Safety of long Anabolic Steroid use
And the life after lengthy use of steroids
All Four parts in one article
Part 1: Introduction and the history of testosterone and Anabolic Steroids
By Joachim Bartoll, January and February, 2017. Classic Muscle Magazine #29
As a coach and student within the fields of sports, human physiology, and performance, I first came across “underground” articles about anabolic steroids in early 1990. At that time, and in the years to follow, some of the top names were Dan Duchaine and Michael Zumpano (The Underground Steroid Handbook), Bill Phillips, and Jens Ingenohl. They laid the ground for other authors such as Bill Roberts, William Llewellyn, Patrick Arnold, Victor Conte, Anthony Roberts, Jose Antonio, Nelson Montana, and John Romano to mention a few. The scene exploded in the late 90’ and early 2000’s with popular steroid handbooks and articles for magazines such as Muscle Media 2000 and Muscular Development.
Before I stumbled upon these early resources in Dan Duchaine and Bill Phillips, I hardly knew about the widespread use of Anabolic Steroids and other drugs in sports. As I dwelled into the subject, it lit a deep interest in endocrinology. I wanted to know exactly what happened in the body and how different hormones interacted and could influence each other – as well as everything else within the human body.
It was not until the mid-90’s, when I started helping and working with bodybuilders that I came in direct contact with steroids. At that time, the most common Anabolic Steroids were different esters of Testosterone together with Deca Durabolin or Equipoise (Boldenone). Some used Anavar and/or Winstrol as a contest-prep and only a handful had started experimenting with insulin and growth hormone. Of course, the use of Clenbuterol and Ephedrine was rampant, but I don’t consider them as steroids, they’re bronchodilators that work as a beta-2 agonist. And yeah, some used Cytomel (T3). Remember, this was in Scandinavia around 1993 and a few years forward. Actually, for the majority of bodybuilders, these staple anabolics where pretty much all they used into the 2000’s. Also, in the late 90’s the use of alpha-Dinitrophenol (DNP) escalated and was frequently used for several years.
Now, unless you have some weird desire to become a world champion bodybuilder, or to compete in Mr. Olympia, the basic stuff mentioned above should be all you need. And if you’re mostly interested in maximizing your health, vitality, energy levels and general wellbeing, the field narrows even more. These steroids are also what most athletes used during the 60’s, 70’s, 80’s and 90’s. So, in that regard, we can look back and see what kind of damage they might have done – if at all. This takes us to the subject of this article series. How safe (or dangerous) are Anabolic Steroids? How about long-term use (or abuse), and how do you fare if you stop them completely after years and years of heavy usage?
The first thing you need to understand is that you cannot patent Testosterone, which makes it almost non-profitable for Big Pharma and the medical community.
Even worse, testosterone can help and treat a lot of modern diseases, which would make them lose tons of profit from other drugs that are useless and even harmful (to make you take even more drugs). Because of this, the media and biased/Big Pharma funded research has demonized this category of drugs to the extent that the consensus of the public is that they are toxic dangerous substances.
The first manufactured testosterone and Anabolic Steroids
Funny fact is that anabolic steroids were never developed for athletic usage or to help build muscle in athletes and bodybuilders. Anabolic Steroids were developed in the mid-1950s and more extensively in the 60s because of inherent problems with early testosterone injections. All anabolic steroids are structurally manipulated forms of testosterone. Testosterone itself was initially isolated in August of 1934 by Butenandt and Hanisch (and only a week later by the Ciba group in Zurich), testosterone was then produced synthetically a year later. Soon afterwards it became evident that testosterone could have a number of medical uses. The most obvious use was to treat men with clinically low testosterone levels. One of the first medical indications for testosterone was to treat depression in men. This makes sense, since one of the primary symptoms of low testosterone is an increased tendency to get depressed. Testosterone was widely prescribed in the early 1940s to treat depression and lack of libido or low sex drive in men. This initial use of testosterone, however, didn’t last long.
