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Anabolic Steroids Long Term Effect

Growing up as a kid in Austin in the late 70’s and 80’s my movie heroes were guys like John Matrix (Arnold Schwarzenegger in Commando) and Rocky Balboa (Sylvester Stallone).  At a young age I decided that I wanted to look like those guys.  Soon thereafter the harsh reality hit that I didn’t have the genetic predisposition or muscle gaining ability to have that build no matter how much time I spent in the gym, and that was that.  Later on, playing high school football and watching other teams and kids play around the state, I saw kids gaining muscle like those icons.  The hum of anabolic steroid use arose. 

As of 2011, there were as many as 3 million anabolic steroid users in the United States and the number is believed to be increasing.  The immediate dangers of anabolic steroids are typically not well understood by many men using steroids.  Most guys that use worry a bit about their testicles shrinking and getting soft with use, but back off to let them try to catch up in size for a while and then start back up again; and that is as far as their concern goes.  When a man has a normal testosterone level and uses, the testosterone levels can go above the normal range which can pose some serious health risks.  Some of the serious risks include caridomyopathy, heart arrhythmias, heart attacks, blood clots forming in the heart, strokes, blood clots in veins, blockages of blood vessels in the retina that can cause blindness, and unsafe rises in the concentration of red blood cells in the blood vessels.  Other effects of anabolic steroids can include depression, irritability, liver toxicity, and anxiety.

These days, as a practicing reproductive urologist specializing in men’s health, I see men in my clinic every week who are suffering from the consequences of prior steroid use.  These men come in complaining of the inability to father children, decreased energy levels, increased fatigue, difficulty with erections, decreased sex drive, depressed mood, tiredness, lack of motivation, sleep disturbances, difficulty with spatial cognition, difficulty concentrating, hot flashes, increased fat mass, decreased muscle mass, decreased bone mineral density and the risk of osteoporosis, deterioration of skin and hair, and decreased exercise tolerance.  This is the clinical presentation of hypogonadism or low testosterone.  Depending on the doses, the number of cycles, and the length of cycles of steroid use in these men’s lifetimes, the consequences can be permanent.  When a man uses anabolic steroids, essentially testosterone, their body gets fooled into thinking that they made that testosterone.  In turn, all of the signals that tell the testicles to work, usually shut down because the body thinks that the testicles are already doing such a good job at making testosterone.  The testicles shut down and that is why they can shrink.  The real trouble is, that depending on the dose, the length of the cycles, and the total duration of use; all of the cells in the testicles may not ramp back up after the man stops using, so the native testicular function of producing testosterone and sperm may not be as good as it was prior to being shut down with steroid use.  This can create a permanent lasting effect.

 These men can be treated with medications to try to regain sperm production if they are interested in fertility, but there is no guarantee that these efforts will be successful.  If a man is not interested in trying to regain his fertility potential and just wants to get back to normal testosterone levels, he can be treated with testosterone replacement therapy, and this will typically be required as life-long therapy.

How about some of the other popular products or compounds found in products on the market touted to increase testosterone levels and its effects?  Tribulus terrestris is a supplement which is commonly used for the purpose of increasing testosterone levels or for post- cycle therapy with the assumption that it will restore the body’s natural testosterone levels after a cycle of anabolic steroid use.  This myth has been disproved as Tribulus terrestris has consistently failed to increase testosterone levels in controlled human studies.  It has also failed to demonstrate strength-enhancing properties in multiple studies.  Another popular compound, Withania somifera, has shown no significant side effects in some studies when compared to placebo; however there has been one report that Withania somifera can stimulate the thyroid and lead to thryotoxicosis (thyroid storm) causing rapid heart rate, sweating, anxiety, and tremor.  Although it was only a single patient case report, one study revealed kidney and liver toxicity and seizures in a young man on Withania somifera, which improved when he discontinued it.  I’m not saying that I disagree with supplementation of any type, but we need to be careful when using non-FDA approved products that have not gone through the stringent clinical trials that help us understand the efficacy and safety of FDA approved products.

My closing recommendation is that a well balanced diet will give men the building blocks that they need to be fit.  I have conceded to the fact that I may never look like Rambo, but would just ask guys to keep in mind that the juice now, may not be worth the squeeze on the body in the future.

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