Anabolic Steroid Side Effects- Part 2

Nelson Vergel

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Anabolic Steroid Side Effects- Part 2
By Mauro DiPasquale, M.D.

Dealing With Side Effects

While there are many possible short term and long term consequences of anabolic steroid use, most of these side effects can be minimized by the judicious use of, or if necessary the discontinuation of the compound(s). As well other measures can be taken to mitigate or eliminate potential side effects and their consequences. The overall risks associated with the use of anabolic steroids are not as great as the sporting federations and the media would lead us to believe.

In men, most of the studies done so far show a reversal of any side effects and the return of normal testicular function and sperm count within three to six months (depending on the duration, type and dosages used - see above) of discontinuing the steroids.
Many of the athletes who use higher doses of two or more anabolic steroids, for prolonged periods of time recognize the risks involved with the use of anabolic steroids. These athletes, whether under medical supervision or not, often use methods and drugs to counteract or nullify these side effects9• Unfortunately, few athletes have the benefit of proper medical care and follow-up.

Avoiding Side Effects

Athletes in general are aware of many of the side effects associated with the use of anabolic steroids and often use other drugs or supplements to counteract or lessen their severity. For example tamoxifen (Nolvadex) is used by male athletes to reduce the estrogenic effects of testosterone and some of the anabolic steroids that aromatize. Tetracycline and other antibiotics (as well as acne creams etc.) are used to counteract the acne. Women try to counteract the masculanizing effects by using the less androgenic compounds and by using birth control pills with high estrogenic and lower progestational effect (using oral contraceptives in which the progestational component has minimal androgenic properties). Evening Primrose, glutathione and hepatoprotectants from plants and herbs are used to decrease the hepatotoxic effects of the oral 17a-alkylated anabolic steroids.

Hypothalamic-Pituitary-Testicular Dysfunction and Anabolic Steroids

While we may be able to discount many of the adverse effects of anabolic steroids, such as isolated cases of liver and kidney tumours, and are unsure of the actual long term liver and cardiovascular consequences of anabolic steroid use, dysfunction of the hypothalamic-pituitary-testicular axis (HPTA), resulting in low serum levels of endogenous testosterone, may be the one tangible serious side effect that can't be ignored or explained away.

Although several studies have documented the hormonal consequences of moderate to high doses of anabolic steroids in both men and women few have reported the long term effects of their use on the HPTA (10•11•12.) I have found that the prolonged use of anabolic steroids can result in the long term suppression of serum testosterone secondary to testicular and hypothalamic-pituitary dysfunction. My data shows that there is an
increased prevalence of both pituitary gonadotropic and testicular dysfunction in men who have used anabolic steroids. As well, anabolic steroids can impair reproductive function at the gonad and/or the hypothalamo-pituitary level.

While some of the anabolic steroids (especially dihydrotestosterone and dihydrotestosterone derivatives) do not suppress the HPTA as much as others13, in sufficient dosages, all anabolic steroids will suppress this axis. Perhaps this suppression of the HPTA is the one adverse effect of anabolic steroids that should be uppermost in the minds of those athletes who use them.

The use of exogenous anabolic-androgenic steroids causes a disturbance in the body's normal hormonal profile, with decreased concentrations of serum hormone binding globulin (SHBG), low concentrations ofluteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone precursors, and testosterone itself, if anabolic steroids and no exogenous testosterone are used. In athletes who use exogenous testosterone, there is also a high ratio of testosterone to its precursor steroids 14.

The formation, secretion, and metabolism of testosterone is a complex process, which occurs through various sensing, feedback, and control mechanisms. The control of the sex hormones involves the hypothalamus, the pituitary, and the gonads. In men regulation of testosterone secretion involves the HPTA, with extrahypothalamic events having some influence at all three levels15. The interaction between the various hormones and releasing factors such as GnRH, LH, FSH, inhibin, and the endogenous opioids, results in variations in the serum levels of testosterone. For example, the hypothalamic decapeptide GnRH is known to regulate the synthesis and secretion of LH and FSH by pituitary gonadotrope cells.

The frequency of pulsatile GnRH secretion changes and LH and FSH are differentially secreted in various physiological situations 16. As well, testosterone seems to affect the pituitary secretion of LH and FSH directly (17•18), the response of LH and FSH to GnRH, and the frequency of pulsatile GnRH release. It is also thought that estrogens, produced from the aromatization of testosterone and other anabolic steroids in parts of the brain and hypothalamus, inhibit LH secretion, and thus decrease testosterone production.


9 Bill JA; Sulter JR; Sachs K; Brigham C. Athletic polydrug abuse phenomenon: a case report .American journal of sports 11(4), Jul/Aug 1983, 269-271.

10 Alan M, Rahltila P, M, Vihlto R. Androgenicanabolic steroid effects on serum thyroid, pituitary and steroid hormones in athletes . Am J Sports Med 1987; 15(4):357-361.

11 Alen M, M, Vihlto R . Response of serum hormones to androgen admilti.stration in power athletes Med. Sci. Sports Bxerc 1985; 17(3) :354-359.

12 Alen M, Hakkinen K. Physical health and fitness of an elite bodybuilder during 1 year of self* administering testosterone and anabolic steroids a case study. Int J Sports Med 1985; 6(1):24-29.

13 Balestreri R, Bertolini s, Chiodini G, Ronzitti M. Pituitary inhibitory and non-inhibitory effects of various anabolic 17-alkylating steroids. Arch Maragllano Pato1 1971; 27 (3) :123-135.

14 Ruokonen A, A1en M, Bolton N, Vihko R. Response of serum testosterone and its precursor steroids, SHBG and CBG to anabolic steroid and testosterone self-administration in man. J Steroid Biochem, 1985; 23(1) :33-38.

15 Ryzhenkov VE, Bekhtereva BP, Sapronov NS. Role of the limbic structures in the mechanism of production of glucocorticoids and estrogens on hypothalamic control of pituitary adrenocorticotropic and gonadotropic functions. Bu11 Bxp Bio1 Med 1974; 77(4):362-265.

16 Dalkin AC, Haisenlecler DJ, Ortolano GA, Ellis TR, Marshall JC. The frequency of gonadotropin releasing-hormone stimulation differentially regulates gonadotropin subunit messenger ribonucleic acid expression. Endocrinology 1989; 125(2):917-924.

17 Sheckter CB, Matsumoto AM, Bremner WJ. Testosterone administration inhibits gonadotropin secretion by an effect directly on the human pituitary. J Endocrino1 Metab 1989; 68(2) :397-401.

Continue to Part 3
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I read the book Drug use & Detection in Amateur Sports, Mario Di Pascuale, and its up dates. I t have a very good information on anabolic steroids that I used for years. I still reading this notes for reference because too many people ask me about it. I will keep looking for the next articles.