The most common question I ever get asked is “aren’t there terrible side effects with steroid use”? And it’s a fair enough question to considering the type of hyperbolic stories you we are often told from the media, politicians and the medical industry that recommends you lead a life of oats and water and enjoy no fun whatsoever. I have spoken with literally hundreds of users over the years and anecdotally the type of horror side effect stories you may of heard of, have not occurred to anyone I have spoken to as well as anyone they have spoken too. Having said that there are medically proven side effects of steroids, they are for the most part extremely rare, usually mild and generally occur with people who have pre-existing medical conditions. From the NSW department of health come the following fact sheet which gives a good overview of the potential side effects:
Steroid Side Effects |
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In men:
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In women:
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*In children and teenagers, anabolic steroids may cause stunted growth.
*Most of the side effects normally stop – if you stop using the drugs.
Interestingly and with respect to NSW department of health they make a point that the side effects are only potential and that most of them stop once you discontinue use. A very reasonable position to take and far less extreme a position I would expect them to take. Nonetheless we should continue and have a good look at the most major and most common steroid side effects:
Inhibition of Natural Hormones
This is probably the most common of the Steroid side-effects and is often (falsely) claimed to be irreversible. Essentially the body tries to stay in a balanced state known as homeostasis. When hormones are introduced into the body (in this case testosterone from anabolic steroids) the brain will tell the testes to stop producing its own hormones in an attempt to create balance. Several studies have conclusively proven that natural hormone production is reduced either mildly to almost completely during steroid use. However in almost all cases the natural hormone production returns to a normal state soon after the completion of a cycle. Longer term studies have found no long-term effects from steroid use once a year has passed since the last injection of steroids in the body.
Liver Damage
This is the most talked about of the steroid side effects and the talk is often very dark and very disturbing. Liver damage is often spoken about with the assumption that every user and every steroid taken is damaging the liver. This is because the liver enzymes are elevated after ingestion of steroids, however what they don’t tell you is that this in the case after the ingestion of anything as the liver produces more enzymes to filter the substance which is its function in the body. A couple of studies in the 90’s really add some perspective:
There was an eight-week study done in 1999, which looked at the effects of an 8-week cycle of oral steroids. The steroids examined were Halotestin (Fluoxymesterone), Dianabol (methylandrostanolone), or Winstrol (Stanozolol) on rats at the dose of 2mg/kg-body weight, administered five times a week for 8 weeks. That s almost 200mgs/day of any of those steroids, for a 200lb user. That is, generally speaking, much more than the average person would use on a cycle. In fact, I have never, in my years of researching steroids and speaking with athletes, heard of anybody using even close to 200mgs/day of Halotestin, Winstrol, or Dianabol, ever!
At the end of that study, in vivo, each rat still had liver enzyme levels that were within normal range!
(*Med Sci Sports Exerc. 1999 Feb;31(2):243-50, Rat liver lysosomal and mitochondrial activities are modified by anabolic-androgenic steroids. Molano F, Saborido A, Delgado J, Moran M, Megias A.)
In another study, 16 bodybuilders using steroids were compared to 12 bodybuilders who were not. Then the bodybuilders who had used steroids stopped taking them for three months, at which points, the researchers found that liver enzymes had returned to the same levels as the non users. After only 3 months!
(*Int J Sports Med 1996 Aug;17(6):429-33, Body composition, cardiovascular risk factors and liver function in long-term androgenic-anabolic steroids using bodybuilders three months after drug withdrawal. Hartgens F, Kuipers H, Wijnen JA, Keizer HA.)
We can see from the chart below that ex-steroid users have totally normal liver enzymes one year after they stop using. In fact, for some liver enzymes, even the current users have normal scores!
Cholesterol
Steroid use can lead to high cholesterol levels as it lowers HDL cholesterol (the good kind) and raise LDL Cholesterol (the bad kind). Although the effect is generally pretty mild it is recommended that those of you with cholesterol issues and even those who don’t stay on a decent diet during your on cycle (you should be anyway). The good news is that after discontinuation your cholesterol levels will return to normal range pretty quickly.
Gynocomastia (Development of breast tissue in males)
The development of gynecomastia or feminization of the breast tissue in males is possible with anabolic steroids. This is due to an excess of estrogen being present in the body, through a process known as “aromatization” whereby androgens like testosterone are converted to estrogen. This excess estrogen then finds its way to the receptors in breast tissue and binds to them.
There are early symptoms such as itchiness of the nipples followed by pain, which develop over several days allowing users to discontinue use or combat the increased estrogen before the estrogen binds to the breast tissue. The two most common ways to counteract gynecomastia are the use an anti-estrogen like Nolvadex or Clomiphene Citrate (best taken post-cycle) or Letrozole, a very strong Aromatase Inhibitor (AI)/anti-estrogenic compound is employed during cycle to effectively starve the growth of nourishing estrogen.
