Anabolic Androgenic Steroids (AAS), as they are known, are different from prednisolone or other corticosteroids which are recommended by physicians to treat several chronic diseases which are inflammatory in nature. AAS are used by sportspersons or teenagers to increase muscle mass, enhance performance or improve physical appearance respectively. Though they both are similar in functions & structure, they are used for varied purposes. Most of them have now been strictly available on prescription basis, but still illegal anabolic steroid use have been widespread around the world.
The adverse health impacts of AAS due to widespread abuse of AAS among athletes have been recently studied & documented. Only after such research studies have brought to light the serious health risks such drugs carry on their overuse, have legal restrictions been put on them to curb their use among the sports fraternity. Almost all international & prestigious sports event organizers & federations have put a ban on use of several such drugs during any event.
Following are the several health risks & diseases caused as a result of indiscriminate use of AAS :
- Cardiovascular Effects
Anabolic steroids have been found to cause abnormal serum lipid levels increasing the levels of low density cholesterol (bad cholesterol) & decreasing the levels of high density cholesterol (good cholesterol). These levels may not normalize despite ceasing the use of these drugs.
Hypertension has been found common in athletes on prolonged use of AAS. There is increased thrombolytic activity of clotting cells which increases risk of strokes & heart attacks.
All above factors predisposes athletes to chronic cardiovascular diseases.
- Hepatic Effects
Most liver enzymes have found to be elevated in steroid users, but these have found to be high even in weightlifters not on steroids.
However, cholestatic jaundice have been found in steroid users but is resolved after 3 months of discontinuing the steroids.
Moreover, hepatic tumors have been quite common among steroid users. Extensive & large scale steroid users have mostly died of hepatocellular carcinomas or hepatic tumor ruptures.
- Musculoskeletal Effects
AAS have been found to increase muscle mass both by inducing muscle hypertrophy & increasing the formation of new muscle fibres.
Some studies have shown premature epiphyseal closure among teenagers, which is detrimental for achieving adequate height, on being exposed to high amounts to androgens through steroid use. This may end up in higher risk of rupture of tendons with increased intensity of training, but this claim lacks sound clinical evidence.
- Renal Effects
Renal parameters such as serum creatinine, blood urea nitrogen & uric acid have been in increased amounts in athletes on steroid use.
There have been cases reported of rhabdomylosis induced acute renal failure in bodybuilders on extensive AAS use. Extensive abuse of AAS & creatine supplement by body builders have also caused renal damage.
- Endocrine Effects
Occurrence of acne is the most common phenomenon in steroid users due to the over stimulation of sebaceous glands by androgens. They may or may not respond to acne therapy.
Alopecia & hair recession has also been observed in both males & females on extensive AAS use. Females on extensive & prolonged periods of AAS use may develop hirsutism, menstrual irregularities, deepening of voice which may be irreversible even after discontinuation of these drugs.
- Immunologic Effects
Risk of infections such as HIV, Hepatitis B & C have been observed in athletes who share needles for intramuscular AAS use.
Unsafe & unhygienic use of syringes among athletes have also increased risk of infections which are haematologic in nature.
- Reproductive Effects
Use of steroids have long term implications in men resulting in decreased endogenous production of testosterone, oligospermia/ azoospermia & testicular atrophy which may be not subside upto 6 months after discontinuation the steroids.
Gynecomastia is observed in males where there is conversion of androgens from steroid use to estradiol & estrogen. This can be due to lack of adequate clearance of hormonal metabolites from the liver.
- Psychological Effects
AAS abuse among athletes have found to cause altered mental status with increased irritability, violent behaviour, aggressiveness, mood swings, depression.
AAS can be dangerously addicting and withdrawal symptoms on cessation of their extensive use have been found to have symptoms similar to those observed with opium addiction. Even electro encephalogram reports have been found similar among use of AAS and other psychoactive substances.
Mood changes with AAS abuse have been paranoia, hypomania & psychotic features which may be dose dependent & not the same across all individuals.
AAS use was found to be extensive among athletes with a distorted body image & those who were dissatisfied with their physical appearance & those who had a narcissistic personality & who were preoccupied with their muscularity. This caused them a reverse anorexia syndrome.