Steroid Side Effects And How To Avoid Them (Part 1 & 2)

  1. Steroid Side Effects And How To Avoid Them (Part 1 & 2)


    Steroid Side Effects And How To Avoid Them
    This chapter, along with the chapter on the proper use of ancillary medications, are two of the most important chapters in this book. Why? Because AAS have side effects, and long-term use of AAS can have a profound effect on longevity and overall quality of life in later years if preventative measures are not taken. Having used steroids myself for over 10 years now, I have suffered through virtually ever side effect listed in this chapter, and have consequently educated myself on how to avoid them.

    Regardless of your age, it’s important to always bear in mind that the use of AAS for the purposes of gaining an edge in sport can be an inherently unhealthy endeavor. There is a distinct difference between the doses of hormones or drugs that are used in slowing the aging process through hormone replacement therapy (hereafter referred to as HRT, please see the chapter on HRT by Dr. Ramon Scruggs for further clarification) and those that are used to enhance performance. If one is to properly use performance enhancing drugs, it is vital that they know the potential side effects of drugs they are using, know how to combat these side effects, and most importantly, actually implement the knowledge they have. Time and time again I’ve seen a bodybuilder develop gynecomastia (commonly referred to as “bitch tits” in the bodybuilding vernacular) despite the fact that the individual in question knew this was a possibility and also knew the preventative measures to take. One should not engage in the use of AAS or any other performance enhancing drug if the maintenance of proper health is not of primary concern.

    Compounding the problem of treating the side effects of AAS is the hysteria surrounding their use in the first place. Many bodybuilders that use steroids find themselves to be social pariahs, muscular misfits if you will, and end up finding comfort in the company of others that engage in steroid use as well. Because a bodybuilder wears his sport, he’s branded a steroid user by many regardless of whether that’s the case or not. Often times, the shame one feels regarding their steroid use will cause them to suffer through the side effects associated with their use, rather than seeking competent medical help. Truth be told, it’s very difficult to find competent medical help to treat the side effects of steroids, as most doctors simply have no idea how to properly do so. More often than not, the physicians I worked with for most of my years on steroids were completely clueless as to how one might ameliorate the negative side effects of these drugs, and would simply tell me to “get off the steroids”. I say this not to dissuade those of you reading this from seeking out the advice of a doctor regarding the side effects of steroid use, just to prepare you for a probable response.

    Most of the side effects related to steroids are cosmetic and will disappear when one discontinues their use. But those that aren’t are the most important to understand and treat as necessary. Most of these cannot be seen or felt, and all are related to issues of cardiovascular health. Steroids can adversely affect cholesterol levels, triglyceride levels, and hypertension, which over time can and will lead to an increase in heart disease. Always monitor your resting hear rate and blood pressure on a weekly basis when taking steroids and have your cholesterol and triglycerides checked every six months if you are using steroid consistently. These are not problems you can live with, ignore them and you may very well die much earlier than you would have otherwise. Ask yourself this question: “How much is every year of my life worth to me?” If you ignore the potential for an increased risk of heart disease when using anabolic steroids, you are essentially answering the question with, “Very little indeed.”

    Before we begin a look at the actual side effects themselves and how to treat them, it’s important to note that not all AAS are created equal!! At times, for the sake of brevity, I will lump all AAS together, but the fact remains that some steroids will cause more negative side effects than others. One of the points of this book is to allow you to make that distinction, and walk away with the knowledge of how to use them as safely as possible. Below is a list of steroids most commonly associated with the side effects listed in this chapter:

    Anadrol-50 (Oxymetholone)
    Dianabol (Methandrostenolone)
    Halotestin (Fluoxymesterone)
    Testosterone and its various esters

    Unfortunately for us, these also happen to be most of THE most effective AAS (with the exception of Halotestin) for building LBM. Generally, the maxim that the more effective a steroid is the more side effects it has holds true.

    Finally, before we begin, readers will notice that I do not advocate the use of estrogen blockers such as nolvadex, clomid (I do post cycle, but not for the purposes of estrogen suppression), or Proviron. With anti-aromatases like Arimidex (anastrazole), Femara (letrozole), and to a lesser extent Cytadren (aminoglutethiamide) becoming cheaper and more readily available, use of estrogen blockers should be relegated to the bodybuilding archives. For a complete explanation as to why, read the chapter Proper Use of Ancillary Medications Both On and Off Cycle.

    AAS Side Effects

    Acne: One of the primary indicators of steroid use is acne, and I’m sure many of you reading this have either experienced acne caused by steroids or have seen someone who has. Like all steroid side effects, the degree to which someone will suffer from acne varies from individual to individual. The more androgenic a compound is, the more profound effect it will have on increasing oil production in the skin via stimulation of the sebaceous glands. Having said that, I’ve seen individuals use incredibly androgenic stacks and never have a hint or a pimple or blemish, and I’ve seen athletes (especially women) use very mild anabolics and suffer from horrible acne.

