A sense of uneasiness is generated when mentioning the use of anabolic-androgenic steroids to a member of the general public. Many people, adhering to the crazed dogma, quickly fill their heads with visions of illicit muscular giants experiencing ludicrous side effects with uncontrollable tempers. To avoid unwanted, media-driven images, users of AAS generally remain part of a secretive society. They gain productive knowledge via private and anonymous locations; such as Internet discussion forums and research articles.
Fact: steroid users are frequently very healthy individuals, simply trying to gain every performance edge they can muster – to meet and exceed training goals. Field surveys suggest nearly four out of five users are recreational athletes with the sole intension of improving physical appearance. An estimated four million American men are taking doctor-prescribed testosterone replacement therapy. As a result of the growing number of medical and non-medical users, androgen sales in the United States are rising 20 to 30 percent each year, despite the fact that AAS were added to the list of Schedule III Controlled Substances in 1990. Studies suggest around 15 to 30 percent of the people routinely using fitness centers are augmenting their efforts with AAS – that’s up to three out of every 10 people in some facilities!
Historically, the efficiency of AAS to generate an effect on muscular development has been underestimated by the medical community. Dr. Nick Evans, UCLA-Orthopaedic Hospital in Los Angeles, published a 2004 article in the Journal of Sports Medicine entitled “Current Concepts in Anabolic-Androgenic Steroids.” According to Evans, the past decade has revealed careful scientific studies demonstrating that suprapharmacological doses of AAS can increase muscle growth and influence body composition. Evans explains that side effects of AAS have been overstated and the more common adverse effects are benign and reversible.
Current estimates concerning drug abuse indicate around three million people in the United States use AAS for its effect on body composition. This has dramatically increased since the National Household Survey on Drug Abuse indicated that more than one million people were using AAS in 1991.
In June 2006, Evans co-published “Anabolic Androgenic Steroids: A Survey of 500 Users.” The investigation was used to identify current trends in the drug-taking habits. In 2004, a Web link was posted on message boards of 12 AAS-related Internet discussion forums. The first 500 completed questionnaires were evaluated using standard statistical methods. Previous studies have documented the validity of Web-based surveys by comparing them with identical studies in the real world.
The following is based on the Internet-based poll of 500 admitted steroid users.
Healthy adult males are the primary candidates for AAS-enhanced training. Females are sensitive to exogenous male hormones and are likely to observe male-like affects – some become irreversible. Males represented 98.8 percent (494/500) of survey respondents. Teens are non candidates, largely due to a state of physical immaturity; they represented only 2.6 percent of the group. However, 26 percent (130/500) of respondents stated they began using AAS during their teenage years.
Doses and patterns
During an adult’s life, the average male produces around seven milligrams of testosterone daily, about 2,500 milligrams each year and a total of 130 grams by 75 years of age. Studies demonstrate testosterone’s anabolic effect is dose dependant, where significant increases in muscle size are only observed in weekly doses above 300 milligrams. Of the 500 survey respondents, doses ranged from 70 to 6,000 milligrams of testosterone or its equivalent per week; whereas 40.4 percent (202/500) reported taking a weekly dose lower than 1,000 milligrams. Larger doses were likely achieved using a combination of two or more different types of AAS. Of the 500 polled, 478 stacked different compounds.
The durations of each steroid cycle ranged from four to 20 weeks. Of the 500 users, 496 reported using injecteable AAS or a combination of injectable and oral substances. Almost half (244/500) of AAS users stayed on a cycle for three to six months – only 6.2 percent (31/500) stayed on for less than three months. The remaining 45 percent stayed on an AAS cycle for over six months; while 6 percent (31/500) continued AAS throughout the year. It is likely that continuous users were probably undergoing replacement therapy under medical supervision but 93 percent (469/500) admittedly self-administered steroid cycles.
Anabolic steroid effects
AAS primary action is to bind to androgen receptors to exert it’s androgenic and anabolic effects. It is reduced in some target tissues – such as skin and liver – to dihydrotestosterone, which also acts on the AR. It is also aromatized to estradiol to exert estrogenic effects. Recent studies demonstrate that ARs can be upregulated by exposure to AAS and the AR number is increased by strength training. Supraphysiological amounts of testosterone have an additive affect on muscle mass when combined with strength training and an adequate diet. It is also suggested that AAS exerts a psychoactive effect on the brain, glucocorticoid antagonism and stimulation of the growth hormone and insulin-like growth factor-1 axis.
Of the 500, 496 reported subjective side effects as a result of their AAS use. Seventy-one percent (355/500) experienced at least three or more complications. Rather than reducing AAS use, a common practice is to self-administer additional medications to alleviate or prevent AAS-induced side effects. The most common were acne, insomnia/sleep disturbances, fluid retention/edema, mood alterations, gynecomastia, testicular atrophy, stretch marks, sexual dysfunction and injection site pain. Hypertension and high cholesterol was not frequently reported; of those, less than a quarter admitted taking any blood pressure of cholesterol-lowering medications.
Of the respondents, 61.4 percent (317/500) admitted that they were concerned about possible detrimental effects on their health; 64.4 percent (322/500) stated they conducted routine health checks. Thirty-seven percent (185/500) discussed AAS use with a physician. Moreover, 91.6 percent (458/500) would prefer to use AAS legally, under direct supervision of a competent physician.
The communication barrier between AAS users and their physicians may rest somewhere between legal issues, the stigma associated with drug use and a perceived lack of physician knowledge regarding AAS.
The public poll revealed only 11 percent (58/500) of respondents obtained AAS legally, with a physicians prescription. The other 89 percent acquired the drugs through other sources; origins included: Mexico, Australia, Asia, United States and Europe – the most common was Mexico. Over half (280/500) reported using AAS produced in underground laboratories, illicit facilities. AAS-related legal problems were reported by 5 percent (25/500); a likely cause of the 11.8 percent (59/500) reported marital or relationship problems that respondents attributed to their drug use.
Anabolic steroids have been singled-out and demonized as an ergogenic aid in sports and strength training – professionally and recreationally. Unfortunately, a lot of the health and legal complications are a direct result of the forced underground practices. If AAS use was legalized and allowed to be as acceptable as mega doses of creatine have become today – what then? Athletes wish to see a qualified practitioner to guide them into safe practices. Big-brother laws hardly work, especially when a substance shows hope for a society best known for its increasing rate of obesity. AAS use remains illicit for most, yet recent medical and anecdotal evidence is demonstrating a positive risk-to-benefit ratio with escalating trends in use.
Evans, N. A. Current concepts in anabolic-androgenic steroids. Am. J. Sports Med. 32:534-542, 2004.
Parkinson, Andrew P., Evans, N.A. Anabolic-Androgenic Steroids: A Survey of 500 Users. Medicine & Science in Sports & Exercise 38 (4): 644-651, 2006.
Dr. Nick Evans Official Web site
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