Side Effects

The action of testosterone can be both beneficial and detrimental to the body. On the plus side, this hormone has the direct impact on the growth of muscle tissues, the production of red blood cells and the overall well being of the organism. But it may also negatively effect (among other things) the production of skin oils, growth of body, facial and scalp hair, and the level of both “good” and “bad” cholesterol in the body.

You could make a case that periodic steroid use might even be a healthy practice. Clearly a person’s physical shape can relate closely to their overall health and well being. Provided some common sense is paid to health checkups, drug choice, dosage and off-time, how can we say for certain that the user is worse off for doing so? This position is, of course, very difficult to publicly justify with steroid use being so deeply stigmatized.

I will discuss all side effects that are or have been related to steroids either by doctors, steroid users, or the media so there is a clear understanding of each and its relativity.

Acne
Acne comes about as a result of steroid use because the sebaceous glands, which secrete oils in the skin, are stimulated by androgens. Increasing such the level of androgens may make acne occur when it normally wouldn’t. On the flip side of this, if you are prone to acne, using substances that have low androgenic activity would elicit less acne occurrence. To treat acne, you have a number of options. The most obvious is to be very diligent with washing and topical treatments. If this proves insufficient, the prescription drug Accutane might be a good option. You could also take an ancillary such as Proscar/Propecia (finasteride) during steroid use, which reduces the conversion of testosterone into DHT, lowering the tendency for androgenic side effects.

Aggression
Aggressive behavior can be one of scarier sides to steroid use. But I’m a firm believer in the "Asshole Analogy" which is that steroids don't make people assholes, they make little assholes bigger assholes. And when someone has an extra 20 or 30 pounds to throw around, they will get noticed more when being an asshole. A steroid user who displays an uncontrollable rage is clearly a danger to himself and those around him. If an athlete is finding himself getting agitated at minor things during a steroid cycle, he should certainly find a means to keep this from getting out of hand. Xanax is on form of suppressing this and tends to be an avenue of choice for steroid users who suffer from aggression.

Blood Clotting Changes
The use of AAS is shown to increase prothrombin time, or the duration it will take for a blood clot to form. This basically means that while an individual is taking steroids, he may notice it takes slightly longer than normal for a small cut or nosebleed to stop bleeding. During everyday activity this is really of no concern, but could be if a sever accident were to occur or an unexpected surgery was needed. The clotting changes brought about by steroids are amplified with the use of medications such as Aspirin and Tylenol. Your doctor should be informed of your steroid use if undergoing any type of treatment with these drugs or in the event of a surgery.

Cancer
Although it is a popular belief that steroids can cause cancer, there is no medical evidence that supports this statement. You will hear on the news about this as well as other things that just aren’t true. They have tried over and over to link steroids to cancer and have been unable to do so. However I have recently seen a study in which high doses of Anadrol were used and severe liver damage was noted over a long period of time. The number of people who have use and continue to use Anadrol have had no such effects which leads me to believe that even if a few people had suffered from liver damage that may have led to cancer, it’s a very small amount compared to the millions who have used Anadrol throughout the years.

Cardiovascular Disease
As mentioned earlier, the use of AAS may have an impact on HDL, LDL and total cholesterol values. As you probably know, HDL is considered the “good” cholesterol and can aid in the removal of cholesterol deposits in the arteries. LDL has the opposite effect, aiding in the buildup of cholesterol in the arteries. The general pattern seen with steroid use is a lowering of HDL concentrations, while total and LDL numbers increase. The ratio of HDL to LDL seems to be more important than the total count, as these two substances seem to balance each other out. If these changes are exacerbated by long-term use of steroidal compounds, it can clearly be detrimental to the cardiovascular system. This may be additionally heightened by a rise in blood pressure, which is common with the use of strongly aromatizable compounds.

It is also important to remember that due to their structure and form of administration, most 17alpha alkylated oral steroids have a much stronger negative impact on these levels compared to injectables.

Since heart disease is one of the top killers worldwide, steroid using athletes (particularly older individuals) should not ignore the risks. If nothing else it is a very good idea to have your blood pressure and cholesterol values measuered during each heavy cycle, making sure to discontinue the drugs should a probem become evident. It would also be advised to limit the intake of foods high in saturated fat and cholesterol. Since blood pressure and cholesterol levels will usually revert back to their pre-treated norms soon after steroids are withdrawn, long-term damage is not a common worry.

