Anabolic Steroids

Medical Issues with Anabolic Steroid Use

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Medical Issues Associated with Anabolic Steroid Use

This paper is review of the article “Medical Issue Associated with Anabolic Steroid Use: are they exaggerated?” The review deals with the medical issues related to the use of anabolic steroids by athletes and bodybuilders. They use such exogenous sources of testosterone in order to attain attributes which would help them in enhancing their performance in sports or other related games. These anabolic steroids provide many advantages like increase in lean body mass, aggression in behavior and maturation of male secondary characteristics. They are taken orally or parenterally and in a cyclic manner. They can also be used along with other drugs to increase efficacy.

Although an athlete may gain all these advantages but he also faces adverse effects of these drugs as they affect multiple systems of our body like heart, liver, brain and bones. However, it is also important to mention that there is little evidence of the serious complications of the use as these changes are transient and get reversible once the athlete stops the use.

The article neither promotes nor discourages the use of the anabolic steroids. It is just a profound discussion on different medical problems related to the use and a view of reports of cases where adverse effects of steroids were seen. It, however, suggests that physicians should cooperate with the athlete and provide him enough information about its controlled use and the health risks so the athlete should decide himself what to do to trade off the harmful effects of steroids.

Critical Evaluation

The article as the title suggests: “The Medical issues associated with anabolic steroid use: are they exaggerated?” By Jay R. Hoffman and Nicholas A. Ratamess reviewed in 2006, discusses the possible adverse health effects of anabolic steroids and gives an apprehensible account of different medical conditions to decide whether their ill effects are dreadful or just being overstated by the medical consultants and physicians dealing with the athlete circle.

Anabolic steroids are synthetic derivatives of male sex hormone testosterone. High testosterone levels cause increased protein synthesis, improvement in muscle size and cause maturation of secondary male characteristics. It was discovered in 1939 that exogenous testosterone enhance the athletic performance. Today the use of such drugs is popular among weight lifters, athletes of the Olympics and Football League players.

Through the use of anabolic steroids, an athlete attains many structural and physiological benefits leading to good performance which include increase in lean mass, increase in bone mineral density, increased glycogen storage, increased neural transmission, increased pain tolerance and aggression.

Anabolic steroids can be taken through both oral and under parenteral administration. Athletes use these steroids in combination with other similar drugs in order to increase the potency of the product through synergistic effect. The use is cyclic which may be interrupted after a period of time such as weeks or several months. Proper management of the drug cycles reduces the negative effects to a large extent.

Medical community has long been trying to stop the anabolic steroid use because of the harmful heath effects it poses but the efforts have not been proved useful. Rather the athletes have lost confidence in the physicians and they make its unprescribed use by consulting friends, Internet or supplier companies.

However, recent literature shows that these health hazards have been exaggerated by the medical practitioners. There is evidence that the ill effects disappear once the steroid use is halted. Other than that, the proper usage is another factor that can combat the undesired impact of steroid on health to a greater extent. An athlete is more likely to get the substance dependence disorder if he uses the products excessively without cycling off. There are a number of adverse health effects reported in medical circles related to the use of anabolic steroids. They affect many of the body systems like cardiovascular, endocrine, dermatological, hepatic, musculoskeletal and psychological. Although there is paucity of enough reported evidences but still there is enough debate done by the author on the negative consequences.

The use of Anabolic steroid may bring about cardiovascular changes in the athletes which may lead to significant disorders. Over the past 20 years, there are reports of body builders acquiring myocardial infarction which is a cardiovascular disease. However, there are mixed cases of both normal and diseased individuals. It is further justified in medical sciences and athletic circle that there is no proof of direct relation of anabolic steroid use and myocardial infarction as many other factors such as diet, genetic predisposition etc. may also be involved.

Anabolic steroid use or abuse is also associated with an increased risk for liver diseases as liver is the main clearing house of steroids. Hepatic carcinomas mainly of female predominance have been reported. Among men, the disease has more chance to occur if there is previous history of liver disease. However, there may be elevation of certain liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatine kinase (CK), but no change is often-regarded more sensitive gamma-glutamyltranspeptidase (GGT) concentration (Dickerman, Pertusi, Zachariah and et al. 1999). The sustenance of GGT further proves that no serious disorder may result because of elevations in enzyme levels.

Similarly, anabolic steroids and bone growth has been examined together to establish a relationship between the two factors. Anabolic steroid use results in significant elevations in estrogens level which causes premature closure of the growth plate. However, there does not appear to be any reports which support the occurrence of premature stunted growth in adolescents using anabolic steroids. Increased dosage, however, may pose serious risk in this regard.

According to the author, there is another issue which is most commonly raised with the anabolic steroid use. It is the psychological and behavioral effects which is somewhat true. But this may also have both positive and negative effects e.g., aggression may be useful for athletic performance but it may have serious consequences outside the athletic environment. Athlete may also experience mood swings and other psychotic disorders.

