Due to their potential for causing health problems, steroids are classified as controlled substances and are banned by many sporting organizations. Yet one in three men training in bodybuilding gyms uses steroids, and more than 4 million Americans are taking doctor-prescribed testosterone. The fact is, testosterone, the active ingredient in anabolic steroids, does work. It boosts muscle mass and turbocharges sex drive. Like any other drug, however, testosterone has potentially harmful effects. The question is, How real are the risks? We hear shocking media reports of steroid-related deaths, but if steroids are so dangerous, how come thousands of bodybuilders use them? Good question.
Testosterone’s anabolic action builds muscle, but its androgenic properties can adversely affect a number of body systems, including the cardiovascular, hormonal, reproductive, gastrointestinal and nervous systems, along with the skin. Based on the medical literature, I compiled a list of all the possible complications of anabolic steroids. Table 1 presents a summary of what can go wrong.
This typical but fictitious scenario reflects the most common side effects associated with anabolic-androgenic steroids: A young man we’ll call Joe, who’s been working out for a year or so, decides to try his first cycle. He finds a dealer, who recommends a course of five Dianabol tablets daily stacked with 200 milligrams per week of injectable nandrolone decanoate. Assuming he scores some legitimate testosterone derivative and not some fake pharmaceutical from a foreign lab, the stuff starts to kick in by the second week. With the testosterone of 10 men rushing through his body, Joe feels strong and full of energy. He’s added 50 pounds to his bench press, gained 10 pounds of bodyweight and is shredding his clothes like the Hulk. It’s not just his arms that are bulging. With the testosterone-fueled sex drive of a hormonally jacked teenager, he has a constant erection. Needless to say, his girlfriend isn’t getting any sleep.
Lifting weights is better than sex. Each workout is like an orgy, with cramping, hot, rushing orgasms in his delts, quads and all over his body. Yes, testosterone is pretty potent stuff.
Then one day in the shower he notices that his testicles are disappearing. Those old plums have shrunk to the size of peanuts. He’s also developed a pair of new, sensitive lumps under his nipples, and his skin has broken out in angry blotches of acne. Oh, crap, and is that his hair falling out in the sink? Whatever. He hits a few poses in the bathroom mirror, and his muscles are filling out nicely, with veins popping up all over his body. Yeah, he’s transforming, all right’in more ways than one.
During the last week of the cycle his butt is hurting from the needle sticks. Still, he manages to sink the last syringe of Deca through the scar tissue. He’s hoping there are no traffic jams on the freeway this week because the slightest road rage escalates into big-time ‘roid rage. At the smallest provocation he’s ready to bust out of his truck. Despite a few battle scars’the acne, the bitch tits, the stretch marks, the temper tantrums, the shrinking nuts and sore butt’Joe likes the gains from his first cycle.
Three weeks after his last dose of the juice, all is not well in Joe’s muscle camp. He’s not as strong as he was when he was on, and his muscles don’t look so pumped’they seem to be melting away. Checking his reflection, he thinks, ‘Mirror, mirror, on the wall, am I really getting small?’ Come to think of it, he’s getting weaker by the day, too, like Popeye without his spinach. His energy tank is low, he feels tired all the time, and going to the gym has become a chore. Worse still, he’s lost interest in sex. His girlfriend’s constantly nagging for some bedroom action, but he can’t get an erection. What’s up? Not Joe, that’s for sure.
In search of a solution to the problem, Joe asks his big friend at the gym. The answer is simple: ‘Dude, you gotta get back on the juice.’ But his friend has more advice: This time he should get some Nolvadex for those bitch tits, some HCG to grow his nuts back and some kind of acne medication. As Joe turns to walk away, his friend adds, ‘Oh, and add some test to your stack too.’ Consolidating a plan of action, Joe makes a list of the so-called medications he needs. He contacts his source, and a dollar deal is struck. ‘Wow,’ Joe thinks to himself, ‘a pumped-up physique sure means a skinny wallet.’
That pretty much sums up the typical steroid cycle: the benefits, the side effects, the withdrawal symptoms and the drug dependence. It’s a tale I hear from steroid users time after time. Steroid Risk
So, what are your odds of developing a complication if you take anabolic steroids? The answer isn’t straightforward because many factors determine the frequency and severity of side effects. In one medical study healthy adult men got a 600-milligram dose of testosterone every week for 10 weeks.1 The researchers concluded that none of the subjects developed any ‘serious’ side effects; however, we must interpret the data with caution. The study lasted only 10 weeks, and 600 milligrams is a relatively moderate dose compared to what many bodybuilders use nowadays.
When I surveyed the drug habits of 100 steroid users, the results indicated that many bodybuilders took between 1,000 and 3,000 milligrams of steroids per week.2 What’s more, they used the drugs for at least six months a year. Of the 100 steroid users in my survey, only 12 denied experiencing any side effects. That means that 88 percent of them experienced some kind of unwanted steroid-related complication’at least four out of every five. The data imply that if you take large doses of anabolic steroids on a regular basis, your chance of experiencing a side effect is 80 percent or more. And what we do know is that the bigger the dose and the longer the duration of steroid use, the greater the health risk.
