolic steroids can increase your LDL levels and reduce your HDL levels. This can cause atherosclerosis and lead to heart disease, too.
- Liver dysfunction: As mentioned above, steroids can cause liver injury. Thus, it is important to monitor liver markers throughout the treatment.
- A higher risk of infection: Steroids used as enhancing drugs sometimes come from an illegal lab. These illegal steroids have a very high risk of contamination.
- Addiction and mental health issues: Even if your testicular function remains the same and you don’t need a constant supply of testosterone, there’s also a mental addiction or dependence to consider. Many users of androgenic steroids suffer from muscle dysmorphia. This is an excessive preoccupation with growing bigger muscles and can turn into a problem similar to anorexia and bulimia.
Steroids are divided into different subtypes. The most critical anabolic steroid in nature is testosterone. Several synthetic substances mimic the function of testosterone. We can use them in patients with low testosterone problems or delayed puberty. However, there are special criteria to recommend testosterone derivates.
Steroid misuse is common among athletes and people who use them for physical performance. However, we should understand the health consequences of illegal steroid use. We have common side effects such as acne, baldness, and pain in the site of injection. Other severe side effects include liver injury, testicular atrophy, and heart disease.
Dietary supplements and testosterone boosters are a safer and more appropriate option for patients with low testosterone levels who do not fulfill the TRT criteria.