Steroids and Adverse Effects

However AAS have been used in experimental clinical trials in the treatment of several dermatological disease conditions (Hartgens and Kuipers (2004). The differing doses between each study may suggest why AAS could be a side-effect of AAS but also why AAS are used as a treatment. Acne would appear to be yet another affect of suprphysiologic doses in-particular. The true implications of ASS and skin problems are therefore yet to be fully established. Moreover acne has little relevance to athletes and performance but the fact that it can act as a tell tale sign of ASS use can lead to the consequence of being caught. However this risk is unlikely to deter many athletes.

Also commonly found in athletes on ASS is stretch marks (Cutaneous striae). They are a result of rapid gains in body mass, in which the skin is unable to accommodate the rate of stretch, and a secondary effect that AAS may have on collagen reducing skin elasticity (Shuster 1979). This appears more profound in the upper body especially the shoulder regions which is probable due to the increased effect AAS has on the trapezius, neck and shoulder regions.

Gynecomastia in men can occur after high dose steroid use and has been reported in roughly 40% of users. This happens when the steroid they are taking is converted by hepatic aromatase enzymes to oestradiol, which then induces development of mammary tissue (Mottram and George (2000). After the discontinuation of ASS the growth of breast tissue subsides but does not disappear completely (Strauss and Yesalis (1991). Sometimes but very rarely a small amount of fluid can be secreted. A Study by Calzada et.,al (2001) on ASS and gynecomastia found that in 5 of the 12 subjects on ASS developed gynecomastia with breast palpable tissue diameter varying between 2-4cm.  They hypothesised that upon the development of gynecomastia the hormonal status is characterized by a clearly persistent estrogenic stimulation derived from the aromatization of testosterone by a local increase in aromatase activity, which is probably induced by the prolonged administration of anabolic steroids (Calzada et.,al (2001). It’s unlikely however that gynecomastia will deter male athletes as a 40% chance of getting it is likely to be seen as a risk worth taking. Additionally, athletes would be happy to have surgery to remove breast tissue. 

Most health implications of ASS occur in both males and females. However AAS in females can pose several other problems. With ASS being a derivative of testosterone, the primary male sex hormone, females can develop masculine traits such as enlarged muscles, deepened voice and increased facial and body hair. In addition, women who undertake resistance training but don’t take ASS can still increase their strength significantly (although probably not as much as with the drugs , figure 3- bhasin et.,al 1996) without noticeably increasing muscle size (Strauss and Yesalis (1991). An investigation on the effects of ASS in woman found that woman on ASS were significantly more muscular than nonusers;  mean fat free mass index (FFMI) of the users was 19.7 B 2.3kg/m2, and the mean FFMI of the nonusers was 17.8 B1.5 kg/m2 (P= 0.001) (Gruber and Pope (2000). The same study found that 14 users reported at least some hypomanic symptoms while using AAS and 10 reported depressive symptoms associated with AAS withdrawal. This appears in line with much of the literature on the psychological effects in men. As with many of the issues raised by ASS, the effects AAS on women are not well understood (Lukas 1993).

A rare occurrence but one that should not be overlooked by athletes is the occurrence of Rhabdomyolysis. Rhabdomyolysis, also known as acute muscle destruction, is common in people who have recently increased their level of excercise, no matter what their previous level of physical fitness (Soni et.,al (1993). This includes well-trained athletes (Santos 1999). A case report of a 39 year old body-builder on ASS was presented by Farkash et.,al (2009). He developed a unique case of localized rhabdomyolysis in the deltoid muscle after the injection of ASS into the shoulder region. Unlike generalized rhabdomyolysis, localized rhabdomyolysis associated with weight lifting is reported very rarely (Bolgiano (1994). For this reason and the fact that the damage occurred in the injection area lead to the belief that ASS coupled with intensive weight-lifting was the cause of rhabdomyolysis. This is the only case so far that has described localized rhabdomyolysis in the area of AAS injection. However, it is possible that many cases go unreported due to athletes refusing medical help due to their ASS use or even go unrecognized and instead diagnosed as a simple muscle strain (Bolgiano (1994). 

End of steroids and adverse effects