Anabolic Steroid

1. Mechanism
   1. Anabolic Steroids are testosterone derivatives
   2. Performance enhancing drugs that that increase muscle protein synthesis
   3. Short term effects: Increased strength and increased Lean Body Mass
2. Epidemiology
   1. Banned by most athletic organizations (NCAA, IOC)
   2. DEA Controlled Substance (Schedule III)
   3. Black market sales: $2 Million per year in U.S.
   4. Prevalence of Anabolic Steroid use
      1. Buckley (1988) 6.6% High School (38% before age 15)
      2. Tennant (1986): 75% of NFL lineman
      3. Rumor (1996) 95% of NFL Lineman
3. Indications: Medical
   1. Anemia
   2. Burn victims
   3. Growth Hormone Replacement
4. Efficacy
   1. Athletes dose 10 to 40 times higher than medical dose
   2. Effective in strength gain (short-term)
      1. Rapid strength and anaerobic power gain
      2. Rapid gain in lean muscle mass and weight
      3. Maintenance of competitive edge
      4. Benefit only with Resistance Training program
5. Adverse Effects: General
   1. Associated with premature death (esp. from Suicide, Myocardial Infarction)
   2. Tendon ruptures from dysplastic collagen changes
   3. Adolescents
      1. Early closing of bone Growth Plates
      2. Decreased adult height
   4. Cardiovascular changes
      1. Hypertension
         1. Grace (2003) J Sci Med Sport 6(3):307-12
      2. Acute Cardiovascular events (platelet aggregation)
         1. Stroke
         2. Myocardial Infarction
      3. Hypercholesterolemia with marked HDL drop (<10)
         1. Hartgens (2004) Br J Sports Med 38(3): 253-9
   5. Liver disease
      1. Increased liver Aminotransferases
      2. Hepatic failure
      3. Peliosis (rare hemorrhagic liver cysts)
      4. Hepatocellular Carcinoma
      5. Hepatic Adenoma
      6. Hepatic cholangiocarcinoma
   6. Psychiatric: Steroid Psychosis ('Steroid Rage')
      1. Aggressiveness
      2. Irritability
      3. Impulsiveness
      4. Impaired judgment
      5. Mania and paranoid Delusions
      6. Addiction potential and withdrawal potential
6. Adverse Effects: Sexual Effects
   1. Libido changes
   2. Severe Cystic Acne
   3. Specific changes in men (may be irreversible)
      1. Decreased sperm production
      2. Testicular atrophy
      3. Scrotal Pain
      4. Gynecomastia (potentially irreversible)
      5. Prostate Cancer increased risk
   4. Specific changes in women
      1. Voice deepening (irreversible)
      2. Hirsutism (potentially irreversible)
      3. Acne Vulgaris
      4. Clitoral hypertrophy (potentially irreversible)
      5. Amenorrhea
      6. Male-pattern baldness
      7. Coarsening of skin (potentially irreversible)
7. References
   1. Bhasin (1996) N Engl J Med 335:1-7
   2. Haupt (1984) Am J Sports Med 12:69-84