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Steroid Side Effects: Symptoms and Signs

Steroid abuse has plagued professional sports for more than 60 years. But it was back in 1849 that German scientist Arnold Adolf Berthold discovered the testes influenced masculine behavior by secreting an unknown substance into the bloodstream. Fifty years later in 1889, Major League Baseball pitcher and Hall of Famer “Pud” Galvin became the first known athlete to inject a steroid-based product when he became a regular user of the rejuvenating product Brown-Sequard elixir.1

The Rise of Anabolic Steroids in Sports

A widely read book called The Male Hormone is rumored to be responsible for the growing use of testosterone (and future anabolic steroids) to increase muscle mass in West Coast bodybuilders in the late 1940s. By the 1950s, the bodybuilding community began widespread experimentation with anabolic steroids, becoming pioneers in their use.1 Famed bodybuilder Arnold Schwarzenegger, who many presumed achieved his impressive physique naturally, admitted to using steroids when they were legal, which no doubt helped him attain Mr. Universe and Mr. Olympia titles.

The doping controversy in sports involves several types of steroids and other banned substances deemed to enhance an athlete’s performance. Harkening back to their longtime use of anabolic steroids and other banned substances, more than 100 Russian Olympic athletes were banned from performing at the 2016 Rio Olympics. In December 2016, a new report was released by the World Anti-Doping Agency, uncovering Russia’s systematic doping from 2011 to 2015, implicating layers of government employees and more than 1,000 athletes in at least 30 sports.2

Outside of the Olympics, sports governing bodies set their own policies regarding sanctioning athletes for doping violations or sample manipulation. In 2009, longtime Yankees player Alex Rodriguez admitted using illicit steroids, saying he took them from 2001 to 2003 when playing for the Texas Rangers due to “an enormous amount of pressure” to perform. His teammate, ex-Yankee Roger Clemens, is believed to have also used them, but in rambling testimony, claimed he never did and also that he did not think they improved athletic performance.3 In 2009, the first MLB player suspended under stricter rules was the Los Angeles Dodgers’ Manny Ramirez when he tested positive for hCG, a substance prescribed to stimulate testosterone production in men and to treat delayed puberty in boys. It is also popular among steroid users because it can mitigate the side effects of ending a cycle of steroids — further proof of Ramirez’s steroid use.4

Bicyclist Lance Armstrong is likely the most well-known professional athlete found guilty of using a wide array of banned substances including anabolic steroids. After years of denial, he was forced to admit use after a fellow bicyclist presented testimony that resulted in his being stripped of seven Tour de France titles and an Olympic bronze medal. The once-beloved cancer survivor was widely scorned for lying and resigned as chairman of his Livestrong Foundation one week after the U.S. Anti-Doping Agency in October 2012 released more than 1,000 pages of evidence supporting the allegations against him.5,6

Stats and Facts

  • In 2013, 4% of 12th graders admitted taking anabolic steroids, with 41% saying they were easy to obtain. An estimated 62% of 12th graders acknowledged steroids are harmful to one’s health.7
  • The use of performance-enhancing drugs in athletes is estimated at 5% to 31%.These substances include anabolic-androgenic steroids (AASs), human growth hormone, creatine, erythropoietin, amphetamines, stimulants and beta-hydroxy-beta-methylbutyrate.8
  • A recent analysis estimates 3 million to 4 million individuals in the U.S., nearly all of whom are male, have used AASs at some point in their lives.9

Steroids 101

The class of drugs known as anabolic-androgenic steroids (AASs) includes all synthetic derivatives of testosterone, available in both oral and injectable forms, as well as methyltestosterone, danazol and oxandrolone. Common street names include juice, gym candy, pumpers, andro, stackers, roids and gear. Anabolic steroids are used medically to induce male puberty, stimulate growth and appetite and treat symptoms of wasting conditions like cancer and AIDS. They are used illegally to boost performance or improve physical appearance.10,11

People who abuse AASs typically take them orally, inject them into muscle or apply them topically (cream, gel or patch) at doses 10 to 100 times higher than those prescribed medically. Illicit steroids are often sold at gyms, sporting competitions and via mail order, putting buyers at risk of ingesting adulterated or contaminated products.10,11 Some athletes are under the misconception they can avoid the detrimental effects and maximize the desired results by:

  • Cycling: Taking doses for a period of time, stopping for a period, and then restarting
  • Stacking: Combining two or more types of steroids
  • Pyramiding: Slowly increasing the dose or frequency of abuse, reaching a peak amount, and then gradually tapering off10

Steroid Side Effects

Anabolic steroids do not trigger rapid increases in the brain chemical dopamine, which causes the “high” that drives people to abuse other substances. However, long-term steroid use can act on some of the same brain pathways and chemicals such as dopamine, serotonin and opioid systems, thereby impacting moods and behaviors.10

Short-term side effects include severe acne, paranoia (e.g. excessive or unreasonable jealousy), extreme irritability, delusions (false beliefs or ideas), impaired judgment, manic or hypomanic symptoms (e.g. extreme mood swings), depression and suicidal tendencies. Aggressive behavior known as “roid rage” can lead to severe outbursts of anger and violence.9,10,11

