Anabolic Steroids: Uses, Abuse, And Side Effects

# Comprehensive Evidence‑Based Guide to the Adverse Health Effects of Anabolic–androgenic Steroid (AAS) Use
**Prepared for: Graduate‑level Course in Sports Medicine & Endocrinology**
**Author:** Dr. Your Name, Ph.D., M.S.C., F.R.M.S.

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## 1. Introduction

- **Definition:** Anabolic–androgenic steroids (AAS) are synthetic derivatives of testosterone that promote anabolic tissue growth while retaining androgenic activity.
- **Historical context:** First synthesized in the 1930s; widespread therapeutic use declined after the 1960s, but recreational use persists—particularly among athletes and bodybuilders seeking performance enhancement or aesthetic improvement.
- **Relevance to sports medicine:** AAS influence a wide range of physiological systems (musculoskeletal, endocrine, cardiovascular, neurological). Understanding their systemic effects is critical for clinicians managing athlete health.

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## 2. Pharmacology Overview

| Property | Description |
|----------|-------------|
| **Mechanism** | Binds androgen receptors → Modulates gene transcription → Stimulates protein synthesis and muscle growth; also influences fat distribution and bone density. |
| **Half‑life** | Varies: Testosterone ~3–4 h (free), but metabolites can persist longer. |
| **Routes of Administration** | Oral (e.g., anabolic steroids with methyl groups) vs Intramuscular injections (unmodified testosterone esters). |
| **Metabolism** | Hepatic → 5α‑reduction, conjugation, excretion in bile/urine. |
| **Bioavailability** | Oral: ~30 % due to first‑pass metabolism; IM: higher. |

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## 2. Typical "Cycle" Protocols (Illustrative)

| Cycle Type | Goal | Example Schedule | Total Duration |
|------------|------|------------------|----------------|
| **Stacking/"Bulking"** | Maximize muscle hypertrophy while keeping androgenic side‑effects low | 5 mg/day for 8 weeks → 10 mg/day for 4 weeks → 0 mg (wash‑out) | 12–16 wks |
| **Maintenance ("Taper")** | Keep strength, avoid significant loss of mass | 7 mg/day for 6 weeks → 3 mg/day for 4 weeks → 0 mg | 10–12 wks |
| **"Rapid" Cut** | Quick fat loss with minimal muscle loss | 5 mg/day for 2 weeks → 10 mg/day for 1 week (high dose) | *Note:* "High‑dose" periods should not exceed a few days, as they increase the risk of **testosterone rebound** and potential side effects.

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## 3. Practical Guidelines

| Step | What to Do | Why It Matters |
|------|------------|----------------|
| **1. Determine your goal (maintenance vs. cutting)** | - For maintenance: use ~5 mg/day for 2–4 weeks.
- For cutting: start with 5 mg/day, increase to 10 mg/day during "burn" days. | Tailoring the dose prevents unnecessary exposure and reduces side‑effects. |
| **2. Start low and go slow** | Begin at 5 mg; if you need more (e.g., for a more aggressive cut), double to 10 mg only after a few weeks. | Allows your body to adjust and limits the risk of acute side‑effects. |
| **3. Plan a "washout" period** | After finishing, stop using testosterone at least 4–6 weeks before next cycle or any new performance‑enhancing drug. | Ensures you’re not overlapping drugs that could interact or mask each other’s effects. |
| **4. Use a "maintenance" window** | Keep your dosage low (5 mg) for the last week of the cycle to smooth the decline, then taper off completely after 7–8 weeks. | Prevents sudden withdrawal and makes it easier to assess drug clearance later. |

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### Practical Timeline Example

| Week | Action |
|------|--------|
| **1‑8** | 5 mg testosterone (or appropriate dose). |
| **9‑10** | Continue 5 mg for smooth tapering. |
| **11‑12** | Stop all injections, no further dosing. |
| **13‑15** | No drug detected in plasma or urine. |
| **16–18** | Baseline assessment: liver/renal function, complete metabolic panel. |
| **19–20** | Repeat assessment to confirm stable baseline before next experimental drug. |

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## Why This Plan Works

1. **Safety** – The chosen dose is low enough that the patient’s hormone levels remain within normal limits and no adverse effects are expected.
2. **Reproducibility** – A fixed schedule (2 weeks on, 2 weeks off) provides a clear protocol that can be replicated across studies or patients.
3. **Time‑Efficiency** – The entire preparation phase lasts just 4–6 weeks, which is short enough not to delay research timelines but long enough for the body to return to baseline.
4. **Baseline Stability** – By ensuring hormone levels are back to normal before any new intervention, you eliminate a major confounding factor.

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## Practical Implementation Checklist

| Step | Action | Timing | Notes |
|------|--------|--------|-------|
| 1 | Obtain informed consent and baseline labs (CBC, CMP, fasting glucose, HbA1c, thyroid panel) | Day 0 | Document any comorbidities. |
| 2 | Initiate oral metformin 500 mg twice daily (or prescribed dose) | Day 1 | Monitor for GI side‑effects; adjust as needed. |
| 3 | Provide dietary counseling: low glycemic index, high fiber, limit refined carbs | Day 1 | Consider Mediterranean or DASH pattern. |
| 4 | Schedule follow‑up visits at weeks 2 and 6 | Weeks 2 & 6 | Reassess weight, fasting glucose, adherence. |
| 5 | At week 8: repeat labs (fasting glucose, HbA1c, lipid panel) | Week 8 | Adjust therapy if needed. |
| 6 | Continue lifestyle modifications long‑term; consider adding exercise program | Ongoing | Monitor for complications of prediabetes/obesity. |

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## 3️⃣ Potential Complications of the Current Condition

| Category | Possible Issues | Why They Matter |
|----------|-----------------|-----------------|
| **Metabolic** | • Development of type 2 diabetes
• Dyslipidemia (↑TG, ↓HDL)
• Hypertension | All increase cardiovascular risk. |
| **Cardiovascular** | • Atherosclerosis → CAD, stroke
• Heart failure (due to LV hypertrophy from HTN) | Leads to morbidity/mortality. |
| **Renal** | • Diabetic nephropathy
• Hypertensive nephrosclerosis | Progressive CKD, need dialysis or transplant. |
| **Neurological** | • Peripheral neuropathy
• Retinopathy (vision loss)
• Cognitive decline | Reduces quality of life; requires support. |
| **Psychological** | • Depression/anxiety due to chronic disease burden | Affects adherence and outcomes. |

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## 4. Evidence‑Based Management Plan

The following plan is adapted from the latest **American Diabetes Association (ADA) Standards of Care 2024**, **International Diabetes Federation (IDF)** guidelines, **European Society for Clinical Nutrition & Metabolism (ESPEN)** recommendations, and **Endocrine Society** clinical practice guidelines.

### A. Glycaemic Control

| Target | Evidence/Guideline |
|--------|---------------------|
| HbA1c