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Immune System Changes

The use of anabolic/androgenic steroids have been shown to produce changes in the body that may impact an individual’s immune system. These changes can be both good and bad for the user. For instance, during steroid treatment, many athletes find they are less susceptible to viral illnesses. New studies involving the user of compounds like oxandrolone and Deca-Durabolin with HIV+ patients seem to support this claim, clearly showing that these drugs can have a beneficial effect on the immune system. Such therapies are, in fact, catching on in recent years, and many doctors are now less reluctant to prescribe these drugs to their ill patients. But just as a person may be less apt to notice illness during steroid treatment, the discontinuance of steroids can produce a rebound effect in which the immune system is less able to fight off pathogens. This most likely coincides with the rebound activity/production of cortisol, a catabolic hormone in the body, which may act to suppress immune system functioning. When the administered steroids are withdrawn, an androgen deficient state is often endured until the body is able to rebalance hormone production. Since testosterone and cortisol seem to counter each others activity in many ways, the absence of a normal androgen level may place cortisol in a unusual active state. During this period of imbalance, cortisol will not only be stripping the body of muscle mass, but may also cause the athlete to be more susceptible to colds, flu, etc. The proper use of ancillary drugs (anti-estrogens, testosterone stimulating drugs) is the most common suggestion for helping to avoid this problem, which will hopefully allow the user to restore a proper balance of hormones once the steroids are removed.

We also cannot ignore the other possibility that steroids could actually increase cortisol levels in the body during treatment. Termed hypercotisolemia, this effect is a common occurrence with anabolic/androgenic steroid therapy. This is because anabolic/androgenic steroids may interfere with the ability for the body to clear corticosteroids from circulation, due to the fact that in their respective pathways of metabolism these hormones share certain enzymes. When overloaded with androgens competing for the same enzymes, cortisol may be broken down at a slower rate, and levels of this hormone will in turn begin to build. Due to their strong tendency to inhibit the activity of the 3beta hydroxysteroid dehydrogenase enzyme, oral c17 alpha alkylated orals may be particularly troublesome in regards to elevated cortisol levels, as again this is a common pathway for corticosteroid metabolism. Though an elevated cortisol level is not common concern during typical steroid cycles, problems can certainly become evident when these drugs are used at very high doses or for prolonged periods of time. This, of course, may lead to the athlete becoming “run-down” adn more susceptible to illness, as well foster a more over-trained and static (less anabolic) state of metabolism.

High Blood Pressure/Hypertension

Athletes using anabolic/androgenic steroids will commonly notice a rise in blood pressure during treatment. High blood pressure is most often associated with the use of steroids that have a high affinity for estrogen conversion, such as testosterone and Dianabol. As estrogen builds in the body, the level of water and salt retention will typically elevate and lead to increased blood pressure. This may be further amplified by the added stress of intense weight training and rapid weight gain. Since hypertension (high blood pressure) can place a great deal of stress on the body, this side effect should not be ignored. If it is left untreated, high blood pressure can increase the likelihood for heart disease, stroke, or kidney failure. Warning signs that one may be suffering from hypertension include a tendency to develop headaches, insomnia, or breathing difficulties. In many instances these symptoms do now become evident until BP is seriously elevated, so lack of these signs is no guarantee that the user is safe. Obtaining your blood pressure reading is a very quick and easy procedure (either at a doctor’s office, pharmacy, or home); steroid-using athletes should certainly be monitoring BP values during stronger cycles so as to avoid potential problems.

If an individual’s blood pressure values are becoming notably elevated, some action should/must be taken to control it. The most obvious is to avoid the continued use of the offending steroids, or at least to substitute them with milder, non-aromatizing compounds. It is also of note that although aromatizing steroids are typically involved, non-aromatizing androgens like trenbolone are occasionally also linked to high blood pressure, so these are perhaps not the ideal alternatives in such a situation. The athlete also has the option of seeking the benefit of high blood pressure medications such as diuretics, which can dramatically lower water and salt retention. Catapres (clonidine HCL) is also a popular medication among athletes, because in addition to its blood pressure lowering properties, it has also been documented to raise the body’s output of growth hormone.

