Steroids come in injectable and orally ingested forms, and both types can influence the functions of several internal organs. I have done an overview of some of the medical studies that address this issue, and it should be understood early on that this piece is not intended to scare anyone. I am merely reporting the findings, and I leave it up to the reader to make whatever choices that he or she sees fit. Indeed, what the medical experts don’t know about steroid use may be even more important than what they do know, but let us cut to the chase.
Whenever one injects intravenous or intramuscular agents there is the possibility of bringing infectious and/or toxic substances directly into the body. This is especially true for drugs that are impure and/or improperly manufactured, and given the third-world origins and black market methods of procuring steroids their purity is often suspect (see Stanley & Ward, 1994). Of course, injecting toxic substances can cause very serious medical repercussions, and many of these are associated with liver problems. After all, the liver is one of the great blood filtering systems of body, and the use of contaminated drugs has been associated with hepatitis (inflamed liver) and other liver diseases. In addition, ignorance of the proper places to inject steroids can lead to damaged nerves and other structures, a serious concern for those who use steroids without proper medical supervision.
However, please do not take these observations as advice to employ oral steroids, for many of these agents are even harsher on the system than are their injectable cousins. Indeed, some orally ingested compounds (e.g. oxymetholone and stanozolol) are far rougher on the liver than are many injectable steroids (e.g. 19-nortestosterone)(see Kaufman & Freidman, 1996). The main point is that one should consult a sports or medical doctor when using steroids, for they have far more medical knowledge about the down-side of specific steroids than does your buddy.
Let us put these issues aside for the time being, and review what anabolic steroid use can do to the liver. We are fortunate because there are illuminating case reports that ought to be of interest to would-be or current users. In one case study a 27-year-old athlete who used intermittent steroid cycles presented with a case of peliosis hepatis (Cabasso, 1994). This is a disease wherein spaces within the liver become so filled with blood that it interferes with their normal functions. The disease is often associated with cancer and tuberculosis, and it can be lethal. Interestingly, peliosis hepatis can occur in cases where doctors prescribe long-term steroid use to treat certain medical problems, so perhaps it is no wonder that it should also occur in athletes who have a long-term history of steroid use.
However, the more common effects of steroid use on the liver are assumed under the general heading of steroid hepatotoxicity (Forbes, Bramston & Collins, 1993). All this term means is that certain anabolic-androgenic substances are toxic to liver cells, and this can result in a wide range of liver problems. These run the gambit from chronic and acute liver infections to malignant and nonmalignant tumors, all of which have been reported in athletes who use steroids (for a review see Welder, Robertson, & Melchert, 1995). Currently, the incidence of steroid-related liver problems in athletes is unknown, although the influences that specific steroids have on haptic functions has been studied by using rat liver cell cultures.
Among the many steroids tested in this procedure are nortestosterone, testosterone, cypionate, danazol, and oxymetholone (see Welder, Robertson, & Melchert, 1995). The results indicate that methyltestosterone, oxymetholone, and stanozolol are extremely toxic to liver cells, even to the point of killing them in cell cultures. This family of substances is known in medical circles as 17 alpha-alkylated anabolic-androgenic steroids, and their use involves a great deal of inherent risk. Nonalkylated steroids, such as testosterone cypionate and 19-nortestosterone, are not as virulent to liver cell cultures, but even here the effects of their chronic use on haptic functions remains to be determined.
Oxymetholone is particularly dangerous. As an acquaintance grimly noted, “Yeah, everyone’s heard of oxymetholone. You take it for a few cycles, you gain forty founds, and then you die.” Indeed, even when employed for medical purposes the long-term use of this substance can produce liver cancer. In one case study a woman developed hepatocellular carcinoma after being treated with oxymetholone for three years to combat aplastic anemia (Kosaka et al., 1996). Happily, an operation saved the woman’s life, but her story is far from unique. Any chronic oxymetholone user faces similar risks, so a liver scan may be in order if you have a history using 17 alpha-alkylated anabolic-androgenic steroids.
