Nadużywanie sterydów anabolicznych – Patofizjologia i mechanizm

Nadużywanie sterydów anabolicznych
Patofizjologia i mechanizm

Sterydy anaboliczno-androgenne (AAS) to syntetyczne i naturalne androgeny, będące pochodnymi testosteronu, które działają głównie poprzez modulację receptorów androgenowych (AR), prowadząc do wzrostu masy mięśniowej, proliferacji komórek satelitarnych mięśni oraz zwiększenia liczby receptorów androgenowych. Suprafizjologiczne dawki AAS wywołują efekty anaboliczne nie tylko przez klasyczne mechanizmy genomowe, ale także przez szybkie, niegenomowe działania, co może tłumaczyć ich silne działanie mimo saturacji receptorów przez endogenny testosteron. Metabolity AAS, takie jak dihydrotestosteron (DHT) i estradiol, powstają w wyniku działania enzymów 5α-reduktazy i aromatazy, a modyfikacje chemiczne cząsteczki testosteronu mają na celu optymalizację efektów anabolicznych przy minimalizacji działań niepożądanych. Nadużywanie AAS prowadzi do zahamowania osi podwzgórze-przysadka-gonady (HPA), skutkującego hipogonadyzmem, zmniejszeniem objętości jąder, azoospermią oraz zaburzeniami płodności. Ponadto, AAS indukują liczne powikłania obejmujące układ sercowo-naczyniowy (np. przerost lewej komory, dyslipidemię z podwyższonym LDL i obniżonym HDL, zwiększoną sztywność tętnic), hepatotoksyczność (zapalenie wątroby z zastojem żółci, cholestaza, uszkodzenie hepatocytów), neurotoksyczność (przyspieszone starzenie mózgu, agregacja beta-amyloidu i białka tau, zaburzenia poznawcze) oraz uszkodzenie nerek (białkomocz, ograniczenie funkcji nerek). Wysokie dawki AAS są również związane z rozwojem uzależnienia psychicznego, objawami odstawienia i zaburzeniami nastroju, w tym depresją i lękiem, co komplikuje proces odstawienia i powrotu do homeostazy hormonalnej.

Powrót do zdrowia po zaprzestaniu stosowania AAS jest zmienny i zależy od dawki, czasu nadużywania oraz indywidualnych cech pacjenta. Fizyczne objawy, takie jak atrofia jąder, mogą wymagać miesięcy do lat na regenerację, podczas gdy spermatogeneza i poziomy gonadotropin (FSH, LH) zwykle wracają do normy w ciągu 2-16 tygodni, choć zdarzają się dłuższe okresy supresji. Libido i funkcje seksualne często ulegają poprawie w ciągu kilku miesięcy, jednak ginekomastia jest zwykle nieodwracalna. Leczenie polega przede wszystkim na zaprzestaniu stosowania AAS, a terapia modulująca estrogeny może wspomagać powrót funkcji erekcyjnej. Ze względu na ryzyko poważnych powikłań sercowo-naczyniowych, hepatotoksyczności, neurotoksyczności oraz uszkodzenia nerek, konieczne jest monitorowanie pacjentów nadużywających AAS oraz edukacja na temat potencjalnych zagrożeń. W praktyce klinicznej ważne jest rozpoznanie objawów nadużywania AAS, ocena funkcji hormonalnej, kardiologicznej, wątrobowej i nerkowej oraz wsparcie psychologiczne w procesie odstawienia i rehabilitacji pacjentów.

Nadużywanie sterydów anabolicznych – Patogeneza

Mechanizmy molekularne działania AAS
Alternatywne ścieżki działania AAS
Wpływ na układ hormonalny

Patofizjologia nadużywania sterydów anabolicznych

Wpływ na układ sercowo-naczyniowy
Wpływ na wątrobę
Wpływ na układ nerwowy
Wpływ na układ moczowy

Mechanizmy uzależnienia od sterydów anabolicznych
Wzorce nadużywania sterydów anabolicznych

Specyfika odstawienia sterydów anabolicznych

Efekty kardiotoksyczne nadużywania sterydów anabolicznych
Efekty hepatotoksyczne nadużywania sterydów anabolicznych
Efekty nadużywania sterydów anabolicznych na płodność

Kolejne rozdziały

Nadużywanie sterydów anabolicznych – Patogeneza

Sterydy anaboliczno-androgenne (AAS) stanowią szeroką grupę naturalnych i syntetycznych androgenów, które są modyfikowanymi wersjami testosteronu. Związki te oddziałują na komórki poprzez wiązanie się z receptorami androgenowymi, co prowadzi do modyfikacji transkrypcji genów w obecności ko-aktywatorów i ko-represorów¹. Klasyczne efekty działania testosteronu wynikają z jego interakcji z receptorem androgenowym, jednak należy podkreślić, że receptory androgenowe są zwykle wysycone przez fizjologiczne poziomy testosteronu, a mimo to suprafizjologiczne dawki testosteronu mogą zwiększać masę mięśniową i siłę ciała². To sugeruje, że anaboliczne efekty egzogennego testosteronu mogą być wyjaśnione mechanizmami innymi niż tylko modulacja receptorów androgenowych.

Mechanizmy molekularne działania AAS

Sterydy anaboliczne naśladują właściwości naturalnie występujących hormonów. Ich skład chemiczny jest podobny do testosteronu i może aktywować receptory testosteronu w organizmie³. Po stymulacji receptorów następuje kaskada reakcji metabolicznych, ponieważ lek instruuje organizm do zwiększenia produkcji tkanki mięśniowej⁴. Sterydy anaboliczne zwiększają proliferację komórek satelitarnych mięśni i sprzyjają tworzeniu nowych miorurek i miojąder⁵. Ponadto, regulują w górę i zwiększają liczbę receptorów androgenowych, co umożliwia zwiększenie intensywności treningu i pośrednio przyczynia się do zwiększenia rozmiaru i siły mięśni⁶.

Znane modyfikacje cząsteczki testosteronu dotyczą alkilacji struktury węgla 17α, której celem jest uzyskanie pochodnych o bardziej anabolicznym i mniej androgennym działaniu niż podstawowa cząsteczka testosteronu, oraz estryfikacji grupy 17β-hydroksylowej przez kwasy karboksylowe, co zwiększa aktywność uzyskanego związku i wydłuża jego działanie poprzez uzyskanie lepszej lipofilności⁷. Warto wspomnieć o leku Dromostanolon, który zwiększa zatrzymywanie azotu, fosforu i potasu, co skutkuje zwiększonym anabolizmem białek i zmniejszeniem katabolizmu aminokwasów, prowadząc do zwiększenia gęstości i twardości mięśni⁸.

Biologiczne efekty AAS i ich metabolitów są głównie pośredniczone przez receptory wewnątrzkomórkowe obecne w mózgu i układzie rozrodczym, a także w wielu tkankach nie związanych z rozmnażaniem, takich jak kości, mięśnie szkieletowe, wątroba, nerki i adipocyty⁹. Efekt anaboliczny związany jest z zatrzymaniem azotu, co skutkuje zwiększeniem jego biodostępności dla tkanek i zmniejszeniem aktywności glikokortykosteroidów, co zmniejsza reakcje kataboliczne¹⁰.

Alternatywne ścieżki działania AAS

Oprócz klasycznego mechanizmu działania AAS, czyli efektów genomowych pośredniczonych przez AR, wykazano również szybkie, niegenomowe efekty dla kilku narządów docelowych¹¹. Biorąc pod uwagę, że szybkie odpowiedzi indukowane przez AAS zostały zaobserwowane w typach komórek, które nie wykazują ekspresji AR lub w obecności antagonistów AR, uzasadnione jest przypuszczenie, że efekty te mogą być wyzwalane przez mechanizmy inne niż pośredniczone przez AR¹².

Testosteron może być przekształcany w estradiol za pośrednictwem enzymu aromatazy oraz przekształcany w dihydrotestosteron (DHT) za pośrednictwem enzymów 5α-reduktazy. Podawanie suprafizjologicznych dawek testosteronu powoduje więc zwiększenie poziomów estradiolu i DHT¹³. Modyfikując cząsteczkę testosteronu, można zapobiec aromatyzacji lub 5α-redukcji, próbując poprawić stosunek korzyści do szkód związanych z danym związkiem¹⁴.

Badania wykazały, że podawanie AAS może prowadzić do zmniejszenia regulacji receptorów androgenowych¹⁵. Ponadto hamowanie aktywności glikokortykoidów prowadzi prawdopodobnie do aktywacji osi hormonu wzrostu (GH) i insulinopodobnego czynnika wzrostu (IGF-1), gdzie zwykle ma działanie hamujące¹⁶.

Wpływ na układ hormonalny

Podawanie egzogennych AAS prowadzi do zmniejszenia regulacji osi podwzgórze-przysadka-gonady (HPA), co prowadzi do zmniejszenia endogennej produkcji testosteronu poprzez hamowanie normalnej funkcji jąder (zmniejszona objętość jąder, produkcja plemników i testosteronu)¹⁷¹⁸. Hipogonadyzm jest charakterystyczną cechą nadużywania AAS, co może mieć głęboki wpływ na układ rozrodczy¹⁹.

Egzogenne podawanie pochodnych syntezy testosteronu indukuje negatywne sprzężenie zwrotne w osi podwzgórze-przysadka, a tym samym hamuje wydzielanie zarówno FSH, jak i LH²⁰. Apoptoza odgrywa ważną rolę w regulacji populacji komórek rozrodczych w dojrzałych jądrach²¹. Leczenie niepłodności testosteronem nie poprawia spermatogenezy; podawany egzogenny testosteron i jego metabolit, estrogen, hamują produkcję hormonu uwalniającego gonadotropinę (GnRH) przez podwzgórze oraz produkcję hormonu luteinizującego (LH) przez przysadkę mózgową, a tym samym produkcję testosteronu jądrowego²².

Po cyklu terapii, czyli PCT, jest nieudowodnioną strategią, której celem jest jak najszybsze przywrócenie endogennej produkcji testosteronu po cyklu AAS. Nieunikniony efekt uboczny nadużywania AAS to zahamowanie produkcji gonadotropiny, głównie do niewykrywalnych poziomów, i późniejsze zamknięcie produkcji testosteronu jądrowego²³.

Patofizjologia nadużywania sterydów anabolicznych

Wpływ na układ sercowo-naczyniowy

Wśród powikłań związanych ze stosowaniem AAS, efekty uboczne sercowo-naczyniowe są postulowane jako mające najsilniejsze konsekwencje dla śmiertelności, a niektóre badania sugerują, że mogą być one pierwotną przyczyną przedwczesnej śmierci u osób stosujących AAS nawet w 33-66% przypadków²⁴. Długotrwałe stosowanie AAS może prowadzić do zwiększonej grubości kompleksu błona wewnętrzna-środkowa tętnicy szyjnej (cIMT), zwiększonej prędkości fali tętna (PWV) i zmniejszonej elastyczności tętnic. Wyniki te były poparte funkcjonalnymi zmianami naczyniowymi po ekspozycji na suprafizjologiczne dawki testosteronu u młodych myszy²⁵.

Podczas gdy mechanizmy leżące u podstaw śmierci sercowej u osób stosujących AAS są niekompletnie zrozumiałe, zaproponowano cztery możliwości, które obejmują: (1) model potencjalizacji miażdżycy, (2) model zakrzepowy, (3) skurcz naczyń wieńcowych i (4) bezpośrednie uszkodzenie serca²⁶. Ryzyko sercowo-naczyniowe związane z AAS obejmuje dysfunkcję mięśnia sercowego, miażdżycę tętnic wieńcowych, hyperkoagulopatię i dysfunkcję wątroby, nadciśnienie, zagrażające życiu arytmie i nagłą śmierć²⁷²⁸.

Koncentryczne przerost lewej komory jest powszechnie obserwowany u długoterminowych użytkowników sterydów, nawet po przerwaniu stosowania AAS²⁹. Przedłużone stosowanie AAS prowadzi również do podwyższenia poziomu LDL i redukcji HDL, co zwiększa ryzyko wystąpienia incydentu sercowego³⁰.

Badania wykazały, że podawanie suprafizjologicznych dawek AAS może potencjalnie prowadzić do strukturalnych zmian ścian naczyń i powodować dysfunkcję śródbłonka, co może wpływać na właściwości elastyczne układu naczyniowego, indukować tworzenie blaszek miażdżycowych i być prekursorem rozwoju miażdżycy³¹. Utrata elastyczności tętnic jest głównie wynikiem nadprodukcji kolagenu³².

Wpływ na wątrobę

Hepatotoksyczność jest powszechnie spotykanym skutkiem ubocznym stosowania AAS, a jedno z badań wykazało, że uszkodzenia wątroby związane z AAS stanowiły 8% wszystkich przypadków uszkodzeń wątroby wywołanych przez leki³³. Spektrum uszkodzeń wątroby wywołanych przez AAS jest zróżnicowane w możliwej patologii³⁴.

Hepatotoksyczność indukowana przez sterydy anaboliczne jest zależna od dawki i przewidywalna. Jej najczęstszą manifestacją jest zapalenie wątroby z zastojem żółci, a inne rodzaje uszkodzeń związane z wysokimi dawkami tych leków to: cholestaza czysta, ostre zapalenie wątroby z zastojem żółci, ostre uszkodzenie hepatokomórkowe i nowotwory wątroby³⁵.

Obecnie uważa się, że mechanizmy patogenezy tych zaburzeń obejmują zaburzenie czynników antyoksydacyjnych, zwiększenie syntezy kwasów żółciowych i indukcję hiperplazji hepatocytów³⁶. Proponowane mechanizmy uszkodzenia wątroby obejmują indukowane przez sterydy anaboliczne nacieki komórek zapalnych w tkance wątrobowej oraz aktywację komórek Kupffera prowadzącą do produkcji cytokin zapalnych i odkładania kolagenu, zwiększony stres oksydacyjny i reaktywne formy tlenu z następową degeneracją mitochondriów w komórkach wątroby oraz stymulację wewnątrzkomórkowych receptorów steroidów androgennych indukującą niekontrolowany wzrost hepatocytów³⁷.

Wpływ na układ nerwowy

Najnowsze doniesienia na temat stosowania ponadfizjologicznych dawek AAS dotyczą znacznego przyspieszenia procesów starzenia się mózgu, dysfunkcji poznawczych i zaburzeń psychospołecznych. Jest to związane z łatwym dostępem AAS do komórek OUN ze względu na ich zdolność do przenikania bariery krew-mózg oraz bogate zaopatrzenie w receptory AAS, które są skoncentrowane w pniu mózgu, ciele migdałowatym, podwzgórzu, prążkowiu, korze mózgowej i hipokampie³⁸.

Literatura pokazuje, że ponadfizjologiczne dawki AAS mogą indukować proces apoptozy komórek nerwowych³⁹. Model neurotoksyczności zaproponowany w 2019 r. opiera się na agregacji beta-amyloidu i białka tau, wynikającej ze wzrostu stresu oksydacyjnego w neuronach OUN⁴⁰. Przyspieszona akumulacja białka Tau i beta-amyloidu jest związana z wpływem AAS na ekspresję i funkcję enzymów zaangażowanych w ich syntezę i eliminację, np. amyloidogennych β- i γ-sekretaz oraz białka prekursorowego amyloidu. Proces ten jest związany ze zwiększonym ryzykiem choroby Alzheimera i innych chorób neurodegeneracyjnych⁴¹.

Badania z wykorzystaniem kultur komórek korowych szczurów badały wpływ testosteronu i trzech jego syntetycznych pochodnych na śmierć neuronów wywoływaną ekscytotoksycznością N-metylo-D-asparaginianu (NMDA)⁴². Stanozolol nie jest substratem dla enzymu aromatazy, co może – nawet jeśli potrzebne są dalsze badania – pomóc nam zrozumieć efekt działania środka anabolicznego Winstrol Depot, który wykazał znaczne zmniejszenie gęstości neuronów⁴³.

Wyniki badań wskazują, że dawki testowane przekroczyły zdolność katalityczną enzymów, ponieważ nastąpiło znaczne zmniejszenie liczby ciał komórek neuronalnych w obszarach korowych⁴⁴. Istnieją dowody, że stosowanie syntetycznych androgenów obniża próg reaktywności emocjonalnej, odpowiedzi motorycznej, czujności na bodźce sensoryczne i zakłóca hamującą kontrolę nad niektórymi zachowaniami⁴⁵.

Badania pokazują, że sterydy anaboliczne mają szkodliwe, a często nieodwracalne efekty na mózg i wpływają na ten organ głównie poprzez dwa mechanizmy: 1) Neuronalną hiperstymulację poprzez zwiększenie aktywacji specyficznych neuroprzekaźników, takich jak noradrenalina, dopamina i serotonina; 2) Znaczne zmniejszenie połączeń neuronalnych w ośrodkowym układzie nerwowym, wpływające na kilka regionów mózgu, w tym zwoje podstawy, hipokamp i obszary korowe⁴⁶.

