Anabolic steroid

.cite journal
author=Grishkovskaya I, Avvakumov GV, Sklenar G, Dales D, Hammond GL, Muller YA
title=Crystal structure of human sex hormone-binding globulin: steroid transport by a laminin G-like domain
journal=EMBO J.
volume=19
issue=4
pages=504–12
year=2000
pmid=10675319
doi=10.1093/emboj/19.4.504] ] Anabolic steroids, or anabolic-androgenic steroids (AAS), are a class of steroid hormones related to the hormone testosterone. They increase protein synthesis within cells, which results in the buildup of cellular tissue (anabolism), especially in muscles. Anabolic steroids also have androgenic and virilizing properties, including the development and maintenance of masculine characteristics such as the growth of the vocal cords and body hair. The word "anabolic" comes from the Greek "anabole", "to build up", and the word "androgenic" from the Greek "andros", "man" + "genein", "to produce".

Anabolic steroids were first isolated, identified and synthesized in the 1930s, and are now used therapeutically in medicine to stimulate bone growth and appetite, induce male puberty, and treat chronic wasting conditions, such as cancer and AIDS. Anabolic steroids also produce increases in muscle mass and physical strength, and are consequently used in sport and bodybuilding to enhance strength or physique. Serious health risks can be produced by long-term use or excessive doses of anabolic steroids. These effects include harmful changes in cholesterol levels (increased low-density lipoprotein and decreased high-density lipoprotein), acne, high blood pressure, liver damage, and dangerous changes in the structure of the left ventricle of the heart. Some of these effects can be mitigated by exercise, or by taking supplemental drugs.

Non-medical uses for anabolic steroids are controversial, because of their adverse effects and their use to gain weight and potential advantage in competitive sports. The use of anabolic steroids is banned by all major sporting bodies, including the International Olympic Committee, Major League Baseball, the National Football League, the National Basketball Association, the National Hockey League, WWE, ICC, ITF, FIFA, FINA, UEFA, the European Athletic Association, and the Brazilian Football Confederation. Anabolic steroids are controlled substances in many countries, including Argentina, Australia, Brazil, Canada, the United Kingdom (UK) and the United States (U.S.), while in other countries, such as Mexico and Thailand, they are readily available over-the-counter. In countries where the drugs are controlled, there is often a black market in which smuggled or counterfeit drugs are sold to users. The quality of such illegal drugs may be low, and contaminants may cause additional health risks. In countries where anabolic steroids are strictly regulated some have called for less regulation.

History

Performance enhancing substances have been used for thousands of years in traditional medicine by societies around the world, with the aim of promoting vitality and strength.cite web
title = A short doping history
publisher = Anti-Doping Hotline
url = http://www.dopingjouren.se/page.asp?page=history
accessdate = 2007-04-24 ] In particular, the use of steroid hormones pre-dates their identification and isolation: medical use of testicle extract began in the late 19th century while its effects on strength were still being studied. [cite journal |author=Kuhn CM |title=Anabolic steroids |journal=Recent Prog. Horm. Res. |volume=57 |issue= |pages=411–34 |year=2002 |pmid=12017555 |url=http://rphr.endojournals.org/cgi/content/full/57/1/411 |doi=10.1210/rp.57.1.411] In 1889, the 72-year-old British neurologist Charles-Édouard Brown-Séquard injected himself with an extract of dog and guinea pig testicles, and reported at a scientific meeting that these injections had led to a variety of beneficial effects.

The development of modern pharmaceutical anabolic steroids can be traced back to 1931 when Adolf Butenandt, a chemist in Marburg, purified 15 milligrams of the male hormone androstenone from tens of thousands of litres of urine. This hormone was synthesized in 1934 by Leopold Ruzicka, a chemist in Zurich. It was already known that the testes contained a more powerful androgen than androstenone, and three groups of scientists, funded by competing pharmaceutical companies in the Netherlands, Germany and Switzerland, raced to isolate it.cite journal
author=Hoberman JM, Yesalis CE
title=The history of synthetic testosterone
journal=Scientific American
volume=272
issue=2
pages=76–81
year=1995
pmid=7817189] cite journal
author=Freeman ER, Bloom DA, McGuire EJ
title=A brief history of testosterone
journal=Journal of Urology
volume=165
issue=
pages=371–373
year=2001
pmid= 11176375
doi=10.1097/00005392-200102000-00004]

This testicular hormone was first identified by Karoly Gyula David, E. Dingemanse, J. Freud and Ernst Laqueur in a May 1935 paper "On Crystalline Male Hormone from Testicles (Testosterone)." [cite journal| author = David K, Dingemanse E, Freud J, Laqueur L|title= Uber krystallinisches mannliches Hormon aus Hoden (Testosteron) wirksamer als aus harn oder aus Cholesterin bereitetes Androsteron|journal= Hoppe Seylers Z Physiol Chem|volume=233|pages=281|year= 1935] They named the hormone "testosterone", from the stems of "testicle" and "sterol", and the suffix of "ketone". The chemical synthesis of testosterone was achieved in August that year, when Butenandt and G. Hanisch published a paper describing "A Method for Preparing Testosterone from Cholesterol." [cite journal |author=Butenandt A, Hanisch G. |title=A Method for Preparing Testosterone from Cholesterol |journal=Chemische Berichte |volume=68 |pages=1859 |year=1935] Only a week later, the third group, Ruzicka and A. Wettstein, announced a patent application in a paper "On the Artificial Preparation of the Testicular Hormone Testosterone (Androsten-3-one-17-ol)." [cite journal|author = Ruzicka L, Wettstein A|title= Sexualhormone VII. Uber diekunstliche Herstellung des Testikelhormons. Testosteron (Androsten-3-one-17-ol.)|journal = Helvetica Chimica Acta|volume = 18|pages= 1264|year = 1935|doi= 10.1002/hlca.193501801176] Ruzicka and Butenandt were offered the 1939 Nobel Prize for Chemistry for their work, but the Nazi government forced Butenandt to decline the honor.

Clinical trials on humans, involving either oral doses of methyl testosterone or injections of testosterone propionate, began as early as 1937. Testosterone propionate is mentioned in a letter to the editor of "Strength and Health" magazine in 1938; this is the earliest known reference to an anabolic steroid in a U.S. weightlifting or bodybuilding magazine.

During the Second World War, German scientists synthesized other anabolic steroids, and experimented on concentration camp inmates and prisoners of war in an attempt to treat chronic wasting. They also experimented on German soldiers, hoping to increase their aggression. Adolf Hitler himself, according to his physician, was injected with testosterone derivatives to treat various ailments. [cite book
title=Macho Medicine: A History of the Anabolic Steroid Epidemic
first = William N. |last = Taylor
publisher = McFarland & Company| year = 1991
isbn= 978-0899506135] The development of muscle-building properties of testosterone was pursued in the 1940s, in the Soviet Union and in Eastern Bloc countries such as East Germany, where steroid programs were used to enhance the performance of Olympic and other amateur weight lifters. [cite journal
last = Sweitzer
first = Philip J.
journal = Journal of Sports Law and Contemporary Problems
year = 2004
title = Drug law enforcement in crisis: cops on steroids
volume = 2
issue = 2
publisher =
date =
url = http://www.law.depaul.edu/students/organizations_journals/student_orgs/lawslj/Volume%202,%20Issue%202/Sweitzer%20Cops%20On%20Steroids.pdf
format =
doi =
accessdate = 2007-05-16 ] In response to the success of Russian weightlifters, the U.S. Olympic Team physician Dr. John Ziegler worked with synthetic chemists to develop an anabolic steroid for American weightlifters, resulting in the production of methandrostenolone (Dianabol).cite journal |author=Calfee R, Fadale P |title=Popular ergogenic drugs and supplements in young athletes |journal=Pediatrics |volume=117 |issue=3 |pages=e577–89 |year=2006 |pmid=16510635 |doi=10.1542/peds.2005-1429] Dianabol, developed by Ciba Pharmaceuticals, was approved for use in the U.S. by the Food and Drug Administration in 1958. Dianabol had the same strength building properties as testosterone, but with reduced side effects. [Justin Peters [http://www.slate.com/id/2113752/ The Man Behind the Juice] , "Slate" Friday, Feb. 18, 2005, Accessed 29 April 2008]

From the 1950s until the 1980s, there were doubts that anabolic steroids produced anything more than a placebo effect. In a 1972 study, [Medicine and Science in Sports, "Anabolic steroids: the physiological effects of placebos." (Ariel & Saville, 1972).] participants were informed they would receive injections of anabolic steroids on a daily basis, but instead had actually been given a placebo. They reportedly could not tell the difference, and the perceived performance enhancement was similar to that of subjects taking the real anabolic compounds. According to Geraline Lin, a researcher for the National Institute on Drug Abuse, these results remained unchallenged for 18 years, even though the study used inconsistent controls and insignificant doses.Lin, Geraline (1996). "Anabolic Steroid Abuse" ISBN 0-7881-2969-4] In a 2001 study, the effects of "high" doses of anabolic steroids were examined, by injecting variable doses (up to 600 mg/week) of testosterone enanthate into muscle tissue for 20 weeks. The results showed a clear increase in muscle mass and decrease in fat mass associated with the testosterone doses. [cite journal
author=Bhasin S, Woodhouse L, Casaburi R, "et al"
title=Testosterone dose-response relationships in healthy young men
journal=Am J Physiol Endocrinol Metab
volume=281
issue=6
pages=E1172–81
year=2001
pmid=11701431]

Pharmacology

Routes of administration

Anabolic steroids are primarily administered orally (by mouth) or parenterally. Some anabolic steroids may also be administered by topical or transdermal methods; however, not as much is known of these more recently developed routes of administration. The traditional routes of administration do not have differential effects on the efficacy of the drug. Studies indicate that the anabolic properties of anabolic steroids are relatively similar despite the differences in pharmacokinetic principles such as first-pass metabolism. However, the first-pass metabolism that orally-administered AAS are subjected to has been shown to produce more harmful side effects, particularly liver damage. [. AJ Giannini,NS Miller, DK Kocjan. Treating steroid abuse: A pediatric perspective. Clinical Pedatrics. 30:538-534, 1991. ]

Anabolic and androgenic effects

,17β-hydroxy-4-androsten-3-one.] As the name suggests, anabolic-androgenic steroids have two different, but overlapping, types of effects. First, they are "anabolic", meaning that they promote anabolism (cell growth). Some examples of the anabolic effects of these hormones are increased protein synthesis from amino acids, increased appetite, increased bone remodeling and growth, and stimulation of bone marrow, which increases the production of red blood cells.

