Anabolic Steroid Abuse

In one study, about 3% of high school students admitted to taking steroid pills or injections without a prescription.

• Anabolic steroids are used illegally to increase muscle, decrease fat, and enhance athletic performance and body appearance.
• Anabolic steroids act by increasing the androgenic testosterone effects within the body.
• Anabolic steroids can lead to potentially fatal side effects.
• Anabolic steroids may be addictive, and users may go through withdrawal.
• Prevention requires community education, as well as reviewing why adolescents may want to start using the drugs and understanding the risks involved.

Anabolic steroids are one type of performance-enhancing drug or medication. They mimic testosterone in the body to enhance performance by making muscle cells larger and by allowing the body to recover more quickly from the stress of exercise. Slang for anabolic steroids is roids.

Performance-enhancing drugs are no longer just for bodybuilders or pro athletes who are willing to try illegal and potentially dangerous means to improve their body's function. These drugs are being used every day by people of all ages, from middle school, high school, and college students to older recreational athletes.

There are two types of steroids that the body naturally produces:

• Catabolic steroids or glucocorticoids are part of the body's response to stress. The word catabolic comes from the Greek word meaning "throw down," and these steroids help break down large chemicals into smaller ones. For example, cortisol helps glycogen (a large molecule that is stored in the liver) metabolize into glucose, a small molecule that can be used for energy by the body. The adrenal glands naturally manufacture cortisol, and it is required for many of the basic functions of the body, including glucose metabolism, the immune response to infection, and protein, fat, and carbohydrate metabolism. Prescription medications, such as prednisone (Deltasone, Liquid Pred), hydrocortisone (Westcort), and dexamethasone (Decadron [discontinued], DexPak), are examples of steroids that are used to reduce inflammation and treat a range of illnesses from asthma and COPD to rheumatoid arthritis and allergic reactions. Low-dose hydrocortisone is the active ingredient in creams that help treat inflammation from insect bites, poison ivy, eczema, and other local skin irritations.
• Anabolic androgenic steroids are steroids that mimic testosterone in the body. Anabolic refers to the properties of these drugs to increase the production of proteins that act as building blocks for muscle cells, bone, and other tissues within the body. The androgenic response (andro=male + genic=formation) describes the increased male features (secondary sexual characteristics) that occur as a result of androgenic steroids, including facial, body, and pubic hair, deepened voice, and increased sex drive or libido.

There are medical indications for prescribing these medications. Some include the following:

• Inadequate testosterone production in the body, either because of inborn errors of metabolism or because of illnesses that decrease production
• Certain types of anemia
• Recovery from major illness or injury, including burns, where the body's metabolism needs to be increased to produce more protein
• An adjunct treatment for certain types of breast cancer
• Hereditary angioedema
• HIV wasting syndrome
• Growth failure and short statures in the pediatric population

Some physicians believe that the decreased testosterone levels that occur normally with aging are an indication for replacement therapy with anabolic steroids, but their use in otherwise healthy older patients is still controversial because of the potential serious side effects.

Chemists have manufactured many different types of anabolic steroids over the past decades. The goal of chemists is to promote the anabolic effect of the drug while decreasing the androgenic side effects that can be life-threatening.

Examples of anabolic steroids include the following:

• Testosterone (Axiron, Androgel, Fortesta, Testopel, Striant, Delatestryl, Testim, Androderm)
• Androstenedione
• Stanozolol (Winstrol)
• Nandrolone (Deca-Durabolin)
• Methandrostenolone (Dianabol)

People abuse steroids for a variety of reasons, but most do it to increase body performance and appearance. There may be peer pressure to use anabolic steroids in some sports because of a fear that normal training will not be enough to succeed. There is also the perception that other athletes are abusing steroids and gaining an unfair advantage.

People who use steroids to enhance their appearance by increasing muscle and decreasing fat may suffer from muscle dysmorphia or abnormal perception of their bodies. Males may think that they are perpetually too small and weak, and females may think themselves fat, even though that perception may not be true.

Bodybuilders and weight lifters are not the only athletes to think that anabolic steroid use is their road to success. Athletes, from strength sports like football and throwing the discus to speed sports like track sprinters and speed skaters, have attempted to use steroids to enhance performance and increase the efficiency of their training.

Though most anabolic steroids need to be injected into the body to be effective, some may be taken by mouth and others used as a cream or gel and applied to the skin. The user will try to take enough anabolic steroids to increase the ability to exercise and allow muscles to grow while minimizing the risk of side effects and the potential of being caught. Usually, people take steroids in cycles with regular injections followed by periods of rest. Numerous books and websites discuss the benefits and risks of different techniques to maximize the effect of a variety of steroids on the body. There is a large underground illegal industry that has grown to meet the demand for anabolic steroids and provides methods to try to avoid detection.

Cycling, stacking, and pyramiding are three common ways that anabolic steroid abusers take their drugs. Cycling refers to taking a steroid for a period, stopping for the body to rest, and then restarting again. If people use more than one type of steroid at a time, this is called stacking. There is the belief that using two or more steroids at a time increases the effectiveness of each. Pyramiding combines cycling and stacking. One or more steroids are begun in a low dose and the dose is gradually increased until halfway through the cycle when the amount is maximized and is then tapered to zero by the end of the cycle.

Tailor exercise programs so that more can be done as the effect of the steroid increases. The cycles of steroid use are usually six to 12 weeks long, followed by a rest period.

In athletes who use anabolic steroids, a cat-and-mouse game exists. They try to time their steroid injections so that the drug is out of their system during drug testing. Sometimes people take masking drugs to try to "beat" the test by making the test negative. Chemists continually develop designer steroids to again prevent their use from being detected.

