Steroid Side Effects #2

Liver Changes
Many steroids cause changes in liver function as shown by alterations in the liver function tests. This is most frequently seen with the oral preparations that are alkylated at the C-17 position. There have been cases of jaundice reported when steroids have been used but these have often been in patients who used unusually large doses or who were suffering from medical diseases. Peliosis hepatica, a condition in which there are blood filled sacs in the liver has been found in people using steroids. Liver tumours have  been noted in people who used anabolic steroids. It is difficult to prove cause and effect, but in some people the tumours have decreased in size after withdrawal of the steroid, suggesting that the drug may stimulate tumour growth rather than cause it.

Sexual Disturbance
Anabolic steroids may cause a disturbance in sexual function. The use of anabolic steroids depresses the formation of the pituitary hormones that affect the function of the testis. Follicle Stimulating Hormone (fsh) is responsible for the formation of sperm and Luteinising Hormone (lh) stimulates the formation of testosterone. Both of these functions are suppressed, at least in part, by anabolic steroids and it is inevitable that the size of the testis will be effected to some degree with their use. This decrease may not be noticed by the individual but is present nevertheless. The degree of decrease in size of the testes varies among users and at times can be quite obvious.
The prolonged use of anabolic steroids will cause a greater loss of size than a short course and the higher the dose, the more likely it is that the testes will decrease in size to a notable degree. Following the cessation of the drug, the testes usually return to their normal size, but in those who have used long or high dose courses it is not uncommon for the changes to persist for many months even up to a year or two. If the reduction of the testes persists, medical advice is needed to restore the bulk of the testes and even then, the recovery may be prolonged. The reduction in Follicule Stimulating Hormone decreases the amount of sperm and decreases the likelihood of pregnancy but this is not a guarantee of contraception. Extended courses may lead to a temporary sterility lasting several years possibly even permanently.
Steroids have an effect on libido. This varies widely from over stimulation to a total loss of libido. When the latter occurs, the athlete should cease the course and wait for the expected return of the sex drive. This does not always happen as the sexual act is a very complex act and there are many causes of impotence. The cause of the loss of libido is not a lack of testosterone. It is due in most cases to outside influences and a few shots of steroids will not fix it but make it worse.
In women there is sometimes an increase in libido when using the drug but this will return to normal on cessation.

Bleeding
Anabolic steroids cause a lengthening of the bleeding time and this can lead to bleeding from the nose, mouth or other orifice. If this occurs and does not settle quickly, or is recurrent, a doctor should be consulted to ensure that there is no serious clotting deficiency that could put a user in a precarious position as a result of a sudden bleed after little trauma such as forcibly blowing one’s nose. It goes without saying that the doctor should be told of the history of steroid use. There is evidence of some athletes suffering a stroke when using steroids due to clot formation, the opposite of bleeding. The clotting mechanisms are very complex and these events are usually associated with large doses. To date the research into this area has not fully explained the different results of steroids on the clotting mechanisms. Similar events have been described in women using the contraceptive pill.

Hair Loss
Balding is part of the genetic make up of many males. In any male who has a predisposition to it the use of steroids may speed up the process. It should be noted that a hair loss might occur in men who have never used a steroid.
Insomnia
If it is difficult to sleep when using steroids the best approach is to cease the drug. Using sleeping tablets will not cure the problem and may have a hangover like effect.

Tendon Damage
Anabolic steroids strengthen muscle and not tendon and there is an increased likelihood of tendon rupture in the users. The event is sudden and demands immediate attention. The most common tendon affected is the biceps tendon and the tear may be partial or complete. It is important that there be no further use of the arm until the problem has been fully evaluated by a doctor. The other frequent site for muscle rupture is in the quadriceps group.

Young People
Anabolic steroids have been reported to be associated with stunting of growth in adolescents. The steroids may lead to premature closure of the epiphyses of the bone. This is the growing part of the bone and once union at that site has occurred, no further increase in height is possible. This will decrease the future benefits of steroids for those interested in appearance or body building competitions. Once this has happened there is no method by which it can be reversed.

Prostate Gland
Studies have shown that the prostate gland increases in size during a course of anabolic steroids and it will decrease after the course. This is of particular interest to the older male who uses these substances as this age group in particular is susceptible to urinary blockage due to swelling of the gland. If there is a difficulty in passing urine in the form of trouble in starting the flow, anabolic steroids should be ceased and medical attention is needed. It is important to establish the correct diagnosis early to enable simple curative measures to be undertaken. Even the young person needs to consider this side effect when faced by urinary problems.

Infections
The commonest infection during the course of steroid use is the one due to lack of sterility in the technique. It can be avoided by using a new syringe and needle for each injection and making sure that the hands are washed before any preparation is done. The infection will show up as an abscess at the site of injection. This may be superficial or deep – the latter may take several days to develop. Once there is a suspicion of an abscess formation medical help is needed immediately. Anabolic steroids have also been known to have an effect on the immune system and some users have been known to complain of having more colds when using steroids.
The other source of infection comes from sharing injecting equipment. This is one way HIV and Hepatitis are spread.