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Conclusions from more recent reviews suggested that the administration of anabolic steroids could consistently result in significant increases in strength if male athletes satisfied certain criteria including the timing of doses and dietary factors (Wright, 1980; Haupt and Rovere, 1984; Alen and Hakkinen, 1987; Strauss and Yesalis, 1991). Then in 1996, Bhasin et al. Subsequent work showed that increases in fat-free mass, muscle size, strength and power are highly dose-dependent and correlated with serum testosterone concentrations (Bhasin et al. Several track and field events demand explosive power, which depends on athletes first developing a solid strength base), buy cernos depot 1000 mg injectable steroids $38.00 nebido. The implications of these subsequent findings need to be emphasized to those concerned with antidoping in sport, in that an approximate doubling of the serum total and free concentrations of testosterone from the baseline values in eugonadal men over a 20-week period caused significant increases in strength and power (see the results reported by Bhasin et al. Although the serum testosterone was measured 7 days after previous injection, which reflect the lowest values after administration, such androgen exposure is relatively small in the context of the regimens often written about in connection with bodybuilding. Even with respect to athletes, this dose is small compared with the amounts that some athletes may have been administering around 30 years ago, as Wright (1980) comments during that period that ‘it is not uncommon for the dose level in national calibre athletes to exceed 1 mg/kg of body weight per day with a rather large number of individuals using two to four times that quantity. The use of smaller doses of anabolic steroids, particularly those formulated for daily administration (such as transdermal applications of testosterone as opposed to i. Out-of-competition testing should counter this strategy. Regardless of the above, it should be stressed that due to anabolic steroid administration being covert in athletics for obvious reasons, very little recent information has come to light regarding the doses of anabolic steroids used by elite athletes who choose to cheat. The undesirable effects arising from anabolic steroid administration ( Table 3 ) have been extensively reviewed (Haupt and Rovere, 1984; Di Pasquale, 1990; Graham and Kennedy, 1990; Landry and Primos, 1990; Shahidi, 2001; Kicman and Gower, 2003b; James and Kicman, 2004). Typically, anabolic steroids are taken in cycles of about 6’12 weeks (the ‘on period’) followed by a variable period off the drugs, from 4 weeks to several months (the ‘off period’) in an attempt to reduce the likelihood of undesirable effects but some bodybuilders will take them almost continuously. Adverse effects from anabolic steroid administration. Target Adverse effect Comment Bone Premature closure of the epiphysis in children Stunting of linear growth Breast Atrophy in women Gynaecomastia and enlarged nipples in men Gynaecomastia can be pronounced and painful; corrective surgery may be necessary. As some anabolics are known to be resistant to aromatization, other mechanisms need to be considered, such altered hepatic function causing an imbalance between androgens and estrogens Cardiovascular Increases risk of thrombotic events such as myocardial infarction or stroke (raised LDL, lowered HDL and apolipoprotein-1, raised haematocrit (due to polycythaemia) and lowered plasma fibrinogen Cardiac damage (left ventricular hypertrophy, fibrosis and heart failure) Sudden cardiac death The link between long-term anabolic steroid use and cardiovascular events remains to be clearly established but the evidence gathered is fairly compelling. This effect is probably underreported Heart disease may be potentiated by concomitant use of growth hormone or insulin (also misused for anabolic purposes) CNS Increased libido in men and women, which may be difficult to control Hypomania (less severe form of mania) Heightened irritability Increased aggression and hostility Destructive Impulses Self-destructive impulses Withdrawal symptoms can include severe depression Psychological effects are unpredictable. Anabolic steroids are implicated in cases of violent behaviour (‘roid rage’) including, manslaughter and murder Polypharmacy can increase the risk of violent criminality (Klotz et al. Hirsutism is at very best only partially reversible on cessation of administration. Liver Impaired function Hepatic cholestasis (bile canal obstruction) causing jaundice Peliosis hepatitis (blood-filled sacs in the liver) Liver tumours (increased risk) Hepatoxicity is associated with 17?-alkylated steroids (orally active) For the liver function test, it is important to include GGT and CK, as ALT and AST can be raised naturally due to exercise Reproductive Suppression of gonadal steroidogenesis Amennorhoea Clitoral hypertrophy Testicular atrophy Disproportionate growth of the inner prostate Masculanization of female foetus Recovery of fertility can take from months up to approximately 1 year after cessation of administration, depending on the extent of abuse Growth of the clitoris is irreversible Skin Cystic acne This can be very severe on the chest, back and face Vocal chords Lengthened in women Irreversible deepening of the voice can result in considerable distress Other Serious infection associated with injected drugs Toxicity from unlicensed products? Needle-exchange programmes are helping to address this problem Extent is unknown. For clinical purposes, the administration of these drugs can be of therapeutic benefit and reasonably safe, with the physician making objective decisions based on the benefit/risk ratio in relation to a patient’s condition.

 

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