Current estimates suggest four million American men are taking doctor-prescribed testosterone replacement therapy and around three million people in the United States use anabolic-androgenic steroids for their effects on body composition. Use has dramatically increased since the National Household Survey on Drug Abuse indicated that a little more than one million people were using AAS in 1991.
While many quickly point the finger at professional athletes – the “cheaters” – field surveys suggest nearly four-out-of-five users are recreational weightlifters simply trying to improve physical appearance and quality of life through hormone therapy. As a result of the growing number of medical and non-medical users, androgen sales in the United States have been rising 20 to 30 percent each year. Look around your gym. Studies suggest around 15 to 30 percent of the people who routinely report to fitness centers are augmenting their efforts with AAS – that’s as high as three out of every 10 people in some facilities!
The media is a powerful tool, persuading the masses. Reporters write news stories that explain events in a way that highlights newsworthy characters. For example, a man killing two coworkers is news, but a former Force Recon Marine killing two coworkers provides a better headline. Even more interesting: a known steroid-using Force Recon Marine kills two coworkers. But what if a bodybuilder miraculously saved two elderly ladies from becoming trampled by a speeding drunk driver? Would the headline ever read, “Steroid user saves two elderly women from disaster?” Yeah right. Simply mentioning anabolic steroid use causes a sense of uneasiness within the general public.
Ask someone to describe a steroid-using athlete and many people quickly conjure up visions of illicit muscular giants experiencing ludicrous side effects with uncontrollable tempers and sex drives. Media-sponsored urban legends regarding steroid use support numerous scare tactics that serve to do nothing more than discourage drug use. One tall tale is the presumed side effect that anabolic steroids will cause a man’s penis to shrink – threatening harm on the essence of his manliness. Testosterone, the parent hormone for all anabolic steroids, is actually responsible for the development of the male sex organ in the fetus. In addition, heavy androgen use by female athletes can increase the size of their respective sex organ, the clitoris. So, anabolic steroid use is more likely to cause a post-puberty increase in the size of the man’s sex organ. Use can lead to atrophy of the testes (not the penis) due to a shutdown of natural androgen levels, but this is widely known amongst AAS users and medical professionals to be a temporary effect. The testes readily return to normal size after exogenous androgen use is discontinued. The fact is the media often enjoys spreading news to simply raise eyebrows, frequently not based on medical fact but subjective opinions. And this is prevalent in their reports regarding AAS use in athletics.
Many sports authorities say performance-enhancing drugs have no place in competitive games due to creating an unfair advantage. However, defining what is, and is not, unfair is impossible. There are too many circumstances to consider – possibilities that have nothing to do with AAS use but create ergogenic effects. For instance, an athlete’s ability to obtain successful coaches and nutritionists could give him or her an unfair advantage over someone less financially well off. Not to mention, endogenous testosterone levels can vary threefold between two different men and 12-fold in women! Is that fair? Most top-tier athletes have superior genetics, to include naturally high androgen levels or a lack of myostatin function resulting in excessive muscle growth of skeletal. The fairest solution seems to not intervene at all and let each trainee decide what’s best for their own athletic development, regulated only by their available resources.
To avoid the media-driven social stigmas, AAS users generally remain part of a secretive society. They admit their use to nobody, to include close friends and family members, even spouses. The Internet provides an enormous venue to gain decent knowledge via a private and generally anonymous communication channel. It seems many bodybuilders who participate in online message systems have come close to earning honorary internal medicine doctorates, after years of rummaging through the thousands of online medical research abstracts and articles. People getting involved in AAS-focused Internet discussion forums frequently receive and give great advice. The online communities often promote collaborative efforts toward safe advice based on previous experiences. The result of threaded discussions offering various points of view are certainly better than most of the gym talk that gets constantly regurgitated, over and over. Whether online or off the Internet, it’s important to always remain cautious of advice from people providing little evidence to support their credibility. When in doubt, ask for more information and supporting documentation.
