What are the side effects of anabolic steroids?

Anabolic steroid side effects

Before we get into all of the side effects of steroid abuse, it is important that you keep the following in mind:

• Not every person doping (using steroids) will experience all of the side effects
• Some steroid users will experience some of the side effects and not suffer from a number of others
• There may be some steroid users who experience very few side effects, and some who do not experience any, bear in mind, most users will experience at least one of the below side effects
• The severity of the side effects will vary between individuals
• The side effects are dependent on several different factors and depend on the individual’s own body
• For these reasons, these side effects are referred to as potential side effects
  
  

General side effects of steroids

The below side effects are the most commonly seen amongst steroid users (we will go into more detail on these below):

• Hair loss 
• Oily hair and skin, severe acne all over the body
• Liver disease (cysts and tumours are commonly seen)
• Heart disease (stroke and heart attack)
• Kidney disease
• Mood changes, increased aggression (roid rage), suicidal tendencies, depression and irritability
• Hypertension (high blood pressure)
• High cholesterol
• Gynecomastia (this is the abnormal development of breasts or mammary glands in men, also known as ‘man-boobs’)
• Infertility in men and women
• Testicles shrinking
• Azoospermia (this is semen that does not contain sperm)
• Menstrual irregularities (this is seen in women who use steroids)
• Stunted growth in teens
• Risk of bacterial or viral infection as a result of unsterile injections
• Excess body and facial hair
• Deeper voice in women (and men), this is known as dysphonia

A number of steroid users tend to live in denial regarding the side effects of steroids. They suggest that those who suffer from the various effects are only steroid abusers and are stacking a number of different forms of the drugs in longer cycles than is necessary which does not give their natural hormone levels and body time to recuperate. However, these claims are not scientifically backed in any way and the side effects of steroids can affect anyone using the drugs as a healthy individual without prescription for purposes other than a professionally diagnosed and monitored medical condition.

Some of the side effects of anabolic steroid use are reversible and can improve through discontinuing the drugs, other side effects can be permanent and even fatal.

The side effects of steroids are a result of the excess amounts of testosterone administered to achieve muscle growth, aerobic capacity and power which affects almost every organ and system in the body. Any drug that affects or changes the homeostasis (the inner workings and systems of the body) of one’s natural state, will have an impact.

These side effects range from physically evident side effects (i.e. acne and hair loss) and even irreversible and life-threatening (i.e. liver damage and heart attacks). ²

The information below describes the effects of steroids:

Steroids and blood pressure

Past studies conducted on anabolic steroid users have shown that these drugs may boost blood pressure as a result of them disrupting the function of nitric oxide. This is a substance that is produced in the blood vessel lining and open or dilates the blood vessels. When nitric oxide function is inhibited and the blood vessels are not dilated, the constriction of the vessels and blood flow can lead to an increase in blood pressure, this is known as hypertension.

How steroids influence behaviour

There have been a number of studies conducted that have identified a pattern of increased levels of testosterone leading to psychological and psychiatric problems. These include feelings of extreme anger and aggression, delusions and even hallucinations. The most commonly seen issue in steroid users is ‘roid rage’.

While roid rage is a documented steroidal side effect, it is often the case that users who are naturally aggressive and short-tempered blame their moods on the drugs.

Tendon rupture while using steroids

The rapid increase of muscle growth (in some cases), can result in trauma to the tendons that are responsible for attaching muscle to the bone, this puts the user at risk of tendon rupture.

Bone production and growth issues while using steroids

Steroids can increase the production of bone in the body, particularly in the face and skull. The teeth are also able to spread out as the mandible and maxillae grow (jaw bones above and beneath the teeth).

An overgrowth of one’s forehead often results in a “Hulk” like look. If younger people such as teenagers who still have some growing to do, use steroids, these drugs are able to prematurely close the bone plates for growth, thus leading to stunted growth.

Skin

Any skin issues, such as acne, are often associated with the excess use of steroids, these problems are similar to what an adolescent male goes through during puberty as result of the spike in testosterone experienced.

Acne is a common side effect of steroid use. A particularly severe form of acne is known as acne conglobate which can develop during the use of steroids and even after the drugs have been discontinued. Female skin can also become ‘coarser’ in appearance due to steroid use.

Infections of the skin can occur at the site of the injection as a result of unsanitary techniques being used for steroid injections.

