When does Steroid Use become Steroid Abuse?
It´s very difficult to understand abuse when it´s talked about regarding steroids.
For example, you can turn on "60 Minutes" and hear about steroids being used to prolong the lives of AIDS and Cancer patients, then on the same night, you can watch the news and hear about athletes abusing it. You can even read "TIME Magazine" and see an article about how steroids have been used to improve height in children, and then read in "Newsweek" that steroids stunt growth! So, the first thing we´ll need to do is define "Abuse" when we´re talking about steroids use. Clearly, there are a lot of different effects that steroids have, and some are good, while some can be bad. So, I think the easiest way to make this understandable to everyone is to relate this to something that´s much easier to get a real grasp on: Alcohol. Don´t worry, we´re going to get to our main topic, which is the very real problem of steroid abuse, soon enough. But first, we need to figure out what we´re talking about.
There´s a clear line between a social drinker and an alcoholic. One is doing damage to themselves, while the other has the clear ability to control their intake of alcohol, and responsibly maintains their faculties while they are drinking. In the end, alcohol abuse is when the cost/benefit ratio is too high, and you spend more time feeling terrible the next day after drinking than time you felt good the night before. This is the same situation I´ve seen with steroids, where in some cases, people can feel very good while on a cycle, they "crash" after it, and feel terrible after they go off their cycle. Abuse is also when you can´t control your intake of something (in this case, we´re still talking about alcohol here), and it begins to register as a compulsive habit. This is when alcoholism begins to manifest in an individual. If we take a look at another topic that gets a decent amount of media attention, I think the line between abuse and use becomes even more clearly defined. We´ve all read or heard about professional athletes who get injured, and receive a prescription for painkillers. And we´ve also heard the stories of them using those painkillers to help heal their bodies, but then continuing their use and eventually becoming addicted.
This downward spiral from use to abuse is very clear, and we can point to a clear point in time when their use becomes detrimental to the athlete. So basically, what I see, when I look at other drugs like alcohol and painkillers, is that there is definitely a clear line between use and abuse. In short, use becomes abuse when the costs begin to outweigh the benefits. Now that we (finally) know what steroid abuse is, we can take a good look at it.
Real steroid abuse is actually very rare, if we look at in this light& but where do we find steroid abuse? Well, typically, we find that steroid abuse is highest in those who are uneducated about their effects and side effects. This group crosses the line between abuse and use, by mistake, typically. Typically, abuse is also dose-dependent, and what this means is that steroids remain useful and continue to help the user until a certain threshold is passed& meaning the dose gets too high. At this point, the user has crossed the line into abuse.
So, when we look at healthy athletes who are emotionally and psychologically stable, we don´t see much real "abuse." What we typically see is the use of steroids helping to prolong a career or stave off injury.
Steroid Use by High School Athletes
High School athletes are in a high risk group for steroid abuse due to a lack of several key developmental factors.
It´s also worth considering that not only does the young, amateur, or high school athlete have far less access to good, relevant information, they also do not have access to many different steroids, nor the funds to get regular bloodwork done and have a competent doctor monitor their health while on a cycle. Not having access to a variety of different steroids often causes athletes to make poor decisions regarding which ones to use, and this is a very likely factor in cycles that constitute abuse rather than use. This can also be especially detrimental to the female athlete who either doesn´t have access to milder steroids that won´t cause side effects, or the correct information on how to use them.
So what are some possible problems that come along with steroid abuse?
Well, the first problem that is a very realistic issue is liver toxicity. This is found in oral steroids, and unfortunately, many people are needle-phobic, so they avoid injectables. This is usually do to misinformation, and the mistaken belief that orally ingested steroids are safer than those which are injectable. This also comes from the idea that steroids can be equated with recreational drugs, where injectable versions (heroin, etc...) are typically more addictive and pose more health risks. With steroids, however, those that are orally administered typically have far more adverse effects than those which are injected. It is very common for oral anabolic steroids to containing what is known as a 17-alkyl group, which makes them both resistant to being broken down in the liver, as well as placing additional strain on it. In this case, the frequency and severity of side effects is variable depending on many factors such as dose, type of drug, duration of use and of course, the individuality of the athletes´ sensitivity to exogenous androgens and response curve to same.