Wpływ na układ moczowy

Uszkodzenie nerek związane z AAS jest mniej zbadane w porównaniu z innymi efektami ubocznymi, chociaż niektóre możliwe mechanizmy obejmują bezpośrednią toksyczność lub nefropatię kwasów żółciowych wtórną do uszkodzenia wątroby związanego z AAS⁴⁷.

Badania wykazały, że nadużywanie sterydów anabolicznych ma potencjalne szkodliwe działanie na nerki, które nie było wcześniej rozpoznawane⁴⁸. Badacze zbadali grupę 10 kulturystów, którzy przyjmowali sterydy anaboliczne przez lata⁴⁹. U wszystkich rozwinął się wyciek białka do moczu i poważne ograniczenie funkcji nerek⁵⁰.

Badacze proponują, że ekstremalne zwiększenie masy mięśniowej zmusza nerki do zwiększenia obciążenia filtracyjnego, wywierając szkodliwy poziom stresu na te narządy⁵¹. Ponieważ uszkodzenie nerek po nadużywaniu sterydów jest bardziej poważne klinicznie i patologicznie niż to obserwowane u pacjentów z chorobliwą otyłością z jeszcze wyższymi wskaźnikami masy ciała, prawdopodobne jest również, że sterydy anaboliczne mają bezpośrednie działanie toksyczne na kłębuszki, których komórki mają receptory dla tych substancji⁵².

Przewlekła hiperfiltracja z diety wysokobiałkowej może przyspieszać progresję do glomerulosklerozy⁵³. Systemowe nadciśnienie, a także ekstremalne epizodyczne podwyższenia ciśnienia krwi, typowo doświadczane podczas podnoszenia ciężarów, również mogą przyczyniać się do uszkodzenia nerek⁵⁴.

Mechanizmy uzależnienia od sterydów anabolicznych

Sterydy anaboliczne są uzależniające z powodu dwóch głównych czynników. Pierwszym jest zachowanie wielu osób z zaburzeniami używania substancji (SUD), kompulsywna potrzeba poszukiwania i używania sterydów anabolicznych. Drugim jest pojawienie się objawów odstawienia sterydów anabolicznych, gdy użytkownik ogranicza lub całkowicie zaprzestaje stosowania sterydów⁵⁵. Obsesyjno-kompulsywne zachowanie mające na celu kontynuowanie stosowania sterydów anabolicznych często zaczyna się, gdy sterydy poprawiają wygląd fizyczny i siłę w krótkim czasie, co może ostatecznie doprowadzić do rozwoju uzależnienia⁵⁶.

Osoby przyjmujące sterydy mogą również rozwinąć tolerancję na leki i doświadczać objawów odstawienia, takich jak niski popęd seksualny, utrata apetytu, wahania nastroju, zmęczenie, bezsenność i depresja, gdy przestają je przyjmować⁵⁷. Osoby, które przyjmują sterydy przez dłuższy czas, zakłócają naturalną równowagę hormonalną w swoim organizmie. Kiedy osoba uzależniona od sterydów nagle przestaje przyjmować leki, może stać się przygnębiona, a nawet mieć myśli samobójcze z powodu tych zaburzeń hormonalnych⁵⁸.

Sterydy działają jako środki podnoszące nastrój, co daje efekty podobne do leków przeciwdepresyjnych. Gdy osoba, szczególnie mężczyzna, kończy cykl steroidowy, może rozwinąć się stan zwany odbiciem estrogenu. Skutkuje to produkcją i uwalnianiem żeńskiego hormonu estrogenu w szybkim, podwyższonym tempie. Skutki uboczne odbicia estrogenu obejmują objawy depresji⁵⁹. Im większa dawka sterydów anabolicznych i im dłuższy czas ich nadużywania, tym cięższe będą objawy odbicia estrogenu⁶⁰.

Nowe badanie zaprojektowane w celu sprawdzenia, czy sterydy androgenno-anaboliczne mogą być uzależniające, wykazało, że chomiki narażone na te związki z czasem wykazywały zachowania uzależniające⁶¹. Konkretny wzorzec nadużywania demonstrowany przez chomiki sugeruje, że powszechnie panujące przekonanie na temat sterydów jest prawdziwe: zamiast ostrego haju, jakiego doświadcza użytkownik kokainy czy heroiny, osoby nadużywające sterydów doświadczają przewlekłego, długotrwałego poczucia dobrego samopoczucia⁶². Innymi słowy, użytkownicy sterydów czują się lepiej na lekach niż bez nich⁶³.

Wzorce nadużywania sterydów anabolicznych

Sportowcy mogą przyjmować ustaloną dawkę jednego lub wielu rodzajów sterydów przez pewien okres, przerwać, a następnie ponownie rozpocząć (cyklicznie) kilka razy w roku. Intermitentne przerywanie stosowania leków ma na celu umożliwienie powrotu do normy poziomów testosteronu endogennego, liczby plemników i osi podwzgórze-przysadka-gonady⁶⁴.

Sportowcy często stosują jednocześnie wiele rodzajów sterydów anabolicznych (praktyka zwana układaniem). Mogą jednocześnie stosować różne drogi podawania (doustną, domięśniową lub przezskórną)⁶⁵. Układanie i piramidowanie mają na celu zwiększenie wiązania receptorów i zminimalizowanie skutków ubocznych, ale te korzyści nie zostały potwierdzone⁶⁶.

Choć stosowanie sterydów anabolicznych-androgennych, w odpowiednich dawkach i pod nadzorem lekarza może być bezpieczne i efektywne w leczeniu stanów chorobowych, to ich nadużywanie, szczególnie w dużych dawkach, prowadzi do poważnych konsekwencji zdrowotnych⁶⁷. Głównym leczeniem dla użytkowników sterydów anabolicznych jest zaprzestanie ich stosowania. Mimo że nie występuje fizyczne uzależnienie, uzależnienie psychiczne, szczególnie u kulturystów wyczynowych i sportowców, może istnieć⁶⁸.

Główne mechanizmy patofizjologiczne nadużywania sterydów anabolicznych	Objawy i skutki	Narządy docelowe
Modulacja receptorów androgenowych	Wzrost masy mięśniowej, hipertrofia mięśni, zmiany w ekspresji genów	Mięśnie szkieletowe, kości, układ rozrodczy
Zaburzenie osi podwzgórze-przysadka-gonady	Hipogonadyzm, zmniejszenie produkcji endogennego testosteronu, zaburzenia płodności	Układ rozrodczy, jądra, przysadka
Wzrost stresu oksydacyjnego	Uszkodzenie komórek, apoptoza, stany zapalne	Wątroba, serce, nerki, neurony
Zaburzenia lipidowe	Zwiększenie LDL, zmniejszenie HDL, miażdżyca, ryzyko chorób sercowo-naczyniowych	Układ sercowo-naczyniowy, naczynia krwionośne
Neurotoksyczność	Zaburzenia poznawcze, zmiany zachowania, agregacja beta-amyloidu, przyspieszone starzenie się mózgu	Ośrodkowy układ nerwowy, hipokamp, kora mózgowa
Mechanizmy uzależnienia	Tolerancja, objawy odstawienia, kompulsywne użycie	Układ nagrody w mózgu, układy neuroprzekaźników

Specyfika odstawienia sterydów anabolicznych

Czas powrotu do zdrowia po odstawieniu sterydów anabolicznych jest bardzo zróżnicowany i zależy od wieku i stopnia nadużywania androgenów. Zmiany fizyczne, takie jak atrofia jąder, mogą wymagać prawie pełnego powrotu do zdrowia przez miesiące do lat; spermatogeneza może osiągnąć pełny powrót do zdrowia w ciągu miesięcy do lat; libido wraca do poziomu wyjściowego w ciągu kilku miesięcy (zazwyczaj mniej nasilone niż podczas stosowania AAS); a powrót do zdrowia po ginekomastii jest mało prawdopodobny⁶⁹.

W przypadku powrotu do zdrowia psychicznego dane są niewystarczające i sprzeczne, wskazujące na przejściowy okres odstawienia, po którym mogą nastąpić utrzymujące się dłużej łagodniejsze objawy⁷⁰. W przypadku powrotu do zdrowia biochemicznego, prawie całkowity powrót testosteronu do normy obserwuje się w ciągu miesięcy, a całkowity powrót do zdrowia gonadotropin jest spodziewany w ciągu 3-6 miesięcy⁷¹.

Stłumienie gonadotropin jest zależne od dawki i zależy również od rodzaju stosowanego androgenu. Innymi słowy, hamowanie zwrotne androgenów nie jest absolutne (włączanie lub wyłączanie), ale stopniowe⁷². Innym powodem zmienności obserwowanej w powrocie do zdrowia po ASIH jest fakt, że neurony KNDy otrzymują dane z otoczenia hormonalnego organizmu od leptyny, CRH, kortyzolu i prolaktyny, a także podlegają wyższej regulacji neuronalnej, takiej jak neurony metaboliczne pierwszego rzędu POMC i NPY/AgRP, a także neurony z regionu jądra nadskrzyżowaniowego⁷³.

W większości badań FSH i LH wracały do wartości wyjściowych (lub nie różniły się znacząco od kontroli) 2-16 tygodni po zaprzestaniu. Jednak kilka badań opisało obniżone poziomy gonadotropin po pomiarze po 2 tygodniach, 6 tygodniach lub 12 tygodniach po zaprzestaniu AAS⁷⁴.

W końcu, zaprzestanie nadużywania AAS jest często związane z uciążliwymi zaburzeniami psychologicznymi, zwłaszcza lękiem i depresją. Nie jest jasne, czy te zaburzenia istnieją przed nadużywaniem AAS i przyczyniają się do nadużywania AAS, czy też nadużywanie AAS ujawnia lub prowadzi do lęku i depresji⁷⁵.

Efekty kardiotoksyczne nadużywania sterydów anabolicznych

Wysokie dawki sterydów anaboliczno-androgennych (AAS) są skuteczne w budowaniu masy mięśniowej, ale niosą ryzyko skutków ubocznych dla układu sercowo-naczyniowego⁷⁶. Coraz więcej dowodów łączy wysokie dawki AAS z różnymi powikłaniami sercowo-naczyniowymi, w tym ze sztywnością tętnic⁷⁷.

Badania wykazały, że podawanie suprafizjologicznych dawek AAS może potencjalnie prowadzić do strukturalnych zmian ścian naczyń i powodować dysfunkcję śródbłonka, co może wpływać na właściwości elastyczne układu naczyniowego, indukować tworzenie blaszek miażdżycowych i być prekursorem rozwoju miażdżycy⁷⁸. Utrata elastyczności tętnic jest głównie wynikiem nadprodukcji kolagenu⁷⁹.

AAS mogą mieć wiele efektów na układ sercowo-naczyniowy, co może przyczyniać się do ryzyka zawałów serca⁸⁰. Wysokie poziomy LDL i niskie poziomy HDL zwiększają ryzyko miażdżycy, stanu związanego z gromadzeniem się płytki wewnątrz tętnic⁸¹. Sterydy zwiększają również ryzyko tworzenia się skrzepów krwi w naczyniach krwionośnych, potencjalnie zakłócając przepływ krwi i uszkadzając mięsień sercowy⁸². Jeśli krew nie może dotrzeć do serca lub mózgu, może to prowadzić do zawału serca lub udaru⁸³.

Ponadto, sterydy anaboliczne mogą powodować zmiany strukturalne w sercu, zmniejszając funkcję komór serca i wywołując nieregularne bicie serca, co może stać się zagrażające życiu⁸⁴. Eksperci ds. zdrowia nie rozumieją w pełni związku między sterydami anabolicznymi a zawałami serca. Jednak badania sugerują, że substancje te mają szkodliwy wpływ na zdrowie układu sercowo-naczyniowego. Z czasem nadużywanie sterydów anabolicznych może powodować zawały serca⁸⁵.

U szczurów leczonych AAS wykazano znaczny wzrost poziomu troponiny I⁸⁶. Troponina I sercowa (cTnI) jest enzymem sercowym, który jest uwalniany, gdy występuje uszkodzenie miocytów i jest uważana za czuły wskaźnik tych uszkodzeń⁸⁷.

Jeśli chodzi o profil lipidowy, u szczurów otrzymujących AAS wykazano znaczny wzrost poziomu cholesterolu w surowicy, trójglicerydów i LDL oraz znaczne zmniejszenie poziomu HDL w surowicy⁸⁸. Nadużywanie AAS w dawkach suprafizjologicznych jest silnie związane z nieprawidłowymi poziomami lipoprotein w osoczu, wykazującymi obniżony poziom HDL i podwyższone poziomy LDL i cholesterolu⁸⁹.

W badaniu histopatologicznym mięśnia sercowego najbardziej obserwowanymi zmianami były zmiany degeneracyjne i martwica mięśnia sercowego (hialinoza), które były poważne u szczurów leczonych AAS⁹⁰.

Efekty hepatotoksyczne nadużywania sterydów anabolicznych

Sterydy anaboliczno-androgenne (AAS) są grupą cząsteczek obejmujących endogenny testosteron i syntetyczne pochodne, które mają zarówno androgenne, jak i anaboliczne efekty⁹¹. Jednak są one powszechnie kupowane nielegalnie i niewłaściwie używane ze względu na ich anaboliczne, budujące mięśnie szkieletowe i poprawiające wydajność efekty. Suprafizjologiczne i długotrwałe stosowanie AAS wpływa na wszystkie narządy, prowadząc do zaburzeń sercowo-naczyniowych, neurologicznych, endokrynologicznych, żołądkowo-jelitowych, nerkowych i hematologicznych. Hepatotoksyczność jest jednym z głównych problemów związanych z leczeniem i nadużywaniem AAS⁹².

Zaproponowano kilka mechanizmów patofizjologicznych, w tym odpowiedź zapalną pośredniczoną przez receptor AR, zaburzenie hepatycznych czynników antyoksydacyjnych, promocję hiperplazji hepatocytów i regulację w górę syntezy kwasów żółciowych⁹³.

Uszkodzenie wątroby wywołane przez leki (DILI) wtórne do stosowania sterydów anabolicznych było podejrzewane, dlatego obliczono wartość R wynoszącą 0,27, wskazującą na wzorzec uszkodzenia cholestatycznego⁹⁴. Hepatotoksyczność indukowana przez sterydy anaboliczne jest zależna od dawki i przewidywalna. Jej najczęstszą prezentacją jest zapalenie wątroby z zastojem żółci, a inne rodzaje uszkodzeń związane z wysokimi dawkami tych leków to: cholestaza czysta, ostre zapalenie wątroby z zastojem żółci, ostre uszkodzenie hepatokomórkowe i nowotwory wątroby⁹⁵.

Uszkodzenie wątroby wywołane przez AAS powinno być brane pod uwagę u pacjentów z zaburzeniami wątroby, zwłaszcza przy rosnącym niezamierzonym spożyciu suplementów zawierających AAS⁹⁶. Stosowanie AAS jest ściśle powiązane z hepatotoksycznością i poważnymi chorobami wątroby, takimi jak cholestaza, wątroba pęcherzykowa i łagodne oraz złośliwe guzy wątroby, a także stłuszczeniowe zapalenie wątroby i dyslipidemia, przy czym wiele badań potwierdza związek przyczynowy⁹⁷.

Efekty nadużywania sterydów anabolicznych na płodność

Niepłodność po stosowaniu AAS jest wtórna do zahamowania poziomu testosteronu wewnątrzjądrowego, co może prowadzić do azoospermii lub oligozoospermii⁹⁸. Męska niepłodność może być bardzo wrażliwą i trudną kwestią dla wielu mężczyzn do zaakceptowania. Może to być dużym zaskoczeniem, że to oni mogą tworzyć problem, przyjmując pewne suplementy – zwłaszcza sterydy (anaboliczne). Sterydy, które są używane do wzmocnienia siły i sprawności, mogą drastycznie obniżyć liczbę plemników (do zera w wielu przypadkach)⁹⁹.

Sterydy, które są przyjmowane w celu promowania wzrostu mięśni i ogólnej sprawności, mogą w rzeczywistości oszukiwać mózg, że produkowana jest wystarczająca ilość testosteronu. W rezultacie mózg zmniejsza swoją sygnalizację do jąder. Stosowanie sterydów może prowadzić do niskiej (lub nieobecnej) liczby plemników i skurczonych jąder. W pewnym sensie sterydy mogą działać jak męska antykoncepcja¹⁰⁰.

