Why do people abuse
anabolic steroids?
One
of the main reasons people give for abusing steroids is to improve
their performance in sports. Among competitive bodybuilders, steroid
abuse has been estimated to be very high. Among other athletes,
the incidence of abuse probably varies depending on the specific
sport.
Another reason people
give for taking steroids is to increase their muscle size and/or
reduce their body fat. This group includes some people who have
a behavioral syndrome (muscle dysmorphia) in which a person has
a distorted image of his or her body. Men with this condition
think that they look small and weak, even if they are large and
muscular. Similarly, women with the syndrome think that they look
fat and flabby, even though they are actually lean and muscular.
Some people who abuse
steroids to boost muscle size have experienced physical or sexual
abuse. They are trying to increase their muscle size to protect
themselves. In one series of interviews with male weightlifters,
25 percent who abused steroids reported memories of childhood
physical or sexual abuse, compared with none who did not abuse
steroids. In a study of women weightlifters, twice as many of
those who had been raped reported using anabolic steroids and/or
another purported muscle-building drug, compared to those who
had not been raped. Moreover, almost all of those who had been
raped reported that they markedly increased their bodybuilding
activities after the attack. They believed that being bigger and
stronger would discourage further attacks because men would find
them either intimidating or unattractive.
Finally, some adolescents
abuse steroids as part of a pattern of high-risk behaviors. These
adolescents also take risks such as drinking and driving, carrying
a gun, not wearing a helmet on a motorcycle, and abusing other
illicit drugs.
While conditions such
as muscle dysmorphia, a history of physical or sexual abuse, or
a history of engaging in high-risk behaviors may increase the
risk of initiating or continuing steroid abuse, researchers agree
that most steroid abusers are psychologically normal when they
start abusing the drugs.
How are anabolic
steroids used?
Some
anabolic steroids are taken orally, others are injected intramuscularly,
and still others are provided in gels or creams that are rubbed
on the skin. Doses taken by abusers can be 10 to 100 times higher
than the doses used for medical conditions.
Steroid abusers typically
"stack" the drugs, meaning that they take two or more different
anabolic steroids, mixing oral and/or injectable types and sometimes
even including compounds that are designed for veterinary use.
Abusers think that the different steroids interact to produce
an effect on muscle size that is greater than the effects of each
drug individually, a theory that has not been tested scientifically.
Often, steroid abusers
also "pyramid" their doses in cycles of 6 to 12 weeks. At the
beginning of a cycle, the person starts with low doses of the
drugs being stacked and then slowly increases the doses. In the
second half of the cycle, the doses are slowly decreased to zero.
This is sometimes followed by a second cycle in which the person
continues to train but without drugs. Abusers believe that pyramiding
allows the body time to adjust to the high doses and the drug-free
cycle allows the body's hormonal system time to recuperate. As
with stacking, the perceived benefits of pyramiding and cycling
have not been substantiated scientifically.
What are the health
consequences of
steroid abuse?
|
Hormonal
system
- men
- infertility
- breast
development
- shrinking
of the testicles
- women
- enlargement
of the clitoris
- excessive
growth of body hair
- both
sexes
Musculoskeletal
system
- short
stature
- tendon
rupture
Cardiovascular
system
- heart
attacks
- enlargement
of the heart's left ventricle
Liver
Skin
- acne
and cysts
- oily
scalp
Infection
Psychiatric
effects
- homicidal
rage
- mania
- delusions
|
Anabolic steroid abuse
has been associated with a wide range of adverse side effects ranging
from some that are physically unattractive, such as acne and breast
development in men, to others that are life threatening, such as
heart attacks and liver cancer. Most are reversible if the abuser
stops taking the drugs, but some are permanent.
Most data on the long-term
effects of anabolic steroids on humans come from case reports
rather than formal epidemiological studies. From the case reports,
the incidence of life-threatening effects appears to be low, but
serious adverse effects may be under-recognized or under-reported.
Data from animal studies seem to support this possibility. One
study found that exposing male mice for one-fifth of their lifespan
to steroid doses comparable to those taken by human athletes caused
a high percentage of premature deaths.
Hormonal
system
Steroid abuse disrupts
the normal production of hormones in the body, causing both reversible
and irreversible changes. Changes that can be reversed include
reduced sperm production and shrinking of the testicles (testicular
atrophy). Irreversible changes include male-pattern baldness and
breast development (gynecomastia). In one study of male bodybuilders,
more than half had testicular atrophy, and more than half had
gynecomastia. Gynecomastia is thought to occur due to the disruption
of normal hormone balance. In the female body, anabolic steroids
cause masculinization. Breast size and body fat decrease, the
skin becomes coarse, the clitoris enlarges, and the voice deepens.
Women may experience excessive growth of body hair but lose scalp
hair. With continued administration of steroids, some of these
effects are irreversible.
Musculoskeletal
system
Rising levels of testosterone
and other sex hormones normally trigger the growth spurt that
occurs during puberty and adolescence. Subsequently, when these
hormones reach certain levels, they signal the bones to stop growing,
locking a person into his or her maximum height.
When a child or adolescent
takes anabolic steroids, the resulting artificially high sex hormone
levels can signal the bones to stop growing sooner than they normally
would have done.
Cardiovascular
system
Steroid abuse has been
associated with cardiovascular diseases (CVD), including heart
attacks and strokes, even in athletes younger than 30. Steroids
contribute to the development of CVD, partly by changing the levels
of lipoproteins that carry cholesterol in the blood. Steroids,
particularly the oral types, increase the level of low-density
lipoprotein (LDL) and decrease the level of high-density lipoprotein
(HDL). High LDL and low HDL levels increase the risk of atherosclerosis,
a condition in which fatty substances are deposited inside arteries
and disrupt blood flow. If blood is prevented from reaching the
heart, the result can be a heart attack. If blood is prevented
from reaching the brain, the result can be a stroke.
Steroids also increase
the risk that blood clots will form in blood vessels, potentially
disrupting blood flow and damaging the heart muscle so that it
does not pump blood effectively.
Liver
Steroid abuse has been
associated with liver tumors and a rare condition called peliosis
hepatis, in which blood-filled cysts form in the liver. Both the
tumors and the cysts sometimes rupture, causing internal bleeding.
Skin
Steroid abuse can cause
acne, cysts, and oily hair and skin.
Infection
Many abusers who inject
anabolic steroids use nonsterile injection techniques or share
contaminated needles with other abusers. In addition, some steroid
preparations are manufactured illegally under non-sterile conditions.
These factors put abusers at risk for acquiring life-threatening
viral infections, such as HIV and hepatitis B and C. Abusers also
can develop infective endocarditis, a bacterial illness that causes
a potentially fatal inflammation of the inner lining of the heart.
Bacterial infections also can cause pain and abscess formation
at injection sites.
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