A study published in 1941, featuring only two subjects, suggested that testosterone could promote prostate cancer. This was a very flawed study because the two subjects started out with extremely low testosterone levels, then were provided with testosterone. The injected testosterone appeared to speed the growth of prostate tumors. But in reality, we nowadays know that providing men who have been suffering from low testosterone for years with the hormone constitutes the only risk of testosterone in relation to prostate cancer. The reason for this has to do with the sudden and extreme reintroduction of testosterone to the prostate. If there is an existing tumor in the gland, multiplying the levels of testosterone several times in only a day or two may promote a growth effect. With that being said, normal levels of testosterone do not promote any kind of tumor growth, since the prostate gland will only accept a finite amount of testosterone.
The early manufacturing and the dangers of oral steroids
In the late 1950s, scientists decided it would be safer to manipulate the structure of testosterone in the hope of improving safety. By binding it to different esters, there would be a “time-release” effect, slowly increasing testosterone levels in the subject as well as keeping a more levelled curve with repeated injections. The goal involved an emphasis on promoting anabolic effects, such as increased muscle mass, red blood cell production, and other positive effects in the body, while lowering the androgenic effect. Among the androgenic effects of testosterone are prostate gland stimulation, increased body hair growth, male pattern baldness and other effects considered less desirable. While thousands of anabolic steroids were developed in the early 60s, only a small percentage progressed to market sales by pharmaceutical companies. The other anabolic steroids that were developed remained on the shelf for a number of reasons, most involving either no advantage over existing anabolic steroid drugs, or increased risks of toxicity as shown in preliminary animal testing. Ironically, many of these older anabolic steroid drugs were resurrected 40 years later and sold as “prohormones”. The problem with these anabolic steroids disguised as prohormones were that they were oral, which means that they have to pass the liver and thus promoted increased risk of liver toxicity.
One of the features of some of these oral anabolic steroid drugs (and some prohormones) was that they have been structurally manipulated to not immediately degrade in the liver (for a time-released effect), as would be the case for less harmful oral testosterone drugs. This resistance to liver metabolism also produces the most common side effect of oral steroids, a type of chemical inflammation of the liver. This is caused by the steroids accumulating in the liver, which blocks the normal flow of bile produced in the liver. This condition of decreased bile flow is called cholestasis, and the accumulation of bile slowly destroys liver cells. The higher the dose of oral steroids, the greater the chance of showing symptoms of liver inflammation. The first sign of such inflammation is an elevation of liver enzymes, which can easily be seen following standard blood tests that measure liver enzymes. If a person gets off the drugs when these elevated liver enzymes become apparent, the liver reverts back to normal and no permanent harm is done. The liver is probably the most regenerative of all internal organs. You can remove 3/4 of the liver, and the rest will eventually grow back. On the other hand, if a person is foolish enough to continue using large doses of oral steroids despite signs of liver inflammation, it can lead to serious health problems. These problems include a condition called Peliosis Hepatis, marked by blood-filled cysts in the liver than can rupture and cause severe internal hemorrhage. Scarring of the liver can also develop, a condition called cirrhosis that is more common in alcoholics. The worst thing that can happen is either complete liver failure or liver cancer. Luckily, these last two conditions are extremely rare in athletes and bodybuilders.
Injectable Anabolic Steroids
What about injected steroids? Generally, the injected forms of testosterone and anabolic steroids aren’t as hard on the liver as the oral versions. The drugs do eventually reach the liver, since the liver is the site of steroid breakdown, regardless of which form they are in.
The notion that injected steroids are safe for the liver is a myth. They are not as acutely dangerous as the oral anabolic steroids, but if used in large doses and with higher frequency (as with water soluble drugs), they are capable of promoting the same type of liver damage as the oral versions.
