Anabolic steroids are compounds, derived from testosterone, which promote tissue growth and repair. Because they have been used improperly by body builders and other athletes, they are controlled substances under United States federal law.
As of 2004, there are four anabolic steroids available:
Although these products have different labeled uses, they are very similar in action and side effects and may be used interchangeably, subject to differences in route of administration and duration of action.
Anabolic steroids are used for the following conditions:
- catabolic states such as chronic infections, extensive surgery, burns, or severe trauma
- anemia associated with renal insufficiency, sickle cell anemia, aplastic anemia, and bone marrow failure
- growth failure, including the short stature associated with Turner's syndrome
Anabolic steroids are not recommended for young children because the drugs may cause an early end to the growth of long bones, which results in short stature. Anabolic steroids should be used with great care in girls, because the drugs have masculinizing properties. The drugs should be reserved for situations in which the benefits outweigh the risk. Anabolic steroids have been associated with liver cancer, and they have psychological effects, such as contributing to rage attacks.
Anabolic steroids cause masculinization of females, including hair growth or loss, enlargement of the clitoris, and deepening of the voice. These effects are not reversible, even when the drug is promptly discontinued. In males past the age of puberty, side effects include increased urinary frequency, breast tenderness and enlargement, and frequent erections. In both males and females, anabolic steroids cause swelling of the feet, liver problems, and stomach upset.
This list of side effects is incomplete; many additional effects have been reported. Specialized drug references maintain for a complete list for each individual drug, including analysis of psychological effects of these drugs that contribute to rage attacks.
Anabolic steroids have an anticoagulant effect. They should be used with care in combination with other drugs that have the same effect, including warfarin, nonsteroidal anti-inflammatory drugs (NSAIDs), and aspirin. Simultaneous use of anabolic steroids and corticosteroids will increase the risk of foot and ankle swelling. The combination is very likely to cause acne. Anabolic steroids may also lower blood glucose levels. They should be used with extreme care in patients taking insulin or other antidiabetic drugs. Other drug interactions have also been reported.
Because of the nature of the adverse effects of anabolic steroids, their use should be restricted to cases where the benefits clearly outweigh the risks. Regular blood testing for blood counts and liver function is essential. Parents should observe the patient carefully for signs of liver damage, including headache, unpleasant breath odor, and black tarry stools.
Anabolic—Refers to metabolic processes characterized by the conversion of simple substances into more complex compounds.
Catabolism—A process of metabolism that breaks down complex substances into simple ones.
Testosterone—Male hormone produced by the testes and (in small amounts) in the ovaries. Testosterone is responsible for some masculine secondary sex characteristics such as growth of body hair and deepening voice. It also is sometimes given as part of hormone replacement therapy to women whose ovaries have been removed.
Turner syndrome—A chromosome abnormality characterized by short stature and ovarian failure caused by an absent X chromosome. It occurs only in females.
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Taylor, William N. Anabolic Steroids and the Athlete. Jefferson, NC: McFarland & Co., 2002.
"Anabolic Steroids." MedlinePlus. Available online at <www.nlm.nih.gov/medlineplus/druginfo/uspdi/202035.html>.
"Steroids (Anabolic-Androgenic.)" National Institute on Drug Abuse. Available online at <www.nida.nih.gov/Infofax/steroids.htm/> (accessed December 18, 2004).
Samuel Uretsky, PharmD