Dobrą wiadomością jest, że jest to często bardzo uleczalna i odwracalna forma męskiej niepłodności. Po zaprzestaniu stosowania sterydów, zwykle zajmuje około trzech miesięcy, aby plemniki powróciły w nasieniu. U mężczyzn, którzy stosowali sterydy przez długi czas, powrót do zdrowia może trwać dłużej – nawet czasami rok lub dłużej¹⁰¹.

Długoterminowy wpływ wysokich dawek AAS na funkcje seksualne pozostaje słabo zdefiniowany¹⁰². Chociaż wysokie dawki T wydawały się chronić funkcję erekcyjną podczas stosowania, de novo objawy takie jak zmniejszone libido i zaburzenia erekcji występowały częściej po zaprzestaniu stosowania T, szczególnie wśród tych, którzy stosowali częściej i przez dłuższy czas¹⁰³.

Te ustalenia mogą sugerować, że do pewnego stopnia organizm staje się zależny od hiper-suplementacji T (zahamowanie osi podwzgórze-przysadka-gonady, możliwa zmiana gęstości receptorów androgenowych, możliwa regulacja w dół na poziomie jądrowym), efekt, który jest rozpoznawany dopiero po zaprzestaniu¹⁰⁴. Stosowanie terapii modulujących estrogen okazało się czynnikiem ochronnym w utrzymaniu funkcji erekcyjnej po zaprzestaniu stosowania AAS¹⁰⁵.

Ogólnie rzecz biorąc, ustalenia sugerują, że zwiększona częstotliwość i czas trwania AAS w wysokich dawkach może skutkować dysfunkcjami seksualnymi po zaprzestaniu stosowania i wymaga dalszych badań¹⁰⁶.