By Joachim Bartoll, March, 2017. Classic Muscle Magazine #30
As the first synthesized testosterone was used to treat depression and lack of libido in men, the early anabolic steroids had a lot of medical indications before they made way for more “effective” drugs. For example, one potent oral anabolic steroid, Anadrol, or ‘oxymetholone’, was primary used to treat a type of anemia associated with kidney disease. Interestingly, many of the long-term side effects of oral steroids are based on studies of hospital patients who were given Anadrol to treat their anemia – as such therapies often lasted for years. But the use of Anadrol was superseded by drugs deemed more effective at treating anemia, such as erythropoietin or EPO. Ironically, EPO and similar drugs have themselves become highly popular and abused drugs within endurance sports, especially competitive cycling. Because of their current rarity in medical practice, along with their legal status (physicians who prescribe anabolic steroids must file triplicate prescriptions, one of whom goes to the Drug Enforcement Agency), most physicians have only a vague idea of how steroids work or even their possible benefits. Many of these same physicians aren’t hesitant about condemning the use of testosterone replacement therapy in men, even in those clinically diagnosed as having low testosterone levels. The reason for this goes back to that 1941 study showing a connection between testosterone and prostate cancer onset. Despite being thoroughly disproved, many physicians still believe that testosterone is a carcinogen and refuse to prescribe it to men for any reason. Because of all these false facts and beliefs, the primary use of anabolic steroid drugs today is not to treat a growing number of medical conditions, but mainly to help build muscle in athletes, bodybuilders, and anyone else interested in adding muscle or improving their body composition.
The Anonymous Users and The Black Market
While anabolic steroids are mostly associated with strength athletes and bodybuilders, as everyone at the top uses them and even most at amateur level does, they still represent a very small percentage of the population. And while anabolic steroids are rampant in most sports – both for enhanced performance and increased healing in treating injuries – the greatest use of the drugs, in share number of people, occurs among those who are not athletes or bodybuilders, or have any interest in competition. These are just people who use anabolic steroids or steroid-like drugs because of the widespread belief that it is the only way to develop an impressive physique or to get that “summer body” with a set of washboard abs.
The major problem with this hidden number of abusers are that they still are young and get most of their information from unreliable sources. These sources include the web sites that sell black market versions of the drugs, as well as self-entitled “steroid gurus” who roam various Internet forums and social media groups dedicated to anabolic steroids and other recreational drugs. Although many of these internet-experts know a lot more than doctors on the subject, most people without a good basic understanding of human physiology has no way of separating the truths from the fiction. This poses another problem, as most doctors are extremely ignorant on the subject or simply refuse to talk about it – two different scenarios that leads to the same result – frustration for anyone trying to get help and information. And instead, even people in need of hormonal therapy turns to the internet and the black market.
And while the information may be skewed, it’s even worse with some of the black-market drugs, since you have no way of knowing if they really contain what they say they do. The only way you can get an idea is by reading comments from other customers and referrals. And even if the comments are legit and the drugs seems fine, the manufacturer can spin on a dime at any given time – by changing the content or lowering the active substance just to get a good pay-off before shutting down the operation and starting a new one. As with all underground and illegal activities, when you start to become popular the authorities will notice and the heat will start to build up. So, as a customer, even if your first shipment was stellar, it doesn’t mean that the next one will be.
Some underground labs will provide lab-test results. However, there is no guarantee that these are real and from an actual lab. So, if you’re looking for anabolic steroids or SARMS, make sure to sign up for several underground discussion boards. Read the comments and feedback from other users and make an informed and educated decision. Also, most dealers will only accept bitcoin, so make sure you know how to buy and transfer crypto – and they will only communicate through encrypted e-mail services such as Proton mail.
Part 3: cardiovascular health and mortality rates
By Joachim Bartoll, March, 2017. Classic Muscle Magazine #30
A while back, there was a study done on rats where they were given the rough equivalent of a human taking large doses of steroids for 15 consecutive years.
This was the ‘real’ first attempt to figure out the long-term health effects of steroids. Since providing large doses of anabolic steroids to human subjects is considered scientifically unethical, rats were the stand-ins for this study. Studies on humans are often interviews of alleged users or short-time studies of someone following an athlete who go about his or her usual business (and drug regimen). Anyhow, the study results on the rats showed increased mortality in the rats provided steroids compared to another group of rats not given the drugs. Specifically, the rats died mostly from complications related to liver and kidney functions.
One notable tricky detail with this study is that rats tend to have a much greater degree of liver and kidney disease compared to humans. And more importantly, rats get these diseases much easier than humans do. Liver failure is actually a common cause of death in laboratory rats. But with that being said, the study did suggest that there might be some health complications down the road for those who use high constant doses of anabolic steroids for several years consecutively.