Second, these steroids are "androgenic" or "virilizing", meaning in particular that they affect the development and maintenance of masculine characteristics. The biochemical functions of androgens such as testosterone are numerous. Processes affected include pubertal growth, sebaceous gland oil production, and sexuality (especially in fetal development). Some examples of virilizing effects are growth of the clitoris in females and the penis in male children (the adult penis does not grow even when exposed to high doses of androgens), increased growth of androgen-sensitive hair (pubic, beard, chest, and limb hair), increased vocal cord size, deepening the voice, increased libido, suppression of natural sex hormones, and impaired production of sperm. [cite journal
title = Recent Progress in Hormone Research - Anabolic steroids
journal = The Endocrine Society
issue = 57
pages = 411–434
publisher = Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina
year = 2002
url = http://rphr.endojournals.org/cgi/content/full/57/1/411
pmid = 12017555
doi = 10.1210/rp.57.1.411
author = Kuhn, C. M.
volume = 57 ]

Through a combination of these effects, anabolic steroids stimulate the formation of muscles and hence cause an increase in the size of muscle fibers, leading to increased muscle mass and strength. [cite journal
author=Schroeder E, Vallejo A, Zheng L, "et al"
title=Six-week improvements in muscle mass and strength during androgen therapy in older men
journal=J Gerontol A Biol Sci Med Sci
volume=60
issue=12
pages=1586–92
year=2005
pmid=16424293] [cite journal
author=Grunfeld C, Kotler D, Dobs A, Glesby M, Bhasin S
title=Oxandrolone in the treatment of HIV-associated weight loss in men: a randomized, double-blind, placebo-controlled study
journal=J Acquir Immune Defic Syndr
volume=41
issue=3
pages=304–14
year=2006
pmid=16540931
doi=10.1097/01.qai.0000197546.56131.40] [cite journal
author=Giorgi A, Weatherby R, Murphy P
title=Muscular strength, body composition and health responses to the use of testosterone enanthate: a double blind study
journal=Journal of science and medicine in sport / Sports Medicine Australia
volume=2
issue=4
pages=341–55
year=1999
pmid=10710012] This increase in muscle mass is mostly due to larger skeletal muscles, and is caused by both increased production of muscle proteins as well as a decline in the breakdown rate of these proteins. A high testosterone dose also decreases the amount of fat in muscle, while increasing protein content. Anabolic steroids can also decrease fat by the an increase in basal metabolic rate, as an increase in muscle size, increases BMR.

Adverse effects

Anabolic steroids can cause many adverse effects. Most of these side effects are dose-dependent, the most common being elevated blood pressure, especially in those with pre-existing hypertension, [cite journal
author=Grace F, Sculthorpe N, Baker J, Davies B
title=Blood pressure and rate pressure product response in males using high-dose anabolic-androgenic steroids (AAS)
journal=J Sci Med Sport
volume=6
issue=3
pages=307–12
year=2003
pmid=14609147
doi=10.1016/S1440-2440(03)80024-5] and harmful changes in cholesterol levels: some steroids cause an increase in LDL cholesterol and a decrease in HDL cholesterol.cite web
last = Tokar
first = Steve
title = Liver Damage And Increased Heart Attack Risk Caused By Anabolic Steroid Use
publisher = University of California - San Francisco
date = 2006 February
url= http://www.medicalnewstoday.com/medicalnews.php?newsid=38069
accessdate = 2007-04-24 ] Anabolic steroids have been shown to alter fasting blood sugar and glucose tolerance tests. [http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3607] Anabolic steroids such as testosterone also increase the risk of cardiovascular disease [cite journal
author=Barrett-Connor E
title=Testosterone and risk factors for cardiovascular disease in men
journal=Diabete Metab
volume=21
issue=3
pages=156–61
year=1995
pmid=7556805] or coronary artery disease. [cite journal
author=Bagatell C, Knopp R, Vale W, Rivier J, Bremner W
title=Physiologic testosterone levels in normal men suppress high-density lipoprotein cholesterol levels
journal=Ann Intern Med
volume=116
issue=12 Pt 1
pages=967–73
year=1992
pmid=1586105] [cite journal |author=Mewis C, Spyridopoulos I, Kühlkamp V, Seipel L |title=Manifestation of severe coronary heart disease after anabolic drug abuse |journal=Clinical cardiology |volume=19 |issue=2 |pages=153–5 |year=1996 |pmid=8821428] Acne is fairly common among anabolic steroid users, mostly due to stimulation of the sebaceous glands by increased testosterone levels.cite journal
author=Hartgens F, Kuipers H
title=Effects of androgenic-anabolic steroids in athletes
journal=Sports Med
volume=34
issue=8
pages=513–54
year=2004
pmid=15248788
doi=10.2165/00007256-200434080-00003] [cite journal |author=Melnik B, Jansen T, Grabbe S |title=Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem |journal=Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG |volume=5 |issue=2 |pages=110–7 |year=2007 |pmid=17274777 |doi=10.1111/j.1610-0387.2007.06176.x] Conversion of testosterone to dihydrotestosterone (DHT) can accelerate the rate of premature baldness for those who are genetically predisposed.

Other side effects can include alterations in the structure of the heart, such as enlargement and thickening of the left ventricle, which impairs its contraction and relaxation. [cite journal
author=De Piccoli B, Giada F, Benettin A, Sartori F, Piccolo E
title=Anabolic steroid use in body builders: an echocardiographic study of left ventricle morphology and function
journal=Int J Sports Med
volume=12
issue=4
pages=408–12
year=1991
pmid=1917226] Possible effects of these alterations in the heart are hypertension, cardiac arrhythmias, congestive heart failure, heart attacks, and sudden cardiac death. [cite journal |author=Sullivan ML, Martinez CM, Gallagher EJ |title=Atrial fibrillation and anabolic steroids |journal=The Journal of emergency medicine |volume=17 |issue=5 |pages=851–7 |year=1999 |pmid=10499702 |doi=10.1016/S0736-4679(99)00095-5] These changes are also seen in non-drug using athletes, but steroid use may accelerate this process. [cite journal |author=Dickerman RD, Schaller F, McConathy WJ |title=Left ventricular wall thickening does occur in elite power athletes with or without anabolic steroid Use |journal=Cardiology |volume=90 |issue=2 |pages=145–8 |year=1998 |pmid=9778553 |doi=10.1159/000006834] [cite journal |author=George KP, Wolfe LA, Burggraf GW |title=The 'athletic heart syndrome'. A critical review |journal=Sports medicine (Auckland, N.Z.) |volume=11 |issue=5 |pages=300–30 |year=1991 |pmid=1829849 |doi=10.2165/00007256-199111050-00003] However, both the connection between changes in the structure of the left ventricle and decreased cardiac function, as well as the connection to steroid use have been disputed. [cite journal
author=Dickerman R, Schaller F, Zachariah N, McConathy W
title=Left ventricular size and function in elite bodybuilders using anabolic steroids
journal=Clin J Sport Med
volume=7
issue=2
pages=90–3
year=1997
pmid=9113423
doi=10.1097/00042752-199704000-00003] [cite journal |author=Salke RC, Rowland TW, Burke EJ |title=Left ventricular size and function in body builders using anabolic steroids |journal=Medicine and science in sports and exercise |volume=17 |issue=6 |pages=701–4 |year=1985 |pmid=4079743 |doi=10.1249/00005768-198512000-00014]

High doses of oral anabolic steroid compounds can cause liver damage as the steroids are metabolized (17α-alkylated) in the digestive system to increase their bioavailability and stability. [cite journal
author=Yamamoto Y, Moore R, Hess H, Guo G, Gonzalez F, Korach K, Maronpot R, Negishi M
title=Estrogen receptor alpha mediates 17alpha-ethynylestradiol causing hepatotoxicity
journal=J Biol Chem
volume=281
issue=24
pages=16625–31
year=2006
pmid=16606610
doi=10.1074/jbc.M602723200] When high doses of such steroids are used for long periods, serious damage to the liver may occur.

