How Much Anabolic Steroids Are Harmless
Anabolic Steroids Side Effects: Erectile Dysfunction as the Price of Muscle Sixpacks
Schoolchildren already help the body shape with anabolic steroids. These are not only a multi-faceted health problem in competitive sports.
Getting anabolic steroids is easy. Anyone who is not served in dubious fitness studios can find well over 300,000 Internet sites such as www.muskelaufbau-turbo.de or www.anabolika-legal.com using relevant search terms. The predominantly male customers are promised "impressive muscles" and prophesied to them: "Everyone will envy you for it." But certainly not about the sometimes considerable side effects. Prof. em. Dr. med. Dr. H. c. Eberhard Nieschlag from the Center for Reproductive Medicine and Andrology at the Münster University Hospital recently at the annual conference of the Applied Endocrinology Section of the German Society for Endocrinology (DGE) in Cologne (1). Nieschlag knows the effects of testosterone and its derivatives from decades of research like hardly any other medical professional. Anabolic androgenic steroids (AAS) are the most frequently used substances worldwide to promote performance, muscle building and physical appearance as so-called "appearance and performance enhancing drugs" (APED). According to a study by the Center for Preventive Doping Research at the German Sport University Cologne, 87% of the APEDs seized on the black market or by customs are anabolic steroids, half of them testosterone preparations such as testosterone enanthate, propionate or isocaproate. Other commonly used AAS include Metandienone, Nandrolone, Trenbolone, Stanozol, and Oralturinabol (2).
The erection also suffers from anabolic steroids
It's not just about doping in top-class sport like the upcoming Olympics, but much more often about misuse among amateur athletes and bodybuilders. AAS is used by men and 1.6% by women with a lifetime prevalence of 6.4% (3). The side effects affect numerous organ systems and metabolic pathways. Since very few users talk openly about their anabolic steroids consumption, Nieschlag advises paying attention to characteristic symptoms. "Above all, acne and striae are often noticed," says the endocrinologist in an interview with Deutsches Ärzteblatt. “We suspect that the question of anabolic steroids could be crucial for a number of young men who go to the doctor for stubborn acne.” Striae usually indicate an unphysiological, too rapid growth of the muscles, for example in the shoulder and neck area Chest muscles and on the thighs and upper arms. The blood count with increased hematocrit values or an unfavorable LDL / HDL profile provide further information. The 17-α-alkylated anabolic steroids in particular can have a direct liver toxicity and increase transaminases. However, this remains undetected as long as the increased blood viscosity does not lead to a thrombosis or yellow sclera and vomiting - combined with increased bilirubin - indicate liver toxicity.
What young men who take anabolic steroids may need to see a doctor are erectile dysfunction. Because, contrary to what the muscle-packed appearance achieved with these substances suggests, their use is coupled with negative feedback on sex hormone production. Via the axis from the hypothalamus, pituitary gland to the gonads, anabolic steroids suppress spermatogenesis, lead to testicular atrophy, ultimately to infertility and also to erection problems and loss of libido in men (4). This side of the anabolic steroids is not known to most people, since they have had a completely different reputation since they were first abused. Among the first athletes to abuse testosterone since the discovery of testosterone (1935) were the German rowers in 1952. They took the sex hormone in order to be able to fulfill their marital duties despite the strenuous exercise.
In a large urology outpatient clinic in the USA, 1.6% of the men had anabolic steroids-induced hypogonadism (ASIH), half of them had presented because of infertility, and consumption was only revealed after the patient had been explored again (5). According to current knowledge, however, permanent damage is not to be feared. This is known from a large number of studies in which testosterone derivatives have been tested as a “pill for men” in more than 1,500 healthy men in the therapeutic area. "After stopping the preparations, the sperm analysis is back to normal after one year for 90% and after two years for 100% of the test subjects," Nieschlag summarizes the results. “But you just have to pay attention. It is therefore all the more regrettable that there are hardly any consultation hours for young men, ”said the reproduction expert. A special one for adolescent boys / men was set up in Münster, but this is an exception. Since the medical examination as part of the military service was no longer available, no doctor can see this group after the last U-examination at the age of 12.