Another study from 2015 on both sedentary and exercising rats using large doses of nandrolone decanoate (Deca-Durabolin) showed the drug to be mildly pro-oxidative, increasing the oxidative stress on the body, but less so in the exercising group as physical training seems to induce the protective antioxidant enzyme system.
Adding to that, another study on nandrolone and rats from 2017 showed a slightly higher positive imbalance in pro-/anti-inflammatory cytokines in the heart tissue of the exercise group after 8 weeks. That imbalance may induce a positive modulatory effect on cardiac adiporeceptors.
In other words, if you were to partake in a testosterone replacement therapy, it would be wise to be physical active and not relying on the drugs to do the work while you sit on the couch swallowing predictive programming on Netflix.
As for females, a recent study on female rats getting nandrolone for 4 weeks showed that exercise in the form of weight lifting in water did not improve the vascular alterations induced by the nandrolone treatment. The nandrolone treatment also showed reduced serum levels of estradiol in females, overriding its cardiovascular protective effect. If this translates to humans, young women abusing AAS can potentially lose the cardio protective effect rendered by estrogen and be more susceptible to cardiovascular alterations.
Calcium deposits and hearth health
However, while lower levels of inflammation are very beneficial, there are more pieces of the puzzle than inflammation alone. One example was a study where a cardiologist measured the extent of calcium deposits in the coronary arteries of 14 elite professional bodybuilders. As is the usual case with science journal articles, the identities of the study subjects were not revealed. But of the 14 men who underwent scans for calcium deposits in their coronary arteries, 12 showed significant amounts of calcium in the vessels. None of them, however, reported any symptoms that would be indicative of cardiovascular disease. But having such increased calcium deposits in now considered a harbinger for future heart attacks and strokes. In other words, it would be crucial to get extra Vitamin K2 during long steroid cycles to help the body to absorb the extra calcium. Unfortunately, very few are aware of this.
Another factor for calcification is the antinutrient oxalate, which binds to calcium and end up in arteries, as kidney stones and in joints (causing joint stiffness and pain). Oxalates are most commonly found in coffee, green leafy vegetables, potatoes and sweet potatoes, fruit, grits, nuts, seeds, and grains (especially bread and pasta). In other words, it’s much more likely that you’ll get calcium deposits from your badly planned diet rather than from the use of anabolic steroids.
Another study released on May 23, 2017, looked at 140 experienced male weightlifters 34 to 54 years of age. 86 of these men reported more than 2 years of cumulative lifetime AAS use and 54 men claimed to be natural. Compared with nonusers, the 86 AAS users demonstrated relatively reduced LV systolic function (left ventricular ejection fraction = 52±11% versus 63±8%) and diastolic function (early relaxation velocity = 9.3±2.4 cm/second versus 11.1±2.0 cm/second).
Exactly why heart function is slightly lower among anabolic androgenic steroid users was not explained. My guess would be a combination of slightly increased blood pressure, increased stimulation of the nervous system, increased red blood cell count, and perhaps in some individuals, overtraining (since the muscular system recover more quickly, but the central nervous system does not.)
Studies on mortality
Last year, a study was released at a medical conference that measured the rates of mortality among professional male bodybuilders. The researchers obtained the health records of 1,578 professional bodybuilders who competed between 1948 and 2014. The researchers were able to obtain mortality data for 597 of these bodybuilders. The information about the men was obtained from public records, competition listings, and bodybuilding websites. The mortality or death rates of the bodybuilders were then compared with mortality data obtained from the Center for Disease Control for men of similar age. The average age of the men in the study was 47.5, with an age range of 25 to 81. The average competition age ranged from 18 to 47, with an average of 25. Of the 597 men examined in the study, 58 or 9.7% were dead and 539 were still alive. Only 40 deaths were expected in this population, and the average age of death was 47.7. As such, the mortality rates of the bodybuilders surveyed in this study was 34% higher than those in an age-matched U.S population of men. The varying causes of death weren’t discussed in the study, but based on the study findings, the study authors suggest that consistently using larger dose cycles of anabolic steroids likely plays a role in increased mortality or shortened longevity.
