Anabolic steroid misuse

• are synthetic derivatives of testosterone
• They may be in tablet or injectable form.
• The anabolic that are bought from the gym or from a dealer may not be what you think you are getting. 
• They may be fake ones, or drugs produced for use in animals e.g. Stanozolol, Stanabolic, Nandrobolin, and Testo L.A.

Commonly Misused Steroids

• There are two types of anabolic steroids:
  • 17 alpha alkyl derivatives:
    • oxandrolone
    • oxymetholone
    • fluoxymesterone
  • 17 beta ester derivatives:
    • testosterone cypionate
    • testosterone enanthate
    • testosterone heptylate
    • testosterone propionate
    • nandrolone decanoate
    • nandrolone phenpropionate
    • dromostanolone

Oral Steroids

• Anadrol (oxymetholone)
• Anavar (oxandrolone)
• Dianabol (methandienone )
• Winstrol (stanozolol)
• Restandol (testosterone undecanoate)

Injectable Steroids

• Deca-Durabolin (nandrolone decanoate)
• Durabolin (nandrolone phenpropionate)
• Depo-Testosterone (testosterone cypionate)
• Agovirin (testosterone propionate)
• Retandrol (testosterone phenylpropionate)
• Equipoise (boldenone undecylenate)

Mechanism of action

• Endogenous androgens(testosterone and dihydrotestosterone) are responsible for the growth and development of the sex organs in men and maintaining secondary sex characteristics.
• Endogenous anabolic steroids and synthetic anabolic steroids mediate their effects by binding to and activating androgen receptors.
  • In skeletal muscle, anabolic steroids regulate the transcription of target genes that control the accumulation of DNA in skeletal muscle required for muscle growth.
  • 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. 
  • They also have a stimulatory effect on the brain through their diverse effects on various central nervous system neurotransmitters, antagonism of glucocorticoids, and stimulation of the growth hormone-insulin-like growth factor-1 axis.
• Nandrolone decanoate
  • is a slow-acting anabolic steroid designed for the sole purpose of increasing muscle mass. 
  • It acts by promoting nitrogen retention in muscles, leading to an increase in muscle size, and providing joint pain relief by promoting collagen synthesis and enhancing bone mineralization.
• Nandrolone phenpropionate
  • an increase in muscle growth, stimulation of appetite, and an increase in the production of red blood cells.
• Dromostanolone
  • is a synthetic anabolic steroid with anti-estrogenic properties and is five times more potent than methyltestosterone, which is being used widely by bodybuilders to prepare for competition.
  •  It increases 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 density and hardness of muscle. 

Administration

• administration can be via oral pills, injections, creams or topical gels, and skin patches.
• Testosterone cypionate
  • 50 to 400 mg intramuscularly once to 4 times a month for primary hypogonadism and hypogonadotropic hypogonadism.
• Testosterone undecanoate
  • initial dose of 750 mg, then 750 mg given four weeks after the first dose, and 750 mg subsequently, given at ten weeks intervals between each dose.
• Testosterone gel
  • 11 mg 3 times daily, with a total dose of 33 mg daily.
• Transdermal testosterone
  • 50 mg applied once daily in the morning to the upper limb, shoulder, or abdomen with a maximum dose of 100 mg per day.

• Nandrolone decanoate
  • dosing is 100 mg per week for comfort and relief of joint pain 
  • dose range of 200 mg to 400 mg per week to increase growth and performance
  • ideally used for about ten to twelve weeks to get the desired results in athletes, powerlifters, and bodybuilders.
• Dromostanolone
  • 200 to 400 mg weekly
  • bodybuilders use to enhance their athletic performance
  • Because of its short half-life, dromostanolone injections are administered every 3 to 4 days.

The apparent positive effects of anabolic steroids include gains in muscular strength (in conjunction with diet and exercise) and quicker healing of muscle injuries. However, the adverse effects, which are dependent on the dose and duration, are numerous.