There are also gender-specific side effects of anabolic steroids. Development of breast tissue in males, a condition called gynecomastia (which is usually caused by high levels of circulating estrogen), may arise because of increased conversion of testosterone to estrogen by the enzyme aromatase. [cite journal |author=Marcus R, Korenman S |title=Estrogens and the human male |journal=Annu Rev Med |volume=27 |issue= |pages=357–70 |year= 1976|pmid=779604 |doi=10.1146/annurev.me.27.020176.002041] Reduced sexual function and temporary infertility can also occur in males. [cite journal
author = Hoffman JR, Ratamess NA
journal = Journal of Sports Science and Medicine
title = Medical Issues Associated with Anabolic Steroid Use: Are they Exaggerated?
date = June 1, 2006
url = http://www.jssm.org/vol5/n2/2/v5n2-2pdf.pdf
format = PDF
accessdate = 2007-05-08 ] [cite journal
author=Meriggiola M, Costantino A, Bremner W, Morselli-Labate A
title=Higher testosterone dose impairs sperm suppression induced by a combined androgen-progestin regimen
journal=J. Androl.
volume=23
issue=5
pages=684–90
year=2002
pmid=12185103] [cite journal
author=Matsumoto A
title=Effects of chronic testosterone administration in normal men: safety and efficacy of high dosage testosterone and parallel dose-dependent suppression of luteinizing hormone, follicle-stimulating hormone, and sperm production
journal=J. Clin. Endocrinol. Metab.
volume=70
issue=1
pages=282–7
year=1990
pmid=2104626] Another male-specific side effect which can occur is testicular atrophy, caused by the suppression of natural testosterone levels, which inhibits production of sperm (most of the mass of the testes is developing sperm). This side effect is temporary: the size of the testicles usually returns to normal within a few weeks of discontinuing anabolic steroid use as normal production of sperm resumes. [cite journal
author=Alén M, Reinilä M, Vihko R
title=Response of serum hormones to androgen administration in power athletes
journal=Medicine and science in sports and exercise
volume=17
issue=3
pages=354–9
year=1985
pmid=2991700] Female-specific side effects include increases in body hair, deepening of the voice, enlarged clitoris, and temporary decreases in menstrual cycles. When taken during pregnancy, anabolic steroids can affect fetal development by causing the development of male features in the female fetus and female features in the male fetus. [cite journal
author=Manikkam M, Crespi E, Doop D, "et al"
title=Fetal programming: prenatal testosterone excess leads to fetal growth retardation and postnatal catch-up growth in sheep
journal=Endocrinology
volume=145
issue=2
pages=790–8
year=2004
pmid=14576190
doi=10.1210/en.2003-0478]

A number of severe side effects can occur if adolescents use anabolic steroids. For example, the steroids may prematurely stop the lengthening of bones (premature epiphyseal fusion through increased levels of estrogen metabolites), resulting in stunted growth. Other effects include, but are not limited to, accelerated bone maturation, increased frequency and duration of erections, and premature sexual development. Anabolic steroid use in adolescence is also correlated with poorer attitudes related to health. [cite journal
author=Irving L, Wall M, Neumark-Sztainer D, Story M
title=Steroid use among adolescents: findings from Project EAT
journal=The Journal of adolescent health : official publication of the Society for Adolescent Medicine
volume=30
issue=4
pages=243–52
year=2002
pmid=11927236]

Mechanism of action

The effect of anabolic steroids on muscle mass is caused in at least two ways: [cite journal
author=Brodsky I, Balagopal P, Nair K
title=Effects of testosterone replacement on muscle mass and muscle protein synthesis in hypogonadal men—a clinical research center study
journal=J. Clin. Endocrinol. Metab.
volume=81
issue=10
pages=3469–75
year=1996
pmid=8855787
doi=10.1210/jc.81.10.3469] first, they increase the production of proteins; second, they reduce recovery time by blocking the effects of stress hormone cortisol on muscle tissue, so that catabolism of muscle is greatly reduced. It has been hypothesized that this reduction in muscle breakdown may occur through anabolic steroids inhibiting the action of other steroid hormones called glucocorticoids that promote the breakdown of muscles. [cite journal
author=Hickson R, Czerwinski S, Falduto M, Young A
title=Glucocorticoid antagonism by exercise and androgenic-anabolic steroids
journal=Med Sci Sports Exerc
volume=22
issue=3
pages=331–40
year=1990
pmid=2199753] Anabolic steroids also affect the number of cells that develop into fat-storage cells, by favouring cellular differentiation into muscle cells instead. [cite journal
author=Singh R, Artaza J, Taylor W, Gonzalez-Cadavid N, Bhasin S
title=Androgens stimulate myogenic differentiation and inhibit adipogenesis in C3H 10T1/2 pluripotent cells through an androgen receptor-mediated pathway
journal=Endocrinology
volume=144
issue=11
pages=5081–8
year=2003
pmid=12960001
doi=10.1210/en.2003-0741]

The main way in which steroid hormones interact with cells is by binding to proteins called steroid receptors. When steroids bind to these receptors, the proteins move into the cell nucleus and either alter the expression of genes [cite journal
author=Lavery DN, McEwan IJ
title=Structure and function of steroid receptor AF1 transactivation domains: induction of active conformations
journal=Biochem. J. |volume=391 |issue=Pt 3 |pages=449–64 |year=2005
pmid=16238547
url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16238547
doi=10.1042/BJ20050872] or activate processes that send signals to other parts of the cell. [cite journal
author=Cheskis B
title=Regulation of cell signalling cascades by steroid hormones
journal=J. Cell. Biochem.
volume=93
issue=1
pages=20–7
year=2004
pmid=15352158
doi=10.1002/jcb.20180]

In the case of anabolic steroids, the receptors involved are called the androgen receptors. The mechanisms of action differ depending on the specific anabolic steroid. Different types of anabolic steroids bind to the androgen receptor with different affinities, depending on their chemical structure. Anabolic steroids such as methandrostenolone bind weakly to this receptor and instead directly affect protein synthesis or glycogenolysis.cite journal
author=Roselli CE
title=The effect of anabolic-androgenic steroids on aromatase activity and androgen receptor binding in the rat preoptic area
journal=Brain Res.
volume=792
issue=2
pages=271–6
year=1998
pmid=9593936
doi=
issn=] On the other hand, steroids such as oxandrolone bind tightly to the receptor and act mostly on gene expression.

Pharmacodynamics

The pharmacodynamics of anabolic steroids are unlike peptide hormones. Peptide hormones cannot penetrate the cell membranes and only indirectly affect the nucleus of target cells through their interaction with the cell’s surface receptors. Conversely, as steroid hormones, anabolic steroids are membrane permeable and influence the nucleus of cells by direct action. The pharmacodynamic action of anabolic steroids begin when the exogenous hormone penetrates the permeable membrane of the target cell and binds to an androgen receptor located in the cytoplasm of that cell. From there, the entire receptor-complex moves from the cytoplasm into the nucleus by a process called translocation. Once in the nucleus, the receptor-complex interacts with the DNA by recoding the genetic information to produce more myonuclei, this is known as transcription. After the restructuring of DNA, mRNA sends the new message back into the cytoplasm where specific organelles, such as ribosomes, make new protein.

