Narcaid ECODA Unit Drug Awareness Bulletin: Anabolic Steroids

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Anabolic steroids are man-made versions of the hormone testosterone.  They are used to enhance strength and athletic performance or to promote a muscular physique.  The possession and supply of anabolic steroids was made illegal in the USA in 1990 but there has reportedly been a recent increase in their use, particularly amongst males.  Anabolic steroids are taken in a much higher dosage than steroids which are prescribed for therapeutic use and examples include Anadrol and Durabolin.

Appearance and Methods of Administration

Anabolic steroids come in the form of tablets, phials or multi-dose bottles.

1. They can be taken orally or, most commonly, by intramuscular injection.

2. Injections of anabolic steroids involve a sustained release of the drug over a period of days or weeks.  The user often experiences pain or discomfort after injection.

3. More than one anabolic steroid is often used at the same time or they are combined with a different type of drug.  This is referred to as ‘stacking’.

4. Anabolic steroids are usually taken intensively for a number of weeks and then repeated following a period of abstinence.  This process is called ‘cycling’.

Clinical Signs

These are usually dependent upon the type and dosage of anabolic steroid(s) and whether they have been mixed with any other drugs.  Signs and symptoms may include raised blood pressure, palpitations, headache and stomach pains.

Effects on the User

. Anabolic steroids have stimulatory effects which can give the user initial feelings of increased energy, motivation, confidence and self-esteem.  These effects can assist in athletic training or body- building as they can boost stamina and decrease fatigue.  This can, however, progress into the user experiencing mood swings, irritability, paranoia, depression, hallucinations  and sudden outbursts of temper (‘roid rages’).

. Anabolic steroids have androgenic effects due to their high testosterone content.  In females this can cause ‘masculinising’, such as a deeper voice and an increase in facial and body hair.  There may also be changes to the menstrual cycle.  In males a process called ‘aromatisation’ occurs, where an excess of testosterone in the body is converted into oestrogen and leads to ‘feminising’ effects such as the development of breasts.  Anabolic steroids also have an adverse effect on the fertility of both sexes.

Specific Medical Dangers

1. Increased risk of muscle or other body damage caused by excessive physical activity.

2. Increased risk of hypertension, thrombosis, heart disease and strokes.

3. Fluid retention which can exacerbate kidney disorders, epilepsy, migraine or diabetes.

4. Abnormal liver function and possible cause of liver, kidney and prostate cancers.

Now test your understanding by looking at the case study and answering the questions.

CASE STUDY: USE OF ANABOLIC STEROIDS

An ambulance is called to a gym where a young male has suffered an injury during a weight training session.  The crew arrive to find 28 year old Michael who clearly has an injury to his right leg and is finding it very difficult to walk. Michael, however, insists that he is not in any pain and is very reluctant to be examined by the crew or to be taken to A and E (ER).  (His friend Simon with whom he had been training had alerted the gym staff to Michael’s injury and asked them to phone for the ambulance).

Eventually Michael agrees to be examined and is found to have an elevated blood pressure and heart palpitations, as well a muscular injury to his right leg.  Simon reveals that Michael had been complaining of a headache and stomach pains before the training session but Michael dismisses these symptoms as being related to a take-away which he had eaten the previous evening.  When Simon presses the point by saying that his friend often seems unwell, Michael loses his temper and becomes very aggressive.  The crew have to restrain Michael, which they find very difficult due to his great physical strength.

Michael soon calms down and allows the crew to transport him to the ambulance.  Simon confides in the paramedic that he has found tablets in Michael’s gym bag which he believes may be anabolic steroids.  He suspects that Michael may have been taking these for some time which would account for a recent significant increase in his build and training stamina.  Simon has also noticed dramatic changes in Michael’s personality and physical appearance.

On investigation at A and E Michael is diagnosed as having sustained a severe muscular injury to his right thigh.  The tablets found in his bag were identified as Anadrol, a very strong oral anabolic steroid.

SELF-DIRECTED STUDY QUESTIONS

Answers are given overleaf.  Please do not submit for marking.

1.  Why would the use of anabolic steroids increase the risk of Michael sustaining muscular or other body damage during training?

2. Which initial clinical signs and symptoms indicate that the patient has taken anabolic steroids?

3. What evidence is there in the case study that the patient has been psychologically affected by his use of anabolic steroids? This patient has taken an oral anabolic steroid. 

4. Which other method of administration is more commonly used?

5. Simon refers to changes in Michael’s physical appearance which may be linked to his use of anabolic steroids.  Outline what these changes are likely to be.

ANSWERS

1. Anabolic steroids increase stamina and reduce feelings of fatigue during exercise and thus allow the user to train more vigorously and for longer periods of time.  This leads to an increased risk of muscle or other body injury.
2. a. Raised blood pressure b. Palpitations c. Headache and stomach pains 
3. The patient loses his temper and becomes very aggressive towards his friend, who later remarks on recent dramatic changes in the patient’s personality.
4. Anabolic steroids are most commonly administered by injection into the muscles.

5.        Anabolic steroids increase muscle mass and physical strength.  They also have a high testosterone content which is aromatised in the male body to produce oestrogen, the ‘female’ hormone.  This leads to the development of breast tissue in males.