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Materiały źródłowe

#1 Anabolic steroids | PPT
https://www.slideshare.net/docpravin/anabolic-steroids-104178799
Anabolic steroids are synthetic androgens that have higher anabolic activity and lesser androgenic activity than testosterone. […] They work by binding to androgen receptors and modifying gene transcription. […] Accepted medical uses of anabolic steroids include treating catabolic states like cancer, but their misuse among athletes to improve performance is considered illegal doping. […] Anabolic steroids: Mechanism of Action MOA: Binds to androgen receptors (AR) Interacts with the androgen response elements Modifies gene transcription in presence of co-activators and co-repressors. […] Anabolic steroids: Misuse Enhance physical abilities in athletes Steroids+ exercise = increased strength of muscle Short-lived effects Uncertain improvement in performance Considered illegal Included in dope-test. […] Anabolic steroids are synthetic androgens with higher selectivity for anabolic effects They are used for brief duration during catabolic states Their use to boost athletic performance is illegal.
#2 Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects
https://pmc.ncbi.nlm.nih.gov/articles/PMC8683244/
Anabolic-androgenic steroids (AAS) encompass a broad group of natural and synthetic androgens. […] The aim of this paper is to review the current evidence base on AAS with emphasis on mechanisms of action, adverse effects, and user profiles that are most likely to engage in AAS misuse. […] The classic effects of serum testosterone derive from its interaction with the androgen receptor. […] The current consensus is that androgenic anabolic steroids do indeed improve both. […] Since androgen receptors are normally saturated by physiologic levels of testosterone, yet supraphysiologic doses of testosterone can increase muscle mass and body strength, the anabolic effects of exogenous testosterone may be explained by mechanisms other than androgen receptor modulation. […] Inhibition of glucocorticoid activity likely results in activation of the growth-hormone (GH) and insulin-like growth factor (IGF-1) axis, where it usually has a suppressive effect.
#3 Anabolic steroids | Better Health Channel
https://www.betterhealth.vic.gov.au/health/healthyliving/steroids
Anabolic steroids are a group of synthetic drugs. They copy the masculinising effects of the male sex hormone, testosterone. […] The misuse of anabolic steroids can cause long-term side effects. These can include cardiovascular complications, liver disease, reproductive organ damage and severe mood swings. […] Anabolic steroids work by imitating the properties of naturally occurring hormones, Their chemical composition is similar to testosterone and can activate the bodys testosterone receptors. […] Once the receptors are stimulated, a domino effect of metabolic reactions takes place as the drug instructs the body to increase muscle tissue production. […] Anabolic steroids can produce many unpleasant and often permanent side effects, including: damage to the gonads (testicles or ovaries), liver disease, malfunctions of the kidneys, liver or heart, 'roid rage’, which is characterised by uncontrollable outbursts of psychotic aggression, paranoia and mood swings, including deep depression.
#4 Anabolic steroids | Better Health Channel
https://www.betterhealth.vic.gov.au/health/healthyliving/steroids
Anabolic steroids are a group of synthetic drugs. They copy the masculinising effects of the male sex hormone, testosterone. […] The misuse of anabolic steroids can cause long-term side effects. These can include cardiovascular complications, liver disease, reproductive organ damage and severe mood swings. […] Anabolic steroids work by imitating the properties of naturally occurring hormones, Their chemical composition is similar to testosterone and can activate the bodys testosterone receptors. […] Once the receptors are stimulated, a domino effect of metabolic reactions takes place as the drug instructs the body to increase muscle tissue production. […] Anabolic steroids can produce many unpleasant and often permanent side effects, including: damage to the gonads (testicles or ovaries), liver disease, malfunctions of the kidneys, liver or heart, 'roid rage’, which is characterised by uncontrollable outbursts of psychotic aggression, paranoia and mood swings, including deep depression.
#5 Anabolic Steroids | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/17499
Endogenous anabolic steroids such as testosterone and dihydrotestosterone, as well as synthetic anabolic steroids, mediate their effects by binding to and activating androgen receptors. […] Anabolic steroids increase muscle satellite cell proliferation and promote the formation of new myotubules and myonuclei. […] Anabolic steroid abuse can inappropriately activate signaling proteins like mTOR, disrupt normal protein synthesis, modify cell cycle metabolism, increase oxidative stress, and cause cellular apoptosis. […] The estimated overall risk of death among chronic anabolic steroid abusers is roughly double or triple that of the age-adjusted male control population. […] Anabolic steroids also upregulate and increase the number of androgen receptors, thus enabling increased training intensity and indirectly contributing to increased muscle size and strength.
#6 Anabolic Steroids | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/17499
Endogenous anabolic steroids such as testosterone and dihydrotestosterone, as well as synthetic anabolic steroids, mediate their effects by binding to and activating androgen receptors. […] Anabolic steroids increase muscle satellite cell proliferation and promote the formation of new myotubules and myonuclei. […] Anabolic steroid abuse can inappropriately activate signaling proteins like mTOR, disrupt normal protein synthesis, modify cell cycle metabolism, increase oxidative stress, and cause cellular apoptosis. […] The estimated overall risk of death among chronic anabolic steroid abusers is roughly double or triple that of the age-adjusted male control population. […] Anabolic steroids also upregulate and increase the number of androgen receptors, thus enabling increased training intensity and indirectly contributing to increased muscle size and strength.
#7 Innovative Reports on the Effects of Anabolic Androgenic Steroid AbuseâHow to Lose Your Mind for the Love of Sport
https://www.mdpi.com/1648-9144/59/8/1439
The known modifications of the testosterone molecule concern the alkylation of the 17Î± carbon structure, the aim of which is to obtain derivatives with more anabolic and less androgenic effects than the basic testosterone molecule, and esterification of the 17Î²-hydroxyl group by carboxylic acids, which increases the activity of the obtained compound and prolongs its action by obtaining better lipophilicity. […] The anabolic effect is related to the retention of nitrogen which results in an increase in its bioavailability to tissues and a decrease in the activity of glucocorticosteroids which reduces catabolic reactions. […] The effect of chronic AAS use on lipid metabolism was emphasized in a study involving men with hypogonadism undergoing testosterone replacement therapy, which resulted in a reduction in high-density lipoprotein cholesterol (HDL) levels in the serum.
#8 Anabolic Steroids | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/17499
Dromostanolone increases the retention of nitrogen, phosphorus, and potassium, resulting in increased protein anabolism and a decrease in the catabolism of amino acids, leading to an increase in the density and hardness of muscle. […] In some cases of symptomatic hypogonadism, clomiphene can be used to increase testosterone levels to normal without directly using anabolic steroids and without affecting fertility.
#9 Innovative Reports on the Effects of Anabolic Androgenic Steroid AbuseâHow to Lose Your Mind for the Love of Sport
https://www.mdpi.com/1648-9144/59/8/1439
Anabolic-androgenic steroids (anabolic-androgenic steroids, AAS) are testosterone-derived compounds whose popularity and use are constantly growing. Chronic use of AAS leads to many hormonal and metabolic disorders in the human body, which often lead to permanent health damage. Changes affect the following systems: cardiovascular, musculoskeletal, reproductive, digestive, and nervous. […] The literature also describes numerous AAS side effects associated with damage to the cardiovascular, immune, nervous, and hematological systems and impaired liver function while more recent reports concern neurodegenerative changes. […] Anabolic-androgenic steroids (AAS) are a group of hormones that include testosterone and many of its synthetic derivatives. The biological effects of SAAs and their metabolites are mainly mediated by intracellular receptors present in the brain and reproductive system as well as many non-reproductive tissues such as bone, skeletal muscle, liver, kidney, and adipocytes.
#10 Innovative Reports on the Effects of Anabolic Androgenic Steroid AbuseâHow to Lose Your Mind for the Love of Sport
https://www.mdpi.com/1648-9144/59/8/1439
The known modifications of the testosterone molecule concern the alkylation of the 17Î± carbon structure, the aim of which is to obtain derivatives with more anabolic and less androgenic effects than the basic testosterone molecule, and esterification of the 17Î²-hydroxyl group by carboxylic acids, which increases the activity of the obtained compound and prolongs its action by obtaining better lipophilicity. […] The anabolic effect is related to the retention of nitrogen which results in an increase in its bioavailability to tissues and a decrease in the activity of glucocorticosteroids which reduces catabolic reactions. […] The effect of chronic AAS use on lipid metabolism was emphasized in a study involving men with hypogonadism undergoing testosterone replacement therapy, which resulted in a reduction in high-density lipoprotein cholesterol (HDL) levels in the serum.
#11 Neurophysiological Repercussions of Anabolic Steroid Abuse: A Road into Neurodegenerative Disorders | IntechOpen
https://www.intechopen.com/chapters/56749
The classical mechanism of action of AS is the AR-mediated genomic effects; however, rapid, nongenomic effects were also demonstrated for several target organs. […] Given that rapid AS-induced responses have been observed in cell types that do not express the AR or in the presence of AR antagonists, it is reasonable to hypothesize that these effects might be triggered by mechanisms other than AR mediated. […] The neurotoxicity induced by AS can be further complicated by the induction of excitotoxicity effect. […] In this context, presenilin 1 (PS1) and presenilin 2 (PS2) regulate the proteolytic function of -secretases, and recent studies have demonstrated that mutations in both protein can result in accumulation of A42, which is the hallmark of Alzheimers disease. […] Taken together, these evidences have demonstrated that AS not only increases the generation of A oligomers in crucial areas of CNS associated with the cognitive and mnemonic capacities but also increases the neurotoxic effect of these molecules, which can substantially increase the susceptibility to Alzheimers disease. […] Taken together, these clinical and experimental evidences imply that chronic exposure to supraphysiological doses of AS can severely impair cognitive and mnemonic capacities.
#12 Neurophysiological Repercussions of Anabolic Steroid Abuse: A Road into Neurodegenerative Disorders | IntechOpen
https://www.intechopen.com/chapters/56749
The classical mechanism of action of AS is the AR-mediated genomic effects; however, rapid, nongenomic effects were also demonstrated for several target organs. […] Given that rapid AS-induced responses have been observed in cell types that do not express the AR or in the presence of AR antagonists, it is reasonable to hypothesize that these effects might be triggered by mechanisms other than AR mediated. […] The neurotoxicity induced by AS can be further complicated by the induction of excitotoxicity effect. […] In this context, presenilin 1 (PS1) and presenilin 2 (PS2) regulate the proteolytic function of -secretases, and recent studies have demonstrated that mutations in both protein can result in accumulation of A42, which is the hallmark of Alzheimers disease. […] Taken together, these evidences have demonstrated that AS not only increases the generation of A oligomers in crucial areas of CNS associated with the cognitive and mnemonic capacities but also increases the neurotoxic effect of these molecules, which can substantially increase the susceptibility to Alzheimers disease. […] Taken together, these clinical and experimental evidences imply that chronic exposure to supraphysiological doses of AS can severely impair cognitive and mnemonic capacities.
#13 Anabolic androgenic steroid abuse in young males in: Endocrine Connections Volume 9 Issue 4 (2020)
https://ec.bioscientifica.com/view/journals/ec/9/4/EC-19-0557.xml
This review summarizes 10 years experience with male abusers of anabolic androgenic steroids (AAS). […] Short-term clinical and biochemical side effects are well established. Long-term side effects are uncertain, but may include heart failure, mood-and anxiety disorders, hypogonadism and subfertility. […] Testosterone can be converted to oestradiol via the aromatase enzyme and converted to dihydrotestosterone (DHT) via the 5-reductase enzymes. Administration of supraphysiological doses of testosterone thus results in increased levels of oestradiol and DHT. […] By modifying the testosterone molecule, aromatisation or 5-reduction can be prevented, attempting to improve the benefit-to-harm ratio of the compound. […] Post cycle therapy, or PCT, is an unproven strategy that aims to restore endogenous testosterone production as soon as possible after a cycle of AAS. An inevitable side effect of AAS abuse is suppression of gonadotropin production, mostly to undetectable levels, and subsequent shutdown of testicular testosterone production.
#14 Anabolic androgenic steroid abuse in young males in: Endocrine Connections Volume 9 Issue 4 (2020)
https://ec.bioscientifica.com/view/journals/ec/9/4/EC-19-0557.xml
This review summarizes 10 years experience with male abusers of anabolic androgenic steroids (AAS). […] Short-term clinical and biochemical side effects are well established. Long-term side effects are uncertain, but may include heart failure, mood-and anxiety disorders, hypogonadism and subfertility. […] Testosterone can be converted to oestradiol via the aromatase enzyme and converted to dihydrotestosterone (DHT) via the 5-reductase enzymes. Administration of supraphysiological doses of testosterone thus results in increased levels of oestradiol and DHT. […] By modifying the testosterone molecule, aromatisation or 5-reduction can be prevented, attempting to improve the benefit-to-harm ratio of the compound. […] Post cycle therapy, or PCT, is an unproven strategy that aims to restore endogenous testosterone production as soon as possible after a cycle of AAS. An inevitable side effect of AAS abuse is suppression of gonadotropin production, mostly to undetectable levels, and subsequent shutdown of testicular testosterone production.
#15 Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects
https://pmc.ncbi.nlm.nih.gov/articles/PMC8683244/
Other studies have shown that AAS administration can result in androgen receptor downregulation. […] The adverse effect profile of exogenous AAS administration is a source of contention, with some raising the possibility that interpretations of data had been exaggerated. […] Among the complications of AAS use, cardiovascular side effects have been postulated to have the strongest mortality altering consequences, with some studies suggesting it to be the root cause of premature death in AAS users in up to 33-66% of cases. […] While the mechanisms behind cardiac death in AAS users are incompletely understood, four possibilities have been proposed, which include (1) atherosclerosis potentiation model, (2) thrombosis model, (3) coronary vasospasm, and (4) direct cardiac injury. […] Infertility following AAS use is secondary to suppression of intratesticular testosterone levels, which can lead to azoospermia or oligozoospermia.
#16 Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects
https://pmc.ncbi.nlm.nih.gov/articles/PMC8683244/
Anabolic-androgenic steroids (AAS) encompass a broad group of natural and synthetic androgens. […] The aim of this paper is to review the current evidence base on AAS with emphasis on mechanisms of action, adverse effects, and user profiles that are most likely to engage in AAS misuse. […] The classic effects of serum testosterone derive from its interaction with the androgen receptor. […] The current consensus is that androgenic anabolic steroids do indeed improve both. […] Since androgen receptors are normally saturated by physiologic levels of testosterone, yet supraphysiologic doses of testosterone can increase muscle mass and body strength, the anabolic effects of exogenous testosterone may be explained by mechanisms other than androgen receptor modulation. […] Inhibition of glucocorticoid activity likely results in activation of the growth-hormone (GH) and insulin-like growth factor (IGF-1) axis, where it usually has a suppressive effect.
#17 Anabolic Steroid Use Disorder | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/17498
Approximately 3 to 4 million Americans used anabolic-androgenic steroids to increase muscle mass, whether for sports to increase their performance or cosmetic purposes, such as enhancing their appearance. […] Among AAS users, about 30% develop dependence, which is characterized by chronic AAS use despite negative consequences and adverse effects on physical, psychosocial, or occupational functioning. […] Hypogonadism is a hallmark of AAS abuse, which may have profound effects on the reproductive system. […] Administration of exogenous AAS results in down-regulation of the HPA axis leading to reduced endogenous production of testosterone by suppressing the normal testicular function (reduced testicular volume, sperm, and testosterone production). […] Cardiovascular risk of AAS includes myocardial dysfunction, coronary atherosclerosis; hypercoagulopathy and hepatic dysfunction, hypertension, life-threatening arrhythmia, and sudden death.
#18 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK538174/
Hypogonadism is a hallmark of AAS abuse, which may have profound effects on the reproductive system. The majority of AAS users found to have low gonadotropin and testosterone levels even after the discontinuation of AAS. Administration of exogenous AAS results in down-regulation of the HPA axis leading to reduced endogenous production of testosterone by suppressing the normal testicular function (reduced testicular volume, sperm, and testosterone production). […] Cardiovascular risk of AAS includes myocardial dysfunction, coronary atherosclerosis; hypercoagulopathy and hepatic dysfunction, hypertension, life-threatening arrhythmia, and sudden death. Concentric Left ventricular hypertrophy is commonly seen in long term steroid users even after discontinuation of AAS. Prolonged use of AAS will also lead to elevation of LDL and reduction of HDL, conferring an increased risk of the cardiac event. AAS abuse may also lead to psychiatric and behavioral disturbances.
#19 Anabolic Steroid Use Disorder | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/17498
Approximately 3 to 4 million Americans used anabolic-androgenic steroids to increase muscle mass, whether for sports to increase their performance or cosmetic purposes, such as enhancing their appearance. […] Among AAS users, about 30% develop dependence, which is characterized by chronic AAS use despite negative consequences and adverse effects on physical, psychosocial, or occupational functioning. […] Hypogonadism is a hallmark of AAS abuse, which may have profound effects on the reproductive system. […] Administration of exogenous AAS results in down-regulation of the HPA axis leading to reduced endogenous production of testosterone by suppressing the normal testicular function (reduced testicular volume, sperm, and testosterone production). […] Cardiovascular risk of AAS includes myocardial dysfunction, coronary atherosclerosis; hypercoagulopathy and hepatic dysfunction, hypertension, life-threatening arrhythmia, and sudden death.
#20 Anabolic steroids abuse and male infertility | Basic and Clinical Andrology | Full Text
https://bacandrology.biomedcentral.com/articles/10.1186/s12610-016-0029-4
For several decades, testosterone and its synthetic derivatives have been used with anabolic and androgenic purposes. […] The abuse of anabolic steroids, is often associated with transient or persistent alterations of male reproductive function by different routes. […] Exogenous administration of testosterone synthesis derivatives induces negative feedback on the hypothalamic-pituitary axis and therefore inhibiting the secretion of both FSH and LH. […] Apoptosis has been reported to play an important role in the regulation of germ cell populations in the adult testis. […] The infertility treatment with testosterone does not improve spermatogenesis; the administered exogenous testosterone and its metabolite, estrogen, suppresses the production of Gonadotropin-releasing hormone (GnRH) by the hypothalamus and the production of luteinizing hormone (LH) by the pituitary gland, and therefore the production of testicular testosterone. […] According to most reports, the quality of sperm tends to normalize spontaneously within 4â12 months after cessation of anabolic steroid abuse. […] However, male infertility related to the abuse of AAS is underdiagnosed and yet it is a potentially curable form.
#21 Anabolic steroids abuse and male infertility | Basic and Clinical Andrology | Full Text
https://bacandrology.biomedcentral.com/articles/10.1186/s12610-016-0029-4
For several decades, testosterone and its synthetic derivatives have been used with anabolic and androgenic purposes. […] The abuse of anabolic steroids, is often associated with transient or persistent alterations of male reproductive function by different routes. […] Exogenous administration of testosterone synthesis derivatives induces negative feedback on the hypothalamic-pituitary axis and therefore inhibiting the secretion of both FSH and LH. […] Apoptosis has been reported to play an important role in the regulation of germ cell populations in the adult testis. […] The infertility treatment with testosterone does not improve spermatogenesis; the administered exogenous testosterone and its metabolite, estrogen, suppresses the production of Gonadotropin-releasing hormone (GnRH) by the hypothalamus and the production of luteinizing hormone (LH) by the pituitary gland, and therefore the production of testicular testosterone. […] According to most reports, the quality of sperm tends to normalize spontaneously within 4â12 months after cessation of anabolic steroid abuse. […] However, male infertility related to the abuse of AAS is underdiagnosed and yet it is a potentially curable form.
#22 Anabolic steroids abuse and male infertility | Basic and Clinical Andrology | Full Text
https://bacandrology.biomedcentral.com/articles/10.1186/s12610-016-0029-4