Kidney Stress/Damage

Since your kidneys are involved in the filtration and removal of byproducts from the body, the administration of steroidal compounds (which are largely excreted in the urine) may cause them some strain. Actual kidney damage is most likely to occur when the steroid user is suffering from severe high blood pressure, as this state can place an undue amount of stress on these organs. There is actually evidence to suggest that steroid use can be linked to the onset of Wilm’s Tumor in adults, which is a rapidly growing kidney tumor normally seen in children and infants. However, such cases are so rare that no conclusive link has been established. Obviously the kidneys are vital to one’s health, sot he possibility of any kind of damage (although low) should not be ignored during heavy steroid treatment. If the user is noticing a darkening of color (in some cases a distinguishable amount of blood), or pain/difficulty when urinating, kidney strain might be a legitimate concern. Other warning signs include pain in the lower back (particularly in the kidney areas), fever, and edema (swelling). If organ damage is feared, the administered steroidal compounds should be discontinued immediately, and the doctor paid a visit to rule out any serious trouble.

Since kidney stress/damage is generally associated with the use of stronger aromatizing compounds such as testosterone and Dianabol (which often raise blood pressure), individuals sensitive to high blood pressure/kidney stress should avoid such compounds until health concerns are safely addressed. If steroid use is still necessitated by the individual, it may be a good idea to avoid the stronger compounds and opt for milder anabolics. Primobolan, Anavar, and Winstrol, for example. do not convert to estrogen at all, and may be acceptable options. Also favorable drugs in this regard are Deca-Durabolin and Equipose, which have only a low tendency to convert to estrogen.

Liver Stress/Damage

Liver stress/damage is not a side-effect of steroid use in general, but is specifically associated with the use of c17 alpha alkylated compounds. These structures contain chemical alterations that enable them to be administered orally. In surviving a first pass by the liver, these compounds place some level of stress on the organ. In some instances, this has led to severe damage, even fatal liver cancer. The disease peliosis hepatitis is one worry, which is an often life-threatening condition in which the liver develops blood-filled cysts. Liver cancer (hepatic carcinoma) has also been noted in certain cases. While these very serious complications have occurred on certain occasions where liver-toxic compounds were prescribed for extended periods, it is important to stress that this is not very common with steroid-using athletes. Most of the documented cases of liver cancer have in fact been in clinical situations, particularly with the use of the powerful oral androgen Anadrol 50 (oxymetholone). This may be directly related to the high dosage of this preparation, as Anadrol 50 contains a whopping 50mg of active steroid per tablet. This is a considerable jump from other oral preparations, most of which contain 5mg or less of a substance. With one Anadrol 50 tablet, the liver will therefore have to process (roughly) the equivalent of 10 Dianabol tablets. This obvious stress is further amplified when we look at the unusually high dosage schedule for ill patients receiving this medication. With Anadrol 50, the manufacturer’s recommendations may call for the use of as many as 8 or 10 tablets daily. This is a far greater amount than most athletes would ever think of consuming, with three or four tablets per day being considered the upper limit of safety. It is also important to note that the actual number of cases involving liver damage have been few, and have not been a significant enough of a problem to warrant discontinuing this compound. Methyltestosterone, the first steroid shown to cause liver trouble, is also still available as a prescription drug. The average recreational steroid user who takes toxic orals at moderate dosages for relatively short periods is therefore unlikely to face devastating liver damage.

Although severe liver damage may occur before the onset of noticeable symptoms, it is common to notice jaundice during the early stages of such injury. Jaundice is characterized by the buildup of bilirubin in the body, which in this case will usually result from the obstruction of bile ducts in the liver. The individual will typically notice a yellowing of the skin and eye whites as this colored substance builds in the body tissues, a clear sign to terminate the use of any cl7 alpha alkylated steroids. In most instances, the immediate withdrawal of these compounds is sufficient to reverse and prevent any further damage. Of course, the athlete should avoid using orals for an extended period of time, if not indefinitely, should jaundice occur repeatedly during treatment. It is also a good idea to visit your physician during oral treatment in order to monitor liver enzyme values. Since liver stress will be reflected in your enzyme counts well before jaundice is noticed, this can remove much of the worry with oral steroid treatment.

Prostate Enlargement

Prostate cancer is currently one of the most common forms of cancer in males. Benign prostate enlargement (a swelling of prostate tissues often interfering with urine flow) can precede/coincide this cancer, and is clearly an important medical concern for men who are aging.