Medical and non-medical uses

Medical uses

Since the discovery and synthesis of testosterone in the 1930s, anabolic steroids have been used by physicians for many purposes, with varying degrees of success.
*Bone marrow stimulation: For decades, anabolic steroids were the mainstay of therapy for hypoplastic anemias due to leukemia or kidney failure, especially aplastic anemia.cite journal |author=Basaria S, Wahlstrom JT, Dobs AS |title=Clinical review 138: Anabolic-androgenic steroid therapy in the treatment of chronic diseases |journal=J. Clin. Endocrinol. Metab. |volume=86 |issue=11 |pages=5108–17 |year=2001 |pmid=11701661 |url=http://jcem.endojournals.org/cgi/content/full/86/11/5108 |doi=10.1210/jc.86.11.5108] Anabolic steroids have largely been replaced in this setting by synthetic protein hormones (such as epoetin alfa) that selectively stimulate growth of blood cell precursors.
*Growth stimulation: Anabolic steroids can be used by pediatric endocrinologists to treat children with growth failure. [cite journal |author=Ranke MB, Bierich JR |title=Treatment of growth hormone deficiency |journal=Clinics in endocrinology and metabolism |volume=15 |issue=3 |pages=495–510 |year=1986 |pmid=2429792 |doi=10.1016/S0300-595X(86)80008-1] However, the availability of synthetic growth hormone, which has fewer side effects, makes this a secondary treatment.
*Stimulation of appetite and preservation and increase of muscle mass: Anabolic steroids have been given to people with chronic wasting conditions such as cancer and AIDS. [cite journal
author=Grunfeld C, Kotler D, Dobs A, Glesby M, Bhasin S
title=Oxandrolone in the treatment of HIV-associated weight loss in men: a randomized, double-blind, placebo-controlled study
journal=J. Acquir. Immune Defic. Syndr.
volume=41
issue=3
pages=304–14
year=2006
pmid=16540931
doi=10.1097/01.qai.0000197546.56131.40] [cite journal |author=Berger JR, Pall L, Hall CD, Simpson DM, Berry PS, Dudley R |title=Oxandrolone in AIDS-wasting myopathy |journal=AIDS |volume=10 |issue=14 |pages=1657–62 |year=1996 |pmid=8970686]
*Induction of male puberty: Androgens are given to many boys distressed about extreme delay of puberty. Testosterone is now nearly the only androgen used for this purpose and has been shown to increase height, weight, and fat-free mass in boys with delayed puberty. [cite journal
author=Arslanian S, Suprasongsin C
title=Testosterone treatment in adolescents with delayed puberty: changes in body composition, protein, fat, and glucose metabolism
journal=J. Clin. Endocrinol. Metab.
volume=82
issue=10
pages=3213–20
year=1997
pmid=9329341
doi=10.1210/jc.82.10.3213]
*Testosterone enanthate has frequently been used as a male contraceptive and it is thought that in the near future it could be used as a safe, reliable, and reversible male contraceptive. [cite journal
author=Matsumoto A
title=Effects of chronic testosterone administration in normal men: safety and efficacy of high dosage testosterone and parallel dose-dependent suppression of luteinizing hormone, follicle-stimulating hormone, and sperm production
journal=J. Clin. Endocrinol. Metab.
volume=70
issue=1
pages=282–7
year=1990
pmid=2104626] [cite journal
author=Aribarg A, Sukcharoen N, Chanprasit Y, Ngeamvijawat J, Kriangsinyos R
title=Suppression of spermatogenesis by testosterone enanthate in Thai men
journal=Journal of the Medical Association of Thailand = Chotmaihet thangphaet
volume=79
issue=10
pages=624–9
year=1996
pmid=8996996]
*Anabolic steroids have been found in some studies to increase lean body mass and prevent bone loss in elderly men.cite journal
author=Kenny AM, Prestwood KM, Gruman CA, Marcello KM, Raisz LG
title=Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels
journal=J. Gerontol. A Biol. Sci. Med. Sci.
volume=56
issue=5
pages=M266–72
year=2001
pmid=11320105
doi=
issn=] cite journal
author=Baum NH, Crespi CA
title=Testosterone replacement in elderly men
journal=Geriatrics
volume=62
issue=9
pages=14–8
year=2007
pmid=17824721
doi=
issn=] cite journal
author=Francis RM
title=Androgen replacement in aging men
journal=Calcif. Tissue Int.
volume=69
issue=4
pages=235–8
year=2001
pmid=11730258
doi=
issn=] However, a 2006 placebo-controlled trial of low-dose testosterone supplementation in elderly men with low levels of testosterone found no benefit on body composition, physical performance, insulin sensitivity, or quality of life. [cite journal |author=Nair KS, Rizza RA, O'Brien P, "et al" |title=DHEA in elderly women and DHEA or testosterone in elderly men |journal=N. Engl. J. Med. |volume=355 |issue=16 |pages=1647–59 |year=2006 |pmid=17050889 |doi=10.1056/NEJMoa054629]
*Used in hormone replacement therapy for men with low levels of testosterone and is also effective in improving libido for elderly males. [cite journal
author=Shah K, Montoya C, Persons R
title=Do testosterone injections increase libido for elderly hypogonadal patients?
journal=The Journal of family practice
volume=56
issue=4
pages=301–5
year=2007
pmid=17403329] [cite journal
author=Yassin A, Saad F
title=Improvement of sexual function in men with late-onset hypogonadism treated with testosterone only
journal=The journal of sexual medicine
volume=4
issue=2
pages=497–501
year=2007
pmid=17367445
doi=10.1111/j.1743-6109.2007.00442.x] [cite journal
author=Arver S, Dobs A, Meikle A, "et al"
title=Long-term efficacy and safety of a permeation-enhanced testosterone transdermal system in hypogonadal men
journal=Clin. Endocrinol. (Oxf)
volume=47
issue=6
pages=727–37
year=1997
pmid=9497881
doi=10.1046/j.1365-2265.1997.3071113.x] [cite journal
author=Nieschlag E, Büchter D, Von Eckardstein S, "et al"
title=Repeated intramuscular injections of testosterone undecanoate for substitution therapy in hypogonadal men
journal=Clin. Endocrinol. (Oxf)
volume=51
issue=6
pages=757–63
year=1999
pmid=10619981
doi=10.1046/j.1365-2265.1999.00881.x]
*Used to treat gender dysmorphia (the belief that one was born the wrong gender) by producing secondary male characteristics, such as a deeper voice, increased bone and muscle mass, facial hair, increased levels of red blood cells and clitoral enlargement in female-to-male patients. [cite journal |author=Moore E, Wisniewski A, Dobs A |title=Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects |journal=J. Clin. Endocrinol. Metab. |volume=88 |issue=8 |pages=3467–73 |year=2003 |pmid=12915619 |url=http://jcem.endojournals.org/cgi/content/full/88/8/3467 |doi=10.1210/jc.2002-021967]

Non-medical use and abuse

It is difficult to determine what percent of the population in general have actually used anabolic steroids, but the number seems to be fairly low. Studies in the United States have shown anabolic steroid users tend to be mostly middle-class heterosexual men with a median age of about 25 who are noncompetitive bodybuilders and non-athletes and use the drugs for cosmetic purposes.cite journal
author=Yesalis CE, Kennedy NJ, Kopstein AN, Bahrke MS
title=Anabolic-androgenic steroid use in the United States
journal=JAMA
volume=270
issue=10
pages=1217–21
year=1993
pmid=8355384
doi=
issn=] Another study found that non-medical use of AAS among college students was at or less than 1%.cite journal
author=McCabe SE, Brower KJ, West BT, Nelson TF, Wechsler H
title=Trends in non-medical use of anabolic steroids by U.S. college students: Results from four national surveys
journal=Drug and alcohol dependence
volume=90
issue=2–3
pages=243–51
year=2007
pmid=17512138
doi=10.1016/j.drugalcdep.2007.04.004] According to a recent survey, 78.4% of steroid users were noncompetitive bodybuilders and non-athletes while about 13% reported unsafe injection practices such as reusing needles, sharing needles, and sharing multidose vials, [cite journal
last = Andrew
first = Parkinson
coauthors = Nick A. Evans
title = Anabolic-Androgenic Steroids: A Survey of 500 Users
journal = Medicine & Science in Sports & Exercise
volume = 38
issue = 4
pages = 644–651
publisher = American College of Sports Medicine
year = 2006
url = http://www.medscape.com/viewarticle/533461
pmid=16679978
accessdate = 2007-04-24 ] though a 2007 study found that sharing of needles was extremely uncommon among individuals using anabolic steroids for non-medical purposes, less than 1%. Anabolic steroid users often are stereotyped as uneducated "muscle heads" by popular media and culture; however, a 1998 study on steroid users showed them to be the most educated drug users out of all users of controlled substances. [cite journal
author=Copeland J, Peters R, Dillon P
title=A study of 100 anabolic-androgenic steroid users
journal=Med. J. Aust.
volume=168
issue=6
pages=311–2
year=1998
pmid=9549549] Another 2007 study found that 74% of non-medical anabolic steroid users had secondary college degrees and more had completed college and less had failed to complete high school than is expected from the general populace.cite journal
author = Cohen, J.
coauthors = Collins, R.; Darkes, J.; Gwartney, D.
year = 2007
title = A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States
journal = Feedback
url = http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=17931410&cmd=showdetailview&indexed=google
accessdate = 2007-11-14] The same study found that individuals using Anabolic steroids for non-medical purposes had a higher employment rate and a higher household income than the general population. Anabolic steroid users also tend to research the drugs they are taking more than any other group of users of controlled substances. Moreover, anabolic steroid users tend to be disillusioned by the portrayal of anabolic steroids as deadly in the media and in politics. [cite web
last =Eastley
first =Tony
title = Steroid study debunks user stereotypes
publisher = abc.net.au
date = January 18, 2006
url = http://www.abc.net.au/am/content/2006/s1550328.htm
accessdate = 2007-04-24 ] According to one study, AAS users also distrust their physicians and in the sample 56% had not disclosed their AAS use to their physicians.cite journal
author=Pope HG, Kanayama G, Ionescu-Pioggia M, Hudson JI
title=Anabolic steroid users' attitudes towards physicians
journal=Addiction
volume=99
issue=9
pages=1189–94
year=2004
pmid=15317640
doi=10.1111/j.1360-0443.2004.00781.x] Another 2007 study had similar findings, showing that while 66% of individuals using anabolic steroids for non-medical purposes were willing to seek medical supervision for their steroid use, 58% lacked trust in their physicians, 92% felt that the medical community's knowledge of non-medical anabolic steroid use was lacking and 99% felt that the public has an exaggerated view of the side effects of anabolic steroid use. A recent study has also shown that long term AAS users were more likely to have symptoms of muscle dysmorphia and also showed stronger endorsement of more conventional male roles.cite journal
author=Kanayama G, Barry S, Hudson JI, Pope HG
title=Body image and attitudes toward male roles in anabolic-androgenic steroid users
journal=The American journal of psychiatry
volume=163
issue=4
pages=697–703
year=2006
pmid=16585446
doi=10.1176/appi.ajp.163.4.697]

Anabolic steroids have been used by men and women in many different kinds of professional sports (cricket, track and field, weightlifting, bodybuilding, shot put, cycling, baseball, wrestling, mixed martial arts, boxing, football, etc.) to attain a competitive edge or to assist in recovery from injury. Such use is prohibited by the rules of the governing bodies of many sports. Anabolic steroid use occurs among adolescents, especially by those participating in competitive sports. It has been suggested that the prevalence of use among high-school students in the U.S. may be as high as 2.7%. [cite journal
author=Hickson R, Czerwinski S, Falduto M, Young A
title=Glucocorticoid antagonism by exercise and androgenic-anabolic steroids
journal=Medicine and science in sports and exercise
volume=22
issue=3
pages=331–40
year=1990
pmid=2199753] Male students used anabolic steroids more frequently than female students and, on average, those who participated in sports used steroids more often than those who did not.

