Anabolic steroids and their risks

Original Article

Vol. 1 No. 4 - Oct/Dec - 2004
Pages:20-
22

Anabolic steroids and their risks

Authors:

INTRODUCTION We are currently living in a time of exaggerated cult of the body and aesthetics: plastic surgeries have tripled in the country, there has been a growing increase in the number of gym-goers and there have never been so many cosmetics and weight-loss products sold, despite the economic crisis. It is imperative to be beautiful, muscular, thin and healthy. In addition to this, there is an exaggerated consumption of everything: money, image, clothes, perfumes, adornments, designer labels, love, sex, consumer goods and legal and illegal substances. To make the exaggerated consumption of substances worse, a new myth has been incorporated into sports practices, which is that various substances are available for gaining muscle mass and consequently improving performance and physical performance. Among them are anabolic androgenic steroids. DEFINITION Anabolic steroids are medications that function like steroids produced by human beings themselves. They can be classified as androgens and corticosteroids. Those that are misused are mostly androgenic steroids (which act like testosterone). The steroids used to treat inflammatory reactions are corticosteroids ( prednisolone, cortisone, beclomethasone, budesonide, dexamethasone and several others), and all have varying degrees of anabolic effects. Androgenic steroids, secreted by the adrenal glands or the testes, are male sex hormones, which include testosterone, dihydrotestosterone and androstenedione. Testosterone, which comes from cholesterol, is produced in men mainly in the testes, with a small amount in the adrenal glands. Testosterone and its metabolites, such as dihydrotestosterone, act on various parts of the human body to produce secondary male sexual characteristics (baldness, facial and body hair, deep voice, greater muscle mass, thicker skin and maturity of the genitals); at puberty, it produces acne, penile and testicular growth (in relation to length and diameter) and fusion of the bone epiphysis, thus ceasing growth in height. Normal production in adult men is about 4 to 9 mg per day, and can be increased by stimulating intense physical exercise. Women produce only 0.5 mg of testosterone/day, hence the difficulty in acquiring muscle mass. HISTORY OF THE DRUG Anabolic steroids gained some prominence for medical use in the early 1950s for the treatment of patients who were deficient in natural estrogens or who suffered from diseases characterized by muscle wasting. Other clinical and therapeutic indications include the treatment of osteoporosis in women and to counteract an excessive decline in lean body mass and an increase in body fat often seen in elderly men. However, anabolic steroids have recently become an integral part of the high-tech environment of competitive sports, being used by approximately 90% of male and 80% of female professional bodybuilders in the hope of improving physical performance. In 1994, more than one million young people in the United States had used anabolic steroids. It is concerning to know that the reason for their use is socially motivated, with the product’s beneficial effects on physical performance being emphasized without concern for serious health damage. Federal authorities have conservatively estimated that the emerging illegal steroid trafficking business, which is a major economic driver of illegal drug use, is worth more than $100 million per year, a figure that is rapidly increasing. In Brazil, although the problem is getting worse, we have not found any studies on the incidence and prevalence of illicit anabolic steroid use among adolescents. However, we can estimate that the preferred user or consumer is between the ages of 18 and 34 and is generally male. INDICATION Anabolic steroids have several clinical uses, with their main function being to replace testosterone in cases where, for some pathological reason, there has been a deficit of this hormone. Many testosterone-like products are used in medical treatment, such as in cases of testosterone deficiency, testicular problems, breast cancer, hereditary angioedema, aplastic anemia, severe endometriosis, and to stimulate growth in cases of delayed male puberty. In addition to their medical use, they have the property of increasing muscle mass and, for this reason, are highly sought after by athletes or people who want to improve their performance and physical appearance. Aesthetic use is not a medical indication, therefore it is illegal and also causes health problems. EXAMPLES OF STEROID MEDICATIONS Steroids can be injected or oral. The preferred form of administration for users is intramuscular application, since the substance acts more quickly than orally. National steroids – Nandrolone decanoate ( Deca-Durabolin® – an injectable steroid with muscle mass gain results and few side effects); testosterone derivatives, such astestosterone propionate, phenylpropionate, isocaproate and decanoate (four types of synthetic testosterone that are very good for gaining mass and strength, but are very loaded with side effects); oxymetholone (an oral steroid that has the greatest power for gaining mass and strength of all those available in Brazil and abroad, but is also by far the most toxic, and can cause instant hepatitis, regardless of the dose); mesterolone (moderate toxicity and few effects on mass gain). Imported steroids – Estazanol , oral and injectable (toxic to the liver); metholone enanthate (little effect on mass gain and less toxic); oxandrolone (does not have many side effects, being preferred by women). SIDE EFFECTS Abusive use of steroids can lead to tremors, severe acne, fluid retention, joint pain, increased blood pressure, altered cholesterol metabolism (decreasing HDL and increasing LDL with increased risk of coronary heart disease), changes in liver function tests, jaundice and liver tumors, polycythemia, exacerbation of sleep apnea, stretch marks and a greater tendency to injuries to the locomotor system (since the joints are not able to increase muscle strength). In addition, individuals who use injectable anabolic steroids run the risk of sharing contaminated syringes and becoming infected with the AIDS or hepatitis B or C viruses.