Adverse Effects

1. Not all steroids will cause the same side effects, but most anabolic steroids, in tablet form have definitive risk of developing
2. Cardiovascular:
   1. Coronary heart disease
   2. Cardiomyopathy
   3. hypertension (3% or less)
3. Endocrine and metabolic:
   1. Decreased HDL cholesterol (6% or less)
   2. hyperlipidemia (6% or less)
   3. hypokalemia
   4. increased serum triglycerides thyroid-stimulating hormone level and plasma estradiol concentration
   5. decreased libido (3% or less)
   6. gynecomastia (3% or less)
   7. hot flashes and weight gain
4. Gastrointestinal:
   1. Gingivitis (9% or less)
   2. mouth irritation (9% or less)
   3. increased serum bilirubin
   4. abnormal hepatic function tests
   5. decreased appetite
   6. dysgeusia
   7. gastroesophageal reflux disease
   8. gastrointestinal hemorrhage.
5. Genitourinary:
   1. Increase in prostate-specific antigen (topical 18% or less)
   2. benign prostatic hypertrophy (12%)
   3. testicular atrophy (6% or less)
   4. suppression of spermatogenesis
   5. mastalgia
   6. hypogonadism (following withdrawal)
   7. prostatitis
   8. dysuria
   9. hematuria
   10. impotence
   11. pelvic pain
   12. urinary incontinence
   13. urinary tract infection
   14. testicular tenderness
   15. ejaculatory disorder
   16. erectile dysfunction (nandrolone)
6. Hematologic and oncologic:
   1. Polycythemia (6%)
   2. prostate carcinoma (less than 3%)
7. Neuromuscular and skeletal:
   1. Myalgia (6% or less)
   2. premature epiphyseal closure (when taken before completion of puberty)
   3. limb pain, tendon rupture, abnormal bone growth, and hemarthrosis
8. Neuropsychiatric:
   1. Emotional lability
   2. major mood disorders 
   3. anosmia, headache, depression, nervousness, body pain, violence, insomnia, and aggressive behavior
9. Dermatologic:
   1. Skin blister (12%)
   2. acne vulgaris (8% or less),
   3. crusted skin, nasal excoriation (6% or less)
   4. contact dermatitis, bulla, skin rash, and pruritus
10. Renal:
    1. Increase in serum creatinine and frequency of urination
11. Nandrolone causes hirsutism and deepening of voice in a woman with extended periods of use due to its androgenic properties.
12. Adverse effects in women are:
    • masculinisation—male-pattern beard growth
    • suppression of ovarian function
    • changes in mood and libido
    • hair loss

Treatment

need to address the underlying causes of the steroid use. This can include:

• psychological therapies (and possibly medications) for muscle dysmorphia
• endocrine therapies to restore function in those suffering from hypogonadism and to alleviate symptoms of depression
• antidepressants for those whose depression does not respond to endocrine therapies
• pharmacological and psychosocial treatments for patients who are also dependent on opioids, which appear to also be effective in alleviating signs of anabolic steroid dependence

Advise to patients

• Can I take other Medications to stop Side Effects?
  • Not really, as these drugs ( HCG, Diuretics) have potential side effects as well. Further more when used together they may be more dangerous.
• But They Work!
  • This is controversial. Scientific evidence shows that they enhance physical performance, if you continue to train, diet and are motivated to continue to muscle build. Remember you cannot give more than what you have!  Also you may become psychologically dependent on them. A feeling of Euphoria exists as well as improvement of self-esteem. You may also have mood swings; “ roid – rages” may occur or you may even become paranoid or depressed.
• What about if I only use small amounts?
  • There is “no safe dose” of anabolic steroids. Remember the higher the dose does not mean, bigger muscles.
• What about the doctor prescribing it?
  • This is also illegal. Your doctor can’t prescribe them unless they are used for medical reason.
  • Bodybuilding, or improvement of sporting performance is not medical reasons for using anabolic Steroids. 
• IF I am using them, what can I do to decrease side effects?
  • Use low doses
  • Never share needles
  • Avoid diuretics with anabolic steroids
  • If side effects develop, don’t use other drugs to treat them
  • Tell your doctor that you are using them
  •  Make sure you know exactly what you are taking