Prostate complications are believed to be primarily dependent on androgenic hormones; particularly the strong testosterone metabolite DHT in normal situations, much in the same way estrogen is linked to breast cancer in women. Although the connection between prostate enlargement/cancer and steroid use is not fully established, the use of steroids may theoretically aggravate such conditions by raising the level of androgens in the body. It is, therefore, a good idea for older athletes to limit/avoid the intake of strong 5-alpha reducible androgens like testosterone, methyltestosterone, and Halotestin, or otherwise use Proscar (finasteride), which was specifically designed to inhibit the 5-alpha reductase enzyme in scalp and prostate tissues. This may be an effective preventative measure for older athletes who insist on using these compounds. Drugs like Dianabol, Anadrol 50, and Proviron, however, which do not convert to DHT yet are still potent androgens, are not affected by its use. It is also important to mention that not only androgens, but also estrogens, are believed necessary for the advancement of this condition. It appears that the two work synergistically to stimulate prostatic tissue growth, such that one without the other would not be enough to cause it. It has, therefore, been suggested that a non-aromatizable compound like DHT may be a safer option for older men looking for androgen replacement therapy than testosterone. MENT is also being looked at as an androgen replacement option for the same reason. Anti-estrogens might even turn out to be more effective at treating BPH than a drug like finasteride, which is used to lower androgenic activity in the prostate. Estrogen suppression is easier to accomplish in males, and should be accompanied with less side effects. It would also be very sound advice, regardless of steroid use, for individuals over 40 to have a physician check the prostate on a regular basis, and never consider self-administering steroids if prostate health is compromised.

Sexual Dysfunction

The functioning of the male reproductive system depends greatly on the level of androgenic hormones in the body. Therefore, the use of synthetic male hormones may have a dramatic impact on an individual’s sexual wellness. On one extreme, we may see a man’s libido and erection frequency become significantly heightened. This is most commonly seen with the use of strongly androgenic steroids, which seem to have the most dramatic stimulating impact on this system. In some instances, this can reach the point of becoming problematic, although more often than not, the athlete is simply much more active and sexually aggressive during the intake of steroids.

On the other extreme, we may also see a lack of sexual interest, possibly to the point of impotency. This occurs mainly when androgenic hormones are very low. This will often happen after a steroid cycle is discontinued, as the endogenous production of testosterone is commonly suppressed during the cycle. Removing the androgen (from an outside source) leaves the body with little natural testosterone until this imbalance is corrected. The loss of its metabolite DHT is particularly troubling, as this hormone may have a strong effect on the reproductive system that may not be apparent with other less androgenic hormones. Therefore, it is a very good idea to use testosterone-stimulating drugs like HCG and/or Clomid|/Nolvadex when coming off of a strong cycle, so as to reduce the impact of steroid withdrawal. Impotency/sexual apathy may also occur during the course of a steroid cycle, particularly when it is based strictly on anabolic compounds.

Since all “anabolics” can suppress the manufacture of testosterone in the body, the administered drugs may not be androgenic enough to properly compensate for the testosterone loss. In such a case, the user might opt to include a small androgen dosage (perhaps a weekly testosterone injection), or again reverse/prevent the androgen suppression with the use of a medication like HCG.

It is also interesting to note that it is not always simply an androgen vs. anabolic issue. People will often respond very differently to an equal dose of the same drug. While one individual may notice sexual disinterest or impotency, another may become extremely aggressive. It is, therefore, difficult to predict how someone will react to a particular drug before having used it.

Stunted Growth

Many anabolic/androgenic steroids have the potential to impact an individual’s stature if taken during adolescence. Specifically, steroids can stunt growth by stimulating the epiphyseal plates in a person’s long bones to prematurely fuse. Once these plates are fused, future linear growth is not possible. Even if the individual avoids steroid use subsequently, the damage is irreversible and he/she can be stuck at the same height forever.

Not even the use of growth hormone can reverse this, as this powerful hormone can only thicken bones when used during adulthood. Interestingly enough, it is not the steroids themselves, but the buildup of estrogen that causes the epiphyseal plates to fuse. Women are shorter than men on average because of this effect of estrogen, and likewise the use of steroids that readily convert to estrogen can prematurely suppress/halt a person’s growth. In fact use of steroids like Anavar, Winstrol, and Primobolan (which do not convert to estrogen) can actually increase one’s height if taken during adolescence, as their anabolic effects will promote the retention of calcium in the bones. This would also hold true for non-aromatizing androgens such as trenbolone, Proviron and Halotestin. It is still good common sense to advise adolescents to avoid steroid use, at least until their bodies are fully mature and steroid use will have a less dramatic impact.?