An unregulated, black-market for steroid procurement will always cater to a large share of abusers, individuals who practice unsafe tactics and then cry about undesirable effects. A lot of health complications are a result of forced underground practices. When surveyed, most steroid-using athletes admit to concerns about their health and want the guidance of a qualified medical practitioner. Due to legalities and crazed media reports, less than half of today’s users have ever discuss AAS use with their physician – not to mention, many perceive physicians to lack sufficient knowledge about using anabolic steroids as performance-enhancing drugs. Hearing “just say no” from a doctor is likely to be no more effective than hearing it from a police officer.
Biased government reactions are an outrage for many steroid users. Many laws have controlled the production and distribution of anabolic steroids, even though reported deaths and injuries are far less than many over-the-counter substances. Cigarettes are a leading cause of cancer; they further impose a health risks on people exposed to second-hand smoke inhalation. Ephedrine was yanked off the market because of concerns about possible abuse, yet alcoholic-related drunk driving reports continue to prevail. Visits to the hospitable due to AAS use are rare, according to the Drug Abuse Warning Network emergency department trends. However, there is an enormous amount of emergency room visits for every day medications, such as acetaminophen and aspirin, as well as prescription medication like Xanax and Prozac. The government chooses to regulate people interested in better human performance via performance-enhancing drugs while largely ignoring medications causing numerous deaths every day.
In 1920, alcohol prohibition in the United States created a major pivot in public respect for Johnny Law. Prohibition proved one major point: despite legalities, suppliers will find a way to meet public demands, even if it means facilitating an unpredictable black market operation. Laws driving purchasers into illicit sales foster a society filled with discontent in local legislature. Many AAS users end up behind bars due to their desire to perform better in athletics… or, for many, to simply look better naked. It seems the money spent on prosecuting successful athletes and recreational bodybuilders would better serve the people by introducing new public health education programs; classes that teach people how to make informed decisions for themselves. Big-brother laws didn’t work in the 1920s and they won’t mystically start working a hundred years later.
Testosterone, the mother of all anabolic steroids, was first synthesized in 1935. Between 1948 and 1955, nearly a thousand testosterone derivatives and analogues were developed. The changes in the parent hormone were primarily attempts to harness anabolic (tissue-building) effects, while producing less androgenic (male-like) reactions to the drugs. Ethylated compounds quickly became popular due to oral availability – no injection necessary. In early research, studies showed that anabolic steroids dramatically increased anabolism as well as maintained or improved bone density. Further studies revealed a substantial effect in treating wasting diseases, offering a possible solution for AIDS patients. AAS has also offered hope for hypogonadal men suffering from depression due to hormonal imbalances. Love handles around the waist, widely accepted as part of the aging process, are not deemed a “medical condition” in older men, even so, countless men have welcomed decreases in abdominal body fat while receiving testosterone replacement therapy. Also, numerous adult men have successfully used testosterone injections as a temporary male contraceptive treatment.
The Anabolic Steroids Control Act of 1990 added anabolic steroids to the Drug Enforcement Administration’s list of schedule III controlled substances. In doing so, legal penalties increased for persons who manufacture, distribute, or dispense AAS to patients. Furthermore, they are required to register annually with the Attorney General’s office. The added legal layers and restrictions resulted in greater separation between the medical community and people experimenting with AAS for greater quality of life or performance-enhancing effects. Since 1990, users have become exceedingly less likely to admit their use to physicians. Likewise, since federal legislation has targeted physicians, few doctors want anything to do with athletes taking steroids. Physicians recommending or prescribing anabolic steroids to patients must be careful to avoid prosecution as a common drug dealer. Some doctors have been criminally prosecuted.
Surveys in the United States suggest around 90 percent of AAS users obtain their drugs illegally. In countries where possession without a prescription is illegal, more than half of the drugs are developed and sold from underground laboratories, distributed worldwide through illicit trafficking networks. There are different restrictions regarding possession and distribution of anabolic steroids throughout the world. Many pharmacies in Asia legally sell steroids without a prescription. Mexican pharmacies often attract U.S. patrons due to their over-the-counter availability. Before using anything, it’s important to become familiar with state and federal laws regarding the possession of these drugs. “Legal Muscle: Anabolics in America,” by Rick Collins, is the standard reference manual for non-medical AAS use under U.S. laws. This huge manual provides an expert’s knowledge in the handling of controlled substance cases, particularly those involving anabolic steroids.