For several decades, testosterone and its synthetic derivatives have been used with anabolic and androgenic purposes. […] The abuse of anabolic steroids, is often associated with transient or persistent alterations of male reproductive function by different routes. […] Exogenous administration of testosterone synthesis derivatives induces negative feedback on the hypothalamic-pituitary axis and therefore inhibiting the secretion of both FSH and LH. […] Apoptosis has been reported to play an important role in the regulation of germ cell populations in the adult testis. […] The infertility treatment with testosterone does not improve spermatogenesis; the administered exogenous testosterone and its metabolite, estrogen, suppresses the production of Gonadotropin-releasing hormone (GnRH) by the hypothalamus and the production of luteinizing hormone (LH) by the pituitary gland, and therefore the production of testicular testosterone. […] According to most reports, the quality of sperm tends to normalize spontaneously within 4â12 months after cessation of anabolic steroid abuse. […] However, male infertility related to the abuse of AAS is underdiagnosed and yet it is a potentially curable form.
#23 Anabolic androgenic steroid abuse in young males in: Endocrine Connections Volume 9 Issue 4 (2020)
https://ec.bioscientifica.com/view/journals/ec/9/4/EC-19-0557.xml
This review summarizes 10 years experience with male abusers of anabolic androgenic steroids (AAS). […] Short-term clinical and biochemical side effects are well established. Long-term side effects are uncertain, but may include heart failure, mood-and anxiety disorders, hypogonadism and subfertility. […] Testosterone can be converted to oestradiol via the aromatase enzyme and converted to dihydrotestosterone (DHT) via the 5-reductase enzymes. Administration of supraphysiological doses of testosterone thus results in increased levels of oestradiol and DHT. […] By modifying the testosterone molecule, aromatisation or 5-reduction can be prevented, attempting to improve the benefit-to-harm ratio of the compound. […] Post cycle therapy, or PCT, is an unproven strategy that aims to restore endogenous testosterone production as soon as possible after a cycle of AAS. An inevitable side effect of AAS abuse is suppression of gonadotropin production, mostly to undetectable levels, and subsequent shutdown of testicular testosterone production.
#24 Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects
https://pmc.ncbi.nlm.nih.gov/articles/PMC8683244/
Other studies have shown that AAS administration can result in androgen receptor downregulation. […] The adverse effect profile of exogenous AAS administration is a source of contention, with some raising the possibility that interpretations of data had been exaggerated. […] Among the complications of AAS use, cardiovascular side effects have been postulated to have the strongest mortality altering consequences, with some studies suggesting it to be the root cause of premature death in AAS users in up to 33-66% of cases. […] While the mechanisms behind cardiac death in AAS users are incompletely understood, four possibilities have been proposed, which include (1) atherosclerosis potentiation model, (2) thrombosis model, (3) coronary vasospasm, and (4) direct cardiac injury. […] Infertility following AAS use is secondary to suppression of intratesticular testosterone levels, which can lead to azoospermia or oligozoospermia.
#25 Reduced arterial elasticity after anabolicâandrogenic steroid use in young adult males and mice | Scientific ReportsClose bannerClose banner
https://www.nature.com/articles/s41598-022-14065-5
High-doses of anabolicâandrogenic steroids (AAS) is efficient for building muscle mass, but pose a risk of cardiovascular side effects. […] Growing evidence links high dose AAS use to a variety of cardiovascular complications, including arterial stiffness. […] Studies have demonstrated that administration of supraphysiological doses of AAS can potentially lead to structural alterations of the vessel walls and cause endothelial dysfunction that can affect the elastic properties of the vasculature, induce formation of plaque and be a precursor in development of atherosclerosis. […] Loss of arterial elasticity is mainly a result of overproduction of collagen. […] Long-term use of AAS may lead to increased cIMT, increased PWV and decreased arterial elasticity. These findings were supported by functional vascular alterations after exposure of supraphysiological doses of testosterone in young mice. The results of the present study indicate that long-term use of AAS is a major threat to cardiovascular health, with increased risk of developing severe cardiovascular events, such as myocardial infarction and stroke.
#26 Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects
https://pmc.ncbi.nlm.nih.gov/articles/PMC8683244/
Other studies have shown that AAS administration can result in androgen receptor downregulation. […] The adverse effect profile of exogenous AAS administration is a source of contention, with some raising the possibility that interpretations of data had been exaggerated. […] Among the complications of AAS use, cardiovascular side effects have been postulated to have the strongest mortality altering consequences, with some studies suggesting it to be the root cause of premature death in AAS users in up to 33-66% of cases. […] While the mechanisms behind cardiac death in AAS users are incompletely understood, four possibilities have been proposed, which include (1) atherosclerosis potentiation model, (2) thrombosis model, (3) coronary vasospasm, and (4) direct cardiac injury. […] Infertility following AAS use is secondary to suppression of intratesticular testosterone levels, which can lead to azoospermia or oligozoospermia.
#27 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK538174/
Hypogonadism is a hallmark of AAS abuse, which may have profound effects on the reproductive system. The majority of AAS users found to have low gonadotropin and testosterone levels even after the discontinuation of AAS. Administration of exogenous AAS results in down-regulation of the HPA axis leading to reduced endogenous production of testosterone by suppressing the normal testicular function (reduced testicular volume, sperm, and testosterone production). […] Cardiovascular risk of AAS includes myocardial dysfunction, coronary atherosclerosis; hypercoagulopathy and hepatic dysfunction, hypertension, life-threatening arrhythmia, and sudden death. Concentric Left ventricular hypertrophy is commonly seen in long term steroid users even after discontinuation of AAS. Prolonged use of AAS will also lead to elevation of LDL and reduction of HDL, conferring an increased risk of the cardiac event. AAS abuse may also lead to psychiatric and behavioral disturbances.
#28 Anabolic Steroid Use Disorder | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/17498
Approximately 3 to 4 million Americans used anabolic-androgenic steroids to increase muscle mass, whether for sports to increase their performance or cosmetic purposes, such as enhancing their appearance. […] Among AAS users, about 30% develop dependence, which is characterized by chronic AAS use despite negative consequences and adverse effects on physical, psychosocial, or occupational functioning. […] Hypogonadism is a hallmark of AAS abuse, which may have profound effects on the reproductive system. […] Administration of exogenous AAS results in down-regulation of the HPA axis leading to reduced endogenous production of testosterone by suppressing the normal testicular function (reduced testicular volume, sperm, and testosterone production). […] Cardiovascular risk of AAS includes myocardial dysfunction, coronary atherosclerosis; hypercoagulopathy and hepatic dysfunction, hypertension, life-threatening arrhythmia, and sudden death.
#29 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK538174/
Hypogonadism is a hallmark of AAS abuse, which may have profound effects on the reproductive system. The majority of AAS users found to have low gonadotropin and testosterone levels even after the discontinuation of AAS. Administration of exogenous AAS results in down-regulation of the HPA axis leading to reduced endogenous production of testosterone by suppressing the normal testicular function (reduced testicular volume, sperm, and testosterone production). […] Cardiovascular risk of AAS includes myocardial dysfunction, coronary atherosclerosis; hypercoagulopathy and hepatic dysfunction, hypertension, life-threatening arrhythmia, and sudden death. Concentric Left ventricular hypertrophy is commonly seen in long term steroid users even after discontinuation of AAS. Prolonged use of AAS will also lead to elevation of LDL and reduction of HDL, conferring an increased risk of the cardiac event. AAS abuse may also lead to psychiatric and behavioral disturbances.
#30 Anabolic Steroid Use Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK538174/
Hypogonadism is a hallmark of AAS abuse, which may have profound effects on the reproductive system. The majority of AAS users found to have low gonadotropin and testosterone levels even after the discontinuation of AAS. Administration of exogenous AAS results in down-regulation of the HPA axis leading to reduced endogenous production of testosterone by suppressing the normal testicular function (reduced testicular volume, sperm, and testosterone production). […] Cardiovascular risk of AAS includes myocardial dysfunction, coronary atherosclerosis; hypercoagulopathy and hepatic dysfunction, hypertension, life-threatening arrhythmia, and sudden death. Concentric Left ventricular hypertrophy is commonly seen in long term steroid users even after discontinuation of AAS. Prolonged use of AAS will also lead to elevation of LDL and reduction of HDL, conferring an increased risk of the cardiac event. AAS abuse may also lead to psychiatric and behavioral disturbances.
#31 Reduced arterial elasticity after anabolicâandrogenic steroid use in young adult males and mice | Scientific ReportsClose bannerClose banner
https://www.nature.com/articles/s41598-022-14065-5
High-doses of anabolicâandrogenic steroids (AAS) is efficient for building muscle mass, but pose a risk of cardiovascular side effects. […] Growing evidence links high dose AAS use to a variety of cardiovascular complications, including arterial stiffness. […] Studies have demonstrated that administration of supraphysiological doses of AAS can potentially lead to structural alterations of the vessel walls and cause endothelial dysfunction that can affect the elastic properties of the vasculature, induce formation of plaque and be a precursor in development of atherosclerosis. […] Loss of arterial elasticity is mainly a result of overproduction of collagen. […] Long-term use of AAS may lead to increased cIMT, increased PWV and decreased arterial elasticity. These findings were supported by functional vascular alterations after exposure of supraphysiological doses of testosterone in young mice. The results of the present study indicate that long-term use of AAS is a major threat to cardiovascular health, with increased risk of developing severe cardiovascular events, such as myocardial infarction and stroke.
#32 Reduced arterial elasticity after anabolicâandrogenic steroid use in young adult males and mice | Scientific ReportsClose bannerClose banner
https://www.nature.com/articles/s41598-022-14065-5
High-doses of anabolicâandrogenic steroids (AAS) is efficient for building muscle mass, but pose a risk of cardiovascular side effects. […] Growing evidence links high dose AAS use to a variety of cardiovascular complications, including arterial stiffness. […] Studies have demonstrated that administration of supraphysiological doses of AAS can potentially lead to structural alterations of the vessel walls and cause endothelial dysfunction that can affect the elastic properties of the vasculature, induce formation of plaque and be a precursor in development of atherosclerosis. […] Loss of arterial elasticity is mainly a result of overproduction of collagen. […] Long-term use of AAS may lead to increased cIMT, increased PWV and decreased arterial elasticity. These findings were supported by functional vascular alterations after exposure of supraphysiological doses of testosterone in young mice. The results of the present study indicate that long-term use of AAS is a major threat to cardiovascular health, with increased risk of developing severe cardiovascular events, such as myocardial infarction and stroke.
#33 Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects
https://pmc.ncbi.nlm.nih.gov/articles/PMC8683244/
Hepatotoxicity is a commonly encountered side effect of AAS use, with one study noting AAS related liver injury comprised 8% of their total cases of drug-induced liver injury. […] The spectrum of AAS induced liver injuries is diverse in possible pathology. […] AAS related renal damage is less studied compared to other adverse effects, although some possible mechanisms include direct toxicity or bile acid nephropathy secondary to AAS related liver injury.
#34 Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects
https://pmc.ncbi.nlm.nih.gov/articles/PMC8683244/
Hepatotoxicity is a commonly encountered side effect of AAS use, with one study noting AAS related liver injury comprised 8% of their total cases of drug-induced liver injury. […] The spectrum of AAS induced liver injuries is diverse in possible pathology. […] AAS related renal damage is less studied compared to other adverse effects, although some possible mechanisms include direct toxicity or bile acid nephropathy secondary to AAS related liver injury.
#35 Drug-induced liver injury secondary to anabolic steroid use | Revista de GastroenterologÃa de MÃ©xico
https://www.revistagastroenterologiamexico.org/en-drug-induced-liver-injury-secondary-anabolic-articulo-S2255534X19300702
Drug-induced liver injury (DILI) secondary to the application of anabolic steroids was suspected, and so an R value of 0.27 was calculated, indicating a pattern of cholestatic injury. […] Hepatotoxicity induced by anabolic steroids is dose-dependent and predictable. Its most frequent presentation is cholestatic hepatitis, and other types of injury associated with high doses of the drugs are: bland or pure cholestasis, acute cholestatic hepatitis, acute hepatocellular injury, and hepatic tumors. […] With all the above and a score of 9 on the CIOMS/RUCAM hepatotoxicity evaluation scale, it was concluded that the patient had highly probable or definitive hepatotoxicity due to anabolic steroid use. […] The US National Institutes of Health also has a website (www.livertox.nih.gov) that describes cases of hepatotoxicity and the mechanism of the liver injury the drugs can cause.
#36 Anabolic androgenic steroid-induced liver injury: An update
https://www.wjgnet.com/1007-9327/full/v28/i26/3071.htm
Anabolic androgenic steroids (AASs) are a group of molecules including endogenous testosterone and synthetic derivatives that have both androgenic and anabolic effects. […] However, they are commonly bought illegally and misused for their anabolic, skeletal muscle building, and performance-enhancing effects. Supraphysiologic and long-term use of AASs affects all organs, leading to cardiovascular, neurological, endocrine, gastrointestinal, renal, and hematologic disorders. Hepatotoxicity is one of the major concerns regarding AASs treatment and abuse. […] It is currently believed that mechanisms of pathogenesis of these disorders include disturbance of antioxidative factors, upregulation of bile acid synthesis, and induction of hepatocyte hyperplasia. […] Proposed mechanisms of liver injury include anabolic steroid-induced infiltration of inflammatory cells in the hepatic tissue, and Kupffer cell activation resulting in production of inflammatory cytokines and collagen deposition, increased oxidative stress and reactive oxygen species with subsequent mitochondrial degeneration in liver cells, and stimulation of intracellular androgenic steroid receptors inducing unregulated growth of hepatocytes.
#37 Anabolic androgenic steroid-induced liver injury: An update
https://www.wjgnet.com/1007-9327/full/v28/i26/3071.htm
Anabolic androgenic steroids (AASs) are a group of molecules including endogenous testosterone and synthetic derivatives that have both androgenic and anabolic effects. […] However, they are commonly bought illegally and misused for their anabolic, skeletal muscle building, and performance-enhancing effects. Supraphysiologic and long-term use of AASs affects all organs, leading to cardiovascular, neurological, endocrine, gastrointestinal, renal, and hematologic disorders. Hepatotoxicity is one of the major concerns regarding AASs treatment and abuse. […] It is currently believed that mechanisms of pathogenesis of these disorders include disturbance of antioxidative factors, upregulation of bile acid synthesis, and induction of hepatocyte hyperplasia. […] Proposed mechanisms of liver injury include anabolic steroid-induced infiltration of inflammatory cells in the hepatic tissue, and Kupffer cell activation resulting in production of inflammatory cytokines and collagen deposition, increased oxidative stress and reactive oxygen species with subsequent mitochondrial degeneration in liver cells, and stimulation of intracellular androgenic steroid receptors inducing unregulated growth of hepatocytes.
#38 Innovative Reports on the Effects of Anabolic Androgenic Steroid AbuseâHow to Lose Your Mind for the Love of Sport
https://www.mdpi.com/1648-9144/59/8/1439
The latest research describing the effect of AAS on the human body mainly covers the effect on the central nervous system; therefore, we considered it appropriate to devote a separate part of the paper to this topic in order to highlight the importance of this research. […] The latest reports on the use of over-physiological doses of AAS relate to the significant acceleration of brain aging processes, cognitive dysfunction, and psychosocial disorders. This is related to the easy access of AAS to CNS cells due to their ability to penetrate the bloodâbrain barrier and the rich supply of AAS receptors, which are concentrated in the brainstem, amygdala, hypothalamus, striatum, cerebral cortex, and hippocampus. […] The literature shows that over-physiological doses of AAS can induce the process of apoptosis of nerve cells.
#39 Innovative Reports on the Effects of Anabolic Androgenic Steroid AbuseâHow to Lose Your Mind for the Love of Sport
https://www.mdpi.com/1648-9144/59/8/1439
The latest research describing the effect of AAS on the human body mainly covers the effect on the central nervous system; therefore, we considered it appropriate to devote a separate part of the paper to this topic in order to highlight the importance of this research. […] The latest reports on the use of over-physiological doses of AAS relate to the significant acceleration of brain aging processes, cognitive dysfunction, and psychosocial disorders. This is related to the easy access of AAS to CNS cells due to their ability to penetrate the bloodâbrain barrier and the rich supply of AAS receptors, which are concentrated in the brainstem, amygdala, hypothalamus, striatum, cerebral cortex, and hippocampus. […] The literature shows that over-physiological doses of AAS can induce the process of apoptosis of nerve cells.
#40 Innovative Reports on the Effects of Anabolic Androgenic Steroid AbuseâHow to Lose Your Mind for the Love of Sport
https://www.mdpi.com/1648-9144/59/8/1439
The model of neurotoxicity proposed in 2019 is based on the aggregation of beta-amyloid and tau protein, resulting from the increase of oxidative stress in CNS neurons. […] Accelerated accumulation of Tau protein and beta-amyloid is associated with the influence of AAS on the expression and function of enzymes involved in their synthesis and elimination, e.g., amyloidogenic Î²- and Î³-secretases and amyloid precursor protein. This process is associated with an increased risk of Alzheimerâs and other neurodegenerative diseases.
#41 Innovative Reports on the Effects of Anabolic Androgenic Steroid AbuseâHow to Lose Your Mind for the Love of Sport
https://www.mdpi.com/1648-9144/59/8/1439
The model of neurotoxicity proposed in 2019 is based on the aggregation of beta-amyloid and tau protein, resulting from the increase of oxidative stress in CNS neurons. […] Accelerated accumulation of Tau protein and beta-amyloid is associated with the influence of AAS on the expression and function of enzymes involved in their synthesis and elimination, e.g., amyloidogenic Î²- and Î³-secretases and amyloid precursor protein. This process is associated with an increased risk of Alzheimerâs and other neurodegenerative diseases.
#42 SciELO Brazil – Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice
https://www.scielo.br/j/bjb/a/396kDZdbgbVK3yYgYb9DGyk/
The prevalence of side effects is directly related to the type of steroid, age, and gender of the user, and duration of administration. […] A study with cortical rats cell cultures examined the effect of testosterone and three of its synthetic derivatives on N-methyl-D-aspartate (NMDA)-induced excitotoxic neuronal death. […] Stanozolol is not a substrate for aromatase enzyme, which may, even in need of further studies, help us to understand the effect of anabolic agent Winstrol Depot, which showed a significant reduction of neuronal density. […] Even so, our results indicate that the doses tested exceeded the enzyme catalytic capacity since there was a significant reduction in the number of neuronal cell bodies in cortical areas. […] There is evidence that the use of synthetic androgens reduce the threshold for emotional reactivity, motor response, alertness to sensory stimuli, and disrupt inhibitory control over some behaviors.
#43 SciELO Brazil – Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice
https://www.scielo.br/j/bjb/a/396kDZdbgbVK3yYgYb9DGyk/
The prevalence of side effects is directly related to the type of steroid, age, and gender of the user, and duration of administration. […] A study with cortical rats cell cultures examined the effect of testosterone and three of its synthetic derivatives on N-methyl-D-aspartate (NMDA)-induced excitotoxic neuronal death. […] Stanozolol is not a substrate for aromatase enzyme, which may, even in need of further studies, help us to understand the effect of anabolic agent Winstrol Depot, which showed a significant reduction of neuronal density. […] Even so, our results indicate that the doses tested exceeded the enzyme catalytic capacity since there was a significant reduction in the number of neuronal cell bodies in cortical areas. […] There is evidence that the use of synthetic androgens reduce the threshold for emotional reactivity, motor response, alertness to sensory stimuli, and disrupt inhibitory control over some behaviors.
#44 SciELO Brazil – Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice
https://www.scielo.br/j/bjb/a/396kDZdbgbVK3yYgYb9DGyk/
The prevalence of side effects is directly related to the type of steroid, age, and gender of the user, and duration of administration. […] A study with cortical rats cell cultures examined the effect of testosterone and three of its synthetic derivatives on N-methyl-D-aspartate (NMDA)-induced excitotoxic neuronal death. […] Stanozolol is not a substrate for aromatase enzyme, which may, even in need of further studies, help us to understand the effect of anabolic agent Winstrol Depot, which showed a significant reduction of neuronal density. […] Even so, our results indicate that the doses tested exceeded the enzyme catalytic capacity since there was a significant reduction in the number of neuronal cell bodies in cortical areas. […] There is evidence that the use of synthetic androgens reduce the threshold for emotional reactivity, motor response, alertness to sensory stimuli, and disrupt inhibitory control over some behaviors.
