Medical Issues Associated with Anabolic Steroid Use

Introduction and Overview

This paper is a review of the article "Medical Issues Associated with Anabolic Steroid Use: Are They Exaggerated?" It examines the medical issues related to the use of anabolic steroids by athletes and bodybuilders, who use exogenous sources of testosterone in order to attain attributes that enhance their performance in sports and related activities. These anabolic steroids provide advantages such as increases in lean body mass, heightened aggression, and maturation of male secondary characteristics. They are taken orally or parenterally in a cyclic manner and can be combined with other drugs to increase efficacy.

Although an athlete may gain these advantages, he also faces adverse effects, as these drugs affect multiple body systems including the heart, liver, brain, and bones. It is important to note, however, that there is limited evidence of serious complications, since many of these changes are transient and reversible once the athlete stops using the drugs.

The article neither promotes nor discourages the use of anabolic steroids. It is instead a thorough discussion of different medical problems related to their use and a review of reported cases where adverse effects were observed. The article suggests that physicians should cooperate with athletes and provide sufficient information about controlled use and associated health risks, so that the athlete can make an informed decision about how to weigh those harmful effects.

Critical Evaluation of the Article

The article "Medical Issues Associated with Anabolic Steroid Use: Are They Exaggerated?" by Jay R. Hoffman and Nicholas A. Ratamess, reviewed in 2006, discusses the possible adverse health effects of anabolic steroids and offers a measured account of different medical conditions — ultimately asking whether their ill effects are genuinely serious or are being overstated by medical consultants and physicians working with athletes.

Anabolic steroids are synthetic derivatives of the male sex hormone testosterone. High testosterone levels cause increased protein synthesis, improvement in muscle size, and maturation of secondary male characteristics. It was discovered in 1939 that exogenous testosterone enhances athletic performance. Today, the use of such drugs is common among weightlifters, Olympic athletes, and professional football players.

Through the use of anabolic steroids, an athlete attains many structural and physiological benefits that contribute to improved performance. These include increases in lean mass, bone mineral density, glycogen storage, neural transmission, pain tolerance, and aggression.

Anabolic steroids can be administered both orally and parenterally. Athletes often use these steroids in combination with other similar drugs to increase potency through a synergistic effect. Use is typically cyclic, interrupted after a period of weeks or several months. Proper management of drug cycles can reduce negative effects to a considerable degree.

The medical community has long attempted to discourage anabolic steroid use because of its harmful health effects, but these efforts have largely failed. Rather than heeding medical advice, athletes have lost confidence in physicians and instead obtain these drugs without prescriptions by consulting friends, the Internet, or supplier companies.

Recent literature suggests, however, that these health hazards have been exaggerated by medical practitioners. There is evidence that ill effects disappear once steroid use is halted, and that proper usage can substantially limit the undesired impact on health. An athlete is more likely to develop a substance dependence disorder if drugs are used excessively without cycling off. Adverse health effects have been reported across many body systems — cardiovascular, endocrine, dermatological, hepatic, musculoskeletal, and psychological — and, although reported evidence remains sparse, the article provides considerable discussion of these negative consequences.

Adverse Health Effects by Body System

The use of anabolic steroids may bring about cardiovascular changes that lead to significant disorders. Over the past two decades, there have been reports of bodybuilders suffering myocardial infarction. However, these cases involve both healthy and previously diseased individuals, and there is no established proof of a direct relationship between anabolic steroid use and myocardial infarction, as other factors — including diet and genetic predisposition — may be involved.

Anabolic steroid use or abuse is also associated with an increased risk of liver disease, since the liver is the primary site of steroid metabolism. Hepatic carcinomas, predominantly in females, have been reported. Among men, the risk is higher in those with a prior history of liver disease. Certain liver enzymes — aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine kinase (CK) — may become elevated, though the more sensitive gamma-glutamyltranspeptidase (GGT) concentration typically remains unchanged (Dickerman, Pertusi, Zachariah et al., 1999). The sustained normal level of GGT further suggests that enzyme elevations alone do not necessarily signal a serious disorder.

The relationship between anabolic steroids and bone growth has also been examined. Steroid use results in significant elevations in estrogen levels, which can cause premature closure of growth plates. However, there do not appear to be any reports confirming the occurrence of premature stunted growth in adolescents who use anabolic steroids, though increased dosage may pose a more serious risk in this regard.

Another commonly raised concern involves the psychological and behavioral effects of anabolic steroid use. These effects can be both positive and negative: aggression, for example, may benefit athletic performance but can have serious consequences outside the competitive environment. Athletes may also experience mood swings and other psychotic disturbances.

Additional adverse effects discussed in the article include acne, male-pattern baldness, gynecomastia (enlargement of breast tissue in men), decreased sperm count, testicular atrophy, impotence, and transient infertility. Several case reports related to each of these conditions are reviewed in the source article.

Conclusion

The author concludes with a non-directive stance on anabolic steroid use, offering a balanced comparison of the medical establishment's approach and the real-world practices of athletes. The article ultimately emphasizes that, in order to maintain the athlete's trust and well-being, he or she should be given proper awareness about drug use, its risks, and its alternatives — rather than simply facing criticism from the medical community. One notable omission, however, is the article's failure to address the ethical issues associated with anabolic steroid use, which represent an additional and significant barrier to resolution in this debate (Simon, 1984).

References

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Dickerman, R.D., Pertusi, R.M., Zachariah et al. (1999). Anabolic steroid-induced hepatotoxicity: Is it overstated? Clinical Journal of Sport Medicine, 9, 34–39.

Maravelias, C., Dona, A.M., Stefanidou, C. et al. (2005). Adverse effects of anabolic steroids in athletes: A constant threat. Toxicology Letters, 158, 167–175.

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Simon, R.L. (1984). Fair play: The ethics of sports. Journal of the Philosophy of Sport, 11(1), 6–13. doi:10.1080/00948705.1984.9714408.