Some of the detrimental side effects of steroids do not appear until years after drug use begins. These include liver damage (e.g. liver tumors and cysts), kidney disease, cardiovascular issues, (e.g. high blood pressure, changes in cholesterol and other blood lipids, enlarged heart, heart attack, blood clotting and stroke) and musculoskeletal injuries (especially tendon ruptures). In addition, people who inject steroids are at greater risk of transmitting or contracting diseases like hepatitis and HIV. Prolonged, high doses may result in neuronal cell death, increasing the possibility of early onset dementia. Side effects vary by gender and present unique risks to teens.9,10,11

  • Men: Gynecomastia (development of breasts), shrinking testicles, decreased sperm count, baldness and increased risk of prostate cancer
  • Women: Menstrual irregularities, growth of facial hair or excessive body hair, male-pattern baldness, enlarged clitoris, deepened voice and infertility
  • Teens: Stunted growth (when high hormone levels from steroids signal the body to stop bone growth too early) and stunted height (if teens use steroids before their growth spurt)

Signs of Steroid Use

There are several physical and emotional signs of possible anabolic steroid use, the first of which is weight gain or rapid muscle development. Swelling of the feet and lower legs is also common, as are shaking and tremors. Though most teens develop acne, parents should be on the lookout for sudden increases in acne and oily skin. Steroid users can also develop purple or red spots on the body, as well as jaundice. Extreme mood swings, increased aggression or irritability and paranoia are possible indications of steroid use.10

Steroid Withdrawal

Anabolic steroid users may develop protracted hypogonadism (diminished functional activity of the testes) following withdrawal, which may persist for years. During withdrawal stages, hypogonadism may cause some users to develop major depression, leading in some cases to suicidal tendencies. In an attempt to self-treat highly distressing withdrawal symptoms, users frequently resume using these drugs, leading to a vicious cycle of dependence.9

Body Image

During the last several decades, the idealized male body type has shifted toward a substantially higher degree of muscularity, reflected in bodybuilding competitors, male models and even in children’s action toys like G.I. Joe. It is commonplace for adolescent males to be inundated with magazine covers, advertisements, television programs and movies featuring muscular men. This may be associated with an increasing prevalence of “muscle dysmorphia,” a form of body image disorder characterized by an obsessive preoccupation with a muscular appearance. Among the estimated 2.2% of U.S. men reported to have body dysmorphic disorder, 9% to 25% have muscle dysmorphia. Men with this condition describe dissatisfaction with body size and shape and are preoccupied with the notion that their bodies are insufficiently muscular. Moreover, these men have higher rates of mood and anxiety disorders, obsessive and compulsive behaviors, substance abuse and impaired social and occupational functioning.9

If you are a parent, it is imperative to establish a healthy body image for your child and promote his or her self-esteem. If you suspect your teen is using steroids, it is important to seek professional help as soon as possible.

  1. The Amazing History of Anabolic Steroids in Sports. MesoRX Steroids website. https://thinksteroids.com/articles/history-anabolic-steroids-sports/ Published August 12, 2011. Accessed December 9, 2016.
  2. Ruiz RR. Russian Doping Program Laid Bare by Mountain of Evidence. The New York Times. December 9, 2016. http://www.nytimes.com/2016/12/09/sports/russia-doping-mclaren-report.html?_r=0 Accessed December 9, 2016.
  3. Sources: Ramirez used fertility drug. ESPN website. http://www.espn.com/mlb/news/story?id=4148907 Published May 8, 2009. Accessed December 9, 2016.
  4. Verducci T. Roger Clemens’ recent statements as strange as some recent contracts. Sports Illustrated November 18, 2014. http://www.si.com/mlb/2014/11/18/roger-clemens-free-agency-james-shields-russell-martin Accessed December 9, 2016.
  5. Lance Armstrong Admits To Using Performance-Enhancing Drugs. NPR website. http://www.npr.org/sections/thetwo-way/2013/01/17/169650077/lance-armstrong-to-admit-to-using-performance-enhancing-drugs Published January 17, 2013. Accessed December 9, 2016.
  6. Lance Armstrong steps down at Livestrong: What will his legacy be? Washington Post website. https://www.washingtonpost.com/sports/lance-armstrong-steps-down-at-livestrong-what-will-his-legacy-be/2012/10/17/be88649c-188e-11e2-9855-71f2b202721b_story.html?utm_term=.20be412e9822 Published October 17, 2012. Accessed December 9, 2016.
  7. Anabolic Steroid Use Statistics. Statistic Brain website. http://www.statisticbrain.com/anabolic-steroid-use-statistics/ Published August 8, 2016. Accessed December 9, 2016.
  8. Sport Psychiatry: An Emerging Specialty. Psychiatry Advisor website. http://www.psychiatryadvisor.com/therapies/addressing-psychiatric-disorders-in-athletes/article/577388/ Published December 6, 2016. Accessed December 9, 2016.
  9. Pope HG, Khalsa JH, Bhasin S. Body Image Disorders and Abuse of Anabolic-Androgenic Steroids Among Men. JAMA. Published online December 08, 2016. doi:10.1001/jama.2016.17441
  10. Drug Facts – Anabolic Steroids. National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/drugfacts/anabolic-steroids Updated March 2016. Accessed December 9, 2016.
  11. What are Anabolic Steroids? Drugs website. https://www.drugs.com/article/anabolic-steroids.html Updated May 4, 2014. Accessed December 9, 2016.

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