Skin abscesses can also occur at the injection sites, these are able to spread to organs inside of the body.   

Another issue arises with the rapid growth of muscles and that is stretch marks.

Infertility associated with steroid use

As a result of the introduction of excess testosterone due to steroid use, the male body will suppress the production of natural testosterone. This often leads to the shrinking of testicles and a decrease in sperm count.

Prostate gland and infertility

Only found in males, the prostate gland is located just beneath the bladder. The main function of the prostate is to maintain the activity of sperm. Some steroids have been seen to enlarge the prostate and because the prostate surrounds the urethra, if this is swollen it can interrupt the flow of urine.

When the prostate is interfered with in any way it can lead to the development of abnormal sperm as well as a decrease in sperm count.

Testes (testicles) and testosterone

When taking steroids, the testes (testicles or balls) will often decrease in their normal functioning as a result of the higher levels of testosterone in the body. When the supplementation of testosterone is stopped, it may take some time for the pituitary gland to send signals to the testicles to inform them to manufacture testosterone once again. When steroids are used long-term or in higher doses, the testes can, in actual fact, stop production of testosterone entirely. This can also result in testicular shrinkage.

Whether testicular shrinkage is permanent or not depends on the potency of the dosage, and the duration for which steroids have been taken. 

Water retention related to steroid use

The use of steroids often results in higher levels of water being retained in the body, this is known as oedema and can lead to puffier cheeks and a rounder face. Water retention can also be seen in the feet and ankles.

The effects of steroids on the eyes

The long-term abuse of steroids can damage the user’s eyes and result in cataracts, infections and glaucoma.

Steroids and hair loss

Both males and females may experience male pattern baldness from the high levels of testosterone caused by steroid use. Testosterone is converted into DHT (dihydrotestosterone) which affects the hair follicles, causing them to thin and eventually die.

Cardiovascular effects of steroids

Issues with the use of steroids and the heart are not to be taken lightly. Cardiovascular side effects are a common occurrence amongst long-term and even short-term steroid users. The use of some steroids can result in heart disease leading to heart attack, heart failure and a decrease in the functioning of the heart. Studies have shown that those who use steroids suffer from impaired use of the left ventricle of their hearts. The left ventricle is responsible for pumping the oxygenated blood to all of the organs and tissues in the body.

Some steroids also lead to an increase in levels of bad cholesterol in the body which can accumulate as plaque in the blood vessel walls and can lead to strokes and heart attacks.

It has also been seen that blood pressure can increase through the use of steroids, which can result in blood clots (deep vein thrombosis). A disruption in blood flow can also damage the heart muscle.

Athletes taking higher doses of steroids are also able to suffer from an enlarged heart. Bear in mind, the heart is a muscle in itself and the more testosterone present in the body, the more this muscle can grow (hence why men often have larger hearts than women). The risks of an enlarged heart include heart attack and CAD (coronary artery disease) – this is from blocked arteries in the heart and high blood pressure.

Stomach issues associated with steroids

Acid reflux, bloating and ulcers have been linked to the use of steroids as a result of stomach acid production being increased due to the hormonal imbalance caused.

Changes to jawline appearance as a result of steroid use

Steroids have also been seen to have a physical effect on the aesthetic appearance of the jawline. High amounts of growth hormone and testosterone create the look of a more defined and square jawline as a result of muscle growth in the jaw and the increase of masculine features.

Effects of steroids on the kidneys

The kidneys are tasked with the vital role of eliminating any waste material from the blood as well as regulating the levels of water and salt in the body. Your kidneys also regulate blood pressure, therefore, high blood pressure can damage your blood vessels and the filtration system of the kidneys. Issues with the use of steroids and the kidneys often arise through the use of oral steroids (tablet form).

The kidneys have to work even harder to absorb and metabolise the steroids, therefore overworking, which can result in tissue damage and scarring. The damage done to the kidneys amongst long-term steroid users has been noted as being more severe than kidney damage amongst morbidly obese people. Should kidney damage occur, then the steroid user should discontinue the use of the drugs. In this case, they may be able to recover from the damage. Some steroids users have suffered from end-stage kidney failure and have required a dialysis. Others, having previously experienced kidney damage, when starting a cycle of steroids again have experienced a relapse of severe kidney damage and dysfunction.

Steroid users also tend to have high protein diets which are often in excess of the recommended intake. This can lead to kidney stones. Too much protein can boost the levels of uric acid and reduce the level of citrate, this is the chemical that is needed in the urine to prevent kidney stones.

