How do anabolic steroids work?
Testosterone serves two fundamental purposes in the body: promoting the development of male sex characteristics and the development of muscle tissue. In typically developing males, a higher level of testosterone found in the bloodstream helps explain, in part, the larger muscles and sheer mass of men compared to their female counterparts. Anabolic steroids, which are developed through a manipulation of the testosterone molecule, produce similar effects, but in a more rapid manner, when taken by any individual.
For much of the modern Olympic games, it was quite common for many athletes to use performance-enhancing drugs, including anabolic steroids. Their use was most prominent and acknowledged from the 1960s to the 1980s. While some athletes were placed on protocols of anabolic steroids secretly under the supervision of their coach and a physician, others athletes were part of large, systematic programs of drug use and performance measurement within their country. It wasn’t until the 2000 Olympic games that stringent restrictions were placed on the use of performance-enhancing drugs and all athletes had to attest that they were not using drugs or otherwise “doping” to enhance their performance.
While the increase in regulations, restrictions, and sanctions have lessened overt use of performance enhancing drugs, there continues to be a dynamic, and well financed, amount of covert use in professional competition. By 2004, the World Anti-Doping Code was created, which codified the specific rules and regulations regarding performance-enhancing drugs and their use in sporting events. Since that time, and with the advent of better testing to identify cases in which athletes have violated the Code, there have been many high profile cases in the media that highlight the ongoing concern with performance-enhancing drugs. It should be noted that the sanctions received for violations have increased quite significantly in the last 15 years. In addition, legislation was passed in 1990, designating anabolic steroids as a Schedule III controlled substance, which makes them subject to criminal penalties if inappropriately manufactured, distributed, or used.
Some individuals may argue that the stakes in modern sports are higher than they have ever been in human history as a means for justifying, excusing, or explaining the use of performance enhancing drugs. However, while the records in sports that exist today are higher than they have been in the past, individual athletes still have to struggle to make a living and support their families, much like their predecessors. In addition, there was less revenue from multiple sources (e.g., commercial endorsements) available to athletes in the past, so making a living as a full-time professional athlete was even more precarious during past generations. In other words, the life of a professional athlete has always been difficult and always required sacrifice. Temptations to cheat and “game the system” have existed in various forms since the beginning of organized competition. What has changed is the manner of sophistication and subtlety in which drugs can be used to enhance one’s performance.
Certainly, what passes as a standard for masculinity in our society has changed over time and this, in part, could be one source of cultural influence in today’s current climate of performance-enhancing drug use. In our modern society, the images that are portrayed in terms of masculinity, femininity, athletic prowess, and endurance can potentially influence individuals in terms of behaviors that they might engage in to meet or exceed an imagined cultural standard.
What are some of the physical and psychological symptoms and side effects of anabolic steroid use in men and women?
There are several well-documented hazards associated with the use of anabolic steroids. One confound in determining the effects of various dose– response relationships is the fact that many individuals illegally abusing anabolic steroids take anywhere from 5 to 500 times the recommended dose. Because of this high degree of variance, it can be hard to gauge the relative risk from individual to individual. However, some generalizations can be made. As these synthetic hormones enter the bloodstream and systemically flood the body with testosterone, changes occur across a wide variety of organ systems, and not all with an efficacious outcome. Given that the liver’s function is to help clear toxins and unnatural substances from the body, it should come as no surprise that this organ can suffer greatly from prolonged anabolic steroid use in both men and women. This is typically seen through the increased risk for tumors, the increase in lifetime risk for liver failure and, when they rupture, the need for emergency liver surgery. An increased risk for cardiovascular disease has also been noted with chronic anabolic steroid use.
One notable change in men with prolonged use is that an individual’s own testes glands begin to produce less testosterone in the body becomes as the body becomes acclimated to having it artificially introduced into the system at higher-than-normal levels. This not only causes male function to decrease (shrinking testicles, lower sperm count, enlarged prostrate) but the low, natural production level also results in less inhibition of naturally occurring estrogen which can result in and increase in feminine, secondary sex characteristics (e.g., enlarged breasts or gynecomastia). Some of these effects are reversible when hormone supplementation is stopped, while others are not.
For women, the sustained use of anabolic steroids, and the introduction of a large amount of testosterone into their bodily systems, has an overall tendency to accentuate stereotypically male characteristics in them, including a lower voice, increased facial hair, increased aggressiveness, decreased body fat, diminished or stopped menstruation, increased acne, and decreased breast size. Again, some of these symptoms are reversible with discontinuation of anabolic steroids, while others continue to persist.
Anecdotally, psychological problems in men and women who abuse anabolic steroids have included severe mood swings and a lower threshold for aggressive behavior, commonly referred to a “’roid rage.” However, more systematic research needs to be conducted in this area to determine more clearly the propensity of these symptoms for different individuals. In short, a variety of other, possibly confounding variables, come into play that can moderate the resultant mood changes with anabolic steroid abuse, such as an individual’s temperament, personality, and the social context within which a person lives and trains.
In term of dependence to anabolic steroids, there is evidence to support the phenomenon of psychological dependence to the drug and associated drug-taking behaviors. Many athletes engage in drug use in a cyclic fashion, incrementally increasing the doses (whether taken orally, intramuscularly, or both) and then tapering down for a period of time, usually at the point when they suspect they will be tested for the presence of illegal drugs in their system. Some muscle atrophy or shrinkage has been noted with the lessening or cessation of anabolic steroids and this, when coupled with an individual who is inordinately preoccupied with their physical appearance, leads to concerns about losing physical appearance and prowess and a higher likelihood to continue to use the drug.
From a perceptual standpoint, some individuals who chronically abuse anabolic steroids development “muscle dysmorphia,” which is a disturbance in their perception of their bodies, much like what is seen with some people who have eating disorders, where the individual believes that their bodies are weak and insufficient (thereby requiring more anabolic steroids), even in the face of physical evidence to the contrary. Unfortunately, it does not appear that in our dominant culture in the United States, with its focus on youth, attractiveness, and physical prowess, will be helping to ameliorate this social problem anytime in the near future