Illegal acquisitions can disrupt social routines and cause marital or relationship problems. Social perceptions surrounding anabolic steroid use, and the consequences of public knowledge, vary greatly. When it comes to discretion, introverted people are obviously better at maintaining privacy than extroverts. A user may forget about the possible legal ramifications while routinely dealing with illicit drug sources; meanwhile, a person with an outside perspective may be less able to discount the situation’s severity. Less predictably, they could quietly condone it one day, then pull the fire alarm the next. Regardless of perceived acceptability, it’s important to closely evaluate every day contacts. Friends may unpredictably object to AAS use, especially those who eventually turn into intimate relationships.
When using anabolic steroids, the rise in total-body hormone levels has a tendency to amplify self confidence and aggressive tendencies. A person’s perceptions of events can become distorted with the temporary change in brain chemistry – at times, confidence can develop into a narcissistic attitude and common annoyances can migrate into aggravating situations. Personal discipline is required to avoid impulsive actions that may lead to criminal acts, domestic violence and the termination of close friendships. It’s important for a person to remain rationale in all situations – never aggressively temperamental. In a court of law, non-medical steroid use is not a valid cop-out for acting out violently. Using AAS is not an excuse for irrational behavior and does not justify impulsive choices. Immature people are not candidates for anabolic steroid use.
The repercussions of AAS use on employment status will depend on the occupational specialty. Blue-color employers might disregard, or even condone, a rapid increase in body weight and musculature, while more white-collar employers may seemingly take offense to the exhibited transformations. Professional and educational institutions may have strong policies in place to protect their property from being perceived as a host for illicit drug trafficking. Aside from professional liabilities, becoming stronger and leaner can be intimidating to a supervisor with a body composition moving in the opposite direction. People don’t like to feel worse about their own physical condition and are likely to project out of frustration – leading to unwanted attention on the bodybuilder.
Bodybuilders considering anabolic steroids must understand that the general public is uneducated about these anabolic hormones and take care in the image their use portrays. A major problem exists amongst adolescents, especially teenagers partaking in competitive sports under heavy parental and peer pressure – many hoping for a scholarship to a great university. Teenagers who do not have access to good coaches and nutritionist look for anything promising to make them bigger, stronger or faster. They readily absorb and accept ridiculous bodybuilding marketing campaigns, advertisements using sports idols and industry buzzwords full of empty promises. When a teenage trainee finds their magic pills aren’t working as expected, they may look to overcompensate and peak into something more powerful… possibly leading to an impulsive grab for anabolic steroids. Fortunately, surveys suggest teen steroid abuse has declined over the last decade.
Impulsive and reckless use by teens is often gains media attention. Young people should never use anabolic steroids. Their bodies must retain full control of blood hormones for proper physical development and sexual maturation. Natural androgen fluctuations during puberty causes steroid-like effects – a deepening of the voice, increased body and pubic hair, greater sexual interest and increased musculature – without administering any anabolic drugs. Self administering exogenous androgens during puberty puts a teen’s body into an unnatural environment from an exogenous hormone supply of supra physiological amounts. Even somewhat modest steroid cycles may increase blood androgen levels from three to 10 times normal levels and most users stay on for eight to 12 weeks at a time. This exposure can prevent a teen from obtaining their genetically predetermined height, due to an AAS-induced premature closure of growth plates. A less tangible side effect, often less concerning to impulsive teens, is a potential for neural effects from the complicated puberty – possibly leading to adult episodes of panic attacks and depression. No athlete should ever consider anabolic steroids prior to 21 years of age and many endocrinologists suggest full maturity isn’t reach until 25. Hormones are powerful messengers and should be treated as such.