    Treating acne is very important, both for physical and psychological reasons. Untreated acne can cause permanent scarring of the skin if it becomes severe enough, resulting in a pockmarked area that can only be smoothed through expensive plastic surgery. And acne can have a very powerful negative psychological effect on someone suffering from it, branding someone a steroid user and further isolating them from “normal” society. Severe acne can and will detract from the most aesthetic of physiques, and take away from ones overall presentation.

    Depending on the severity, there are several options for the treatment of acne. Since acne is generally caused by the more androgenic steroids, there is always the option of switching to steroids that have few androgenic properties, such as nandrolone, oxandrolone, or primobolan. Light cases can commonly be controlled through frequent washings of the effected area (to remove excess dirt and oil before pores become clogged and infected) and the use of over the counter topical treatments. Moderate cases will generally respond to the use of Retin-A coupled with use of an antibiotic (such as tetracycline) which kills the bacteria which feeds off the oil created by the sebaceous gland. Severe cases of acne should be treated with Accutane, a prescription drug manufactured by Roche that is very effective at permanently eliminating acne. Accutane has a host of unpleasant side effects itself, and treatments are both lengthy and costly (health insurance is a must), but its use is much better than the possibility of permanent scarring from cystic acne. Fortunately, while acne is one of the most commonly seen side effects, it’s also the easiest to treat, as competent Dermatologists can easily be found.

    It should also be noted that acne commonly become an issue for bodybuilders that do not cycle off steroids correctly, which will often cause a severe imbalance between levels of androgens and estrogens. Preparation for your off cycle period is equally important as the time spent on steroids, so use of an anti-aromatase both on and immediately following a cycle containing AAS that can convert to estrogen is a must.

    Aggression: Men, due to their higher natural production of testosterone, are generally more aggressive than women. AAS, especially those that are extremely androgenic, will further increase aggression in both males and females. This can be beneficial as long as the individual in question can focus the aggression appropriately, such as the lifting of heavier weights during training. There often seems to be a direct correlation between ones ability to control aggression and ones intelligence.

    There is nothing worse than an out of control steroid user who is unable or unwilling to control their aggression. Before beginning a cycle of AAS, especially one containing strong androgens, you must prepare yourself mentally for the fact that you are in all likelihood going to be more aggressive than normal, and consequently take the time to assess the nature of your reactions while using them.

  2. Controlling yourself during a cycle is simply a matter of maturity, intelligence, and discipline. If you find that you are becoming easily irritated, constantly arguing with others, or becoming extremely upset over minor things, the use of androgenic compounds should be reduced or eliminated altogether. Might does not make right, and any bodybuilder who allows steroids to control their demeanor is simply affirming the stereotypes people have about overly muscular people.

    Benign Prostatic Hyperplasia: BPH is simply an enlargement of the prostate, a walnut-sized gland that surrounds the urethra whose function is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic. This condition is now considered a normal part of aging for men, with more than half of men in their 60’s and upwards of 90% of men in their 70’s-80’s will show some symptoms. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

    Although no conclusive medical evidence exists that long term use of testosterone will lead to an increase in BPH or an acceleration in its development, such a conclusion can readily be made by understanding the mechanisms through which BPH develops. DHT is a primary culprit in the development of BPH, and it is theorized that estrogen may play a role as well. Men who cannot produce DHT do not develop BPH, and the primary treatment for BPH is Proscar (Finasteride), which inhibits the 5a-reductase enzyme. It is this enzyme which is responsible for converting testosterone (along with Halotestin) into DHT. Studies done with animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth.

    Knowing that use of testosterone will increase both levels of DHT and estrogen if the appropriate accessory medications are not used, you can see where I draw my conclusions. It is highly likely that long term use of testosterone, whether it be for performance enhancement of hormone replacement therapy purposes, will accelerate the onset of BPH. Thusly, one should use both an anti-aromatase and 5a-reducatase inhibitor when using testosterone.

    Birth Defects: This applies only to female steroid users, as steroid use by males cannot induce birth defects. Any female using steroids should have a pregnancy test before doing so and use an effective form of birth control while on them. When used by a female who is pregnant, AAS can cause Adreno-genital syndrome, which will result in the inappropriate growth of the genitals in a developing fetus.