Acne
Unfortunately Acne is a prevalent side effect of using anabolic steroids. The skins sebaceous glands usually experience increased activity, which promotes oily skin causing your pores to become clogged more quickly and possibly causing acne as a result. Cleaning your skin regularly and thoroughly or using a topical anti-androgen should minimise the effects, most of which will pass once you stop your cycle anyway.
Increased Aggresiveness (Roid Rage)
Increased aggressiveness is often claimed to occur with anabolic steroid use. Although it´s highly rare (less than 5%), significant psychiatric symptoms have been found in some steroid users, including aggression and increased violence, mania, and even psychosis. Unfortunately these studies involved no control group so factors such as the type of people naturally inclined to use steroids, pre-existing mental conditions and natural changes occurring during the study can not be calculated. Whilst it is possible that it has some psychological effects there is simply no evidence to suggest common portrayal of “roid rage” or excessive aggression exist.
In 2000 a landmark study of 109 users of varying backgrounds and experience found that only 5 of the subjects people exhibited Psychological (Manic or Hypomanic) effects dispelling the myth that “roid rage” or increased aggression was an inevitable side effect of steroid use. (*Archives of General Psychiatry, Volume 57, February 2000.)
Baldness
Steroids can exasperate baldness for men with pre-existing genetic conditions. As Male pattern bladness is though to reside in the x chromosone exclusively, a good indication to see if you are at risk is to look at the men on your mothers side. If a majority of them are bald then the Dihydrotestosterone (DHT) in many steroids may increase the chances of premature balding. This is merely a cosmetic effect and not a sign of something more sinister. The good news is you can avoid it altogether by avoiding certain steroids or by taking anti-baldness medication such as Finasteride and Dutesteride.
Stunted Growth (height)
The use of some steroids can possibly stunt the growth potential of still maturing children, teens and young adults. This is only possible with certain steroids, and not with others. In fact, certain steroids have been used in clinical settings to improve growth rates in children. It is probable that the premature closure of the epiphysial cartilage, which is most likely caused by aromatizable steroids, will lead to a possible growth inhibiting effect, and could ultimately result in a shorter adult height. This is most likely an irreversible side effect, as the growth plates would have fused and can not “re-open”. Anavar (Oxandrolone) has been used to improve the height of growth stunted children, and it is probable that most other DHT-derived steroids could also be used for this purpose as could certain anti-estrogens. In 99.9% of humans, the process of bone elongation ends at around the mid to late teen years so non-medical steroid use is definitely a big no-no for anyone under 20. Wait to you finish growing!
Prostate Enlargement
Once again, this is only a possible side effect, but steroids can potentially cause enlargement of the prostate. The media-perpetuated claim of possible prostate cancer seems to be wholly unfounded, according to most research. In many cases, this enlargement is quickly remedied upon cessation of anabolic steroid use. Typically, a product such as Finasteride or Dutesteride is taken to avoid this problem, with a high degree of success.
Kidney Problems
Certain anabolic steroid usage may place greater strain on the kidneys. Since kidneys are involved in the filtration and excretion processes, when a foreign substance is administered, they necessarily work harder. Some steroid users have noticed very dark urine while on a cycle, and this is indicative of the kidneys working overtime to accomplish their goal. One of the major offenders of this seems to be Trenbolone, which turns the user’s urine a very dark color. This problem is alleviated when enough water is consumed daily. Some steroids (Nandrolones) are even used to help treat people with kidney problems! So clearly, they aren’t as bad as they’re made out to be.
Sterility in Males and Females
Temporary sterility is a common side effect of steroids in both males and females. In fact, anabolic steroids are so proficient at this that they have actually been studied and approved by the World Health Organization as a male contraceptive possibility. Steroids do this by disrupting the various hormones in women which potentiate the ability to have regular menstrual cycles. In men, steroids lower Follicle Stimulating Hormone (FSH) to the point where normal production of sperm is not possible. This isn´t to say that nobody on a cycle has every conceived; quite the opposite, actually. There’ ve been legions of “happy accidents” reported to me by athletes who were on cycles and thought they couldn´t possibly conceive.
Sterility caused by steroids is temporary, of course, and reverses post-cycle. This reversal is typically sped up by the post-cycle therapy which often involves the use of SERMs such as Nolvadex or Clomid , and/or Human Chorionic Gonadotropin.
(1. Fertil Steril. 2004 Jan;81(1):226. 2. Urology. 2000 Oct 1;56(4):669.3. J Clin Endocrinol Metab. 1985 Oct;61(4):746-52 4. Fertil Steril. 1994 May;61(5):911-4. 5. Andrologia. 1985 Sep-Oct;17(5):497-501 6. Urol Clin North Am. 1986 Aug;13(3):455-63.)
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