Administration

There are three common forms in which anabolic steroids are administered: oral pills, injectable steroids, and skin patches. Oral administration is most convenient, but the steroid must be chemically modified so that the liver cannot break it down before it reaches the systemic circulation; these formulations can cause liver damage in high doses. [cite journal
author=Mutzebaugh C
title=Does the choice of alpha-AAS really make a difference?
journal=HIV Hotline
volume=8
issue=5–6
pages=10–1
year=1998
pmid=11366379] Injectable steroids are typically administered into the muscle, not into the vein, to avoid sudden changes in the amount of the drug in the bloodstream. Transdermal patches (adhesive patches placed on the skin) may also be used to deliver a steady dose through the skin and into the bloodstream. Injection is the most common method used by individuals administering anabolic steroids for non-medical purposes.

Minimization of side effects

Various methods of minimizing the adverse effects of anabolic steroids have been implemented by those using them either for medical or other reasons. For example, users may increase their cardiovascular exercise level to help to counter the effects of changes in the left ventricle. [cite journal
author=Kokkinos P, Narayan P, Colleran J, "et al"
title=Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension
journal=N. Engl. J. Med.
volume=333
issue=22
pages=1462–7
year=1995
pmid=7477146
doi=10.1056/NEJM199511303332204] Some androgens are converted by the body into estrogen, a process, known as aromatisation, which has potential adverse effects described previously. Consequently, during a steroid cycle, users may also take drugs to prevent aromatisation (called aromatase inhibitors) or drugs which affect estrogen receptor binding (called selective estrogen receptor modulators or SERMs): for example, the SERM tamoxifen prevents binding to the estrogen receptor in the breast, and so it can be used to reduce the risk of gynecomastia.cite journal
author=Medraś M, Tworowska U
title=Treatment strategies of withdrawal from long-term use of anabolic-androgenic steroids
journal=Pol Merkur Lekarski
volume=11
issue=66
pages=535–8
year=2001
pmid=11899857]

To combat the natural testosterone suppression and to restore proper function of numerous glands involved, what is known as "post-cycle therapy" or PCT is sometimes used. PCT takes place after each cycle of anabolic steroid use and typically consists of a combination of the following drugs, depending on which protocol is used:
* A SERM such as clomiphene citrate or tamoxifen citrate (this is the primary PCT drug).cite journal
author=Dony J, Smals A, Rolland R, Fauser B, Thomas C
title=Effect of lower versus higher doses of tamoxifen on pituitary-gonadal function and sperm indices in oligozoospermic men
journal=Andrologia
volume=17
issue=4
pages=369–78
pmid=3931502]
* An aromatase inhibitor such as anastrozole. [cite journal
author=Plourde P, Reiter E, Jou H, "et al"
title=Safety and efficacy of anastrozole for the treatment of pubertal gynecomastia: a randomized, double-blind, placebo-controlled trial
journal=J. Clin. Endocrinol. Metab.
volume=89
issue=9
pages=4428–33
year=2004
pmid=15356042
doi=10.1210/jc.2004-0082]
* Human chorionic gonadotropin, although it is more common now to use this throughout the cycle rather than after it.

The aim of PCT is to return the body's endogenous hormonal balance to its original state within the shortest period of time. People prone to the premature hair loss exacerbated by steroid use have been known to take the prescription drug finasteride for prolonged periods of time. Finasteride reduces the conversion of testosterone to DHT, the latter having much higher potency for alopecia. Finasteride is useless in the cases when steroid is not converted into a more androgenic derivative. [cite journal
author=Kaufman K, Olsen E, Whiting D, "et al"
title=Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group
journal=J Am Acad Dermatol
volume=39
issue=4 Pt 1
pages=578–89
year=1998
pmid=9777765
doi=10.1016/j.jaad.2006.05.007] Since anabolic steroids can be toxic to the liver or can cause increases in blood pressure or cholesterol, many users consider it ideal to get frequent blood work tests and blood pressure tests to make sure their blood pressure or cholesterol are still within normal levels.

Controversies

Anabolic steroids, like other drugs, have been the subject of controversy. Although anabolic steroids have been frequently linked in the media to dangerous side effects and high mortality rates, cite web|url=http://virtualmentor.ama-assn.org/2005/11/oped2-0511.html |title=Steroid Hysteria: Unpacking the Claims |accessdate=2007-09-14 |last=Frost |first=Norman |publisher=American Medical Association ] they are used widely in medicine with an accepted side effect profile, providing patients are monitored for possible complications. [cite journal
author=Schroeder E, Vallejo A, Zheng L, "et al"
title=Six-week improvements in muscle mass and strength during androgen therapy in older men
journal=J. Gerontol. A Biol. Sci. Med. Sci.
volume=60
issue=12
pages=1586–92
year=2005
pmid=16424293] [cite journal
author=Grunfeld C, Kotler D, Dobs A, Glesby M, Bhasin S
title=Oxandrolone in the treatment of HIV-associated weight loss in men: a randomized, double-blind, placebo-controlled study
journal=J. Acquir. Immune Defic. Syndr.
volume=41
issue=3
pages=304–14
year=2006
pmid=16540931
doi=10.1097/01.qai.0000197546.56131.40] cite journal
author=Bhasin S, Woodhouse L, Casaburi R, "et al"
title=Testosterone dose-response relationships in healthy young men
journal=Am. J. Physiol. Endocrinol. Metab.
volume=281
issue=6
pages=E1172–81
year=2001
pmid=11701431] Former assistant professor at the University of Toronto and World Wrestling Entertainment athletic physician Mauro Di Pasquale has stated, "As used by most people, including athletes, the adverse effects of anabolic steroids appear to be minimal." [cite web
last = Kotler
first = Steven
title = Sympathy for the Devil
publisher = LA Weekly
month= July | year= 2005
url=http://www.laweekly.com/general/features/sympathy-for-the-devil/417/?page=3
accessdate = 2007-04-24 ]

In 1992, NFL football player Lyle Alzado died from brain cancer, which he attributed to the use of anabolic steroids. cite web|url=http://espn.go.com/classic/biography/s/Alzado_Lyle.html |title=Not the size of the dog in the fight |accessdate=2007-07-05 |last=Puma |first=Mike |work=ESPN.com |publisher=ESPN ] However, although steroids have been known to cause liver cancer, [cite journal |author=Maravelias C, Dona A, Stefanidou M, Spiliopoulou C |title=Adverse effects of anabolic steroids in athletes. A constant threat
journal=Toxicol. Lett. |volume=158 |issue=3 |pages=167–75 |year=2005
pmid=16005168 |doi=10.1016/j.toxlet.2005.06.005] there is no published evidence that anabolic steroids cause either brain cancer or the specific type of T-cell lymphoma that caused his death. [cite web|url=http://healthresources.caremark.com/topic/steroids |title=Ills & Conditions |accessdate=2007-06-28 |last=Woolston |first=Chris |date=2004-03-24 |work=CONSUMER HEALTH INTERACTIVE ] Alzado's doctors stated that anabolic steroids did not contribute to his death. [cite web|url=http://www.elitefitness.com/articledata/hbosteroids/HBO-Real-Sports-steroid-special.avi |publisher = elitefitness.com | title=Real Sports, Lyle Alzado |accessdate = 2007-04-24]

Other purported side effects include the idea that anabolic steroids have caused many teenagers to commit suicide. [cite news | first= | last= | coauthors= | title=Teens & Steroids: A Dangerous Mix | date=2004-06-03 | publisher=CBS Broadcasting Inc. | url =http://www.cbsnews.com/stories/2004/06/03/eveningnews/main620967.shtml | work =CBS | pages = | accessdate = 2007-06-27 | language = ] While lower levels of testosterone have been known to cause depression, and ending a steroid cycle temporarily lowers testosterone levels, the hypothesis that anabolic steroids are responsible for suicides among teenagers remains unproven. Although teen bodybuilders have been using steroids since at least the early 1960s, there have been few studies examining a possible link between steroids and suicide in the medical literature. [cite web
last = Darkes, PhD
first = Jack
title = Anabolic-Androgenic Steroids and Suicide, A Brief Review of the Evidence.
publisher = MESO-Rx
month=July | year=2005|url=http://www.mesomorphosis.com/articles/darkes/anabolic-steroids-and-suicide.htm
accessdate = 2007-04-24 ]

