I agree, aspirin, although a life saving medication, has been associated with numerous deaths secondary to GI bleeds. The question really should look at the number of users of steroids who medical side effects. Many millions of people use aspirin everyday; of course there are going to be deaths. However, the incidence is very low. Of the number of steroid abusers (not casual 1 mg test a week users), what percentage have serious medical side effects. I don't think we have a good answer, as most of them do not use under medical supervision. Also, there have been no prospective, double-blind studies done to compare it to placebo. All of the data is anecdotal. Thus, those of you who deny the risk of steroids are basically uneducated fools who are sticking their heads in the sand. If you want to play the game, at least be reasonably intelligent and get your chemistries checked. Stupidity and ignorance are the reasons people have serious side effects. My two cents.
Are you kidding? No studies. There are numerous studies on the subject. All the studies done are studies of bodybuilders and the effects of AS compared to Placebo.I agree most "abusers" or users in general should seek medical supervision no question about that, but there are numerous studies on the issue. I hope that you don't consider a gram of test a week as being "low". A gram of test a weeks constitutes abuse on anylevel. Anything way over baseline that is not needed to return testosterone to normal levels constitutes abuse. And a gram is abuse. Steroids and their being in the same class as heroin is a joke, surely being a fellow physician you see that. It should not be a schedule 3, not even close.
I wouldn't call almost 8000 deaths a year from NSAID's small. Compared to how many people use NSAIDS is a small percentage, but not a small number. The two are not the same. A million people use anabolic steroids in the US, most without supervison and the list of deaths are almost nonexistant. Now how many have heart attacks or Kidney failure is the question. Is it a direct cause of AS abuse, you bet it is. But the numbers are not near 8000, again not even close. A drug that is scheduled is a drug that has potential for abuse, which steroids do. But more importantly, have the ability to cause death directly. Not only indirectly. Steroids do not cause death directly. If you overdose on Heroin, CNS depression can occur, thus death ensues. Steroids do not share this ability with other narcotic anelgesics or simular scheduled medications. Now there are scheduled medications which this does not happen, and this does not apply or coarse. I think AS use in general by bodybuilders is not a smart decision, on any level period. Any self medicating and abuse of any medication is not smart and can prove fatal. If you do decide I agree and you should have a complete blood panel done on a monthly basis. Anabolics used efficiently and effectively under direct supervision of a health care professional that are not abused can be very safe. Anything that is abused can be harmful, AS is no exception.
I have not also in all my years in practice have a wide spread problem with my patients sharing needles and having hepatic trouble, that is a erban legend. Now it does happen, but very, very infrequently. You should know better.
The most dangerous effect of anabolic steroids is on the cardiovascular system. No longitudinal studies have been conducted on the effect of anabolic steroids on cardiovascular morbidity and mortality. Most short term useage problems or "sudden" problems arise from the users already having a defect of the heart and rises in bloodpressure is the most likely culprit in problems associated with this condition. Anabolic steroid abuse is mostly cited as the the underlying culprit in most cases if not all cases. This is the most important reason in my opinion as if not under direct supervision how would you know if you have a defect that may be life threatening? Simply you don't. This is where the greatest problems arise from AS abuse. It takes much longer sometimes years of abuse otherwise for AS to have a damaging effect on abusers who do not have such pre-existing conditions of the cardiovascular system, this has been proven in numerous studies. Kidney damage is another problem, again associated with the rise in blood pressure associated with AS abuse as the kidneys play a important role in the control of blood pressure. Again, a precondition(defect) usually is already present that is not easily indenified by a individual unless under the direct supervision of a health care professional, and sometimes still goes undetected regardless.
Most of the investigations have been focused on risk factors for cardiovascular diseases, and in particular the effect of anabolic steroids on blood pressure and on plasma lipoproteins. In most cross-sectional studies serum cholesterol and triglycerides between drug-free users and non-users is not different. However, during anabolic steroid use total cholesterol tends to increase, while HDL-cholesterol demonstrates a marked decline, well below the normal range. Serum LDL-cholesterol shows a variable response: a slight increase or no change. The response of total cholesterol seems to be influenced by the type of training that is done by the athlete. When a great deal of the exercise consists of aerobic exercise, the increasing effect of AS is counterbalanced by an exercise-induced increasing effect, which may result in a net decline in total cholesterol. Aerobic training does not seem to be able to offset the steroid-induced decline in HDL-cholesterol and its subfractions HDL-2, and HDL-3.
The precise effect of anabolic steroids on LDL-cholesterol is unknown yet. It appears that anabolic steroids influence hepatic triglyceride lipase (HTL) and lipoprotein lipase (LPL). Males usually have higher levels of HTL, while females have higher LPL activity. HTL is primarily responsible for the clearance of HDL-cholesterol, while LPL takes care of cellular uptake of free fatty acids and glycerol. Androgens and anabolic steroids stimulate HTL, presumably resulting in decreased serum levels of HDL-cholesterol.
The effect of anabolic steroids on triglycerides is not well known. It is suggested that relatively low doses do not affect the serum triglyceride levels, while it cannot be excluded that higher doses elicit an increase.
There is evidence that the use of anabolic steroids does elicit structural changes in the heart and that the ischemic tolerance is decreased after steroid use. Echocardiographic studies in bodybuilders, using anabolic steroids, reported a mild hypertrophy of the left ventricle, with a decreased diastolic relaxation, resulting in a decreased diastolic filling. Some investigators have associated cardiomyopathy, myocardial infarction, and cerebro-vascular accidents with abuse of anabolic steroids. However, a possible causal relationship could not been proved, because longitudinal studies that are necessary to prove such a relationship, have not been conducted yet. There is convincing evidence that oral administration of anabolic steroids has stronger adverse effects on the mentioned variables than parenteral administration.
Although the effects of anabolic steroids have an unfavorable influence on the risk factors for cardiovascular disease, no data are available about the long term effects. Most of the mentioned effects appear to reverse within 6-8 weeks after abstention. It is unknown, however, whether the structural changes as reported in the heart, are reversible as well.
No unanimity exists about the influence of anabolic steroids on arterial blood pressure. The response is most probably dose dependent. There is some data suggesting that high doses increase diastolic blood pressure, whereas low doses fail to have a significant effect on diastolic blood pressure. Increases in diastolic blood pressure normalize within 6-8 weeks after abstinence from anabolic steroids. It appears that repeated intermittent use of anabolic steroids does not affect diastolic blood pressure during drug free periods. Not only do anabolic steroids play a role indirectly on the effects of erythropoeisis, but most importantly directly, but that is another topic for another time. Besides I am being paged, back to work.