Depression
Obviously steroid use will have an impact on hormone levels in the body, which in turn may result in a change in someone’s general disposition or mood. On the one hand, we might see very aggressive behavior as I have mentioned before. But for some people there is also, at times, the other extreme side, depression. Neither of these occurs in everyone, but only in some people. Depression is most evident when coming off a cycle. Given a deeply suppressed endogenous testosterone level, it may take some time for your normal hormonal balance to return. During this period, estrogen levels may be more stable than testosterone, as our bodies can produce it as well. The result may be a window of time where estrogen seems to be the dominant sex hormone. For some, this windo can be filled with feelings of emotional sensitivity, sadness, and lack of motivation (symptoms of depression).

Just because you may suffer from a lack of motivation after ending a cycle, doesn’t mean you are automatically suffer from depression. Most people see this lack of motivation post cycle due to the fact of feeling like you don’t have the help of steroids to be strong and big. It is for this reason that I noted this. You must push through this time period and understand that at some point you will most likely go back on cycle and be bigger and stronger than you are or were when on your last cycle. That if you don’t continue to work hard in the gym, you will lose what you have gained and be back to square one when starting your next cycle.

Gynecomastia
Gynecomastia is the medical term for development of female breast tissue in the male body, more commonly known as bitch tits. This happens when a male is presented with an unusually high level of estrogen, particularly with the use of strong aromatizing androgens such as testosterone and Dianabol. The excess estrogen can act upon receptors in the breast and stimulate the growth of mammary tissue. To fight this side effect during steroid therapy, many find it necessary to use some form of estrogen maintenance medication. This includes an estrogen antagonist such as Clomid or Noladex, which block estrogen from attaching to and activating receptors in the breast and other tissues, or an aromatase inhibitor such as Femara or Arimidex, which blocks the enzyme responsible for the conversion of androgens to estrogen.

Hair Loss
The use of highly androgenic steroids can negatively impact the growth of scalp hair. In fact, the most common form of male pattern hair loss is directly linked to the androgens I such tissues, most specifically the stronger DHT metabolite to testosterone. Since there is a genetic factor involved, many individuals won’t ever see signs of this side effect, even with heavy steroid use. People who suffer from this type of hair loss should be very cautious when using the stronger drugs like testosterone, Anadrol, Halotestin and Dianabol.

In many instances, the renewal of lost hair can be very difficult, so avoiding this side-effect before it occurs is the best advice. For those who need to worry, the decision should probably be made to wither stick with milder substances, like Deca-Durabolin, or use the ancillary drug Propecia/Proscar (finasteride) when taking testosterone, methyltestosterone or Halotestin.

High Blood Pressure/Hypertension
People using anabolic/androgenic steroids will commonly notice a rise in blood pressure during treatment. High blood pressure is most commonly linked to steroids that have a high affinity for estrogen conversion, such as testosterone and Dianabol. As estrogen builds in the body, the level of water and salt retention will typically elevate and lead to increased blood pressure. This may be further amplified by the added stress of intense weight training and rapid weight gain. Since hypertension can place a great deal of stress on the body, this side effect should not be ignored. If it’s left untreated, high blood pressure can increase the likelihood for heart disease, stroke or kidney failure. Warning signs of hypertension include an increased tendency to develop headaches, insomnia, and breathing difficulties. Steroid users should certainly be monitoring BP values during stronger cycles to avoid potential problems.

If an individual’s BP values are becoming notably elevated, some action should be taken to control it. You can either discontinue the se of the offending steroids, or at least substitute them with milder, non-aromatizing compounds. You also have the option of seeking the benefit of high blood pressure medications such as diuretics, which can dramatically lower water and salt retention. Catapres is also a popular medication among athletes, because in addition to its BP lowering ability, it has also been documented to raise the body’s output of growth hormone.

Immune System Changes
The use of AAS has been shown to produce changes in the body that may impact your immune system. These changes can be both good and bad for the user. For instance, during steroid treatment, many athlete’s find they are less susceptible to viral illness. New studies involving the use of compounds like oxandrolone and Deca-Durabolin with HIV patients seems to support this claim. But just as a person may be less apt to notice illness during a cycle, the discontinuance of steroid can produce a rebound effect in which the immune system is less able to fight off pathogens. This most likely coincides with the rebound activity/production of cortisol. During the period of imbalance due to the withdrawal of steroids, cortisol will not only be stripping the body of muscle mass, but may also cause the person to be more susceptible to colds, flu, etc. The proper use of ancillary drugs (anti-estrogens, testosterone stimulating drugs) is the most common suggestion for helping to avoid this problem.

Kidney Stress/Damage
Since your kidneys are involved in the filtration and removal of byproducts from the body, the administration of steroidal compounds (which are largely excreted in the urine) may cause some strain. Actual kidney damage is most likely to occur when the steroid user is suffering from severe high blood pressure.