#45 SciELO Brazil – Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice
https://www.scielo.br/j/bjb/a/396kDZdbgbVK3yYgYb9DGyk/
The prevalence of side effects is directly related to the type of steroid, age, and gender of the user, and duration of administration. […] A study with cortical rats cell cultures examined the effect of testosterone and three of its synthetic derivatives on N-methyl-D-aspartate (NMDA)-induced excitotoxic neuronal death. […] Stanozolol is not a substrate for aromatase enzyme, which may, even in need of further studies, help us to understand the effect of anabolic agent Winstrol Depot, which showed a significant reduction of neuronal density. […] Even so, our results indicate that the doses tested exceeded the enzyme catalytic capacity since there was a significant reduction in the number of neuronal cell bodies in cortical areas. […] There is evidence that the use of synthetic androgens reduce the threshold for emotional reactivity, motor response, alertness to sensory stimuli, and disrupt inhibitory control over some behaviors.
#46 SciELO Brazil – Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice
https://www.scielo.br/j/bjb/a/396kDZdbgbVK3yYgYb9DGyk/
Studies show that anabolic steroids have detrimental and often irreversible effects on the brain and affect this organ primarily through two mechanisms: 1) Neural hyperstimulation by increasing the activation of specific neurotransmitters, such as norepinephrine, dopamine, and serotonin; 2) Significant reduction in neural connectivity of the central nervous system affecting several regions of brain, including the basal ganglia, hippocampus and cortical areas. […] The results here obtained can have serious implications in the second mechanism, since researchers observed a significant decrease in the neuronal population in some of the areas mentioned. […] These data show that supra-physiological doses of stanozolol and testosterone cypionate can cause considerable damage to the nervous tissue, with structural and probable sequential behavioral impairment.
#47 Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects
https://pmc.ncbi.nlm.nih.gov/articles/PMC8683244/
Hepatotoxicity is a commonly encountered side effect of AAS use, with one study noting AAS related liver injury comprised 8% of their total cases of drug-induced liver injury. […] The spectrum of AAS induced liver injuries is diverse in possible pathology. […] AAS related renal damage is less studied compared to other adverse effects, although some possible mechanisms include direct toxicity or bile acid nephropathy secondary to AAS related liver injury.
#48 Weightlifters Bulking Up With Anabolic Steroids Also Do Serious Harm To Kidneys | Columbia University Irving Medical Center
https://www.cuimc.columbia.edu/news/weightlifters-bulking-anabolic-steroids-also-do-serious-harm-kidneys
Anabolic steroids may help athletes gain muscle mass and strength, but this bulking up comes at the risk of serious kidney damage, according to research published in the Journal of the American Society of Nephrology. […] The findings indicate that the habitual use of anabolic steroids has potential harmful effects on the kidneys that were not previously recognized. […] Anabolic steroid abuse is prevalent among both amateur and professional athletes. […] While these drugs are known to cause endocrine and liver dysfunction, until now their effects on the kidneys have not been appreciated, says Vivette DAgati, M.D., the Columbia University Medical Center researcher and practicing physician who led the study. […] The investigators studied a group of 10 bodybuilders who took anabolic steroids for years.
#49 Weightlifters Bulking Up With Anabolic Steroids Also Do Serious Harm To Kidneys | Columbia University Irving Medical Center
https://www.cuimc.columbia.edu/news/weightlifters-bulking-anabolic-steroids-also-do-serious-harm-kidneys
Anabolic steroids may help athletes gain muscle mass and strength, but this bulking up comes at the risk of serious kidney damage, according to research published in the Journal of the American Society of Nephrology. […] The findings indicate that the habitual use of anabolic steroids has potential harmful effects on the kidneys that were not previously recognized. […] Anabolic steroid abuse is prevalent among both amateur and professional athletes. […] While these drugs are known to cause endocrine and liver dysfunction, until now their effects on the kidneys have not been appreciated, says Vivette DAgati, M.D., the Columbia University Medical Center researcher and practicing physician who led the study. […] The investigators studied a group of 10 bodybuilders who took anabolic steroids for years.
#50 Weightlifters Bulking Up With Anabolic Steroids Also Do Serious Harm To Kidneys | Columbia University Irving Medical Center
https://www.cuimc.columbia.edu/news/weightlifters-bulking-anabolic-steroids-also-do-serious-harm-kidneys
All developed protein leakage into the urine and severe reductions in kidney function. […] The researchers propose that extreme increases in muscle mass drive the kidneys to increase their filtration load, placing harmful levels of stress on these organs. […] Because the kidney injury following steroid abuse is more severe clinically and pathologically than that seen in morbidly obese patients with even higher body mass indices, it is also likely that anabolic steroids have direct toxic effects on the glomeruli, whose cells bear receptors for these agents. […] Chronic hyperfiltration from a high-protein diet may accelerate progression to glomerulosclerosis. […] Systemic hypertension as well as the extreme episodic elevations in blood pressure typically experienced during heavy weight lifting also may contribute to kidney injury. […] Therefore, more sensitive tests to measure renal function and urinary protein are needed to detect the early stages of kidney disease in this population. […] This condition is likely to be under-recognized without more widespread screening of individuals at risk.
#51 Weightlifters Bulking Up With Anabolic Steroids Also Do Serious Harm To Kidneys | Columbia University Irving Medical Center
https://www.cuimc.columbia.edu/news/weightlifters-bulking-anabolic-steroids-also-do-serious-harm-kidneys
All developed protein leakage into the urine and severe reductions in kidney function. […] The researchers propose that extreme increases in muscle mass drive the kidneys to increase their filtration load, placing harmful levels of stress on these organs. […] Because the kidney injury following steroid abuse is more severe clinically and pathologically than that seen in morbidly obese patients with even higher body mass indices, it is also likely that anabolic steroids have direct toxic effects on the glomeruli, whose cells bear receptors for these agents. […] Chronic hyperfiltration from a high-protein diet may accelerate progression to glomerulosclerosis. […] Systemic hypertension as well as the extreme episodic elevations in blood pressure typically experienced during heavy weight lifting also may contribute to kidney injury. […] Therefore, more sensitive tests to measure renal function and urinary protein are needed to detect the early stages of kidney disease in this population. […] This condition is likely to be under-recognized without more widespread screening of individuals at risk.
#52 Weightlifters Bulking Up With Anabolic Steroids Also Do Serious Harm To Kidneys | Columbia University Irving Medical Center
https://www.cuimc.columbia.edu/news/weightlifters-bulking-anabolic-steroids-also-do-serious-harm-kidneys
All developed protein leakage into the urine and severe reductions in kidney function. […] The researchers propose that extreme increases in muscle mass drive the kidneys to increase their filtration load, placing harmful levels of stress on these organs. […] Because the kidney injury following steroid abuse is more severe clinically and pathologically than that seen in morbidly obese patients with even higher body mass indices, it is also likely that anabolic steroids have direct toxic effects on the glomeruli, whose cells bear receptors for these agents. […] Chronic hyperfiltration from a high-protein diet may accelerate progression to glomerulosclerosis. […] Systemic hypertension as well as the extreme episodic elevations in blood pressure typically experienced during heavy weight lifting also may contribute to kidney injury. […] Therefore, more sensitive tests to measure renal function and urinary protein are needed to detect the early stages of kidney disease in this population. […] This condition is likely to be under-recognized without more widespread screening of individuals at risk.
#53 Weightlifters Bulking Up With Anabolic Steroids Also Do Serious Harm To Kidneys | Columbia University Irving Medical Center
https://www.cuimc.columbia.edu/news/weightlifters-bulking-anabolic-steroids-also-do-serious-harm-kidneys
All developed protein leakage into the urine and severe reductions in kidney function. […] The researchers propose that extreme increases in muscle mass drive the kidneys to increase their filtration load, placing harmful levels of stress on these organs. […] Because the kidney injury following steroid abuse is more severe clinically and pathologically than that seen in morbidly obese patients with even higher body mass indices, it is also likely that anabolic steroids have direct toxic effects on the glomeruli, whose cells bear receptors for these agents. […] Chronic hyperfiltration from a high-protein diet may accelerate progression to glomerulosclerosis. […] Systemic hypertension as well as the extreme episodic elevations in blood pressure typically experienced during heavy weight lifting also may contribute to kidney injury. […] Therefore, more sensitive tests to measure renal function and urinary protein are needed to detect the early stages of kidney disease in this population. […] This condition is likely to be under-recognized without more widespread screening of individuals at risk.
#54 Weightlifters Bulking Up With Anabolic Steroids Also Do Serious Harm To Kidneys | Columbia University Irving Medical Center
https://www.cuimc.columbia.edu/news/weightlifters-bulking-anabolic-steroids-also-do-serious-harm-kidneys
All developed protein leakage into the urine and severe reductions in kidney function. […] The researchers propose that extreme increases in muscle mass drive the kidneys to increase their filtration load, placing harmful levels of stress on these organs. […] Because the kidney injury following steroid abuse is more severe clinically and pathologically than that seen in morbidly obese patients with even higher body mass indices, it is also likely that anabolic steroids have direct toxic effects on the glomeruli, whose cells bear receptors for these agents. […] Chronic hyperfiltration from a high-protein diet may accelerate progression to glomerulosclerosis. […] Systemic hypertension as well as the extreme episodic elevations in blood pressure typically experienced during heavy weight lifting also may contribute to kidney injury. […] Therefore, more sensitive tests to measure renal function and urinary protein are needed to detect the early stages of kidney disease in this population. […] This condition is likely to be under-recognized without more widespread screening of individuals at risk.
#55 Anabolic Steroid Addiction And Abuse
https://www.addictioncenter.com/stimulants/steroids/
Anabolic steroids are addictive due to two primary factors. The first is a behavior of many individuals with substance use disorders (SUDs), the compulsive need to seek out and use anabolic steroids. The second is the appearance of anabolic steroid withdrawal symptoms when the user cuts back on or stops steroid use completely. The obsessive-compulsive behavior to keep using anabolic steroids often begins when the steroids improve physical appearance and strength in a short amount of time, which may eventually result in an addiction developing. […] People taking steroids may also develop a tolerance to the drugs and experience withdrawal symptoms such as low sex drive, loss of appetite, mood swings, fatigue, insomnia, and depression when they stop taking them. […] People who take steroids for a prolonged period of time disrupt natural hormonal balances in their bodies. When someone addicted to steroids suddenly stops taking the drugs, they can become depressed and even suicidal due to these hormonal imbalances.
#56 Anabolic Steroid Addiction And Abuse
https://www.addictioncenter.com/stimulants/steroids/
Anabolic steroids are addictive due to two primary factors. The first is a behavior of many individuals with substance use disorders (SUDs), the compulsive need to seek out and use anabolic steroids. The second is the appearance of anabolic steroid withdrawal symptoms when the user cuts back on or stops steroid use completely. The obsessive-compulsive behavior to keep using anabolic steroids often begins when the steroids improve physical appearance and strength in a short amount of time, which may eventually result in an addiction developing. […] People taking steroids may also develop a tolerance to the drugs and experience withdrawal symptoms such as low sex drive, loss of appetite, mood swings, fatigue, insomnia, and depression when they stop taking them. […] People who take steroids for a prolonged period of time disrupt natural hormonal balances in their bodies. When someone addicted to steroids suddenly stops taking the drugs, they can become depressed and even suicidal due to these hormonal imbalances.
#57 Anabolic Steroid Addiction And Abuse
https://www.addictioncenter.com/stimulants/steroids/
Anabolic steroids are addictive due to two primary factors. The first is a behavior of many individuals with substance use disorders (SUDs), the compulsive need to seek out and use anabolic steroids. The second is the appearance of anabolic steroid withdrawal symptoms when the user cuts back on or stops steroid use completely. The obsessive-compulsive behavior to keep using anabolic steroids often begins when the steroids improve physical appearance and strength in a short amount of time, which may eventually result in an addiction developing. […] People taking steroids may also develop a tolerance to the drugs and experience withdrawal symptoms such as low sex drive, loss of appetite, mood swings, fatigue, insomnia, and depression when they stop taking them. […] People who take steroids for a prolonged period of time disrupt natural hormonal balances in their bodies. When someone addicted to steroids suddenly stops taking the drugs, they can become depressed and even suicidal due to these hormonal imbalances.
#58 Anabolic Steroid Addiction And Abuse
https://www.addictioncenter.com/stimulants/steroids/
Anabolic steroids are addictive due to two primary factors. The first is a behavior of many individuals with substance use disorders (SUDs), the compulsive need to seek out and use anabolic steroids. The second is the appearance of anabolic steroid withdrawal symptoms when the user cuts back on or stops steroid use completely. The obsessive-compulsive behavior to keep using anabolic steroids often begins when the steroids improve physical appearance and strength in a short amount of time, which may eventually result in an addiction developing. […] People taking steroids may also develop a tolerance to the drugs and experience withdrawal symptoms such as low sex drive, loss of appetite, mood swings, fatigue, insomnia, and depression when they stop taking them. […] People who take steroids for a prolonged period of time disrupt natural hormonal balances in their bodies. When someone addicted to steroids suddenly stops taking the drugs, they can become depressed and even suicidal due to these hormonal imbalances.
#59 Anabolic Steroid Addiction And Abuse
https://www.addictioncenter.com/stimulants/steroids/
Steroids act as mood elevators, which results in effects similar to antidepressants. Once a person, especially a man, stops a steroid cycle, a condition called estrogen rebound may develop. It results in the production and release of the female hormone estrogen at rapid, elevated levels. Side effects of estrogen rebound include symptoms of depression. The larger the dosage of anabolic steroids and the longer the duration of their abuse, the more severe the symptoms of estrogen rebound will be.
#60 Anabolic Steroid Addiction And Abuse
https://www.addictioncenter.com/stimulants/steroids/
Steroids act as mood elevators, which results in effects similar to antidepressants. Once a person, especially a man, stops a steroid cycle, a condition called estrogen rebound may develop. It results in the production and release of the female hormone estrogen at rapid, elevated levels. Side effects of estrogen rebound include symptoms of depression. The larger the dosage of anabolic steroids and the longer the duration of their abuse, the more severe the symptoms of estrogen rebound will be.
#61 New study finds anabolic steroids may be addictive | EurekAlert!
https://www.eurekalert.org/news-releases/920937
A new study designed to test whether androgenic-anabolic steroids may be addictive found that hamsters exposed to the compounds demonstrated addictive behavior over time. […] The findings demonstrate that anabolic steroids do have the potential to be addictive. […] Cleary the animals perceive the steroids to be rewarding. […] This preference demonstrates the drugs’ potential for addiction. […] The specific pattern of abuse demonstrated by hamsters suggests that a commonly held belief about steroids is true: rather than an acute high like that experienced by a cocaine or heroine user, steroid abusers experience a chronic, long-term sense of well-being. […] In other words, steroid users feel better on the drugs than they do off of them. […] Coaches and athletes need to be aware of this potential, and add it to the list of dangers associated with using anabolic steroids.
#62 New study finds anabolic steroids may be addictive | EurekAlert!
https://www.eurekalert.org/news-releases/920937
A new study designed to test whether androgenic-anabolic steroids may be addictive found that hamsters exposed to the compounds demonstrated addictive behavior over time. […] The findings demonstrate that anabolic steroids do have the potential to be addictive. […] Cleary the animals perceive the steroids to be rewarding. […] This preference demonstrates the drugs’ potential for addiction. […] The specific pattern of abuse demonstrated by hamsters suggests that a commonly held belief about steroids is true: rather than an acute high like that experienced by a cocaine or heroine user, steroid abusers experience a chronic, long-term sense of well-being. […] In other words, steroid users feel better on the drugs than they do off of them. […] Coaches and athletes need to be aware of this potential, and add it to the list of dangers associated with using anabolic steroids.
#63 New study finds anabolic steroids may be addictive | EurekAlert!
https://www.eurekalert.org/news-releases/920937
A new study designed to test whether androgenic-anabolic steroids may be addictive found that hamsters exposed to the compounds demonstrated addictive behavior over time. […] The findings demonstrate that anabolic steroids do have the potential to be addictive. […] Cleary the animals perceive the steroids to be rewarding. […] This preference demonstrates the drugs’ potential for addiction. […] The specific pattern of abuse demonstrated by hamsters suggests that a commonly held belief about steroids is true: rather than an acute high like that experienced by a cocaine or heroine user, steroid abusers experience a chronic, long-term sense of well-being. […] In other words, steroid users feel better on the drugs than they do off of them. […] Coaches and athletes need to be aware of this potential, and add it to the list of dangers associated with using anabolic steroids.
#64 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids
Athletes may take a fixed dose of one or multiple kinds of steroids for a certain period, stop, then start again (cycling) several times a year. Intermittently stopping the drugs is believed to allow endogenous testosterone levels, sperm count, and the hypothalamic-pituitary-gonadal axis to return to normal. […] Athletes frequently use multiple kinds of anabolic steroids simultaneously (a practice called stacking). They may use different routes of administration (oral, IM, or transdermal) simultaneously. […] Stacking and pyramiding are intended to increase receptor binding and minimize adverse effects, but these benefits have not been proved. […] The main treatment for users of anabolic steroids is cessation of use. Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.
#65 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids
Athletes may take a fixed dose of one or multiple kinds of steroids for a certain period, stop, then start again (cycling) several times a year. Intermittently stopping the drugs is believed to allow endogenous testosterone levels, sperm count, and the hypothalamic-pituitary-gonadal axis to return to normal. […] Athletes frequently use multiple kinds of anabolic steroids simultaneously (a practice called stacking). They may use different routes of administration (oral, IM, or transdermal) simultaneously. […] Stacking and pyramiding are intended to increase receptor binding and minimize adverse effects, but these benefits have not been proved. […] The main treatment for users of anabolic steroids is cessation of use. Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.
#66 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids
Athletes may take a fixed dose of one or multiple kinds of steroids for a certain period, stop, then start again (cycling) several times a year. Intermittently stopping the drugs is believed to allow endogenous testosterone levels, sperm count, and the hypothalamic-pituitary-gonadal axis to return to normal. […] Athletes frequently use multiple kinds of anabolic steroids simultaneously (a practice called stacking). They may use different routes of administration (oral, IM, or transdermal) simultaneously. […] Stacking and pyramiding are intended to increase receptor binding and minimize adverse effects, but these benefits have not been proved. […] The main treatment for users of anabolic steroids is cessation of use. Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.
#67 Anabolic Steroids | healthdirect
https://www.healthdirect.gov.au/anabolic-steroids
Anabolic steroids are synthetic (human-made) medicines that copy the effects of testosterone. […] They are used medically for hormone problems or muscle loss, but some people misuse them to build strength and muscle mass. […] Short-term side effects include mood changes and long-term effects can include heart problems or cancer. […] Anabolic steroids can also be prescribed to replace muscle lost because of conditions such as cancer or AIDS, or to treat some types of breast cancer and anaemia. […] The long-term side effects of anabolic steroids include liver damage, high blood pressure and high cholesterol, heart attack and stroke, kidney or prostate cancer, depression, stunted growth, and premature bone and skin ageing. […] People who misuse anabolic steroids for performance or weight loss purposes may also cause accidental nerve damage while injecting their muscles. […] Using anabolic steroids can lead to addiction, because people rely on the drugs for confidence and self-esteem. […] Anabolic steroids used correctly and under the guidance of your doctor can be safe for use. They can be unsafe if you misuse them.
