Effects of androgenic-anabolic steroids in athletes

• Published in: Sports medicine (Auckland) 2004-01, Vol.34 (8), p.513-554
• Main Authors: HARTGENS, Fred, KUIPERS, Harm
• Format: Article
• Language: English
• Subjects: Anabolic Agents - pharmacology; Androgens - pharmacology; Biological and medical sciences; Body Composition - drug effects; Cardiovascular Diseases - chemically induced; Chemical and Drug Induced Liver Injury; Doping in Sports; Drug intoxications. Doping; Female; Genital Diseases, Male - chemically induced; Humans; Male; Medical sciences; Mental Disorders - chemically induced; Muscle, Skeletal - drug effects; Pharmacology. Drug treatments; Physical Endurance - drug effects; Steroids - pharmacology
• ISSN: 0112-1642; 1179-2035
• DOI: 10.2165/00007256-200434080-00003

Androgenic-anabolic steroids (AAS) are synthetic derivatives of the male hormone testosterone. They can exert strong effects on the human body that may be beneficial for athletic performance. A review of the literature revealed that most laboratory studies did not investigate the actual doses of AAS currently abused in the field. Therefore, those studies may not reflect the actual (adverse) effects of steroids. The available scientific literature describes that short-term administration of these drugs by athletes can increase strength and bodyweight. Strength gains of about 5-20% of the initial strength and increments of 2-5 kg bodyweight, that may be attributed to an increase of the lean body mass, have been observed. A reduction of fat mass does not seem to occur. Although AAS administration may affect erythropoiesis and blood haemoglobin concentrations, no effect on endurance performance was observed. Little data about the effects of AAS on metabolic responses during exercise training and recovery are available and, therefore, do not allow firm conclusions. The main untoward effects of short- and long-term AAS abuse that male athletes most often self-report are an increase in sexual drive, the occurrence of acne vulgaris, increased body hair and increment of aggressive behaviour. AAS administration will disturb the regular endogenous production of testosterone and gonadotrophins that may persist for months after drug withdrawal. Cardiovascular risk factors may undergo deleterious alterations, including elevation of blood pressure and depression of serum high-density lipoprotein (HDL)-, HDL2- and HDL3-cholesterol levels. In echocardiographic studies in male athletes, AAS did not seem to affect cardiac structure and function, although in animal studies these drugs have been observed to exert hazardous effects on heart structure and function. In studies of athletes, AAS were not found to damage the liver. Psyche and behaviour seem to be strongly affected by AAS. Generally, AAS seem to induce increments of aggression and hostility. Mood disturbances (e.g. depression, [hypo-]mania, psychotic features) are likely to be dose and drug dependent. AAS dependence or withdrawal effects (such as depression) seem to occur only in a small number of AAS users. Dissatisfaction with the body and low self-esteem may lead to the so-called 'reverse anorexia syndrome' that predisposes to the start of AAS use. Many other adverse effects have been associated with AAS misuse, i