The use of steroids has also been associated with kidney cancer, for like the liver, the kidneys are also responsible for filtering waste products. In two case studies 26-year-old bodybuilders reported with renal cell carcinoma (Bryden, Rothwell & O’Reilly, 1995). One had been using a range of steroids for six years, and the other had been using steroids for just 20 months. The authors of the study surmise that the hypertrophic (growth) changes caused by the steroids may have enhanced kidney cancer cell development, growth, and proliferation. The treatment for this condition is either the complete or partial removal of the diseased kidney, although chemotherapy and radiotherapy can also be used in certain cases.
In addition to the liver and kidneys, steroid use can also influence the sexual hormones that we normally produce. The general effect of chronic steroid use is to diminish the body’s normal production of testosterone and related substances. This is because our body has many chemical sensors that detect high levels of androgenic agents in the blood. The chemosensors respond to high levels of these substances by sending out chemical messages that tell the organs that normally produce these agents to slow down. Of course, some of these messages go to the testicles, and this can result in curtailing some of their functions. For example, the testicles can cease releasing androgens and making sperm, and as a result they can begin to atrophy (Kaufman & Freidman, 1996; Stanley & Ward, 1994). This shrinkage often occurs following long-term steroid use, although it is reversible in most cases.
With regard to sperm production, the long-term use of steroids can cause a condition called azoospermia. The sperm count declines, and those that are made become inactive and/or deformed. In short, a chronic steroid user may eventually fire blanks when it comes to having sex, although steroid use may actually enhance libido. In one case study a bodybuilder who used steroids for five years became azoospermatic (Turek et al., 1995). It took extensive intervention with gonadotropic agents to stimulate his system enough to produce normal sperm, although he was eventually able to father the child that he so desperately desired.
However, it isn’t just sperm production that one must be concerned with when it comes to steroid use and sexuality. The prostate gland produces the seminal fluid that conveys sperm, and its functions can also be influenced by steroid use. In a very interesting case study an athlete who routinely used steroids was tested during one of his 15-week cycles (Wemyss-Holden, Hamdy & Hastie, 1994). As the cycle progressed his prostate gland became enlarged, and as a result it became more difficult for him to urinate. In addition, he also experienced an increased need to urinate during the night. What effects these changes have on the subsequent development of prostate cancer are unknown, although it is clear that steroids can alter prostate functions.
Lastly, we will briefly discuss the effects steroid use has on the muscles. Of course, steroids certainly increase muscle size, strength, and even endurance, and anyone who denies this is not dealing with reality. The problem is that the size and strength increases often cannot be retained by the user’s innate resources (Haupt, 1993). The steroid user is thus faced with the constant need to go on the sauce in order to maintain the gains that have been arrived at through using steroids. The end result is a constant on/off series of cycles that systematically increases the risk of chronic steroid-induced damage. Granted, one does not lose everything that has been gained during off-the-sauce periods, but the loss is often so extreme that it becomes a psychological burden.
In addition, steroid use can lead to problems within the skeletal-muscular system (see Stannard & Bucknell, 1993). Anytime one gains a lot of muscle mass and strength in a short time there is a price to be paid. The connective tissues that support muscles and tendons do not develop very quickly, and the end result can be devastating muscle belly injuries, torn ligaments, and ruptured tendons. These incidents are seen with increasing frequency, and I personally know of one case wherein a steroid-using football player suffered a ruptured pectoralis major. It was a grotesque injury, and the bulk of this athlete’s pectoralis ended up lumped together in a mass near his arm pit.
Thus far in this series we have seen that there are many steroid users. We have also seen some medical evidence that indicates steroids can cause cardiovascular problems, liver damage, sexual malfunctions, and muscular injures. I must again caution that far more testing is in order before definitive material on the effects of steroid use can be provided. However, it is a good idea to seek sound medical advice when considering steroid use, so please seek the counsel and supervision of a sports’ doctor when using these substances. In the last part of this series we shall address the psychology of steroid use. As with the other parts of this series, please feel free to contact me if you have any observations or questions.
