Anabolic steroids: Lots of muscle in the short term, potentially devastating health consequences in the long term.
Why do people use anabolic steroids? Most researchers and health professionals with an interest in this area could tell you, correctly, that the answer is increasingly 'to be more muscular and attractive' rather than 'to compete better inmy sport' or 'to domy job better' [1] Embedded within this motivation, however, is a rarely acknowledged fact that has implications for researchers, health professionals and the public: steroids are extremely effective at building large amounts of muscle in a very short amount of time [2] In contrast, the most significant health consequences of steroid use, including a twofold increase in mortality because of cardiovascular causes [3] appear only in the long term, many years after the commencement of use. Acknowledgement and understanding of the effectiveness of steroids are important for remedying users' perceptions that health professionals 'don't know' anything about steroids, improving aetiological models of steroid use, and for improving prevention and treatment efforts. To fully appreciate just how effective steroids are at building muscle, one should turn to the research of Shalendar Bhasin, the world's foremost authority on the effects of exogenous testosterone (steroids) onmale body composition. In one study [2] 35 young men were randomised to one of five groups to receive weekly injections of testosterone enanthate a commonly used steroid in amounts that varied from 25 to 600 mg/week. After 20weeks, the men who received 600 mg/week had gained, on average, 8kg of muscle, and lost, on average, 1kg of body fat. These figures are impressive enough, but the real eye opener is that the men were instructed not to participate in strength training or endurance exercise during the course of the study. Essentially, these results could have been achieved while sitting on the couch.Moreover, 600mg/week of testosterone enanthate is the amount used by most beginner or first time steroidusers [1] Experienced users frequently report injecting in excess of 1000mg/week of testosterone enanthate [4] In another study [5] Bhasin randomised men to one of four conditions: 600mg/week of testosterone enanthate and no exercise, 600mg/week of testosterone enanthate and standardised exercise, placebo and no exercise and placebo and standardised exercise. At 10weeks, the men given 600mg/week of testosterone enanthate who did not exercise had put on more muscle mass than the men who were not on testosterone and who did exercise. The implications of this research are hard to ignore: other things being equal, a person cannot out train, out diet or outperform steroids. In contrast, the most significant health consequences of steroid use appear only in the long term. Users have twice the cardiovascular morbidity and mortality rate of non users [3] and damage to the neuroendocrine system may lead to infertility and lifelong dependence on testosterone replacement therapy [6] High doses of steroids may also be neurotoxic [7] ominously suggesting that steroid use carries the potential for brain damage later in life. To this end, a recent study found large cognitive deficits in the visuospatial memory of chronic steroid users compared with non users [8] Why, however, is it important to acknowledge the exceptional effectiveness of steroids for building muscle in the short term? Surely, we should be focusing on the impairment associated with steroid use, not the socalled benefits, risking appearing to sanction their continued use? Undeniably, it is true that we need to help clients and the public understand the harm associated with steroid use. However, understanding the science behind steroid efficacy is also critical for those researchers, health professionals and policy makers who aim to prevent or treat steroid abuse. For starters, steroid use, like all illicit drug use, exists in a social context [9] and understanding steroid efficacy helps us to understand the allure of steroids. It helps to explain how steroid use can propagate through groups of boys who attend the gym together, wherein a steroid using peer is able to achieve results that his non using peers simply cannot hope to emulate. It helps to explain the psychology of some first time users, who profess that they will use only for the short term, that they can do 'just one cycle' of steroids, and then 'hold on' to the body they have achieved [10] It helps to explain why many steroid users are so reluctant to discontinue use and why those who do are prone to relapse and return to use. And it helps to explain the aetiology of anabolicandrogenic steroid dependence, a condition of psychological dependence on the drug that affects approximately one third of steroid users [11] These
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