Since kidney stress/damage is generally associated with the use of stronger aromatizing compounds such as testosterone and Dianabol, individuals sensitive to high blood pressure/kidney stress should avoid such compounds until health concerns are safely addressed. If steroid use is still necessitated by the individual, it may be a good idea to avoid the stronger compounds and opt for one of the milder anabolics. Primobolan, Anavar and Winstrol, for example, do not convert to estrogen at all, and may be acceptable options. Also favorable drugs in this regard are Deca-Durabolin and Equipoise, which have a low tendency to convert to estrogen.

Liver Stress/Damage
Liver stress/damage is not a side-effect of steroid use in general, but is specifically associated with the use of c17 alpha alkylated compounds. These structures contain chemical alterations that enable them to be administered orally. In surviving a first pass by the liver, these compounds place some level of stress on the organ. In some instances, this has led to severe damage, even fatal liver cancer. Keep in mind, most oral compounds are altered like this, to include, Tylenol, Aspirin, and most oral medication you will receive from you doctor to combat sickness. Most of the liver cancer cases have in fact been in clinical situations, particularly with the use of the powerful oral androgen Anadrol (oxymethalone). This may be directly related to the high dosage of this preparation, as Anadrol contains a whopping 50mg of active steroid per tablet. This is a considerable jump from other preparations, most of which contain 5-10mg of a substance. With one Anadrol 50 tablet, the liver will therefore have to process (roughly) the equivalent of 10 Dianabol tablets. This obvious stress is further amplified when we look at the usually high dosage schedule for ill patients receiving this medication. With Anadrol 50, the manufacturer’s recommendations may call for the use of as many as 8 or 10 tablets daily. This is a far greater amount the most athletes would ever think of consuming, with 3 or 4 tablets per day being considered extreme.

Prostate Enlargement
Prostate cancer is currently one of the most common forms of cancer in males. Prostate complications are believed to be primarily dependant on androgenic hormones; particularly the strong testosterone metabolite DHT in normal situations, much in the way estrogen is linked to breast canner in women. Because steroids can raise the level of androgens in the body, there is an argument that theoretically steroids could lead to prostate cancer. It is, therefore, a good idea for older men to limit/avoid the intake of strong 5-alpha reducible androgens like testosterone, methyltestosterone and Halotestin, or otherwise use Proscar, which was specifically designed to reduce 5-alpha reductase enzyme in scalp and prostate tissue. This may be a preventative measure for older men insisting on the use of these compounds. However, drugs like Dianabol, Anadrol, and Proviron, which do not convert to DHT yet are still potent androgens, are not affected by its use.

Sexual Dysfunction
The functioning of the male reproductive system depends greatly on the level of androgenic hormones in the body. Therefore, the use of synthetic male hormones may have a dramatic impact on an individual’s sexual wellness. On one extreme, we may see a man’s libido and erection frequency become significantly heightened. This is most commonly seen with the use of strongly androgenic steroids, which seem to have the most dramatic stimulating impact on the system. In some instances, this can reach the point of becoming problematic, although more often than not, the athlete is much more active and sexually aggressive during the intake of steroids.

On the other extreme, we may see a lack of sexual interest, possibly to the point of impotency. This occurs when androgenic hormones are very low. This will often happen after a steroid cycle is discontinued, as the endogenous production of testosterone is commonly suppressed during the cycle. Removing the androgen (from an outside source) leaves the body with little natural testosterone until this imbalance s corrected. The loss of it’s’ metabolite DHT is particularly troubling, as this hormone may have a strong effect on the reproductive system that may not be apparent with other less androgenic hormones. Therefore, it is a very good idea to use testosterone-stimulating drugs like HCG and/or Clomid/Nolvadex when coming off a strong cycle, so as to reduce the impact of steroid withdrawal. Impotency/ sexual apathy may also occur during the course of a steroid cycle, particularly when it is strictly on anabolic compounds. Since all “anabolics” can suppress the manufacture of testosterone in the body, the administered drugs may not be androgenic enough to properly compensate for the testosterone loss. In such a case, the user might opt to include a small androgen dosage (perhaps a weekly testosterone injection), or again reverse/prevent the androgen suppression with the use of a medication like HCG.

I think it’s also interesting to note that it’s always simply an androgen vs. anabolic issue. People will often respond very differently to an equal dose of the same drug. When one individual may notice sexual disinterest or impotency, another may become extremely aggressive. It is, therefore, difficult to predict how someone will react to a particular drug before having used it.