#68 Anabolic Steroids – Special Subjects – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/special-subjects/illicit-drugs-and-intoxicants/anabolic-steroids
Athletes may take a fixed dose of one or multiple kinds of steroids for a certain period, stop, then start again (cycling) several times a year. Intermittently stopping the drugs is believed to allow endogenous testosterone levels, sperm count, and the hypothalamic-pituitary-gonadal axis to return to normal. […] Athletes frequently use multiple kinds of anabolic steroids simultaneously (a practice called stacking). They may use different routes of administration (oral, IM, or transdermal) simultaneously. […] Stacking and pyramiding are intended to increase receptor binding and minimize adverse effects, but these benefits have not been proved. […] The main treatment for users of anabolic steroids is cessation of use. Although physical dependence does not occur, psychologic dependence, particularly in competitive bodybuilders and athletes, may exist.
#69 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)
https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml
Hypogonadism can result following anabolic steroid abuse. The duration and degree of recovery from anabolic steroid-induced hypogonadism (ASIH) is immensely variable, and there is a paucity of prospective controlled data characterising the trajectory of natural recovery following cessation. This poses difficulties for users trying to stop androgen abuse, and clinicians wanting to assist them. The objective of this paper was to synthesise evidence on the physical, psychological and biochemical patterns of ASIH recovery. […] We present the pathophysiology of ASIH through a literature review of hypothalamicpituitarytestosterone axis recovery in supraphysiological testosterone exposure. This is followed by a scoping review of relevant observational and interventional studies published on PubMed and finally, a conclusion that is an easy reference for clinicians helping patients that are recovering from AAS abuse. Results indicate that ASIH recovery depends on age and degree of androgen abuse, with physical changes like testicular atrophy expected to have near full recovery over months to years; spermatogenesis expected to achieve full recovery over months to years; libido returning to baseline over several months (typically less potent than during AAS use); and recovery from gynaecomastia being unlikely. For psychological recovery, data are insufficient and conflicting, indicating a transient withdrawal period which may be followed by persisting longer-term milder symptoms. For biochemical recovery, near complete recovery of testosterone is seen over months, and complete gonadotropin recovery is expected over 36 months. Further prospective studies are indicated to more closely describe patterns of recovery.
#70 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)
https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml
Hypogonadism can result following anabolic steroid abuse. The duration and degree of recovery from anabolic steroid-induced hypogonadism (ASIH) is immensely variable, and there is a paucity of prospective controlled data characterising the trajectory of natural recovery following cessation. This poses difficulties for users trying to stop androgen abuse, and clinicians wanting to assist them. The objective of this paper was to synthesise evidence on the physical, psychological and biochemical patterns of ASIH recovery. […] We present the pathophysiology of ASIH through a literature review of hypothalamicpituitarytestosterone axis recovery in supraphysiological testosterone exposure. This is followed by a scoping review of relevant observational and interventional studies published on PubMed and finally, a conclusion that is an easy reference for clinicians helping patients that are recovering from AAS abuse. Results indicate that ASIH recovery depends on age and degree of androgen abuse, with physical changes like testicular atrophy expected to have near full recovery over months to years; spermatogenesis expected to achieve full recovery over months to years; libido returning to baseline over several months (typically less potent than during AAS use); and recovery from gynaecomastia being unlikely. For psychological recovery, data are insufficient and conflicting, indicating a transient withdrawal period which may be followed by persisting longer-term milder symptoms. For biochemical recovery, near complete recovery of testosterone is seen over months, and complete gonadotropin recovery is expected over 36 months. Further prospective studies are indicated to more closely describe patterns of recovery.
#71 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)
https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml
Hypogonadism can result following anabolic steroid abuse. The duration and degree of recovery from anabolic steroid-induced hypogonadism (ASIH) is immensely variable, and there is a paucity of prospective controlled data characterising the trajectory of natural recovery following cessation. This poses difficulties for users trying to stop androgen abuse, and clinicians wanting to assist them. The objective of this paper was to synthesise evidence on the physical, psychological and biochemical patterns of ASIH recovery. […] We present the pathophysiology of ASIH through a literature review of hypothalamicpituitarytestosterone axis recovery in supraphysiological testosterone exposure. This is followed by a scoping review of relevant observational and interventional studies published on PubMed and finally, a conclusion that is an easy reference for clinicians helping patients that are recovering from AAS abuse. Results indicate that ASIH recovery depends on age and degree of androgen abuse, with physical changes like testicular atrophy expected to have near full recovery over months to years; spermatogenesis expected to achieve full recovery over months to years; libido returning to baseline over several months (typically less potent than during AAS use); and recovery from gynaecomastia being unlikely. For psychological recovery, data are insufficient and conflicting, indicating a transient withdrawal period which may be followed by persisting longer-term milder symptoms. For biochemical recovery, near complete recovery of testosterone is seen over months, and complete gonadotropin recovery is expected over 36 months. Further prospective studies are indicated to more closely describe patterns of recovery.
#72 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)
https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml
AAS abuse can have numerous potential sequelae, as summarised in Table 1. Most symptoms of ASIH can be understood through prolonged feedback inhibition (if not long-term suppression) of gonadotropin-releasing hormone (GnRH) and therefore luteinising hormone (LH) and follicle-stimulating hormone (FSH). The degree and duration of suppression of GnRH varies depending on several factors, as explored below with the mechanism of pathophysiology coming from animal studies due to paucity of human studies. […] The suppression of gonadotropins is dose dependent and is also dependent on the type of androgen used. In other words, the feedback inhibition of androgens is not absolute (switching on or off) but that of degree. […] Another reason for the variation seen in recovery from ASIH is that KNDy neurons receive input from the hormonal milieu of the organism from leptin, CRH, cortisol and prolactin, as well as being subject to higher neuronal regulation, such as the first-order metabolic neurons POMC and NPY/AgRP as well as neurons from the suprachiasmatic region.
#73 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)
https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml
AAS abuse can have numerous potential sequelae, as summarised in Table 1. Most symptoms of ASIH can be understood through prolonged feedback inhibition (if not long-term suppression) of gonadotropin-releasing hormone (GnRH) and therefore luteinising hormone (LH) and follicle-stimulating hormone (FSH). The degree and duration of suppression of GnRH varies depending on several factors, as explored below with the mechanism of pathophysiology coming from animal studies due to paucity of human studies. […] The suppression of gonadotropins is dose dependent and is also dependent on the type of androgen used. In other words, the feedback inhibition of androgens is not absolute (switching on or off) but that of degree. […] Another reason for the variation seen in recovery from ASIH is that KNDy neurons receive input from the hormonal milieu of the organism from leptin, CRH, cortisol and prolactin, as well as being subject to higher neuronal regulation, such as the first-order metabolic neurons POMC and NPY/AgRP as well as neurons from the suprachiasmatic region.
#74 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)
https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml
Lastly, cessation of AAS abuse is commonly associated with burdensome psychological disorders, especially anxiety and depression. Whether these disorders predate and contribute to the abuse of AAS, or whether AAS abuse brings out or leads to anxiety and depression, is unclear. […] In summary, psychological disturbances affect many former AAS abusers, but long-term symptoms are mild in most cases. Evidence to indicate a specific timeframe for recovery and the predictors of recovery is lacking. Further studies that can quantify and take into account the bidirectional relationship between the psychopathology of AAS abuse and the effect of AAS abuse on psychopathology are needed. […] The recovery of serum testosterone levels after AAS cessation is variable and controversial. […] Taken together, testosterone recovery is expected but likely to be incomplete despite months or years of AAS cessation. […] In most studies, FSH and LH recovered to baseline values (or were not significantly different to controls) 216 weeks after cessation. However, a few studies described reduced gonadotropin levels when measured at 2 weeks, 6 weeks or 12 weeks after AAS cessation.
#75 Physical, psychological and biochemical recovery from anabolic steroid-induced hypogonadism: a scoping review in: Endocrine Connections Volume 12 Issue 12 (2023)
https://ec.bioscientifica.com/view/journals/ec/12/12/EC-23-0358.xml
Lastly, cessation of AAS abuse is commonly associated with burdensome psychological disorders, especially anxiety and depression. Whether these disorders predate and contribute to the abuse of AAS, or whether AAS abuse brings out or leads to anxiety and depression, is unclear. […] In summary, psychological disturbances affect many former AAS abusers, but long-term symptoms are mild in most cases. Evidence to indicate a specific timeframe for recovery and the predictors of recovery is lacking. Further studies that can quantify and take into account the bidirectional relationship between the psychopathology of AAS abuse and the effect of AAS abuse on psychopathology are needed. […] The recovery of serum testosterone levels after AAS cessation is variable and controversial. […] Taken together, testosterone recovery is expected but likely to be incomplete despite months or years of AAS cessation. […] In most studies, FSH and LH recovered to baseline values (or were not significantly different to controls) 216 weeks after cessation. However, a few studies described reduced gonadotropin levels when measured at 2 weeks, 6 weeks or 12 weeks after AAS cessation.
#76 Reduced arterial elasticity after anabolicâandrogenic steroid use in young adult males and mice | Scientific ReportsClose bannerClose banner
https://www.nature.com/articles/s41598-022-14065-5
High-doses of anabolicâandrogenic steroids (AAS) is efficient for building muscle mass, but pose a risk of cardiovascular side effects. […] Growing evidence links high dose AAS use to a variety of cardiovascular complications, including arterial stiffness. […] Studies have demonstrated that administration of supraphysiological doses of AAS can potentially lead to structural alterations of the vessel walls and cause endothelial dysfunction that can affect the elastic properties of the vasculature, induce formation of plaque and be a precursor in development of atherosclerosis. […] Loss of arterial elasticity is mainly a result of overproduction of collagen. […] Long-term use of AAS may lead to increased cIMT, increased PWV and decreased arterial elasticity. These findings were supported by functional vascular alterations after exposure of supraphysiological doses of testosterone in young mice. The results of the present study indicate that long-term use of AAS is a major threat to cardiovascular health, with increased risk of developing severe cardiovascular events, such as myocardial infarction and stroke.
#77 Reduced arterial elasticity after anabolicâandrogenic steroid use in young adult males and mice | Scientific ReportsClose bannerClose banner
https://www.nature.com/articles/s41598-022-14065-5
High-doses of anabolicâandrogenic steroids (AAS) is efficient for building muscle mass, but pose a risk of cardiovascular side effects. […] Growing evidence links high dose AAS use to a variety of cardiovascular complications, including arterial stiffness. […] Studies have demonstrated that administration of supraphysiological doses of AAS can potentially lead to structural alterations of the vessel walls and cause endothelial dysfunction that can affect the elastic properties of the vasculature, induce formation of plaque and be a precursor in development of atherosclerosis. […] Loss of arterial elasticity is mainly a result of overproduction of collagen. […] Long-term use of AAS may lead to increased cIMT, increased PWV and decreased arterial elasticity. These findings were supported by functional vascular alterations after exposure of supraphysiological doses of testosterone in young mice. The results of the present study indicate that long-term use of AAS is a major threat to cardiovascular health, with increased risk of developing severe cardiovascular events, such as myocardial infarction and stroke.
#78 Reduced arterial elasticity after anabolicâandrogenic steroid use in young adult males and mice | Scientific ReportsClose bannerClose banner
https://www.nature.com/articles/s41598-022-14065-5
High-doses of anabolicâandrogenic steroids (AAS) is efficient for building muscle mass, but pose a risk of cardiovascular side effects. […] Growing evidence links high dose AAS use to a variety of cardiovascular complications, including arterial stiffness. […] Studies have demonstrated that administration of supraphysiological doses of AAS can potentially lead to structural alterations of the vessel walls and cause endothelial dysfunction that can affect the elastic properties of the vasculature, induce formation of plaque and be a precursor in development of atherosclerosis. […] Loss of arterial elasticity is mainly a result of overproduction of collagen. […] Long-term use of AAS may lead to increased cIMT, increased PWV and decreased arterial elasticity. These findings were supported by functional vascular alterations after exposure of supraphysiological doses of testosterone in young mice. The results of the present study indicate that long-term use of AAS is a major threat to cardiovascular health, with increased risk of developing severe cardiovascular events, such as myocardial infarction and stroke.
#79 Reduced arterial elasticity after anabolicâandrogenic steroid use in young adult males and mice | Scientific ReportsClose bannerClose banner
https://www.nature.com/articles/s41598-022-14065-5
High-doses of anabolicâandrogenic steroids (AAS) is efficient for building muscle mass, but pose a risk of cardiovascular side effects. […] Growing evidence links high dose AAS use to a variety of cardiovascular complications, including arterial stiffness. […] Studies have demonstrated that administration of supraphysiological doses of AAS can potentially lead to structural alterations of the vessel walls and cause endothelial dysfunction that can affect the elastic properties of the vasculature, induce formation of plaque and be a precursor in development of atherosclerosis. […] Loss of arterial elasticity is mainly a result of overproduction of collagen. […] Long-term use of AAS may lead to increased cIMT, increased PWV and decreased arterial elasticity. These findings were supported by functional vascular alterations after exposure of supraphysiological doses of testosterone in young mice. The results of the present study indicate that long-term use of AAS is a major threat to cardiovascular health, with increased risk of developing severe cardiovascular events, such as myocardial infarction and stroke.
#80 Do steroids cause heart attacks? Effect on cardiac health
https://www.medicalnewstoday.com/articles/do-steroids-cause-heart-attacks
Anabolic steroids can increase the risk of heart attacks and other cardiovascular complications when a person misuses them. […] Yes, misusing anabolic steroids can lead to heart attacks. […] When a person misuses them, they can affect heart health and may cause early heart attacks. […] AASs can have multiple effects on the cardiovascular system, which may contribute to the risk of heart attacks. […] High LDL and low HDL levels increase the risk of atherosclerosis, a condition involving a buildup of plaque inside arteries. […] Steroids also increase the risk of blood clots forming in blood vessels, potentially disrupting blood flow and damaging the heart muscle. […] If blood cannot reach the heart or brain, it can lead to a heart attack or stroke. […] Additionally, anabolic steroids may cause structural changes in the heart, decreasing the function of the hearts ventricles and inducing an irregular heartbeat, which could become life threatening. […] Health experts do not fully understand the link between anabolic steroids and heart attacks. However, research suggests these substances have detrimental effects on cardiovascular health. In time, the misuse of anabolic steroids may cause heart attacks.
#81 Do steroids cause heart attacks? Effect on cardiac health
https://www.medicalnewstoday.com/articles/do-steroids-cause-heart-attacks
Anabolic steroids can increase the risk of heart attacks and other cardiovascular complications when a person misuses them. […] Yes, misusing anabolic steroids can lead to heart attacks. […] When a person misuses them, they can affect heart health and may cause early heart attacks. […] AASs can have multiple effects on the cardiovascular system, which may contribute to the risk of heart attacks. […] High LDL and low HDL levels increase the risk of atherosclerosis, a condition involving a buildup of plaque inside arteries. […] Steroids also increase the risk of blood clots forming in blood vessels, potentially disrupting blood flow and damaging the heart muscle. […] If blood cannot reach the heart or brain, it can lead to a heart attack or stroke. […] Additionally, anabolic steroids may cause structural changes in the heart, decreasing the function of the hearts ventricles and inducing an irregular heartbeat, which could become life threatening. […] Health experts do not fully understand the link between anabolic steroids and heart attacks. However, research suggests these substances have detrimental effects on cardiovascular health. In time, the misuse of anabolic steroids may cause heart attacks.
#82 Do steroids cause heart attacks? Effect on cardiac health
https://www.medicalnewstoday.com/articles/do-steroids-cause-heart-attacks
Anabolic steroids can increase the risk of heart attacks and other cardiovascular complications when a person misuses them. […] Yes, misusing anabolic steroids can lead to heart attacks. […] When a person misuses them, they can affect heart health and may cause early heart attacks. […] AASs can have multiple effects on the cardiovascular system, which may contribute to the risk of heart attacks. […] High LDL and low HDL levels increase the risk of atherosclerosis, a condition involving a buildup of plaque inside arteries. […] Steroids also increase the risk of blood clots forming in blood vessels, potentially disrupting blood flow and damaging the heart muscle. […] If blood cannot reach the heart or brain, it can lead to a heart attack or stroke. […] Additionally, anabolic steroids may cause structural changes in the heart, decreasing the function of the hearts ventricles and inducing an irregular heartbeat, which could become life threatening. […] Health experts do not fully understand the link between anabolic steroids and heart attacks. However, research suggests these substances have detrimental effects on cardiovascular health. In time, the misuse of anabolic steroids may cause heart attacks.
#83 Do steroids cause heart attacks? Effect on cardiac health
https://www.medicalnewstoday.com/articles/do-steroids-cause-heart-attacks
Anabolic steroids can increase the risk of heart attacks and other cardiovascular complications when a person misuses them. […] Yes, misusing anabolic steroids can lead to heart attacks. […] When a person misuses them, they can affect heart health and may cause early heart attacks. […] AASs can have multiple effects on the cardiovascular system, which may contribute to the risk of heart attacks. […] High LDL and low HDL levels increase the risk of atherosclerosis, a condition involving a buildup of plaque inside arteries. […] Steroids also increase the risk of blood clots forming in blood vessels, potentially disrupting blood flow and damaging the heart muscle. […] If blood cannot reach the heart or brain, it can lead to a heart attack or stroke. […] Additionally, anabolic steroids may cause structural changes in the heart, decreasing the function of the hearts ventricles and inducing an irregular heartbeat, which could become life threatening. […] Health experts do not fully understand the link between anabolic steroids and heart attacks. However, research suggests these substances have detrimental effects on cardiovascular health. In time, the misuse of anabolic steroids may cause heart attacks.
#84 Do steroids cause heart attacks? Effect on cardiac health
https://www.medicalnewstoday.com/articles/do-steroids-cause-heart-attacks
Anabolic steroids can increase the risk of heart attacks and other cardiovascular complications when a person misuses them. […] Yes, misusing anabolic steroids can lead to heart attacks. […] When a person misuses them, they can affect heart health and may cause early heart attacks. […] AASs can have multiple effects on the cardiovascular system, which may contribute to the risk of heart attacks. […] High LDL and low HDL levels increase the risk of atherosclerosis, a condition involving a buildup of plaque inside arteries. […] Steroids also increase the risk of blood clots forming in blood vessels, potentially disrupting blood flow and damaging the heart muscle. […] If blood cannot reach the heart or brain, it can lead to a heart attack or stroke. […] Additionally, anabolic steroids may cause structural changes in the heart, decreasing the function of the hearts ventricles and inducing an irregular heartbeat, which could become life threatening. […] Health experts do not fully understand the link between anabolic steroids and heart attacks. However, research suggests these substances have detrimental effects on cardiovascular health. In time, the misuse of anabolic steroids may cause heart attacks.
#85 Do steroids cause heart attacks? Effect on cardiac health
https://www.medicalnewstoday.com/articles/do-steroids-cause-heart-attacks