Arnold Schwarzenegger has admitted to using anabolic steroids during his bodybuilding career for many years before they were made illegal, [cite web
last =
first =
title = Critics Slam Schwarzenegger on Steroids
publisher = Associated press
url =http://www.foxnews.com/story/0,2933,149466,00.html
accessdate = 2007-05-11 ] and in 1997 he underwent surgery to correct a defect relating to his heart. Some have assumed this was due to anabolic steroids. [ cite web|url=http://www.schwarzenegger.com/news.asp?id=18 |title=SCHWARZENEGGER'S FRIENDS AND COLLEAGUES BLAST PREMIERE MAGAZINE AND WRITER JOHN CONNOLLY FOR PUBLISHING ARTICLE THEY DENOUNCE AS TOTAL FABRICATION |accessdate=2008-04-14 |date=2001-03-08 |work=www.schwarzenegger.com |publisher=Oak Productions, Inc ] Although anabolic steroid use can sometimes cause enlargement and thickening of the left ventricle, Schwarzenegger was born with a congenital genetic defect in which his heart had a bicuspid aortic valve; a condition that rendered his aortic valve with two cusps instead of three, which can occasionally cause problems later in life. [cite web
last = Guttman
first = Monika
title = Schwarzenegger gets new role: patient at University Hospital
publisher = University of Southern California
year= 1997
url= http://www.usc.edu/hsc/info/pr/1volpdf/pdf97/313.pdf
accessdate = 2007-04-24]

"Roid rage"

Another condition that is frequently discussed as a possible side effect of anabolic steroids is known as "roid rage"; however there is no consensus in the medical literature as to whether such a condition actually exists. Testosterone levels are indeed associated with aggression and hypomania, but the link between other anabolic steroids and aggression remains unclear.cite journal
author=Uzych L
title=Anabolic-androgenic steroids and psychiatric-related effects: a review
journal=Canadian journal of psychiatry. Revue canadienne de psychiatrie
volume=37
issue=1
pages=23–8
year=1992
pmid=1551042
doi=
issn=] While some studies have shown a correlation between manic symptoms and anabolic steroid use, [cite journal
author=Pope H, Katz D
title=Affective and psychotic symptoms associated with anabolic steroid use
journal=The American journal of psychiatry
volume=145
issue=4
pages=487–90
year=1988
pmid=3279830] later studies have questioned these conclusions. Currently, three blind studies have demonstrated a link between aggression and steroid use, but with estimates of over one million past or current steroid users in the United States, an extremely small percentage of those using steroids appear to have experienced mental disturbance severe enough to result in clinical treatments or medical case reports.cite journal
author=Bahrke MS, Yesalis CE, Wright JE
title=Psychological and behavioural effects of endogenous testosterone and anabolic-androgenic steroids. An update
journal=Sports medicine (Auckland, N.Z.)
volume=22
issue=6
pages=367–90
year=1996
pmid=8969015
doi=
issn=] cite journal
author=Dalby JT
title=Brief anabolic steroid use and sustatined behavioral reaction
journal = American Journal of Psychiatry
volume=149
issue=3
pages=271–272+1616
year=1992
pmid=1734751
doi=
issn=] Individual studies vary in their findings, with some reporting no increase in aggression or hostility with anabolic steroid use, and others finding a correlation. [cite journal
last = Pope
first = Harrison G.
coauthors = Elena M. Kouri, PhD; James I. Hudson, MD, SM
title =Effects of Supraphysiologic Doses of Testosterone on Mood and Aggression in Normal Men
journal = Med Sci Sports Exerc.
volume = 57
issue = 2
pages = 133–140
publisher = Arch Gen Psychiatry
month=February | year=2000| url = http://archpsyc.ama-assn.org/cgi/content/abstract/57/2/133
pmid = 10665615
accessdate = 2007-04-24
doi =10.1001/archpsyc.57.2.133 ] [cite journal |author=Pagonis TA, Angelopoulos NV, Koukoulis GN, Hadjichristodoulou CS |title=Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse |journal=Eur. Psychiatry |volume=21 |issue=8 |pages=551–62 |year=2006 |pmid=16356691 |doi=10.1016/j.eurpsy.2005.09.001] Including a study of two pairs of identical twins, in which one twin used anabolic steroids and the other did not, found that in both cases the steroid-using twin exhibited high levels of aggressiveness, hostility, anxiety and paranoid ideation not found in the "control" twin. [cite journal |author=Pagonis TA, Angelopoulos NV, Koukoulis GN, Hadjichristodoulou CS, Toli PN |title=Psychiatric and hostility factors related to use of anabolic steroids in monozygotic twins |journal=Eur. Psychiatry |volume=21 |issue=8 |pages=563–9 |year=2006 |pmid=16529916 |doi=10.1016/j.eurpsy.2005.11.002]

It has previously been theorized that some studies showing a correlation between angry behavior and steroid use are confounded by the fact that steroid users are likely to demonstrate cluster B personality disorders prior to administering steroids.cite journal
author=Perry PJ, Kutscher EC, Lund BC, Yates WR, Holman TL, Demers L
title=Measures of aggression and mood changes in male weightlifters with and without androgenic anabolic steroid use
journal=J. Forensic Sci.
volume=48
issue=3
pages=646–51
year=2003
pmid=12762541
doi=
issn=] In addition, many case studies have concluded anabolic steroids have little or no real effect on increased aggressive behavior.cite journal
author=Fudala P, Weinrieb R, Calarco J, Kampman K, Boardman C
title=An evaluation of anabolic-androgenic steroid abusers over a period of 1 year: seven case studies
journal=Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists
volume=15
issue=2
pages=121–30
year=2003
pmid=12938869] cite journal
author=Bhasin S, Storer T, Berman N, "et al"
title=The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men
journal=N. Engl. J. Med.
volume=335
issue=1
pages=1–7
year=1996
pmid=8637535
doi=10.1056/NEJM199607043350101] [cite journal
author=Tricker R, Casaburi R, Storer T, "et al"
title=The effects of supraphysiological doses of testosterone on angry behavior in healthy eugonadal men—a clinical research center study
journal=J. Clin. Endocrinol. Metab.
volume=81
issue=10
pages=3754–8
year=1996
pmid=8855834
doi=10.1210/jc.81.10.3754] [cite journal
author=O'Connor D, Archer J, Hair W, Wu F
title=Exogenous testosterone, aggression, and mood in eugonadal and hypogonadal men
journal=Physiol. Behav.
volume=75
issue=4
pages=557–66
year=2002
pmid=12062320
doi=10.1016/S0031-9384(02)00647-9]

Legal and sport restrictions

Legal status

The legal status of anabolic steroids varies from country to country: some have stricter controls on their use or prescription than others. In the U.S., anabolic steroids are currently listed as Schedule III controlled substances under the Controlled Substances Act, which makes the possession of such substances without a prescription a federal crime punishable by up to seven years in prison. In Canada, anabolic steroids and their derivatives are part of the Controlled drugs and substances act and are Schedule IV substances, meaning that it is illegal to obtain or sell them without a prescription; however, possession is not punishable, a consequence reserved for schedule I, II or III substances. Those guilty of buying or selling anabolic steroids in Canada can be imprisoned for up to 18 months. Import and export also carry similar penalties. [citeweb |url= http://laws.justice.gc.ca/en/ShowFullDoc/cs/C-38.8//20070425/en?command=home&caller=SI&fragment=anabolic&search_type=all&day=25&month=4&year=2007&search_domain=cs&showall=L&statuteyear=all&lengthannual=50&length=50
title= Controlled Drugs and Substances Act
publisher = Canada Department of Justice
accessdate= 2007-04-25] Anabolic steroids are also illegal without prescription in Australia, [cite web
title = Steroids
publisher = Australian Institute of Criminology
year = 2006
url = http://www.aic.gov.au/research/drugs/types/steroids.html
accessdate =2007-05-06 ] Argentina, Brazil and Portugal, [cite web
title = Library of congress search
publisher = Library of congress
url = http://www.glin.gov/search.action?searchDetails.andSubjectTerms=true&searchDetails.hitsPerPage=10&searchDetails.includeAbstractFields=false&searchDetails.includeAllFields=true&searchDetails.includeNameFields=false&searchDetails.includeNumberFields=false&searchDetails.includeTitleFields=false&searchDetails.issuanceDateFrom=&searchDetails.issuanceDateTo=&searchDetails.offset=0&searchDetails.publicationDateFrom=&searchDetails.publicationDateTo=&searchDetails.publicationJurisdictionExclude=false&searchDetails.publicationLanguage=&searchDetails.queryString=steroid&searchDetails.queryType=ALL&searchDetails.searchAll=true&searchDetails.searchJudicialDecisions=false&searchDetails.searchLaws=false&searchDetails.searchLegalLiterature=false&searchDetails.searchLegislativeRecord=false&searchDetails.showSummary=true&searchDetails.sortOrder=default&searchDetails.subjectTerm=%5B%5D&searchDetails.subjectTerms=&searchDetails.summaryLanguage=&searchDetails.activeDrills=&searchDetails.offset=0&showSummary=true&refineQuery=anabolic&refineQueryType=ALL&refine=Refine+Search
accessdate =2007-05-06 ] and are listed as Schedule 4 Controlled Drugs in the United Kingdom. On the other hand, anabolic steroids are readily available without a prescription in some countries such as Mexico and Thailand.