Women fear the deep anabolic voice
This is different for women who, during puberty, often visit the gynecologist because of the prescription of hormonal contraceptives or because of menstrual disorders or pain. Women are far more reluctant to use anabolic steroids anyway. As in men, acne threatens to worsen appearance, made worse by hirsutism and alopecia. What is most feared, however, is a permanently deep voice - "a highly sensitive indicator of anabolic steroids consumption in women," explains Nieschlag and: "This is usually irreversible and known in the community, which is why women are much more cautious are."
Other side effects of anabolic steroids in females are difficult to assess. Because women who train a lot have to face physical symptoms that are not associated with sportiness and fitness. The so-called “female athlete triad” includes cycle irregularities, eating disorders and osteoporosis. There is evidence that anabolic steroids could have certain positive effects on such complaints. “However, to conclude from this that anabolic steroids could prevent these disorders has not been proven and therefore taking them would be dangerous,” explains Nieschlag.
It becomes threatening when long-term use damages the heart. Testosterone has a direct apoptotic effect on the cardiomyocytes in cell culture. This explains why AAS users can find myocardial scars even if they have normal coronary arteries. Whether hypertension is induced by means of anabolic steroids is controversial. Dreaded causes of sudden cardiac death are changes in the ECG, such as arrhythmias or prolonged repolarization, as well as hypertrophic cardiomyopathy and myocardial infarction. “It is not uncommon for users to take diuretics before competitions so that the muscle packs appear particularly taut due to the dehydration,” says Nieschlag. The associated electrolyte disturbances increase the risk of conduction to the heart.
The substances are disadvantageous even for the musculoskeletal system, the aspect of which is to be built up. It is interesting that, in a comprehensive review from 1991, the medical profession attributed the effects to a placebo effect, although a real anabolic steroids boom had set in since the 1970s (6). In the meantime, numerous studies with supraphysiological studies have shown that an anabolic effect comes about through hypertrophy of the muscle fibers (types 1 and 2) mediated by the androgen receptor and through the increase in muscle nuclei and capillaries per fiber. This is what users want. If, however, children or adolescents are already receiving the substances, the activation of the endochondral bone formation leads to an early closure of the epiphyses. The growth in length is slowed down.
Boom: testosterone gels for older men
The effect on the kidneys is similarly ambivalent. Although AAS was used in the pre-erythropoietin era for anemia therapy in kidney patients for more than 25 years, this is not a defense, because the therapeutic doses were much lower. Elevated creatinine levels should be clarified precisely because they can be a harmless consequence of increased muscle mass, but can also be a consequence of rhabdomyolysis and toxic bilirubin concentrations in the case of liver damage, especially with long-term AAS abuse.
In view of this diverse potential for damage, Nieschlag expressly warns against the practice, which is booming, especially in the USA, of administering testosterone to seniors more and more often without a clear indication. As long as you only get it i. m. could apply, this was still an obstacle. But since gels have existed, so-called “low testosterone clinics” have spread across the United States, reports Nieschlag. This is equivalent to abuse and is now being fought to a large extent by the FDA (7). The term “climacteric virile”, which Nieschlag considers absolutely inapplicable, must serve as a justification for supplying the elderly with these substances. There is “late onset hypogonadism”, he says, and this is a real indication for testosterone administration in older men. Beyond that, however, the man does not experience a climacteric, no drying up of sperm production: "I have been campaigning for 40 years to abolish the term 'climacteric virile". "
Dr. med. Martina Lenzen-Schulte
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Anabolic steroids and psyche
Under high doses of anabolic steroids - for example 500 g to 1,000 g testosterone enanthate per week - aggressiveness, excessive self-confidence, hyperactivity and even psychotic behavior are described. In a survey of 500 bodybuilders and athletes, 60% stated that they ingested such amounts. It is unclear whether people who are so dissatisfied with their appearance or who, against their better judgment, expose themselves to the effects of such substances are not predisposed to psychological disorders from the outset.
A development of dependency is also known, associated with mental changes, memory loss and cognitive impairment. About 30% develop an addiction after abuse. Withdrawal symptoms are depression, loss of libido, sleep disorders and suicide.
Source: Nieschlag E, Vorona E: Doping with anabolic android steroids (AAS): Adverse effects on non-reproductive organs and functions. Rev Endocr Metab Disord. 015; 16 (3): 199-211.
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