Like alcohol or street drugs, the common signs of addiction may develop with the use of steroids. These include drug cravings, requiring more drugs to get the same effect, and withdrawal symptoms if someone stops the drug. The following is a statement from the National Institute of Drug Abuse concerning anabolic steroids:

"An undetermined percentage of steroid abusers may become addicted to the drugs, as evidenced by their continued abuse despite physical problems and negative effects on social relations. Also, steroid abusers typically spend large amounts of time and money obtaining the drugs, which is another indication that they may be addicted.

Individuals who abuse steroids can experience withdrawal symptoms when they stop taking steroids, such as:

• mood swings,
• fatigue,
• restlessness,
• loss of appetite,
• insomnia,
• reduced sex drive, and
• steroid cravings.

The most dangerous of the withdrawal symptoms is depression because it sometimes leads to suicide attempts. If left untreated, some depressive symptoms associated with anabolic steroid withdrawal have been known to persist for a year or more after the abuser stops taking the drugs."

• Anabolic steroids are used as performance-enhancing drugs to increase the ability to do work and exercise by abnormally stimulating muscle growth, power, and aerobic capacity. This increased function comes with a cost of potentially life-threatening side effects.
• The complications of anabolic steroid abuse are a result of excess testosterone affecting almost all the organ systems in the body. Some of the effects are reversible and decrease when the drug abuse stops while others are permanent and irreversible.
• In males, the excess steroid suppresses the normal testosterone production in the body. This can lead to shrunken testicles and decreased sperm count, baldness, and breast development (gynecomastia).
• In females, anabolic steroid abuse can lead to masculinization with loss of body fat and breast size, swelling of the clitoris (which may be permanent and not resolve, even though a woman stops using steroids), deepening of the voice, and the development of facial and body hair.
• Life-threatening side effects include:
  • heart attack and stroke,
  • the risk of forming blood clots (deep vein thrombosis and pulmonary embolus),
  • liver cancer, and
  • liver failure.
• Excess steroid use often affects the skin, and the issues are similar to the adolescent male going through puberty with its testosterone spike. Hair can become oily.
• Acne is often present. Acne conglobata is a particularly severe form of acne that can develop during steroid abuse or even after a person stops taking the drug. Infections are a common side effect of steroid abuse because of needle sharing and unsanitary techniques used when injecting drugs into the skin. These are similar risks to IV drug abusers with increased potential to acquire blood-borne infections such as hepatitis and HIV/AIDS. Skin abscesses may occur at injection sites and may spread to other organs of the body. Endocarditis or an infection of the heart valve is not uncommon.
• Psychiatric and psychological complications include manic behavior and psychosis, including hallucinations and delusions. Aggressive behavior is common and known as "roid rage."
• Because muscle growth can occur quickly, it can cause stress on the tendons that attach the muscle to bone and those who abuse anabolic steroids are at risk for tendon rupture.
• Anabolic steroids can increase bone production, especially in the skull and face. Teeth can splay apart as the maxilla and mandible grow. There can be an overgrowth of the forehead, giving an "Incredible Hulk" appearance. If adolescent teenagers abuse steroids before they have finished growing, these drugs can prematurely close bone growth plates, leading to short stature.

The diagnosis of anabolic steroid abuse in high school, college, and professional athletes may occur with a failed drug test, but many people who abuse these drugs are never randomly tested. Doctors often make the diagnosis when someone develops one of the side effects of steroid use.

Once the potential diagnosis of drug abuse is considered, the healthcare provider must offer the opportunity for the patient to consider drug treatment options, just like any other addictive drug. However, the patient must take the first step in diagnosis and treatment by admitting there is a potential for abuse and their willingness to consider intervention and treatment.

Counseling is the mainstay of therapy for anabolic steroid abuse. The patient and their support group, family, and friends, need to appreciate that the approach to this addiction may be similar to addiction to other drugs and alcohol.

Depression and suicidal thoughts may occur when one stops taking steroids, and this potential must be monitored closely.

Withdrawal symptoms vary with each patient, and the healthcare professional may need to prescribe short courses of medications to help with headaches, muscle aches, and insomnia.

Prevention of steroid abuse begins at a young age. There is pressure even in middle school to take drugs to increase performance on the playing field and in the gym. As well, personal appearance and perception begin early on. Unrealistic expectations can drive adolescent boys and girls to try to achieve the often unrealistic image of models in fashion magazines and athletes in the gym.

Counseling and guidance that continues through high school and beyond effectively decrease steroid use in the younger population.

According to the National Institute of Drug Abuse, the use of anabolic steroids continues to be a significant problem in the adolescent population. Their continuing monitoring studies found that in 2014 the following percentage of students used anabolic steroids in the past year:

• 8th grade, 0.6%
• 10th grade, 0.7%
• 12th grade, 0.6%

Over their lifetime, 1.9% of the 12th graders had abused steroids.

While many websites teach people how to abuse anabolic steroids without being caught, many can educate them about their benefits, risks, and dangers. Examples include the following:

"Anabolic Steroid Abuse," National Institute on Drug Abuse
http://www.drugabuse.gov/drugs-abuse/steroids-anabolic

"NIDA InfoFacts: Steroids (Anabolic-Androgenic)," National Institute on Drug Abuse
http://www.drugabuse.gov/infofacts/steroids.html

"Research Report Series - Anabolic Steroid Abuse," National Institute on Drug Abuse
http://www.nida.nih.gov/ResearchReports/Steroids/anabolicsteroids5.html#addictive