Steroid Side Effects—New Research

Jerry Brainum

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Much of the medical literature on anabolic steroid use in sports and bodybuilding isn’t relevant. Studies often involved dosages that had no resemblance to what was used by real-world athletes. Conservative study designs were based on medical ethics, in that no one really knew the possible health effects of using amounts that far exceeded what’s commonly prescribed for therapeutic purposes. That explains the claims that anabolic steroids don’t build muscle. Of course they don’t—when the dose is one tablet a day of Dianabol.

The end of the controversy about the role of anabolic steroids in developing muscular size and strength came with the 1996 publication of a study in the New England Journal of Medicine. It clearly showed that 600 milligrams of weekly testosterone injections boosted muscular gains, especially when combined with weight training. That, of course, came as no surprise to anyone in the bodybuilding world. It did, however, change the opinions of medical professionals, who were forced to accept the indisputable fact that steroids work when used in significant amounts.

While doctors no longer deny that steroids aid muscular growth, they still warn of significant health risks linked to the use of steroids—especially in light of the extreme amounts commonly used by athletes. While the average man produces about nine milligrams of testosterone daily, many athletes inject themselves with more than 1,000 milligrams a week. Surely there’s a price to pay for such pharmaceutical extravagance—or is there?

Scientists are constrained by medical ethics to limit the doses of steroids that they administer to subjects in their studies. Thus, the latest trend among researchers who investigate the health and performance effects of anabolic steroids is the “observational” study. The researchers don’t supply any drugs but observe subjects who use their own. The subjects permit the researchers to monitor them via various medical tests. It gives a more accurate view of the impact of athletic doses of anabolic steroids and other drugs.

A recent observational study published by a group of Italian researchers provided an interesting overview of the long-term effects of anabolic steroids because it featured 20 male bodybuilders who’d never previously used them. It lasted two years and involved extensive physical evaluations of the subjects every six months. The bodybuilders provided their own drugs, which included injectable and oral steroids as well as other drugs commonly used in athletic and bodybuilding circles—clenbuterol; Cytodren; Nolvadex; human chorionic gonadotropin, a.k.a. hCG; thyroid; insulin and aromatase-blockers. On the average, 10 drugs were used during a cycle.

At the start of the study the bodybuilders received counseling about possible risks and side effects linked to steroid use. That caused two of the men to immediately withdraw from the experiment. Subsequently, seven other men withdrew for various reasons, some involving adverse mental effects such as aggression and depression, sexual dysfunction, family problems and inability to attend scheduled medical exams. The subjects all ate a high-protein diet and increased their protein intake after starting the drugs. They also used such nutritional supplements as creatine and amino acids.

Gynecomastia, or male breast development, occurred in five subjects, producing notable pain in two. Only one subject showed “clinical relevance”—presumably he needed surgery to correct the gyno. Measures of estrogen, the usual cause of gyno, increased in the subjects—not surprising, as many anabolic steroids are converted into estrogen—but it was considered clinically insignificant because the measures varied among the subjects.

A common side effect of long-term steroid use is shrinkage of the testicles. Sure enough, 16 of the 20 subjects experienced that. A semen analysis after two years showed a drop in sperm count and fertility but no reduction in sperm motility or shape, both of which can also adversely affect fertility. Two of the bodybuilders showed no sperm production, while another two had counts not consistent with fertility. Many bodybuilders use hCG to prevent those effects, but only eight of the 20 subjects used hCG.