Some additional adverse effects discussed by the author can be summarized as acne, male pattern baldness, gynecomastia (enlargement of male breast), decreased sperm count, testicular atrophy, impotence, and transient infertility. The author has discussed several reports related to all of these disorders.

There is a possibility that female use anabolic steroids. Hence, it is important to mention the harmful effects of steroids on females as well. It may cause masculinization, altered menstruation and the most important point to mention is, in contrast to men, the adverse effects in females may not be transient. It means that females may have long-term ill effects even after they have quitted its use.

Lesser reports have been available on the long-term adverse effects. Little information is available concerning steroid-related diseases or associated deaths in these former athletes who are now well into middle age. Author believes that research should focus on these former athletes to ascertain possible long-term effects from exogenous steroid use.

The author further emphasizes that despite conservative approach taken by medical doctors, clinical treatment in recent years with anabolic steroids has increased lean tissue and improved daily functional performance in AIDS patients, patients receiving dialysis, patients with chronic obstructive pulmonary disease, and patients of myocardial infarction.

The author concludes with a non-directive approach regarding the use of anabolic steroids. He does not support the use but provides a profound comparison of the medical approach and the experimental practices of the athletes. The article finally emphasizes that in order to increase the credibility of athlete, he should be given proper awareness about the drug use and its alternative means rather than criticizing its use. However, the author has neglected the ethical issues related to the use of anabolic steroids which are another barrier in the way (Simon, 1984).


The medical literature is replete with cases of liver damage, heart attacks, behavior problems and premature deaths (Maravelias, Dona, Stefanidou and et al., 2005). Conversely according to assumed prevalence of these anabolic steroids in the United States, the number of cases with adverse events is relatively low (Angel, Chester, Green, and et al., 2012). There are several points in the study which do prove that anabolic steroids if carefully used with several factors kept in consideration may minimize the negative influences. Age of the athlete is an important factor. Extremely young or old people may not tolerate changes in androgen. Similarly gender is another factor as females are more sensitive towards the androgenic use and may have long-term effects (Pavlatos, Fultz, Monberg and et al., 2001). Proper dosage also carries weight-age (Perry, Lund, Deninger and et al., 2005).

According to research report series published by ‘national institute of drug abuse’, almost all data on the long-term effects of anabolic steroids in humans come from case reports rather than formal epidemiological studies. Serious adverse effects are under recognized or under reported. Data from animal studies seem to support the possibility that they may have harmful effects but there is some difference in the mode of action of drug in human and animal. Also side effects of the steroids recede as the athlete stops their use (Dhar, Stout, Link and et al., 2005). The health benefits and side effects of every drug differ depending upon the individual health status and the type of organ the drug effects. Therefore, proper monitoring can help in avoiding or decreasing the deleterious effects of the anabolic steroids.

Despite athletes may get awareness about all the medical issues and adverse affects, they will always try to make themselves better in order to compete and maintain their bodies. So the doctors should do research on different types of anabolic steroids. They should test their potency, efficacy and harmful effects and after considering all these factors they should suggest proper dosage for the right use. It is because; controlling the use of steroids by not prescribing it has not proved successful. Athletes are in the need of steroids so the medical practitioners should try to prescribe them the best suited steroid. The discussion between the doctor and athlete may help both of them make an effective plan. It is most likely to increase the confidence of athlete in the physician and prevent him from ill use of the drug. Also the doctors should prescribe a particular type of steroid for a particular athlete according to his requirement and health status.

All these measures will be useful as the athlete will not make unprescribed use of the steroids with the fear of being admonished by the medical community and the negative effects of the steroids will also be reduced to a large extent. It is no doubt that if performance enhancers were made legal, then they could be safely distributed and regulated so that players aren’t forced to rely on shady back alley transactions for untested drugs.


Angel, P., Chester, N., Green, D. And et al. (2012). Anabolic steroids and cardiovascular risk. Sports medicine, 42, 119-134.

Dhar, R., Stout, C.W., Link, M.S. And et al. (2005) Cardiovascular toxicities of performance enhancing substances in sports. Mayo Clinic Proceedings, 80, 1308-1315.

Dickerman, R.D., Pertusi, R.M., Zachariah and et al. (1999) Anabolic steroid-induced hepatotoxicity: Is it overstated? Clinical Journal of Sport Medicine 9, 34-39.

Maravelias, C., Dona, A.M., Stefanidou, C. And et al. (2005). Adverse effects of anabolic steroids in athletes. A constant threat. Toxicology Letters, 158, 167-175.

Perry, P.J., Lund, B.C., Deninger, M.J. And et al. (2005) Anabolic steroid use in weightlifters and bodybuilders. An internet survey of drug utilization. Clinical Journal of Sports Medicine, 15, 326-330.

Pavlatos, A.M., Fultz, O., Monberg, M.J. And et al. (2001) Review of oxymtholone: A 17?-alkylated anabolic-androgenic steroid. Clinical Therapy 23, 789-801.

Simon R.L (1984) Fair play: The ethics of sports. Journal of the Philosophy of Sport, 11(1), 6-13. doi 10.1080/00948705.1984.9714408.