Bodybuilders must reflect on their physical health and medical history before self-prescribing anabolic steroids. It’s vital to understand personal predispositions and ailments that could be negatively impacted by the use of AAS. Cardiovascular health can temporarily decline while administering AAS. Users often report increased levels of low-density lipoproteins, a form of cholesterol that can cause a buildup of plaques in the arteries. LDL is often referred to as bad cholesterol. To make things worse, high-density lipoproteins can decline. HDL is considered good cholesterol; it protects the arteries by transporting cholesterol to the liver for elimination. Furthermore, liver enzymes can become elevated – directly from the use of oral steroids, or indirectly from an increase in muscle damage brought about from greater training volume and intensity. The concurrent use of various hepatoxic drugs, binge drinking alcoholic beverages and exposure to environmental toxins can further degrade liver values during an AAS-assisted training program.
It’s necessary to be under the protection of some sort of medical insurance, in case an unforeseen complication arises from the use of the powerful hormones. Hospital visits not covered by insurance can cost a patient a lot of hard-earned money. Since many users obtain the drugs from underground labs, the risk of administering a contaminated substance is significant. Obtaining and maintaining a prescription from a legitimate testosterone replacement therapy clinic can be costly. Occasionally, blood chemistry reports should be analyzed to determine any growing health risks – without full medical coverage, these tests can present a hefty bill.
To add to financial requirements associated with AAS use, ancillary drugs and dietary supplements are often needed to combat unwanted side effects, such as anti-estrogens and diuretics. A high-protein diet, largely based on animal meat, is required to provide the building blocks for muscle and protein is the most expensive macronutrient to obtain. Frequently consuming high-protein meals is much more pricier than high-carbohydrate or high-fat diets – unless you herd your own cattle or maintain a personal chicken coop.
Many fight the thought of it, but the decision to enhance strength-training efforts with AAS should be discussed with a spouse, or close family member, before using. Strong marriages are likely to fumble if hidden drugs are found in the home. With family support, a bodybuilder can use openly and safely. Be sure to provide credible research and anecdotal evidence to correctly explain associated benefits and risks. Demonstrate knowledge about performance-enhancing drugs and well-planned intention for anabolic steroid use. Support from inside the household could prevent major medical complications some day. If a steroid user is incoherent from a serious accident requiring hospitalization, then a spouse or other close companion should be able to supply a list of administered drugs to emergency medical personnel. It’s important for an operating physician to know everything a patient is taking, prior to performing surgery or recommending medications.
Anabolic steroids are most effectively integrated as respected supplements for enhancing physical fitness, not as a crutch to be used in irrational amounts by a previously inactive person. Bodybuilders should have a full understanding of sound training principles, nutritional manipulations for meeting physique goals and personal limitations. AAS should only be considered as a support for increased muscularity and definition – not as a magic pill. An appropriate training program and dietary structure will optimize the anabolic cycles. Periods of rapid strength gains can cause severe injuries in athletes using improper form, or simply unable to fully recruit a muscle due to lack of familiarity. No amount of anabolic hormones will make up for a lack of research and experience. A trainee must understand more than simple athletic fundamentals and already exhibit a respectable amount of musculature. Advanced diet and training strategies are required to maintain additional slabs of muscle resulting from AAS cycles. Years of training experience will help an athlete better prepare their body and expose known injury risks, prior to introducing periods of increased muscle growth that cause rapid strength gains.
A bodybuilder considering anabolic steroid use must be a mature athlete and person. During a time of quick fixes and fast foods, many are quick to overlook any natural bodybuilding experience and jump right in. They learn injection procedures before proper exercise prescription. Sure, microwaving bagged dinners presents a quick meal, but is it reasonable to expect human beings to make such instant changes in body composition? Humans represent complex organisms that don’t react well when thrown way out of homeostatis. The human body does a wonderful job of protecting itself from environmental changes – even adapting to extremes when possible – but it can only deal with so much before it buckles under pressure. Expecting to jump immediately from untrained to powerfully muscular in a matter of months will cause injury. Aside from health risks, muscle gains quickly diminish once drug use is stopped.
A physical examination by a licensed medical practitioner should be performed before any AAS cycle. An expert’s review can confirm good health or reveal possible medical concerns. Understanding your body, prior to cycling steroids, can help better identify complications stemming from their use later on. At a minimum, blood chemistry reports should be requested from any decent laboratory to reveal any red flags. Anabolic steroids can be used safely, only when administered responsibly.
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.