The history of the U.S. legislation on anabolic steroids goes back to the late 1980s, when the U.S. Congress considered placing anabolic steroids under the Controlled Substances Act following the controversy over Ben Johnson's victory at the 1988 Summer Olympics in Seoul. During deliberations, the AMA, DEA, FDA as well as the NIDA all opposed listing anabolic steroids as controlled substances, citing the fact that use of these hormones does not lead to the physical or psychological dependence required for such scheduling under the Controlled Substance Act. Nevertheless, anabolic steroids were added to Schedule III of the Controlled Substances Act in the Anabolic Steroid Control Act of 1990.USBill|101|HR|4658] The same act also introduced more stringent controls with higher criminal penalties for offenses involving the illegal distribution of anabolic steroids and human growth hormone. By the early 1990s, after anabolic steroids were scheduled in the U.S., several pharmaceutical companies stopped manufacturing or marketing the products in the U.S., including Ciba, Searle, Syntex and others. In the Controlled Substances Act, anabolic steroids are defined to be any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promote muscle growth. The act was amended by the Anabolic Steroid Control Act of 2004, which added prohormones to the list of controlled substances, with effect from January 20, 2005.cite web | url=http://www.usdoj.gov/dea/pubs/cngrtest/ct031604.html | title=News from DEA, Congressional Testimony, 03/16/04 | accessdate=2007-04-24] In September 2007 the DEA wrapped up an 18-month international investigation of illicit anabolic steroid use in which 124 arrests were made and which targeted over 25 Chinese companies which produced raw materials for producing steroids and human growth hormone. The investigation, dubbed "Operation Raw Deal," was the largest anabolic steroid operation in United States history and involved China, Mexico, Canada, Australia, Germany and Thailand among other countries. The investigation also focused on online message boards where advice was given on how to use anabolic steroids and the DEA also intercepted hundreds of thousands of e-mails. The DEA has also stated that the e-mails intercepted were compiled into a massive database of names which could lead to months or years of future arrests of steroid users. [cite news | first=Pete | last=YOST | coauthors= | title=DEA Announces Wide-Ranging Steroid Busts | date= | publisher=Associated press | url =http://www.sfgate.com/flat/archive/2007/09/24/news/archive/2007/09/24/national/w073110D79.html | work = | pages = | accessdate = 2007-09-24 | language = ] [cite news | first=Shaun | last=Assael | coauthors= | title='Raw Deal' busts labs across U.S., many supplied by China | date=2007-09-24 | publisher= | url =http://sports.espn.go.com/espn/news/story?id=3033532 | work =ESPN The Magazine | pages = | accessdate = 2007-09-24 | language = ] [cite news | first=Josh | last=Peter | coauthors= | title='Roids raids' | date=2007-09-24 | publisher= | url =http://sports.yahoo.com/top/news?slug=jo-steroids092407&prov=yhoo&type=lgns | work =Yahoo! Sports | pages = | accessdate = 2007-09-24 | language = ]

tatus in sports

Anabolic steroids are banned by all major sports bodies including the Olympics, [cite web
title = Olympic movement anti-doping code
publisher = International Olympic Committee
year = 1999
url = http://www.medycynasportowa.pl/download/doping_code_e.pdf
format = PDF
accessdate =2007-05-06 ] the NBA, [cite web
title = THE NBA AND NBPA ANTI-DRUG PROGRAM
work = NBA Policy
publisher = findlaw.com
year = 1999
url = http://news.findlaw.com/legalnews/sports/drugs/policy/basketball/index.html
accessdate =2007-05-06 ] the NHL, [cite web
title = NHL/NHLPA PERFORMANCE-ENHANCING SUBSTANCES PROGRAM SUMMARY
publisher = nhlpa.com
url = http://www.nhlpa.com/PerformanceEnhancing/index.asp
accessdate =2007-05-06 ] as well as the NFL. [cite web
title = List of Prohibited Substances
publisher = nflpa.com
year = 2006
url = http://www.nflpa.org/pdfs/RulesAndRegs/ProhibitedSubstances.pdf
accessdate =2007-05-06 ] The World Anti-Doping Agency (WADA) maintains the list of performance-enhancing substances used by many major sports bodies and includes all anabolic agents, which includes all anabolic steroids and precursors as well as all hormones and related substances. [cite web
title = World anti-doping code
publisher = WADA
year = 2003
url = http://www.wada-ama.org/rtecontent/document/code_v3.pdf
format = PDF
accessdate =2007-07-10 ] [cite web
title = Prohibited list of 2005
publisher = WADA
year = 2005
url = http://www.wada-ama.org/rtecontent/document/summary_2005.pdf
format = PDF
accessdate =2007-05-06 ] Spain has passed an anti-doping law creating a national anti-doping agency. [cite news
title = Spain's senate passes anti-doping law
work = Associated press
date = October 5, 2006
publisher = Herald Tribune
url = http://www.iht.com/articles/ap/2006/10/05/sports/EU_SPT_Spain_Doping.php
accessdate =2007-05-06 ] Italy passed a law in 2000 where penalties range up to three years in prison if an athlete has tested positive for banned substances. [cite news
last = Johnson
first = Kevin
title = Italian anti-doping laws could mean 3 years in jail
publisher = USA TODAY
date = 2006-02-20
url = http://www.usatoday.com/sports/olympics/torino/2006-02-19-anti-doping-laws_x.htm
accessdate =2007-05-06 ] In 2006, Russian President Vladimir Putin signed into law ratification of the International Convention Against Doping in Sport which would encourage cooperation with WADA. Many other countries have similar legislation prohibiting anabolic steroids in sports including Denmark, [cite web
title = Act on promotion of doping-free sport
publisher = kum.dk
year = 2004
url = http://www.kum.dk/graphics/kum/downloads/Kulturomraader/Ophavsret/Doping%20lov.pdf
format = PDF
accessdate =2007-05-06 ] France, [cite web
title = Protection of health of athletes and the fight against doping
publisher = WADA
year = 2006
url = http://www.wada-ama.org/rtecontent/document/national_laws_sports_code_legislative_part_En.pdf
format = PDF
accessdate =2007-05-06 ] the Netherlands [cite web
title = ANTI-DOPING LEGISLATION IN THE NETHERLANDS
publisher = WADA
year = 2006
url = http://www.wada-ama.org/rtecontent/document/Dutch_Legislation_Concerning_Doping_Jan_2007.pdf
format = PDF
accessdate =2007-05-06 ] and Sweden. [cite web
title = The Swedish Act prohibiting certain doping substances (1991:1969)
publisher = WADA
year = 1991
url = http://www.wada-ama.org/rtecontent/document/National_Laws_Swedish_Act.pdf
format = PDF
accessdate =2007-05-06 ]

Illegal trade in anabolic steroids

In countries where anabolic steroids are illegal or controlled, the majority of steroids are obtained illegally through black market trade.Yesalis, Charles. (2000). "Anabolic Steroids in Sport and Exercise" ISBN 0-88011-786-9 ] [cite web
last = Black
first = Terry
title = Does the Ban on Drugs in Sport Improve Societal Welfare?
publisher = Faculty of Business, Queensland University of Technology
year = 1996
url=http://irs.sagepub.com/cgi/content/abstract/31/4/367
accessdate = 2007-04-24 ] These steroids are usually manufactured in other countries, and therefore must be smuggled across international borders. Like most significant smuggling operations, organized crime is involved. Smuggling of anabolic steroids often occurs in conjunction with other illegal drugs, although in comparison with the trade in psychoactive recreational drugs such as cannabis and heroin, there have not been many high profile cases of individual smugglers of anabolic steroids being caught.

In addition to smuggling, illegal trade in counterfeit drugs has emerged rapidly in recent years, as computers and scanning technology have made it easy to copy the label design of genuine products. Consequently, the market has been flooded with products containing anything from vegetable oil to toxic substances. These products have been bought and injected by unsuspecting users, some of whom have died as a result of blood poisoning, methanol poisoning, or subcutaneous abscess. [ cite web|url=http://findarticles.com/p/articles/mi_m1370/is_v21/ai_5242330 |title=For athletes and dealers, black market steroids are risky business |accessdate=2007-07-08 |last=Stehlin |first=Dori |year=1987 |work=FDA Consumer ]

Production

Anabolic steroids need sophisticated pharmaceutical processes and equipment to produce, so they are either manufactured by legitimate pharmaceutical companies or by underground laboratories with large overheads. Common problems associated with illegal drug trades, such as chemical substitutions, cutting, and diluting, affect illegal anabolic steroids as well, so that when they reach the distribution level, the quality may be compromised and the drugs may be dangerous. In the 1990s, most U.S. producers such as Ciba, Searle and Syntex stopped making and marketing anabolic steroids within the U.S. However, in many other regions, particularly Eastern Europe, they are still produced in quantity. European anabolic steroids are the source of most medical grade anabolic steroids sold illegally in North America. However, anabolic steroids are still in wider use for veterinary purposes, and many illegal anabolic steroids are actually veterinary grade. [cite web
title = Steroids
work = North Eastern AIDS Prevention Program
publisher = Victoria Australia Department of Human Services
url = http://www.dhs.vic.gov.au/neapp/steroids.htm
accessdate = 2007-04-24 ] These can also be dangerous, as they may have been produced and handled in cruder and less sterile environments. [cite web
title = Anabolic Steroid Abuse and Violence
publisher = NSW Bureau of Crime Statistics and Research
month = July | year = 1997
url=http://www.lawlink.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/cjb35.pdf/$file/cjb35.pdf
format = PDF
accessdate = 2007-05-06 ] [cite journal
author=Walters M, Ayers R, Brown D
title=Analysis of illegally distributed anabolic steroid products by liquid chromatography with identity confirmation by mass spectrometry or infrared spectrophotometry
journal=Journal - Association of Official Analytical Chemists
volume=73
issue=6
pages=904–26
year=1990
pmid=2289923]

