In the last article we discussed the top three side effects of anabolic steroids that I see among patients. In this installment, we will continue with the next tier-- the next most common side effects from gear that I encounter in my medical practice.
(1) If high blood pressure, thickening of the blood and elevated liver enzymes are the TOP 3 we spoke of last week., the next most common side effect of anabolic steroids would have to be suppression of natural hormone production. In almost all cases, adding an exogenous hormone into your body will instruct your endocrine system to stop producing that said hormone. This is because your body yearns for "homeostasis," or "its natural state of balance. When too much testosterone circulates, the pituitary gland stops sending stimulatory signals (LH & FSH) to the testicles. We call this negative feedback. Different steroids cause varying degrees of inhibition ranging from total shut down of natural testosterone production, to very mild inhibition, to little or no inhibition. In almost all cases, this inhibition ceases once the steroids are no longer active in the body. There was a study in The Journal of Steroid Biochemistry and Molecular Biology, from 2003 where former steroid users who had NOT used anabolic steroids in over a year, had their hormone levels tested. In the study, ALL of the subjects had normal levels of all hormones tested (Testosterone, LH, estrogen) after one year of non-use. Clearly, suppression has been exaggerated. However, a year is a long time, and the study didn't comment on the shortest time to hormone normalization; thus many users employ PCT (post-cycle therapy). The treatment protocol I use is very similar to the one listed in Dave's Q&A thread. There are many PCT protocols out there, as well as many intra-cycle protocols to prevent or treat suppression. There is not one right answer to this dilemma. Most use some combination of anti-estrogen, clomiphene, tamoxifen, and/or Human Chorionic Gonadatropin (HCG).
(2) Next would be gynecomastia, or the development of breast tissue in males. This is due to an excess of estrogen being present in the body, due to a process known as "aromatization", whereby androgens like testosterone are converted to estrogen. This excess estrogen then finds its way to receptors in breast tissue and stimulates them to start enlarging. Most experience itchiness of the nipples, followed by pain, followed by a small "lump". The most common ways to treat gynecomastia or "bitch tits" is to use a estrogen receptor antagonist such as Nolvadex or an aromatase inhibitoir such as Arimidex, Aromasin, or letrozole (Femara). All of these compounds can be used with some degree of success; although I've had the best results when using Letrozole. I recommend 2.5mg daily for 3 days, then 1.25mg daily for 3 days, then 1.25mg every other day for 2 weeks. I have had decent success by injecting triamcinolone (a local-acting corticosteroid) into the "lump" if no resolution is seen using any of the meds listed above. This is somewhat painful but it sure beats surgery. It should be said that surgery is the only definitive treatment. Once the entire gland is excised (if done correctly), it should never recur again.
(3) Another adverse effect I see fairly commonly is lipid panel abnormalities. Most common are reductions in HDL or "good" cholesterol, and elevations in LDL or "bad" cholesterol. These usually return to baseline after cessation of the steroid cycle. I highly advise against statin type cholesterol drugs while on oral anabolics, or in the presence of liver enzyme elevations, as statin-type drugs are known to negatively affect the liver. I do routinely recommend using niacin to raise HDL, or Red Rice Yeast to lower LDL, if necessary.
(4) The last of this second-tier of steroid cycle side effects would be acne. Steroids increase androgens which increase sebum productio
n, leading to acne breakouts . . . most commonly on the face, chest, and back. Frequently steroid-acne is itchy. Some dermatologists believe that steroid-induced acne is more closely related to pityrosporum folliculitis. This has held true in about 50% of my bodybuilder patients when scrapings were performed. Steroid acne can be controlled with more frequent showers, especially after workouts. Vitamin B5 (Pantothenic Acid) can be very effective in some, at doses of 3-5g per day. Most tablets are dosed at 500mg. Nizoral (Ketoconazole) shampoo can be very helpful, because it prevents the breakdown to DHT (dihydrotestosterone) in the skin. It's best to use it as a body-wash and leave on for 5 minutes then rinse off. Use daily for 5-7 days, then once a week throughout the cycle. Finasteride and Duasteride can also be used, because they minimize conversion of testosterone to DHT. Another approach would be to try your typical acne products such as benzoyl peroxide and/or topical or oral antibiotics.
In the next installment we'll cover the most common bodybuilder injuries I witness in my Sports Medicine Clinic.
Again, unless you come see me in person, these are only guidelines. I provide the information to let you know it's ok to seek care. Be aware, be careful, be smart, don't panic, and see your doc. And if they can't help, or won't., call me for a phone consultation.
Anthony F. Human, D.O.
General Practice/Sports Medicine
Human Wellness Group, LLC
678-689-6888
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