Anabolic steroids are all basically derivatives of testosterone. Of course, the degree to which they resemble this parent hormone is different, and as a result, so are their various effects. Clearly, this means that administration of anabolic steroids to someone with already normal hormonal levels leads to supra-physiological concentrations of testosterone or derivatives. Since the human body works off a negative feed back loop, production and release of various hormones in the endocrine system can be suppressed. The degree to which they are suppressed is dependant on the compound used as well as the dose. In general, though, this suppression can lead to long term effects if the athlete is abusing steroid dosages or duration. Secondary or primary hypogonadism, as well as reduced sperm counts and infertility can result. This is usually temporary and reversible with treatment, however it can be long term, although likely isn´t permanent. However, there have been documented cases where hypogonadism lasted for more than 12 weeks.
This hormonal disruption caused by steroid abuse can also lead to the premature closing of growth plates in athletes who haven´t reached their ultimate height, as increased estrogen via the aromatase enzyme can "seal" the plates. When steroids that convert to estrogen are given to adolescents who are still growing and developing, side effects are much more common and as I said, the most obvious of these is the cessation of longitudinal growth. Steroids which are derived from DHT do not seem to possess this potential for abuse in terms of ultimate height retardation.
Another possibility from aromatization (conversion of testosterone to estrogen) is breast formation or gynocomastia. This is caused by increased levels of circulating estrogens, which is the female sex hormone. This is the most obvious side effect from steroid abuse, as other side effects can be attributed to other factors (acne for example), or are not outwardly obvious (hormonal disruption, for example...).
Although anabolic steroids can be used to build a spectacular body in females, their potential for abuse is still very high.
Steroid use and abuse for Women Athletes
Abuse of steroids can also wreak havoc on the female athlete´s body. Keep in mind, in the normal female body only relatively small amounts of testosterone are produced. A substantial increase in circulating hormones (androgens in this case) will cause irregularities of the menstrual cycle. Virilization (development of male sexual characteristics) can also result as a result of the same hormones being administered to women. Clitoral enlargement, although usually temporary while on a cycle can also result, as can the growth of excess body and facial hair, a deepening of the voice, and possibly male pattern baldness. Anabolic steroid abuse by pregnant women can also cause sexual defects in the unborn fetus. Let me state, at this point, that any steroid use by pregnant women is abuse. Read that sentence again, if you´re unclear on my position on that matter.
Steroid abuse can also affect the heart (cardiovascular system) and cholesterol (lipid profile). Generally, in studies where steroids are abused, HDL-cholesterol (the good stuff) declines, and LDL-cholesterol tends to go up. Yeah, the good cholesterol goes down and the bad cholesterol goes up. In a related area, the heart often has to work harder because of this, and there also seems to be a steroid-related mild hypertrophy of the left ventricle which is accompanied by a decreased diastolic relaxation. This is very unclear, as regards steroid use, with regards to potential for reversibility and what portion is due to steroid use and what portion is due to training, which also increases ventricle size. Also in a related vein (ha ha) are increases in diastolic blood pressure. All of this increases risk for cardiovascular disease.
Steroid abuse also can cause potential aggressiveness. This is from higher circulating androgen levels, and while increased aggressiveness may be beneficial for training and competition, when steroids are abused may also lead to violence out of the gym or off the field. This may also cause a form of dependency, although that remains unclear currently in the medical field with regards to steroid abuse.
It´s important to note that steroid abuse is the cause of many side effects, and that the simple use of steroids can not be blamed for this. It´s when the line is crossed from use into abuse that we see all of these effects as being not only possible but probable.