Testicular Atrophy

The human body always prefers to remain in a very balanced hormonal state, a tendency known as homeostasis. When the administration of androgens from an outside source causes a surplus of hormone, it will cause the body to stop manufacturing its own testosterone. Specifically, this happens via a feedback mechanism where the hypothalamus detects a high level of sex steroids (including androgens, protestins, and estrogens) and shuts off the release of GnRH (Gonadotropin Releasing Hormone, formerly referred to as luteinizing hormone releasing hormone). This, in turn, causes the pituitary to stop releasing luteinizing hormone and FSH (follicle stimulating hormone), the two hormones (primarily LH) that stimulate the Leydig’s cells in the testes to release testosterone (negative feedback inhibition has been demonstrated at the pituitary level as well. Without stimulation by LH and FSH, the testes will be in a state of production limbo, and may shrink from inactivity. In extreme cases the steroid user can notice testicles that are unusually and frighteningly small.

However, this effect is temporary, and once the drugs are removed (and hormone levels rebalanced) the testicles should return to their original size. Many regular steroid users find this side effect quite troubling, and use HCG during a steroid cycle in order to try to maintain testicular activity (and size) during treatment. The more estrogenic androgens (testosterone, Anadrol 50, and Dianabol) are most dramatic in this regard, and are not the best choices for individuals who seriously want to avoid testicle shrinkage. Non-aromatizing anabolics would be a better option, however, be warned that all steroids will suppress the production of testosterone if taken at an anabolicly effective dosage (yes even Anavar and Primobolan).

Water and Salt Retention

Many anabolic/androgenic steroids can increase the amount of water and sodium stored in body tissues. In some instances, steroid-induced water retention can bring about a very bloated appearance to the body (hands, arms, face, etc.), which will also reduce the visibility of muscle features (loss of definition). Athletes often ignore this side effect, particularly during bulking cycles when the excess water stored in the muscles, joints, and connective tissues will help to improve an individual’s overall strength. With the use of many strong androgens, water retention can account for much of the initial strength and body weight gain during steroid treatment, with “water-weight” sometimes amounting to ten or more pounds.

Although water retention may not be the most unwelcome side effect during a bulking cycle (greater strength and mass), it can lead to dangerous problems such as high blood pressure and kidney damage. The body is clearly under more strain when dealing with an unusually high level of water, so athletes should not simply ignore this. Water retention is most specifically associated with the presence of estrogen in the body, and is therefore common with the use of aromatizing compounds (such as testosterone and Dianabol). If water retention becomes an obvious problem during a cycle, the use of an anti-estrogen (Nolvadex, Proviron) may help minimize it. An anti-aromatase like Arimidex is, in fact the most effective option, a drug that inhibits the conversion of testosterone to estrogen. Sometimes the athlete will alternately opt to use a diuretic, which can rapidly shed the water so as to achieve a more comfortable/attractive physique in a short period of time. This is a common practice when preparing for a competition, as diuretic use allows the user a great level of control over water stores. Of course, discontinuing the offending compounds, or substituting them with a milder anabolic, would be the simplest option for recreational steroid users.

Virilization

Since anabolic/androgenic steroids are synthetic male hormones, they can produce a number of undesirable changes when introduced into the female body. This includes the possibility of “virilization”, which refers to the tendency for women to develop masculine characteristics when taking these drugs. Virilization symptoms include a deepening or hoarsening of the voice, changes in skin texture, acne, menstrual irregularities, increased libido, hair loss (scalp), body/facial/pubic hair growth, and an enlargement of the clitoris.

In extreme cases the female genitalia can become very disfigured, and may actually take on a penis-like appearance. Clearly, women must be very careful when considering the use of steroids, especially since most virilization symptoms are irreversible. The stronger androgenic compounds should be off-limits, with cautious female athletes restricting themselves to the use of only mild anabolics such as Winstrol, Primobolan, Anavar, and Durabolin(the faster acting nandrolone). Since even these milder anabolics have the potential to cause problems, users should additionally remember to be conservative with drug dosages and duration of intake. After each cycle a notable break from treatment would be a good idea as well, so that the body has sufficient time to reestablish a hormonal balance.