Anabolic steroid

Anabolic steroid

Anabolic steroids are often used to increase physical performance and muscle growth. When used incorrectly in large doses for a long time and without medical supervision, they can cause irregular and irrational behavior and a variety of physical side effects.
Anabolic steroids include testosterone and all drugs that are chemically and pharmacologically related to testosterone that promote muscle growth; There are many such drugs. Anabolic steroids are used clinically to treat hypogonadism in men with low testosterone levels. Because anabolic steroids are also anti-catabolic and improve protein utilization, they are sometimes given to burnt, bedridden, or debilitated patients to prevent muscle atrophy.
Some doctors prescribe anabolic steroids to patients who are debilitated by AIDS or who are suffering from cancer. However, there is little evidence to recommend such therapy and few guidelines for how complementary androgens may affect the development of underlying diseases. Testosterone has gained a solid reputation for its benefits in healing wounds and injured muscles, although there is little evidence to support these claims.

Pathophysiology

Pathophysiology

Anabolic steroids have androgenic effects (eg, hair or libido changes, aggression) and anabolic effects (eg, increased protein intake, increased muscle mass). Androgenic effects cannot be separated from anabolic effects, but some anabolic steroids have been synthesized to minimize androgenic effects.
Testosterone is rapidly broken down in the liver; Oral testosterone is inactivated too quickly to be effective, and injectable testosterone must be modified (eg, by esterification) to slow absorption or stop breakdown. Modified 17-alpha alkylation analogs are often effective when taken orally, but side effects can increase. Transdermal preparations are also available.

Clinical manifestations

Clinical manifestations

The most characteristic sign of the use of anabolic steroids is a rapid increase in muscle mass. The rate and extent of the increase are directly related to the doses taken. In patients taking physiological doses, growth is slow and often imperceptible; Those who take high doses can gain several kilos of lean body mass per month. There is a barely noticeable increase in energy expenditure and libido (in men).

Psychological effects are often noticed by family members (usually only at very high doses):

  • Broad and irregular mood swings
  • Irrational behavior
  • Increased aggression (“rage steroid”)
  • Irritability
  • Increased libido
  • Depression

Men can suffer from gynecomastia, testicular atrophy and impaired fertility. In women, virilizing effects (eg alopecia, clitoral enlargement, hirsutism, deeper voice) are common. In addition, breast size may decrease; the vaginal mucosa may be atrophied and menstruation may be altered or absent. Virilization and gynecomastia can become irreversible.

Diagnostic

Diagnostic

Urine analysis.
Anabolic steroid users are usually identified through urinalysis. Anabolic steroid metabolites can be detected in the urine up to 6 months (even longer for certain types of anabolic steroids) after ingestion of the drug.
Exogenously absorbed testosterone is indistinguishable from endogenous testosterone. However, when high testosterone levels are detected, the ratio of testosterone to epitestosterone (an endogenous steroid chemically almost identical to testosterone) is measured. normal ratio <6:1; when using exogenous testosterone, the ratio increases.

Processing

Processing

Termination of use.
The main treatment for those who use anabolic steroids is to stop using them. Although physical dependence is not observed, psychological dependence can exist, especially in competitive bodybuilders. Gynecomastia may require surgical reimbursement.