Distribution

In the U.S., Canada and Europe, steroids are purchased just like any other illegal drug, through dealers who are able to obtain the drugs from a number of sources. Instead, illegal anabolic steroids are sold at gyms, competitions, and through the mail. For the most part, these substances are smuggled, but may also be obtained through pharmacists, veterinarians, and physicians. [ cite web|url=http://www.gdcada.org/statistics/steroids.htm |title=Steroids |accessdate=2007-09-13 |work=National Institute on Drug Abuse |publisher=GDCADA ] [ cite web|url=http://parentingteens.about.com/cs/anabolicsteroids/l/blsteroid2.htm |title=Drug Use: Anabolic Steroids |accessdate=2007-09-13 |work=The National Institute on Drug Abuse |publisher=About, Inc. ] In addition, a significant number of counterfeit products are sold as anabolic steroids, particularly via mail order from websites posing as overseas pharmacies. Individuals also produce fake steroids and attempt to sell them over the Internet, causing a wide variety of health concerns. In the U.S., black market importation continues from Mexico, Thailand, and other countries where steroids are more easily available or not illegal at all. [ cite web|url=http://www.usdoj.gov/oig/reports/DEA/a0719/app2.htm |title=The Drug Enforcement Administration's International Operations (Redacted) |accessdate=2007-09-13 |work=Office of the Inspector General |publisher=USDOJ ]

Movement for decriminalization

After the Anabolic Steroid Control Act of 1990 listed anabolic steroids as Schedule III controlled substances in the U.S., a small movement has arisen that is highly critical of current laws concerning anabolic steroids. On June 21, 2005, "Real Sports" aired a segment discussing the legality and prohibition of anabolic steroids in America.cite web
last = Bryant
first = Gumbel
authorlink = Bryant Gumbel
title = Real Sports
publisher = HBO
date= 21 June, 2005
url= http://www.elitefitness.com/articledata/hbosteroids/HBO-Real-Sports-steroid-special.avi
format = AVI video file
accessdate = 2007-04-24 ] The show featured Gary I. Wadler, M.D., chairman of the U.S. Anti-Doping Agency and a prominent anti-steroid activist. When pressed for scientific evidence by correspondent Armen Keteyian that anabolic steroids are as "highly fatal" as is often claimed, Wadler admitted there was no evidence. Bryant Gumbel concluded the "hoopla" concerning the dangers of anabolic steroids in the media was "all smoke and no fire". The show also featured John Romano, a pro-steroid activist who writes "The Romano Factor", a pro-steroid column for bodybuilding magazine "Muscular Development".

In July 2005, Philip Sweitzer, an attorney and author, published an open letter to the Members of the House Committee on Government Reform, and the Senate Committee on Commerce "et al". In it he criticized lawmakers' actions in scheduling anabolic steroids, as well as criticized their "disregard of scientific reality for symbolic effect". He also pleaded for the consideration of the decriminalization of anabolic steroids and asked for a new policy direction. [cite web
last = Sweitzer, Esq
first = Philip
title = An Open Letter to the Members of the House Committee on Government Reform, and the Senate Committee on Commerce, Science and Transportation, on the Recent Hearings and Legislation relating to the use of Anabolic Steroids in Sports
publisher = MESO-Rx.
month= July | year= 2005
url= http://www.mesomorphosis.com/articles/sweitzer/letter-to-congress-regarding-steroids.htm
accessdate = 2007-04-24 ] Several other legal reviewers have criticized controlled substance status for anabolic steroids, including lawyer Rick Collins whose book, "Legal Muscle", details published resources on anabolic steroids and the law. Collins opposes non-medical teen steroid use or steroid use to cheat in sports, but advocates wider discretion for physicians in the case of mature adults. In 2006, he argued at PUMPED, a steroid seminar in Manhattan, that the reporting of the risks associated with anabolic steroids in the media is biased and misinformed. He also argues that anabolic steroid criminalization increases the risks associated with anabolic steroids due to impurities in black market products.cite web
last = Collins
first = Rick
title = PUMPED: A Truth-Enhancing Seminar on Steroid Use and the Law
publisher = drugpolicy.org
year= 2006
url=http://www.drugpolicy.org/docUploads/PUMPED051006.pdf
format = PDF
accessdate = 2007-04-24 ] [cite web
last = Collins
first = Rick
title = PUMPED:(Audio)
publisher = drugpolicy.org
year= 2006
url=http://www.drugpolicy.org/docUploads/podcast_steroidSeminar_051706.mp3
format =
accessdate = 2007-04-24 ] However, the U.S. government's position since the late 1980s has been and continues to be that the risks of steroid use are too great to allow them to be decriminalized or unregulated.

ee also

* Prohormone
* Steroid
* Steroid stack
* Growth hormone treatment

References

Further reading

*cite book
last = Collins
first = Rick
authorlink =
coauthors =
title = Legal Muscle: Anabolics in America
publisher = Legal Muscle Publishing Inc.
date = December 1, 2002
location =
pages = 430
url= http://www.amazon.com/dp/0972638407/
doi =
id = ISBN 0-9726384-0-7
*cite book
last = D. Kochakian
first = Charles
authorlink =
coauthors =
title = Anabolic Steroids in Sport and Exercise
publisher = Human Kinetics
date =
location =
pages =
url = http://books.google.com/books?id=I7-D2jH-OJ4C&dq=Anabolic+Steroid+book&pg=PR6&ots=UEjV5g55wR&sig=O42E7j1M4cpWpL_iqKFQslqSQz8&prev=http://www.google.com/search%3Fhl%3Den%26ie%3DISO-8859-1%26q%3DAnabolic%2BSteroid%2Bbook&sa=X&oi=print&ct=result&cd=1
doi =
id =
*cite book
last = Daniels
first = R. C.
authorlink =
coauthors =
title = The Anabolic Steroid Handbook
publisher = Richard C Daniels
date = February 1, 2003
location =
pages = 80
url= http://www.amazon.com/dp/0954822706/
doi =
id = ISBN 0-9548227-0-6
*cite book
last = Gallaway
first = Steve
authorlink =
coauthors =
title = The Steroid Bible
publisher = Belle Intl; 3rd Sprl edition
date = January 15, 1997
location =
pages = 125
url= http://www.amazon.com/dp/1890342009/
doi =
id = ISBN 1-890342-00-9
*cite book
last = Llewellyn
first = William
authorlink =
coauthors =
title = ANABOLICS 2007 : Anabolic Steroid Reference Manual (6th Ed.)
publisher = Body of Science
date = January 28, 2007
location =
pages = 988
url= http://www.molecularnutrition.net/products_book.html
doi =
id = ISBN 978-0967930466
*cite book
last = Roberts
first = Anthony
authorlink =
coauthors = Brian Clapp
title = Anabolic Steroids: Ultimate Research Guide
publisher = Anabolic Books, LLC
month = January | year = 2006
location =
pages = 394
url= http://www.amazon.com/dp/1599751003/
doi =
id = ISBN 1-59975-100-3
*cite book
last = Roberts
first = Anthony
authorlink =
coauthors =
title = Beyond Steroids
publisher = EF Publishing Inc.
month = May | year = 2006
location =
pages = 250
url = http://www.elitefitness.com/reports/beyondsteroids/
doi =
id =
*cite book
last = Taylor
first = William N
authorlink =
coauthors =
title = Anabolic Steroids and the Athlete
publisher = McFarland & Company
date = January 1, 2002
location =
pages = 373
url = http://books.google.com/books?id=OGcQ0Tp2AFcC&dq=Anabolic+Steroid+book&pg=PA1&ots=qK1SwShzfg&sig=xWUdFM18Ov9_MfijxOyPzE954IQ&prev=http://www.google.com/search%3Fhl%3Den%26ie%3DISO-8859-1%26q%3DAnabolic%2BSteroid%2Bbook&sa=X&oi=print&ct=result&cd=2
doi =
id = ISBN 0-7864-1128-7
*cite book
last = Yesalis
first = Charles E.
authorlink =
coauthors =
title = Anabolic Steroids in Sport and Exercise
publisher = Human Kinetics Publishers; 2nd edition
month = July | year = 2000
location =
pages = 493
url= http://www.amazon.com/Anabolic-Steroids-in-Sport-Exercise/dp/0880117869
doi =
id = ISBN 0-88011-786-9

External links

* [http://historyofalcoholanddrugs.typepad.com/alcohol_and_drugs_history/steroids/index.html Steroids news page] – Alcohol and Drugs History Society
* [http://www.steroidmediawatch.com/ Steroidmediawatch] – Anabolic Steroids in the media
* [http://www.steroidlaw.com/ Steroidlaw by Rick Collins] – Law concerning Anabolic Steroids (Mostly Relevant to the United States of America)
* [http://www.steroidabuse.com Association against Steroid Abuse]
* [http://www.mesomorphosis.com/articles/ Mesomorphosis steroid articles] – Articles on Steroids
* [http://www.dmoz.org/Sports/Strength_Sports/Bodybuilding/Supplements/Anabolic_Steroids Dmoz Directory of websites on anabolic steroids]