There are a few concerns with a study such as this, however. Without knowing the specific causes of death, we cannot tell whether or how much the men’s use of steroids played a role in their premature mortality. For example, many of these men may have died from natural causes not related to their steroid usage. Some may have had genetic predispositions to certain diseases that acted like a biological time bomb in their bodies. In some cases, the steroid use may have triggered naturally existing health problems. An example of this would be a person genetically prone to having cardiovascular disease such as the late Mike Matarazzo – a professional bodybuilder who died on August 16, 2014 at age 48 following complications while awaiting open heart surgery. He was rumored to have had heart attacks shortly after he retired from bodybuilding competition. His heart continued to show signs of significant heart failure, necessitating the surgery that led to his death. The question about Mike is whether his long-time steroid use contributed to his death. While it may appear obvious that it did, consider that both his father and grandfather also suffered from severe heart disease, yet had never taken any anabolic drugs in their lives.
Other things to consider is that some of the men surveyed in the study may have died from diseases not related to genetics or steroid use. Since anabolic steroids when taken in large doses will depress the immune system, acquiring a normally easily survived disease such as influenza can prove deadly. With a decreased immune response, the flu can quickly lead to pneumonia. And while pneumonia is normally easily treatable, in those with compromised immune systems it can turn deadly. When you read that an older person died of “old age,” it almost always means that the person died from pneumonia. The immune system declines with age, and diseases easily handled by the young prove deadly to the old, such as pneumonia or other common infections.
Finally, the survey of mortality in bodybuilders doesn’t take into account deaths caused by accidents, such as car accidents. Or they may have been killed in a robbery or some other violent activity, which is not unheard of as some get involved in the drug business.
Quality of life and other issues
Another newly published study (as of March 2017) looked at 683 former elite athletes who used high-dose steroid regimes when they were competitive examined the possible health effects of steroids in these athletes 30 years following the use of the drugs.
The study involved sending out a questionnaire. Of these 683 former elite athletes, 21% or 143 admitted lifetime use of anabolic steroids, while 79% or 540 denied ever having used steroids. A lot of athletes in this latter group probably lied about their drug use, which would be a bit silly considering it had been 30 years since they retired – but I digress.
This questionnaire study showed that former elite athletes who used anabolic steroids during their career was associated with tendon ruptures (p=0.01), depression (p=0.001), anxiety (p=0.01) and lower prevalence of prostate hypertrophy (p=0.01) and decreased libido (p=0.01). Former advanced “AAS-abusers” within this group had higher anxiety (p=0.004) compared to the former less advanced AAS-abusers. Moreover, former advanced AAS-abusers, compared to the mild users, reported more psychiatric problems (p=0.002), depression (p=0.003) and anxiety (p=0.00).
Heart growth and abnormalities
Some animal studies have showed that providing animals with large doses of steroids that are about the equivalent of what elite athletes commonly use leads to structural changes in the heart muscle – something that could later predispose to cardiovascular disease.
Some researchers speculate that the enlarged heart muscle caused by a combination of high dose steroid use, growth hormone use, and exercise itself could predispose to later congestive heart failure – which affects about 40% of older people even if they never touch anabolic drugs.
One way around this possibility is to continue to do aerobic exercise, which provides a type of balance to the structural changes in the heart promoted by weight-training. Arnold Schwarzenegger had to have heart surgery in 1997 to replace a defective valve in his heart. At the time of his surgery to replace the defective aortic valve, speculation arose that Arnold was paying the price for his years of steroid use as a competitive bodybuilder. In fact, the type of valve degeneration that Arnold had was entirely genetic; his mother had the same condition, making it obvious where the source of Arnold’s problem came from. Arnold allegedly never had any actual heart problems, but rather viewed the defective valve as a problem better handled before it could turn serious. As such, he opted for elective surgery to repair the valve.