In men – Decreased or atrophy of testicular volume, reduced sperm count, impotence, infertility, baldness, oliguria and dysuria, prostate hypertrophy and breast development with gynecomastia that is not always reversible.

In women – Hair growth with a masculine distribution, changes or absence of the menstrual cycle, hypertrophy of the clitoris, deep voice and reduction in breasts (atrophy of breast tissue).

In adolescents – Early skeletal maturation with premature closure of the bone epiphyses, short stature and accelerated puberty, leading to dysmorphic growth.

Abuse of anabolic steroids can cause emotional problems such as mood swings, including uncontrollable aggression and anger, and lead to violent episodes such as suicide and homicide, especially depending on the frequency and volume used. Users present depressive symptoms of withdrawal syndrome when they stop using the drug, which can contribute to dependence. They can also experience pathological jealousy, manic and schizophrenic episodes, extreme irritability, illusions (which may involve a distortion of judgment regarding feelings and invincibility), distraction, mental confusion and forgetfulness, in addition to changes in libido and their consequences. Some causes indicated for the use of anabolic steroids include dissatisfaction with physical appearance and low self-esteem. Social pressure, the cult of the body that our society values so much, the false healthy appearance and the prospect of becoming a sex symbol are reasons for the use/abuse of these drugs. A good physical appearance helps in acceptance by the group, promotes admiration from everyone and creates new opportunities.

In this frantic search for the ideal body, the individual uses a series of substances and ends up having a disturbance in the perception of his body image, which includes him in the group of young people with emotional problems, presenting clinical conditions today called muscular dysmorphism or bigorexia/vigorexia (despite the enormous gain in body muscle, the individual always feels weak in relation to others). In the language of young people, “pumping up” means becoming more attractive to girls and stronger and more powerful in front of the group of friends/enemies. CONCLUSION Should anabolic steroids be used or not? The approval and use of any drug are matters of decision, that is, whether or not their therapeutic benefits compensate for their adverse effects. In adequate therapeutic doses and under medical control and supervision, steroids cause few side effects. Use for aesthetic or frivolous reasons, always in high doses (abuse), is what brings serious consequences. The International Olympic Committee has classified 20 anabolic steroids and related compounds as banned drugs, and athletes who use them are subject to harsh disciplinary penalties. It is important that health professionals who treat adolescents are aware of this fact and ask about the use of these substances during the interview. Parents, educators and health professionals should always discuss preconceived values of our society, rationalizing the cult of the body and working to restore prudence and prevent health risks. They should also encourage other positive internal skills that we all have (especially young people, who have them and are unaware of their possession).

References

1. McArdle WD, Katch FI. Exercise Physiology 1998;435-8. 2. Ribeiro PC. Substance abuse: anabolic steroids and energy drinks. Latin American Adolescence 1999;97:102. 3. Website: www.planetavida.com.br. 1. Physician. 2. Pediatrician and hebiatrician; professor of the Specialization Course in Adolescence at the Faculty of Medical Sciences of Minas Gerais. Undergraduate work carried out by AGM during the Medicine course at Estácio de Sá University (UNESA).