The bottom line is, if you take anabolic steroids, you have an 80 percent chance of experiencing at least one of the common complications:
Fluctuating sex drive
Now, you may be thinking that those common steroid-induced complications aren’t real side effects’that they’re nothing more than a minor inconvenience. In fact, most steroid users accept the problems as a necessary evil in their pursuit of size, and they use other drugs to combat them rather than quit using steroids. Some of the problems are reversible and disappear when they stop using steroids. Other effects, like hair loss, stretch marks and acne scars, can be permanent, however.
Testicle shrinkage. When you use anabolic steroids, your body senses a testosterone overload. As a result the testes stop making testosterone. Like many other body tissues, the testes function on the use-it-or-lose-it principle, so when they’re out of work, they shrink in size, or atrophy. That means while you’re stomping around the mall trying on new oversize shirts and baggy pants, you may have to purchase a multipack of extra-small underwear. The only way to halt that period of self-induced testicular unemployment is to stop using steroids. Your nuts will eventually regain their original size, but it will take around six months of your being steroid free. Some users try to expedite the process with drugs like human chorionic gonadotrophin (HCG, or Pregnyl) or clomiphene citrate (Clomid). Those so-called fertility drugs can kick-start sleeping testes back into action, but the effect is only temporary. The bottom line is, if you toy with testosterone, your testicles get tiny. You can’t use juice and have a handful of big nuts at the same time. You’ll have to make the choice.
Gynecomastia. The development of female breast tissue affects one in three male steroid users. Some of that extra testosterone circulating through your body gets converted to estrogen, and the imbalance of the female hormone can lead to the development of a couple of female appendages. For many steroid users that side effect is reversible’when you quit using the drugs, the gyno disappears. Treatment for male gynecomastia is the prescription-only anti-estrogen drug tamoxifen (Nolvadex), about 20 milligrams daily. It can be used either to treat gyno or keep it from occurring in the first place. Surgical excision is an option for persistent cases of gyno that are resistant to drug treatment.
Skin changes. Testosterone is converted into dihydro-testosterone (DHT), a by-product that makes the skin more oily, which can cause acne. DHT can also accelerate male-pattern baldness. The prescription drug finasteride (Propecia, Proscar) may help block the conversion of testosterone to DHT. Steroids may also affect skin elasticity, which means muscle growth may cause stretch marks.
Withdrawal. Steroid-induced problems don’t end when you finish a cycle. At least 70 percent of steroid users report symptoms of withdrawal when they stop using the drug. Those withdrawal symptoms include loss of muscle size and strength, fatigue, reduced sex drive and depression. Because steroids suppress your own hormone production, when you discontinue them, your testosterone level drops into your boots, falling to an almost undetectable amount. In other words, when you come off the juice, you have the testosterone level of a two-year-old. It’s not surprising that you feel as weak as a kitten when you stop taking steroids. Your muscles shrink, your strength falls off sharply, and you lose interest in sex.
Addiction. The knee-jerk reaction to withdrawal is to score some more steroids pretty damn quick. You crave the rush of all that testosterone pumping through your veins, and that represents a form of psychological’and physical’drug dependence.
Long-term Health Risks
Research suggests that a moderate weekly dose of around 500 milligrams of testosterone, taken for two months, may be relatively safe. Don’t look at that as a green light telling you that it’s safe to proceed. Steroid use is rarely limited to a single episode. Steroid cycles are repeated over many years, and with time the dosage gradually increases. As the dose and duration of steroid use escalate, so do the health risks. Relatively minor side effects evolve into bigger problems, manifesting as irreparable heart or liver damage, high blood pressure, stroke or heart attack. I was one of a panel of medical experts who participated in a recent article on steroids in the Los Angeles Times. The consensus was that although short-term use of low-dose testosterone appears relatively safe, the potential health risks of long-term steroid use are unknown.
The Final Word
With any drug there’s use and then there’s abuse. There are minor side effects and major ones, and the old axiom applies: Everything in moderation. If you get a hangover from excess alcohol, the solution is to drink less or don’t drink at all. Far be it from me to point a finger. My aim is just to provide information so you can make safe choices. It’s better to have some knowledge than none at all. Remember that bodybuilding is supposed to be a healthy pastime, not a fast track to an early demise.
Legislation isn’t always successful at preventing drug use. If you must use steroids, stick with lower doses and cycle off for adequate amounts of time. Be sure that you remain in control of the drug, not vice-versa.
Side Effects of Anabolic Steroids
Gynecomastia (bitch tits)
Fluid retention (edema)
Increased facial and body hair
Decreased sperm count
Fluctuating sex drive
High blood pressure
Mood swings (‘roid rage)
Addiction and dependence
Facial and body hair growth
Injection Related Pain
Infection or abscess
HIV or hepatitis (needle sharing)
Schedule III controlled substance
Editor’s note: Nick Evans, M.D., lives and works in Los Angeles. His new book will be in stores soon. You can contact him at www .DrNickEvans.com.
References 1 Bhasin, S., et al. (1996). The effects of supra-physiological doses of testosterone on muscle size and strength in normal men. New England Journal of Medicine. 335:1-5. 2 Evans, N. (1997). Gym and tonic: a profile of 100 male steroid users. British Journal of Sports Medicine. 31:54-58. IM