Part 4: more on mortality
By Joachim Bartoll, April, 2017. Classic Muscle Magazine #31
One of the main points regarding high doses of anabolic steroids and mortality is the almost complete lack of significant reports about deaths directly related to steroid use. Finding a direct cause and effect relationship, (which you can with a lot of medicine/drugs), between extensive steroid use and mortality is nearly impossible. Simply put, the steroids will not kill you – however, the effects they have on various tissues and organs in the body might shorten your lifespan in certain scenarios – or they may worsen genetic defects that are already existing. What we mean here is the direct toxic effect of a drug. While a lot of popular drugs within the medical community is very toxic and has the potential to kill you, there is no such immediate risk with anabolic steroids.
As for long-term effects and increased mortality risk, there are few studies often cited in medical literature. When looking closer at them, high dose steroid usage could possibly lead to the following medical problems:
- Elevated blood cholesterol levels, particularly the low-density lipoprotein form that is most associated with cardiovascular disease (CVD).
- Platelet aggregation. Platelets are clotting factors found in the blood. They function to speed the formation of blood clots, which prevents death caused by excessive bleeding. However, when platelets tend to stick together in the blood, they can form a dangerous clot that can obstruct blood flow. If this happens in a coronary artery already occluded by atherosclerosis, a heart attack can occur.
- Increased blood pressure. This is the first thing you’ll notice on a steroid cycle, especially if it’s high in androgens. Steroids induce a rise in blood pressure through various mechanisms, including sodium retention. This increased blood pressure is the prime risk factor for strokes. Several cases exist in the medical literature of athletes who have suffered strokes while on a high dose steroid regime.
- Pulmonary embolism. This is a blood clot that forms in the lung and can cause rapid death. While this can be caused by some type of steroids is debatable, some cases of bodybuilders who were on extensive steroid regimes and suffered pulmonary embolisms exist in the medical literature.
Besides these cardiovascular risks, high dose steroid regimes also exert their main stress on liver function. This was discussed earlier in relation to oral anabolic steroids, which provide the greatest stress to liver function because of their accumulation in the organ.
While there is a lot of case studies in the medical literature about health problems associated with anabolic steroid use, what is questionable are the long-term effects of using high dose steroid regimes. Will there be a high health price to pay years after getting off steroids? As noted previously, there is some evidence of this in the form of now retired athletes and bodybuilders who show various health problems, mostly related to cardiovascular function. A recent study suggested that testosterone itself can directly promote atherosclerosis, the main underlying cause of most heart attacks and strokes. But it’s a confusing issue, since many other studies show protective effects of testosterone on heart function, and that a lack of testosterone can lead to serious heart problems. As noted earlier, while steroids are known to promote an enlargement of the left ventricle of the heart, which is the portion of the heart that pumps blood throughout the body, this must be differentiated from a similar enlargement that happens with long-standing uncontrolled high blood pressure. That latter condition does lead to eventual congestive heart failure. With athletes who have enlarged hearts, the consensus of medical opinion is that it’s more of an accommodation of the heart to deal with the stress of exercise. In short, the heart is larger, but not weaker as it is with those who have high blood pressure.
To examine what happens to athletes who used high dose steroid regimes previously, a group of researchers looked at the responses of Swedish elite power athletes who competed between the years 1960 and 1979 in wrestling, Olympic weightlifting, powerlifting, and throwing events in track and field (hammer throw, discus, javelin, and shot put.) These events involve power and strength, and thus feature athletes most likely to turn to performance enhancing drugs including anabolic steroids. When searching for former athletes to interview for this study, the study authors found that some of the athletes had committed suicide. The suicide rate among these former athletes was increased by 2 to 4-times when they were between 30 and 50 years of age. On the other hand, the athletes show a lower incidence of cancer compared to non-athletes in the same age range. Of the 683 former athletes that responded to the questionnaire about their past steroid usage, the average age of the former athletes was 57, with an age range of 39 to 82. The 143 athletes who admitted to having used steroids were further divided into two groups: “advanced,” meaning that they had used steroids for a minimum of two years; and a “less advanced” group that claimed to have used the steroids less than two years. A final group consisted of former athletes who had never used steroids. They were used as a control group to compare long-term health status with the steroid users.