Testicular Atrophy
The human body prefers to remain in a very balanced hormonal state, a tendency known as homeostasis. When the administration of androgens from an outside source causes a surplus of hormone, it will cause the body to stop manufacturing its own testosterone. Specifically, this happens via a feedback mechanism where the hypothalamus detects a high level of sex steroids (including androgens, progestins and estrogens) and shits off the release of GnRH (Gonadotropin Releasing Hormone, also referred to as luteinizing hormone releasing hormone). This, in turn, causes the pituitary to stop releasing luteinizing hormone and FSH (follicle stimulating hormone), the two hormones (primarily LH) that stimulate the Leydig’s cells in the testes to release testosterone (negative feedback inhibition has been demonstrated at the pituitary level as well). Without stimulation by LH and FSH, the testes will be in a state of production limbo, and may shrink from inactivity. In extreme cases the steroid user can notice testicles that are unusually and frighteningly small. However, this effect is temporary, and once the drugs are removed (and hormone levels rebalanced) the testicles should return to their original size.

Water and Salt Retention
Many AAS can increase the amount of water and sodium stored in body tissues. In some instances, steroid induced water retention can bring about a very bloated appearance to the body (hands, arms, face, etc.), which will also reduce the visibility of muscle features (loss of definition). Most people will often ignore this side effect, particularly during bulking cycles when the excess water stored in the muscles, joints and connective tissues will help to improve an individual’s overall strength.

Although water retention may not be the most unwelcome side effect during a bulking cycle, it can lead to dangerous problems such as high blood pressure and kidney damage. The body is clearly under more of a strain when dealing with an unusually high level of water, so athletes should not simply ignore this. Water retention is most specifically associated with estrogen in the body, and is therefore common with the use of aromatizing compounds. If water retention becomes an obvious problem during a cycle, the use of an anti-estrogen such as Nolvadex or Proviron may help to minimize it. An antiaromatase like Arimidex is the most effective option, a drug that inhibits the conversion of testosterone to estrogen.

The Side Effects I Have Endured
One of the sides I suffered from was my bones and ligaments not growing in strength at the same rate my muscles were. As a result of this I broke my back while doing routine dead lifts. It put me out of the gym for nearly 6 months. For 6 months I could even enter a gym as I was going through physical therapy to get back to where I could work out again. It killed me. I mean absolutely killed me. And the worst part about someone like myself, who is used to working out all the time and seeing my gym rat buddies is being bored out of my mind while I sit at home when I would normally be working out. And because I am used to eating a diet that's designed for someone who weighed as much as I did and worked out as often as I did I kept eating that diet because it's what filled me up. In doing so I became horribly fat and out of shape. I had tons of muscle atrophy and couldn't do anything about it. I am still, to this day, working to get back to my pre-back injury physique. The sad part is, I lost in about 1 year, what will probably take me 2-3 years to get back to.

I have also developed a heart murmur. I don't know if this is directly related to steroid use and there is no way to prove it. But the science behind it makes sense. If steroids make all muscles grow, and the heart is a muscle, then it would grow bigger because of steroid use. However, the valves of the heart are not made of muscle and would therefore not grow with the heart. This would in turn create a situation in which the valves would not be big enough to make a complete seal when the blood circulates throughout your heart, thus circling back to the notion that I may have this condition because of steroids.

After all this, I ask myself, would I do it all again. Without hesitation my answer is yes. There is no cost big enough to make me forget, and not want, the compliments and reactions I have received from people when I was at my biggest. The admiration I received from fellow gym goers. The looks and comments from little kids as I walked past. And the recognition I was given on stage when I competed. It's not very often you see a 24 year old kid on stage in a bodybuilding competition that's bigger than everyone there; young and old. At my biggest, I competed at 233 lbs. In the off season I weighed 257 lbs. Not too shabby for someone who stands only 5'10" and had 4 years of steroid experience under his belt.

One last thing I would like to add id the fact that most of the serious side effects (heart disease, liver stress/damage, prostate enlargement, kidney stress/damage, cancer, etc.) have never been proven to be a direct result of steroid use in any study. They are all theoretical assumptions. There have been no deaths as a result of steroid use or anything else you hear on the news or ESPN every night when they talk about steroid use. I would also like to add that periodic use of steroids at a safe level in an adult male has proven to have little to no side effects at all. But steroid use in adolescent males has proven to have many more side effects that can be long-lasting and irreversible. I believe a lot of what the media puts out there is to try and steer high school kids clear of hormones such as these and therefore groups everyone who uses them into the categories they talk about.

All of the sides listed above could potentially be a reality though, so be warned that any steroid use is at your own risk.