    Cancer: Steroids are commonly believed to cause cancer, even by many who use them. This is primarily for one reason, the hysteria surrounding the death on former football great Lyle Alzado, who died of a brain tumor in 1992. Prior to his death, Lyle went on a very public campaign divulging his many years of steroid abuse, and pointing the figure at AAS as the causative factor behind his cancer. The media latched on to this and exploited it for all it was worth, despite the fact that Lyle’s own physician readily admitted that AAS could in no way caused the cancer the killed his patient.
    The fact is that the number of cases that have directly linked steroids to cancer is statistically insignificant, and all are related to the use of C17 alpha alkylated compounds. Again, C 17 alpha aklylation is a chemical modification that allows steroids to be used orally. This makes them mildly hepatotoxic, and continued use over long periods of time can place serious stress on the liver. The few cases of liver damage and subsequent cancer that have been confirmed to be related to the use of AAS have occurred in primarily in sick patients whose liver function had already been compromised in some fashion, not athletes. Furthermore, the steroid involved in these cases was almost always Anadrol-50. This makes complete sense, as Anadrol comes in a very high dose per pill (50 mg) when compared to other oral steroids. Furthermore, the amount of Anadrol that was often to prescribed to patients was astronomical, the Physician’s Desk Reference (known as the PDR, the reference guide physicians use when prescribing drugs) recommended 1-5 mg/kg of body weight per day. To put this into perspective, a 200 lb individual would be given anywhere between 100-500 mg of Anadrol per day. This is between 2-10 tabs of Anadrol daily. Anyone having used real Anadrol (and there’s very few that have, almost ALL of the oxymetholone available today is severely underdosed) knows that even 100 mg is an incredibly effective dose that will always be accompanied by a host of negative side effects.

    My point is not to minimize the dangers of long term use of 17-AA AAS, but the truth is that short term use of them (4-8 weeks) is a relatively safe proposition.

    Cardiovascular Disease: Refer to chapter

    Depression: Use of AAS can have a profound affect on an individual’s disposition. Depression is most commonly exhibited in male bodybuilders post cycle, when estrogen levels can be incredibly high and endogenous production of testosterone has been suppressed. This can leave a male bodybuilder with a hormone profile more resembling that of a woman, and this can play a profound role in their attitude and outlook on life. More than once I’ve seen incredibly muscular and normally stoic males reduced to tears over sappy television commercials and lamenting their deteriorating condition as the imbalance of estrogen/testosterone wreaks havoc on them physically and mentally. Once again, this can be avoided through use of proper ancillary medications both on and off cycle. Estrogen levels must be kept in check at all times to ensure both maximum gains and minimum side effects. Please refer to the chapter, Proper Use of Ancillary Medications Both On and Off Cycle for more information.

    Edema: Many AAS will affect the amount of will affect the amount of water that is stores in the various tissues of the body. To some degree this can be beneficial, the strength that one will gain through the retention of water in muscle and connective tissues will certainly help add additional LBM over time. However, the moon face of a bodybuilder on a bulking cycle suffering from extreme edema is both physically repugnant and inherently unhealthy. One should not ignore the fact that water retention can have a negative impact on both blood pressure and renal function.
    Edema is associated with increased levels of estrogen, and thus the culprit for it is once again the aromatizing androgens. An athlete should always prepare for this when using these steroids, through proper application of anti-aromatases like Arimidex, Femara, or Cytadren.

    Gynecomastia: Primarily referred to as “bitch tits” or gyno, gynecomastia refers to enlargement of the male breasts. Male breast tissue is ripe with estrogen receptors, just as in that of a female. Consequently, elevated estrogen levels can cause swelling and eventual growth of this tissue, leaving a man with unsightly lumps beneath both nipples. The effect is exactly that experienced by a male pre-op transsexual receiving female hormones to induce the growth of the breasts, albeit on a lesser scale. Untreated, the swollen breast tissue will harden, becoming permanent fixtures underneath your nipples until removed by surgery.

    Because elevated levels of estrogen are the primary culprit behind the development of gyno, one should always use an anti-aromatase when using steroids that aromatize. This would normally be during a bulking cycle, when the use of strong, aromatizing androgens becomes a necessity. Unlike many others that have commented on the subject of gynecomastia and estrogen suppression, I would not wait until the effects of estrogen can be seen or felt before incorporating the proper ancillary drugs into my regime, they should be in place from Day 1!

    It should be noted that I do recommend use of an estrogen antagonist when using Anadrol-50 (oxymetholone), as this drug exhibits estrogen-like activity despite the fact that it does not aromatize. Because of this, the estrogenic effects of Anadrol cannot be combated using an anti-aromatase, and one would need use an estrogen receptor antagonist such as Nolvadex or Clomid.

    There are several AAS that exhibit progestational activity, such as many of the nandrolones or trenbolone (which is derived from nandrolone). It is possible that these steroids could produce or exacerbate gyno in a very small percentage of extremely sensitive individuals, even without elevated estrogen levels. Male bodybuilders that are extremely sensitive to the effects of progestins will have a very hard time avoiding the development of gyno, since the majority of effective steroids either aromatize, exhibit estrogenic qualities on their own (Anadrol), or have progestenic activity. These individuals would need to totally suppress estrogen production while on cycle (using both an anti-aromatase and an estrogen antagonist) or find someway to acquire the drug RU-486, the so-called abortion pill. Use of RU-486 would be the ideal situation for these individuals, as it is a progesterone antagonist. Unfortunately, this drug is nearly impossible to obtain.

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