The results of the study showed that those who used the largest amount of anabolic steroids showed a greater incidence of tendon ruptures, depression, and anxiety. Interestingly, the former anabolic steroid users showed lower rates of prostate gland hypertrophy and decreased libido or sex drive, compared to those who never used steroids. This was an unexpected finding, since using large amounts of testosterone is often linked to benign prostatic hypertrophy, or excessive growth of the prostate gland that can cause health problems. While using steroids usually increases libido (testosterone is the hormone of libido or sex drive in both sexes), libido often declines when athletes get off the drugs because of a deficiency in natural testosterone production in the body, which is repressed when on steroids – often accompanied with an increase in estrogen due to higher aromatization. The study authors didn’t explain why never using steroids would cause more of a decrease in libido compared to those who had used large doses of the drugs in the past. On the other hand, testosterone production does tend to decline about 2% each year starting at age 40 in most men. As such, the lower libido shown by men who never used steroids can be considered a natural course of events. But that doesn’t explain why libido appeared to be preserved in former steroid users years after they had ceased using the drugs. A guess would be more effective satellite cells and nervous system, which could tie in to other functions in the body such as libido. There are simply not enough research or knowledge in this field to say for sure.
The study authors also suggested that the reason why the former steroid users may have showed a decreased incidence of prostate problems may have occurred because of a long-standing undiagnosed chronic low testosterone level induced by their previous use of high dose steroids. While this may explain the lower incidence of prostate enlargement in these former athletes, it also means that they are at a higher risk of prostate cancer, which is strongly linked to chronic low testosterone levels, as is cardiovascular disease. In addition, this explanation is problematic because having a chronic low testosterone level is closely associated with low libido, yet the former steroid users didn’t show this effect.
Even more interesting was the comparisons between those who had never used steroids and the steroid users for various health parameters. Those who never used steroids showed considerably more cardiovascular problems than did the steroid users, included increased heart attacks and heart failure. This is the precise opposite of what many physicians and researchers would predict for long-term steroid users. Why this was so wasn’t explained in the study. But my guess is that most of the former athletes may have kept up their exercise regimes and maintained healthier diets compared to their non-athletic counterparts. This could easily explain the decreased incidence of adverse cardiovascular events in the former athletes compared to the non-athletes. Perhaps the athletes also avoided known promoters of cardiovascular disease, such as smoking and excessive alcohol intake. Athletes do tend to take a greater interest in health, even those who use steroids and other drugs – and actually often more so. The former steroid users also showed less kidney problems, again going against the common belief that using steroids can cause permanent kidney damage. But this isn’t to say that steroid use in relation to kidney function is always benign.
The primary findings of this study are that former users of high dose steroid regimes appear to have a slightly higher rate of psychological problems, such as anxiety and depression, compared to non-users. Why this is so isn’t clear, but my first inclination is the sudden drop of testosterone and increase in estrogen after going off steroids. There could also be other temporary or more long-term changes to brain chemistry, but that’s another article in itself.
The former steroid users also showed a greater incidence of tendon ruptures. This relates to the rapid strength gains at the beginning of steroid cycles as well as changes caused in structural connective tissue proteins induced by steroids that can weaken tendons and predispose to possible injuries.
The study authors also correctly note that the anabolic steroid regimes used in the past do not resemble those used by current competitors or most others who use the drugs. The doses and number of drugs used today make the older steroid regimes seem like something made for total beginners. And yes, as I have worked with athletes since the early 90’s and spoken to hundreds of athletes who were active during the 70’s and 80’s, I can honestly say that what many of the elite bodybuilders used in the past really does pale in comparison to what current competitive bodybuilders, especially those in the pro ranks, use today. As such, it’s difficult to predict the future health problems that current competitors will face when their competition days are long gone. If they are lucky, most of the side effects they may experience while on the drugs, such as liver inflammation, will recede to normal when they get off the drugs. I would suggest that the primary risk for current high dose steroid users involves deleterious changes in the heart that may prove dangerous down the road. This relates mainly to those who use high dose steroid regimes involving various oral and injected drugs, as well as high dose growth hormone use, which also affects the heart. However, such changes are not a source of concern for men who are on testosterone replacement therapy, which involves far lower doses of testosterone compared to typical athletic use. The same hold true for those taking low dosages of testosterone to feel better and have more energy, such as 250 to 300 mg a week.
Rates of mortality are higher among professional male bodybuilders.
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