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Anabolic Steroids: Abuse & Addiction

What are anabolic steroids?

Synthetically derived variants of testosterone – the male sex hormone, are known as anabolic steroids. They are technically known as androgenic anabolic steroids or AAS [1], where ‘androgenic’ refers to the promotion of masculine characteristics, while ‘anabolic’ refers to the growth process involved. These steroids help in the growth of skeletal muscle tissue in the body and therefore, lead to an increase in lean body mass. These are prescribed in conditions that result from hormone deficiency – such as delayed onset of puberty and for treatment of diseases such as cancer and AIDS which are accompanied by muscle atrophy or loss of muscle tissue. They are also used in the treatment of some forms of anaemia, osteoporosis and primary biliary obstruction, which is an autoimmune disease pertaining to the liver.

In recent times though, anabolic steroids are being used as performance enhancement drugs by athletes competing in various sports. Since, anabolic steroids increase the rate at which protein synthesis happens in cells, they promote growth of muscle tissue and consequently enhance size of the muscle; hence, they are frequently consumed by bodybuilders to improve physical appearance. In addition to their anabolic characteristics, these steroids promote competitiveness and aggressiveness, which may be attributed to their androgenic effects. These traits are certainly desirable for intense competitive sporting activities.

How are anabolic steroids consumed?

Anabolic steroids can be taken orally or can be injected into the bloodstream. Topical applications in the form of gels, creams and patches are also commonly available. The type and dosage depends on the age of the patient, along with the type of medical condition and its severity.

When these steroids are consumed for performance enhancement, the dosage varies significantly, and at times may even be more than 100 times the upper limit of the recommended dosage. Users of anabolic steroids believe that by arranging and manipulating the dosage and combination of drugs, effectiveness can be increased significantly; at the same time, the body is given time to adjust in a manner that harmful side effects are avoided. The two most common methods used are ‘stacking’ and ‘pyramiding’. Stacking involves the consumption of two or more anabolic steroids under the belief that these interacting steroids will have increased effectiveness in comparison to when they are consumed individually. Pyramiding refers to the process of gradually increasing the dosage of the steroids and then tapering it back to zero, over a period of 8 to 12 weeks. This is subsequently followed by a period of no usage, when the body returns to normal production of hormones. However, such theories have not been scientifically proven and are based on personal experiments conducted by steroid users.

How do anabolic steroids work?

Anabolic steroids work in two primary ways – firstly, by stimulating protein synthesis in the cells of muscle tissue, thereby promoting cellular growth; secondly, by blocking the hormone cortisol, which is released during bouts of intense exercise and leads to muscle tissue breakdown. In such a manner, not only does muscle wastage get prevented, consumers believe that steroid usage leads to muscle growth thereby enhancing performance exponentially.

What is the prevalence of anabolic steroid usage?

According to the study ‘Monitoring the future’ conducted by National Institute on Drug Abuse (NIDA) in 2002, 46.1% of 12th graders surveyed, 33.2% of 10th graders and 22% of 8th graders surveyed, said that it was easy to obtain anabolic steroids [2]. Centre for Disease Control and Prevention (CDC) data reveals that more than 0.6 million students have used steroids in the year 2005 [3]. In the National Household Survey on Drug Abuse conducted by Substance Abuse & Mental Health Services Administration in 1994, the number of Americans using anabolic steroids was pegged at 1.08 million [4]. It was also revealed that the usage was more prevalent among men, but this trend has been changing in recent times. A number of women, especially teenage girls, are turning to anabolic steroids for reducing body fat. By 1997, the number of teenage girls admitting to steroid usage had jumped to 175,000 [5]; a 100% increase from 1991 figures. All these figures, covering the past two decades, indicate that not only are anabolic steroids easily available, they are also being consumed in large quantities by the population, irrespective of age and sex.

What are the side effects of anabolic steroid usage?

The myriad side effects of anabolic steroid usage are commonly observed. Some side effects are reversible, while long term and unguided usage may lead to permanent damage to the body. The major side effects include liver damage, liver tumours, jaundice, renal failure, high blood pressure, fluid retention, an increase in LDL and decrease in HDL that may lead to cardiovascular and coronary artery diseases. Side effects also include decrease in natural production of testosterone in the body, alteration in thyroid functioning, headaches, nosebleeds, cramps and insulin insensitivity. In men, testicular atrophy or shrinking of testicles along with a reduction in sperm count, infertility, erectile dysfunction and impotency have been observed. Loss of hair leading to baldness and development of breasts, also called gynecomastia are also common. In women, enlargement of the clitoris, facial hair growth, baldness and menstrual cycle issues are common side effects. In adolescents, changes due to puberty get accelerated, and skeletal development may be stunted in case consumption of anabolic steroids is done prior to growth spurt that is generally experienced. In addition to these side effects, anabolic steroids are commonly injected, which increases the risk of contracting hepatitis and HIV that eventually leads to AIDS.

Apart from the physiological side effects associated with consumption of anabolic steroids, significant psychological effects have also been observed. Symptoms include over aggression, mania and violence. Although cases are less frequent, long term side effects such as psychosis and suicide have also been seen.

Are anabolic steroids addictive in nature?

Unlike other drugs of abuse, anabolic steroids do not have similar acute effects on the brain. Specifically, consumption of these steroids does not lead to an increase in the neurotransmitter Dopamine, which is responsible for providing the ‘kick’ or ‘high’ that eventually leads to addiction. However, long term usage has shown to impact chemical pathways of the brain that are also affected by other drugs. This leads to impacting the mood and behaviour of the individual consuming the steroid. It is because of the reinforcing effects that anabolic steroids are addictive in nature.

When consumption of anabolic steroids is stopped, withdrawal symptoms are experienced. These include fatigue, restlessness, mood swings, anxiety, insomnia, loss of appetite and reduced libido. The biggest danger is from clinical depression which enhances suicidal as well as homicidal tendencies. Quite often, people in these situations, turn to other forms of substance abuse, in order to control the withdrawal symptoms.

Considering the immediate benefits that are provided by anabolic steroids, it is no surprise that these performance enhancers attract sportsmen and body builders and increase psychological dependence. Consumption of steroids, coupled with good exercise and nutrition leads to increase in lean muscle tissue and enhanced performance. Consequently, when consumption is stopped at the end of the cycle, reduction in performance growth rate is experienced. This, along with decreased level of testosterone leads to a low mood and a state of depression. As can be expected, once a person starts consuming anabolic steroids, it becomes extremely difficult to get off them. Avoiding them completely is therefore the only fool proof way of avoiding all the side effects that can damage lives completely.



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