Anabolic steroids can increase the risk of heart attacks and other cardiovascular complications when a person misuses them. […] Yes, misusing anabolic steroids can lead to heart attacks. […] When a person misuses them, they can affect heart health and may cause early heart attacks. […] AASs can have multiple effects on the cardiovascular system, which may contribute to the risk of heart attacks. […] High LDL and low HDL levels increase the risk of atherosclerosis, a condition involving a buildup of plaque inside arteries. […] Steroids also increase the risk of blood clots forming in blood vessels, potentially disrupting blood flow and damaging the heart muscle. […] If blood cannot reach the heart or brain, it can lead to a heart attack or stroke. […] Additionally, anabolic steroids may cause structural changes in the heart, decreasing the function of the hearts ventricles and inducing an irregular heartbeat, which could become life threatening. […] Health experts do not fully understand the link between anabolic steroids and heart attacks. However, research suggests these substances have detrimental effects on cardiovascular health. In time, the misuse of anabolic steroids may cause heart attacks.
#86 The toxic effects of anabolic steroids ânandrolone decanoateâ on cardiac and skeletal muscles with the potential ameliorative effects of silymarin and fenugreek seeds extract in adult male albino rats | BMC Pharmacology and Toxicology | Full Text
https://bmcpharmacoltoxicol.biomedcentral.com/articles/10.1186/s40360-023-00658-x
Anabolic steroids (AS) are commonly abused by body builders and athletes aiming to increase their strength and muscle mass but unfortunately, the long-term use of AS may lead to serious side effects. […] Nandrolone Decanoate is one of the Class II anabolic androgenic steroids which quickly spread globally and used clinically and illicitly. […] The anabolic steroids toxic effects on rats showed a significant decrease in serum High Density Lipoprotein (HDL) level and increase in cholesterol, triglycerides, and Low-Density Lipoprotein (LDL) levels. […] There was a significant elevation in cardiac troponin I level. […] As regards to histopathological examination of the cardiac and skeletal muscles, the study showed marked degenerative changes and necrosis. […] Anabolic steroids have a toxic effect on the cardiac and skeletal muscles of albino rats with improvement by treatment with fenugreek seeds extract and silymarin.
#87 The toxic effects of anabolic steroids ânandrolone decanoateâ on cardiac and skeletal muscles with the potential ameliorative effects of silymarin and fenugreek seeds extract in adult male albino rats | BMC Pharmacology and Toxicology | Full Text
https://bmcpharmacoltoxicol.biomedcentral.com/articles/10.1186/s40360-023-00658-x
The use of AS showed a dramatic increase in the recent years especially by young adults aiming to increase their power, their body mass and weight and to have a better appearance improving their self-esteem. […] Our work was performed to assess the toxic effects of AS on the heart and the skeletal muscles and assessment of the ameliorative effects of silymarin and fenugreek seeds extract. […] The AS treated rats showed a significant elevation in troponin levels. […] Cardiac troponin I (cTnI) is a cardiac enzyme which is released when ether is a damage in the myocytes and considered a sensitive factor of these damages. […] The activity of cardiac enzyme biomarkers including troponin showed a significant decrease with fenugreek seeds by 27% indicating the cardio-protective effect of fenugreek seeds.
#88 The toxic effects of anabolic steroids ânandrolone decanoateâ on cardiac and skeletal muscles with the potential ameliorative effects of silymarin and fenugreek seeds extract in adult male albino rats | BMC Pharmacology and Toxicology | Full Text
https://bmcpharmacoltoxicol.biomedcentral.com/articles/10.1186/s40360-023-00658-x
As regards to the lipid profile, rats received AS showed a significant elevation in serum cholesterol, triglycerides and LDL levels and a significant decrease in serum HDL levels. […] The abuse of AS in supra-physiological doses is strongly associated with abnormal levels of plasma lipoproteins showing a decreased level of HDL and increased levels of LDL and cholesterol levels. […] The antioxidant effects of silymarin and fenugreek seeds extract were evaluated on the heart, skeletal muscles and showed that, the tissue levels of SOD, Catalase and reduced glutathione decreased in AS treated rats compared to the control group. […] High doses of nandrolone decanoate are metabolized by cytochrome P450 mono-oxygenases. This results in production of reactive oxygen species leading to the upregulation followed by exhaustion of the antioxidants enzymes activity.
#89 The toxic effects of anabolic steroids ânandrolone decanoateâ on cardiac and skeletal muscles with the potential ameliorative effects of silymarin and fenugreek seeds extract in adult male albino rats | BMC Pharmacology and Toxicology | Full Text
https://bmcpharmacoltoxicol.biomedcentral.com/articles/10.1186/s40360-023-00658-x
As regards to the lipid profile, rats received AS showed a significant elevation in serum cholesterol, triglycerides and LDL levels and a significant decrease in serum HDL levels. […] The abuse of AS in supra-physiological doses is strongly associated with abnormal levels of plasma lipoproteins showing a decreased level of HDL and increased levels of LDL and cholesterol levels. […] The antioxidant effects of silymarin and fenugreek seeds extract were evaluated on the heart, skeletal muscles and showed that, the tissue levels of SOD, Catalase and reduced glutathione decreased in AS treated rats compared to the control group. […] High doses of nandrolone decanoate are metabolized by cytochrome P450 mono-oxygenases. This results in production of reactive oxygen species leading to the upregulation followed by exhaustion of the antioxidants enzymes activity.
#90 The toxic effects of anabolic steroids ânandrolone decanoateâ on cardiac and skeletal muscles with the potential ameliorative effects of silymarin and fenugreek seeds extract in adult male albino rats | BMC Pharmacology and Toxicology | Full Text
https://bmcpharmacoltoxicol.biomedcentral.com/articles/10.1186/s40360-023-00658-x
Histopathological examination of cardiac muscle in our study showed that, the most observed lesions were degenerative changes and cardiac muscles necrosis (hyalinosis) which was severe in rats treated with AS. […] The toxic effect of AS could be improved with treatment by silymarin and fenugreek seeds extract. […] Anabolic Steroids have a toxic effect on cardiac and skeletal muscles associated with alteration of the biochemical markers, oxidative stress, and histopathological changes. However, fenugreek seeds extract and silymarin improved the toxic effects of AS on the cardiac and skeletal muscles with better results of fenugreek seeds extract.
#91 Anabolic androgenic steroid-induced liver injury: An update
https://www.wjgnet.com/1007-9327/full/v28/i26/3071.htm
Anabolic androgenic steroids (AASs) are a group of molecules including endogenous testosterone and synthetic derivatives that have both androgenic and anabolic effects. […] However, they are commonly bought illegally and misused for their anabolic, skeletal muscle building, and performance-enhancing effects. Supraphysiologic and long-term use of AASs affects all organs, leading to cardiovascular, neurological, endocrine, gastrointestinal, renal, and hematologic disorders. Hepatotoxicity is one of the major concerns regarding AASs treatment and abuse. […] It is currently believed that mechanisms of pathogenesis of these disorders include disturbance of antioxidative factors, upregulation of bile acid synthesis, and induction of hepatocyte hyperplasia. […] Proposed mechanisms of liver injury include anabolic steroid-induced infiltration of inflammatory cells in the hepatic tissue, and Kupffer cell activation resulting in production of inflammatory cytokines and collagen deposition, increased oxidative stress and reactive oxygen species with subsequent mitochondrial degeneration in liver cells, and stimulation of intracellular androgenic steroid receptors inducing unregulated growth of hepatocytes.
#92 Anabolic androgenic steroid-induced liver injury: An update
https://www.wjgnet.com/1007-9327/full/v28/i26/3071.htm
Anabolic androgenic steroids (AASs) are a group of molecules including endogenous testosterone and synthetic derivatives that have both androgenic and anabolic effects. […] However, they are commonly bought illegally and misused for their anabolic, skeletal muscle building, and performance-enhancing effects. Supraphysiologic and long-term use of AASs affects all organs, leading to cardiovascular, neurological, endocrine, gastrointestinal, renal, and hematologic disorders. Hepatotoxicity is one of the major concerns regarding AASs treatment and abuse. […] It is currently believed that mechanisms of pathogenesis of these disorders include disturbance of antioxidative factors, upregulation of bile acid synthesis, and induction of hepatocyte hyperplasia. […] Proposed mechanisms of liver injury include anabolic steroid-induced infiltration of inflammatory cells in the hepatic tissue, and Kupffer cell activation resulting in production of inflammatory cytokines and collagen deposition, increased oxidative stress and reactive oxygen species with subsequent mitochondrial degeneration in liver cells, and stimulation of intracellular androgenic steroid receptors inducing unregulated growth of hepatocytes.
#93 Anabolic androgenic steroid-induced liver injury: An update
https://www.wjgnet.com/1007-9327/full/v28/i26/3071.htm
AAS-induced liver injury should be taken in consideration in patients with liver disorders, especially with the increasing unintentional ingestion of supplements containing AAS. […] AAS use is closely linked to hepatotoxicity and serious hepatic conditions such as cholestasis, peliosis hepatis, and benign and malignant hepatic tumors, as well as steatohepatitis and dyslipidemia with multiple studies supporting a causal association. Several pathophysiological mechanisms have been proposed including AR receptor-mediated inflammatory response, disturbance of hepatic antioxidant factors, promotion of hepatocyte hyperplasia, and upregulation of bile acid synthesis.
#94 Drug-induced liver injury secondary to anabolic steroid use | Revista de GastroenterologÃa de MÃ©xico
https://www.revistagastroenterologiamexico.org/en-drug-induced-liver-injury-secondary-anabolic-articulo-S2255534X19300702
Drug-induced liver injury (DILI) secondary to the application of anabolic steroids was suspected, and so an R value of 0.27 was calculated, indicating a pattern of cholestatic injury. […] Hepatotoxicity induced by anabolic steroids is dose-dependent and predictable. Its most frequent presentation is cholestatic hepatitis, and other types of injury associated with high doses of the drugs are: bland or pure cholestasis, acute cholestatic hepatitis, acute hepatocellular injury, and hepatic tumors. […] With all the above and a score of 9 on the CIOMS/RUCAM hepatotoxicity evaluation scale, it was concluded that the patient had highly probable or definitive hepatotoxicity due to anabolic steroid use. […] The US National Institutes of Health also has a website (www.livertox.nih.gov) that describes cases of hepatotoxicity and the mechanism of the liver injury the drugs can cause.
#95 Drug-induced liver injury secondary to anabolic steroid use | Revista de GastroenterologÃa de MÃ©xico
https://www.revistagastroenterologiamexico.org/en-drug-induced-liver-injury-secondary-anabolic-articulo-S2255534X19300702
Drug-induced liver injury (DILI) secondary to the application of anabolic steroids was suspected, and so an R value of 0.27 was calculated, indicating a pattern of cholestatic injury. […] Hepatotoxicity induced by anabolic steroids is dose-dependent and predictable. Its most frequent presentation is cholestatic hepatitis, and other types of injury associated with high doses of the drugs are: bland or pure cholestasis, acute cholestatic hepatitis, acute hepatocellular injury, and hepatic tumors. […] With all the above and a score of 9 on the CIOMS/RUCAM hepatotoxicity evaluation scale, it was concluded that the patient had highly probable or definitive hepatotoxicity due to anabolic steroid use. […] The US National Institutes of Health also has a website (www.livertox.nih.gov) that describes cases of hepatotoxicity and the mechanism of the liver injury the drugs can cause.
#96 Anabolic androgenic steroid-induced liver injury: An update
https://www.wjgnet.com/1007-9327/full/v28/i26/3071.htm
AAS-induced liver injury should be taken in consideration in patients with liver disorders, especially with the increasing unintentional ingestion of supplements containing AAS. […] AAS use is closely linked to hepatotoxicity and serious hepatic conditions such as cholestasis, peliosis hepatis, and benign and malignant hepatic tumors, as well as steatohepatitis and dyslipidemia with multiple studies supporting a causal association. Several pathophysiological mechanisms have been proposed including AR receptor-mediated inflammatory response, disturbance of hepatic antioxidant factors, promotion of hepatocyte hyperplasia, and upregulation of bile acid synthesis.
#97 Anabolic androgenic steroid-induced liver injury: An update
https://www.wjgnet.com/1007-9327/full/v28/i26/3071.htm
AAS-induced liver injury should be taken in consideration in patients with liver disorders, especially with the increasing unintentional ingestion of supplements containing AAS. […] AAS use is closely linked to hepatotoxicity and serious hepatic conditions such as cholestasis, peliosis hepatis, and benign and malignant hepatic tumors, as well as steatohepatitis and dyslipidemia with multiple studies supporting a causal association. Several pathophysiological mechanisms have been proposed including AR receptor-mediated inflammatory response, disturbance of hepatic antioxidant factors, promotion of hepatocyte hyperplasia, and upregulation of bile acid synthesis.
#98 Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects
https://pmc.ncbi.nlm.nih.gov/articles/PMC8683244/
Other studies have shown that AAS administration can result in androgen receptor downregulation. […] The adverse effect profile of exogenous AAS administration is a source of contention, with some raising the possibility that interpretations of data had been exaggerated. […] Among the complications of AAS use, cardiovascular side effects have been postulated to have the strongest mortality altering consequences, with some studies suggesting it to be the root cause of premature death in AAS users in up to 33-66% of cases. […] While the mechanisms behind cardiac death in AAS users are incompletely understood, four possibilities have been proposed, which include (1) atherosclerosis potentiation model, (2) thrombosis model, (3) coronary vasospasm, and (4) direct cardiac injury. […] Infertility following AAS use is secondary to suppression of intratesticular testosterone levels, which can lead to azoospermia or oligozoospermia.
#99 Steroid Use and Fertility –
https://txfertility.com/male-infertility/steroid-use-fertility/
Male infertility can be a very sensitive and difficult issue for many men to accept. It can come as a big surprise that they may be creating the problem by taking certain supplements â especially (anabolic) steroids. Steroids that are used to enhance strength and fitness can actually drastically lower a sperm count (to zero in many cases). […] Steroids that are taken to promote muscle growth and overall fitness can actually trick the brain into thinking that there is a sufficient amount of testosterone being produced. As a result, the brain decreases its signaling to the testicles. Steroid use can actually lead to low (or absent) sperm counts and shrunken testicles. In a sense, steroids can act like male birth control. The good news is that this is often a very treatable and recoverable form of male infertility. Once the steroid use has stopped, it generally takes about three months for sperm to return in the semen. For men who have used steroids for a long time, recovery may take longer â even sometimes a year or more.
#100 Steroid Use and Fertility –
https://txfertility.com/male-infertility/steroid-use-fertility/
Male infertility can be a very sensitive and difficult issue for many men to accept. It can come as a big surprise that they may be creating the problem by taking certain supplements â especially (anabolic) steroids. Steroids that are used to enhance strength and fitness can actually drastically lower a sperm count (to zero in many cases). […] Steroids that are taken to promote muscle growth and overall fitness can actually trick the brain into thinking that there is a sufficient amount of testosterone being produced. As a result, the brain decreases its signaling to the testicles. Steroid use can actually lead to low (or absent) sperm counts and shrunken testicles. In a sense, steroids can act like male birth control. The good news is that this is often a very treatable and recoverable form of male infertility. Once the steroid use has stopped, it generally takes about three months for sperm to return in the semen. For men who have used steroids for a long time, recovery may take longer â even sometimes a year or more.
#101 Steroid Use and Fertility –
https://txfertility.com/male-infertility/steroid-use-fertility/
Male infertility can be a very sensitive and difficult issue for many men to accept. It can come as a big surprise that they may be creating the problem by taking certain supplements â especially (anabolic) steroids. Steroids that are used to enhance strength and fitness can actually drastically lower a sperm count (to zero in many cases). […] Steroids that are taken to promote muscle growth and overall fitness can actually trick the brain into thinking that there is a sufficient amount of testosterone being produced. As a result, the brain decreases its signaling to the testicles. Steroid use can actually lead to low (or absent) sperm counts and shrunken testicles. In a sense, steroids can act like male birth control. The good news is that this is often a very treatable and recoverable form of male infertility. Once the steroid use has stopped, it generally takes about three months for sperm to return in the semen. For men who have used steroids for a long time, recovery may take longer â even sometimes a year or more.
#102 Impact of anabolic androgenic steroids on sexual function – Armstrong – Translational Andrology and Urology
https://tau.amegroups.org/article/view/19737/html
The long-term impact of high dose AAS use on sexual function remains poorly defined. […] Although high T dosages appeared to be protective of erectile function during use, de novo symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. […] These findings may suggest that to some degree, the body becomes dependent upon hyper-supplementation of T (suppression of hypothalamic-pituitary-gonadal axis, possible change in androgen receptor density, possible down regulation at nuclear level), an effect that is only recognized after discontinuing. […] The use of estrogen-modulating therapies were found to be a protective factor in maintaining erectile function after discontinuing AAS. […] Overall, findings suggest that increased frequency and duration of high-dose AAS may result in sexual dysfunctions following discontinuation and warrants further study.
#103 Impact of anabolic androgenic steroids on sexual function – Armstrong – Translational Andrology and Urology
https://tau.amegroups.org/article/view/19737/html
The long-term impact of high dose AAS use on sexual function remains poorly defined. […] Although high T dosages appeared to be protective of erectile function during use, de novo symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. […] These findings may suggest that to some degree, the body becomes dependent upon hyper-supplementation of T (suppression of hypothalamic-pituitary-gonadal axis, possible change in androgen receptor density, possible down regulation at nuclear level), an effect that is only recognized after discontinuing. […] The use of estrogen-modulating therapies were found to be a protective factor in maintaining erectile function after discontinuing AAS. […] Overall, findings suggest that increased frequency and duration of high-dose AAS may result in sexual dysfunctions following discontinuation and warrants further study.
#104 Impact of anabolic androgenic steroids on sexual function – Armstrong – Translational Andrology and Urology
https://tau.amegroups.org/article/view/19737/html
The long-term impact of high dose AAS use on sexual function remains poorly defined. […] Although high T dosages appeared to be protective of erectile function during use, de novo symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. […] These findings may suggest that to some degree, the body becomes dependent upon hyper-supplementation of T (suppression of hypothalamic-pituitary-gonadal axis, possible change in androgen receptor density, possible down regulation at nuclear level), an effect that is only recognized after discontinuing. […] The use of estrogen-modulating therapies were found to be a protective factor in maintaining erectile function after discontinuing AAS. […] Overall, findings suggest that increased frequency and duration of high-dose AAS may result in sexual dysfunctions following discontinuation and warrants further study.
#105 Impact of anabolic androgenic steroids on sexual function – Armstrong – Translational Andrology and Urology
https://tau.amegroups.org/article/view/19737/html
The long-term impact of high dose AAS use on sexual function remains poorly defined. […] Although high T dosages appeared to be protective of erectile function during use, de novo symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. […] These findings may suggest that to some degree, the body becomes dependent upon hyper-supplementation of T (suppression of hypothalamic-pituitary-gonadal axis, possible change in androgen receptor density, possible down regulation at nuclear level), an effect that is only recognized after discontinuing. […] The use of estrogen-modulating therapies were found to be a protective factor in maintaining erectile function after discontinuing AAS. […] Overall, findings suggest that increased frequency and duration of high-dose AAS may result in sexual dysfunctions following discontinuation and warrants further study.
#106 Impact of anabolic androgenic steroids on sexual function – Armstrong – Translational Andrology and Urology
https://tau.amegroups.org/article/view/19737/html
The long-term impact of high dose AAS use on sexual function remains poorly defined. […] Although high T dosages appeared to be protective of erectile function during use, de novo symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. […] These findings may suggest that to some degree, the body becomes dependent upon hyper-supplementation of T (suppression of hypothalamic-pituitary-gonadal axis, possible change in androgen receptor density, possible down regulation at nuclear level), an effect that is only recognized after discontinuing. […] The use of estrogen-modulating therapies were found to be a protective factor in maintaining erectile function after discontinuing AAS. […] Overall, findings suggest that increased frequency and duration of high-dose AAS may result in sexual dysfunctions following discontinuation and warrants further study.