26 March 2021 Author : Carlos Fernandes The use of anabolic steroids in doses above physiological by athletes from various areas to improve their performance was banned by the International Olympic Committee in 1967. Currently, the misuse of these compounds is widespread in the general population, has marked harmful effects and is a public health concern. Most users of anabolic steroids are men (about 80%), whether in a non-competitive sports context, due to aesthetic reasons, to increase physical performance or to counteract the effects of natural aging. It is estimated that the prevalence of anabolic steroids use in men is 1% -5%, and significantly lower in women. In Portugal, the few data available were obtained in a study carried out in gyms in Porto region, and revealed that more than 60% of respondents had already used substances with the aim of increasing physical performance, with anabolic androgenic steroids being the most frequent. What are anabolic steroids? Anabolic androgenic steroids, often referred to only as anabolic steroids or steroids , are synthetic compounds with a chemical structure similar to testosterone and with : Anabolic effects, ie, increase in muscle mass and decrease in fat mass; Androgenic effects, that is, to stimulate the development of male sexual characteristics. The intention of using anabolic steroids outside of any medical indication is to take advantage of their anabolic effects. However, the biological effects of these compounds are due to its binding to a single type androgen receptor. Therefore, i t is impossible to completely separate the anabolic effects from the androgenic effects . Testosterone is the main male sex hormone. Physiologically, its effects are consequent to the conversion to dehydrotestosterone, which has an androgenic potency far superior to that of testosterone. Examples of anabolic steroids used in injectable formulations are: Testosterone cypionate Testosterone enanate (Testoviron®) Testosterone undecanoate (Nebido®) Testosterone proprionate Nandrelone decanoate (Deca-Durabolin®) Nandrelone undecanoate (Dynabolan®) Nandrelone cypionate (Dynabol®) Nandrolone fempropionate (Durabolon®) Boldenone undecylenate (Equipoise®) Trenbolone esters (Trenabol®) Examples of anabolic steroids in oral administration formulations are: Stanozole (Winstrol®) Methyltestosterone Mesterolone (Proviron®) Oxandrolone (Anavar®, Oxandrin®) Oxymetallone (Anadrol®) Methandrostenolone (Dianabol®) How does users obtain the anabolic steroids? Drugs that contain androgenic steroids and whose commercialization is authorized are subject to medical prescription and have precise indications . These drugs are not intended for people with normal hormonal levels, nor those indications cover aesthetic, physical performance, sports performance, or similar objectives. Therefore, almost always, those looking for or using anabolic steroids in these circumstances are afraid to address the issue with doctors. Most seek information online or from other users. They develop strong opinions on the subject, albeit on a non-scientific basis and often only derived from reports of personal experiences. The expansion of anabolic steroids misuse has also led to its illegal production and acquisition mechanisms. Production is, in many cases, carried out in unauthorized locations, which calls into question the control of the manufacturing process and the safety of the products. The acquisition is almost always illegal, through online contact or personal knowledge. What are the effects of using anabolic androgenic steroids? All people develop symptoms resulting from the consumption of anabolic steroids or related to the interruption of their use. The symptoms that can cause someone using anabolic steroids to seek medical care or that can be seen during a consultation are numerous. They can be more or less important, depending on the doses and the time of use, if are still taken it or have been stopped. Examples include: Musculoskeletal symptom s: such as body muscle disproportion and tendinopathies; Endocrinological symptoms , including signs of hypogonadism in men, with gynecomastia, altered libido, erectile dysfunction, infertility or testicular atrophy; Dermatological symptoms : such as severe acne, stretch marks, androgenic alopecia and reactions at the injection site when used by this route; Cardiovascular symptoms : hypertension, diastolic dysfunction, cardiomyopathy, heart attack or arrhythmia. Psychiatric symptoms : depression, anxiety, increased aggression, violent behavior, or insomnia. It is known that about a third of users develop addiction . Dependent users are more likely to abuse other substances, such as alcohol, tobacco and drugs, and of mental illness. Depending on the type of anabolic steroid, dose and dosing schedule, changes in the laboratory tests may occur , for example in: Complete blood count, with an increase in hematocrit; Lipid profile, with a reduction in cholesterol levels of high-density lipoproteins (HDL) and an increase in low-density lipoproteins (LDL); Liver function, with increased transaminases; Suppression of gonadotropins luteotropic hormone (LH) and follicle stimulating hormone (FSH); Testosterone and estradiol increased or decreased depending on the type of anabolic steroids and the cycles used; Changes in the spermogram, with decreased spermatogenesis (sperm formation). Therapeutic approach Abstinence from the consumption of anabolic androgenic steroids is essential for recovery . The change in the functioning of the hypothalamic-pituitary-gonadal axis, which controls the physiological production of sex hormones, induced by anabolic steroids use causes hypogonadotropic hypogonadism to occur frequently following the cessation of its intake. This hypogonadism can manifest itself, for example by: Relative decrease in muscle strength; Decrease in physical performance; Libido alteration; Erectile dysfunction; Infertility; Testicular atrophy. Recovery can happen spontaneously. However, the time required varies and the symptomatic periods can be quite prolonged until it happens. In cases where symptoms of hypogonadism are poorly tolerated , pharmacological stimulation of pituitary production of luteinizing hormone (LH) may be a possibility. In some cases, a weaning scheme may be considered that will aim to maintain normal testosterone values before complete suspension. If gynecomastia occurs, treatment should also be considered. For men with an immediate desire for fertility , therapy to stimulate spermatogenesis may be prescribed. The desire to cease consumption of anabolic steroids is, of course, determinant for the clinical conduct to be taken. In cases where there is no interest in abandoning consumption, it is important to explain the health risks associated with these compounds, as there are still many no informed users. Meet the endocrinology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