High blood pressure can also have an effect on the kidneys due to damage caused to blood vessels by causing the narrowing and thickening of these. This can lead to a reduced supply of blood to and filtration by the kidneys.

Effects of steroids on the liver

The liver is the largest organ in the body and it vital for filtering harmful toxins found in the blood. As well as this, the liver will store specific nutrients such as minerals and vitamins needed for the body and managing the levels of certain chemicals which include sugar, cholesterol and proteins.

The liver creates a substance known as bile which aids in the process of food digestion. The use of steroids is associated with liver damage that is, in some cases, irreversible.

Steroids taken orally are harder for the liver to breakdown and metabolise which can lead to a decrease in the function of the liver and its ability to clear out any waste products. This is not to say that injected steroids do not have any side effects. Different forms of the drug come with their own impact on the body.

Some forms of counterfeit steroids have had bacteria and viruses detected in them which can also lead to a further decrease in liver function.

There are a number of warning signs that your body will exhibit should you be suffering from severe liver damage. One of these is jaundice (a yellowing of the skin and eyes). If liver damage is detected it is advised that the user stop what is causing it, in this case, steroids and allow for the liver to regenerate itself, as it is the only organ in the body that can self-heal. However, these healing properties of the liver are only viable to a certain point, should there be a large amount of damage and scarring present, the liver may not be able to heal itself.

Effects of steroids on the chest

Testosterone can be converted into oestrogen in the male body through the use of the enzyme known as aromatase that is found in the body tissue, mainly muscle and fat. When a man has extra oestrogen in his system, this can lead to a number of different side effects, such as the build-up of extra fat under the skin, oedema (water retention) and the development of gynecomastia, also known as ‘man boobs’.

In most cases, ‘man boobs’ have to be surgically removed as the levels of testosterone in the steroid user’s body do not return to normal once the steroids are stopped.

To combat these effects, a number of athletes also use oestrogen-suppressing drugs known as aromatase inhibitors. An example of this form of the drug is Arimidex.

In women, the breasts will actually shrink in size as a result of the lack of oestrogen and increased testosterone levels.

Side effects associated with steroid use in women            

The use of steroids in females can result in a process of female characteristics becoming masculinised. Issues that arise are a loss of breast tissue, body fat and a swollen clitoris, this is known as clitoromegaly. Swelling of the clitoris may be a permanent feature and may never resolve even after steroids have been discontinued.  Other masculine features that arise are a deepening of the voice, as well as an increase in the size and development of the body and facial hair.

Females who take steroids may also experience irregularities in their menstrual cycles. These abnormalities can manifest through less or more frequent menstruation and in some cases, menstruation may not take place at all. When the steroids are stopped, this often results in the menstrual cycle returning to normal, however, the recovery can range from a number of weeks to months and will depend on the class of drugs and dosages used, as well as the duration of steroid use. Any abnormalities caused are a result of the upset in the natural hormones in the female body and the offsetting of the production of oestrogen from an abundance of testosterone being present in the body. These changes can have an impact on infertility later in the user’s life, however, these effects are yet to be further explored.

Dysphonia (deeper voice)

A deeper voice is a common side effect of anabolic steroids and is seen to often affect females as a result of excess testosterone leading to the development of male characteristics. 

Anabolic steroids have an effect on the larynx and the muscles that are involved in the generation of vocals. The development of a deeper voice in females will typically occur in stages, normally beginning with a hoarser voice which is followed by alterations in the pitch of the voice.

The development rate of these changes will depend on the steroids being used, their severity and dosage.

If dysphonia is detected early on, the effects can be reversed through discontinuing the use of steroids. If not, the results are often permanent.

Increased body and facial hair (Hirsutism)

This is particularly seen in women as they may experience hair growth on their face, chest, hands and other areas of the body. This side effect is also dependent on the type of steroid being used and the dosage. As previously stated, steroids may also result in male pattern baldness in men and women. Therefore, steroids often cause an increase in body hair and a decrease in hair on top of the head.

 

^_References

^{_{2. National Institute on Drug Abuse. August 2006. Anabolic Steroid Abuse. Available: https://www.drugabuse.gov/publications/research-reports/anabolic-steroid-abuse/what-are-health-consequences-steroid-abuse [Accessed 31.07.2017]}}