The inside information on appearance
and performance enhancing drugs (APEDs).

Dangers of Steroid Abuse

Physical Effects

• Musculoskeletal System
  • Bones stop growing
• Cardiovascular system
  • Water and salt retention = high blood pressure
  • Elevated cholesteral and triglycerides
  • Blood clotting disorders
• Skin
  • Balding
  • Acne (really bad acne!) on the back, shoulders and chest
  • Oily skin
  • Puffy cheeks
• Gastrointestinal system
  • Liver cysts / liver cancer
• Hypertension
• Increased chance of injury to tendons, ligaments, and muscles
• Jaundice, trembling, aching joints
• Bad Breath
• Users can become addicted

Boys

• Gynocomastia (Grow breasts)
• Testicular atrophy
• Low sperm count
• Impotence / Sterility
• Prostate growth
• Cancer
• Premature balding 

Girls 

• Male body hair (e.g., beard)
• Male pattern baldness
• Deepened voice
• Irregular periods
• Breast shrinkage
• Potential birth defects
• Enlarged clitoris

 

Psychological Effects

• “Roid Rage”-increased aggressiveness, anger and hostility, which may progress to violence
• Reckless behavior
• Feelings of inadequacy
• Restlessness
• Psychosis
• Decrease libido
• Depression (serious enough to cause suicidal thoughts) 
• Mood Swings
• Psychological addiction

In a small but alarming new study, middle-aged weight lifters who took steroids for roughly a decade showed evidence of impaired heart pumping function that was not seen in weight lifters who did not take steroids.

The finding suggests that many years of anabolic steroid use weakens the heart more than has been previously recognized, says cardiologist and study researcher Aaron L. Baggish, MD, of Harvard Medical School and Massachusetts General Hospital.

It may also have important public health implications because the use of steroids to improve sports performance is no longer the exclusive domain of a small group of elite athletes.

Steroids use is now common in fighting sports, such as boxing and mixed martial arts, in addition to weight lifting, Baggish says.

Anabolic steroids are synthetically produced drugs that mimic the naturally occurring male sex hormone testosterone, which builds muscle.

"Steroid use in the general public wasn't really an issue until the late 1980s or even the mid-1990s," Baggish tells WebMD. "Even now, when we hear about steroids it's because a professional baseball player or cyclist has taken them. But the vast majority of steroid use is now happening among casual athletes who work 9-to-5 jobs."

In an effort to better understand the impact of long-term anabolic steroid use on the heart, Baggish and colleagues performed heart function testing on 12 weight lifters who took steroids and seven who did not take the drugs.

The average age of the study participants was 40, and the steroid users had taken the drug for an average of nine years. The two groups were similar with respect to duration of weight lifting, total physical activity level, and weight, but the steroid users had more muscle mass than nonusers.

Doppler echocardiography ultrasound was used to examine blood flow through the heart.

In most of the steroid users, the heart's main pumping chamber, known as the left ventricle, showed evidence of weakness during contraction.

A healthy left ventricle pumps 55% to 70% of the blood that fills the heart. This measurement is known as ejection fraction.

Ten of the 12 steroid users had ejection fractions of less than 55%, which has been linked to an increased risk for heart failure and sudden cardiac arrest.

Only one of the seven weightlifters with no history of steroid use had a low ejection fraction.

The steroid users also showed evidence of impaired diastolic function, which is the ability of the left ventricle to relax and fill with blood following contraction.

Left ventricle relaxation was reduced by almost half among steroid users compared to nonusers.

The study appears in the latest (4/2010) issue of the American Heart Association journal Circulation:  Heart Failure.

It was originally intended as a pilot study, but the findings were so striking the researchers decided they needed to be published.

Steroids and the Kidneys

Athletes who use anabolic steroids may seriously damage their kidneys, according to new findings presented at the American Society of Nephrology's Renal Week conference (3/2010).

“Athletes who use anabolic steroids and the doctors caring for them need to be aware of the potentially serious risks to the kidney,” said lead investigator Leal Herlitz, MD, Assistant Professor of Pathology at Columbia University Medical Center in New York.

Reports of professional athletes who abuse anabolic steroids are increasingly common.  Most people know that using steroids is not good for their health, but until now their effects on the kidneys have not been known. 

Dr. Herlitz and her colleagues recently conducted the first study describing injury to the kidneys following long-term abuse of anabolic steroids. They studied a group of 10 bodybuilders (six Caucasians and four Hispanics) who used steroids for many years and experienced proteinuria and severe reductions in kidney function. 

The men were seen between 1999 and 2009 and had highly muscular physiques. All were long-term anabolic androgenic steroid abusers, had proteinuria of 1g/day or greater, and a renal biopsy diagnosis of focal segmental glomerulosclerosis (FSGS). The average BMI was 34.7 kg/m² (range: 27-43).  The men presented with proteinuria (mean 10.1 g/day, range 1.3- 26.3 g/day) and renal insufficiency (mean serum creatinine 3.0 mg/dL, range: 1.3- 7.8 mg/dL).  Five men presented with full nephritic syndrome.

It is well known that FSGS typically occurs when the kidneys are overworked. The kidney damage observed in this group of bodybuilders had similarities to that seen in morbidly obese patients, but appeared to be even more severe.  Renal biopsy revealed FSGS in nine of the patients; four of the nine patients also had glomerulomegaly. One patient had glomerulomegaly alone. Three biopsies showed collapsing lesions of FSGS and four had perihilar lesions. Seven of the 10 men had tubular atrophy of 40% or greater and interstitial fibrosis.

“It is important to recognize that all the people in this series were long-term abusers, ranging from eight to 20 years of use,” explained Dr. Herlitz, who presented study findings at the 2009 Renal Week conference here. “So, it is unlikely that someone who uses for a few months is going to be significantly harmed. I really have no basis for estimating the prevalence of this problem and I'm hoping that this study will bring attention to the issue so that people will be aware of the entity and we can start to better understand who is affected and why.”

Follow-up data were available for eight of the 10 patients. The mean follow-up was 2.2 years. One patient progressed rapidly to end-stage renal disease (ESRD) and seven patients received renin-angiotensin system (RAS) blockade. One of these seven also received corticosteroid therapy. All seven patients who received RAS blockade discontinued anabolic androgenic steroids and reduced their exercise regimens. They also lost weight and had a stabilization or improvement in serum creatinine and a decrease in proteinuria.

Although the bodybuilders who discontinued steroid use experienced improvement in their kidney abnormalities, one individual with advanced kidney disease progressed to ESRD and required dialysis. One subject started taking steroids again and suffered a relapse, developing progressive proteinuria and renal insufficiency.

Compared with historical controls who had obesity-related glomerulopathy, FSGS in these bodybuilders was a more severe form of the disease with higher creatinine and proteinuria levels at presentation. These patients also tended to have more glomerular and tubulointerstitial scarring.

The researchers proposed that extreme increases in muscle mass require the kidneys to increase their filtration rate, placing harmful levels of stress on the kidneys. “As in obese patients, the increased strain on the kidney from the elevated body mass leads to hyperfiltration injury,” Dr. Herlitz explained.

It is also likely that steroids have direct toxic effects on the kidneys. “Numerous animal models have shown adverse effects of androgens on the kidneys and we believe that the anabolic steroids themselves may be directly nephrotoxic,” she said.