Since first being linked to a series of high profile cheating scandals and serious health risks, anabolic steroids have been among science’s most reviled chemical outcasts.
Condemned by the medical profession and outlawed by the authorities, you’d be forgiven for thinking these performance enhancing tools were as much an ill-advised thing of the past as the mullets and legwarmers with which they shared their heyday. Yet recent evidence suggests that steroid use is once again experiencing a sharp rise.
So against a backdrop of new health benefits continually being attributed to testosterone, levels of which steroids increase massively, should we even be concerned by the apparent renewed popularity of this incredibly powerful synthetic hormone?
Although first developed in Germany during the 1930s and being utilised covertly in world sport by the 1970s, by all accounts it’s the 80s that are considered something of a golden (or perhaps more accurately, bronzed) age for steroids. Widely available for the first time and largely unregulated, initially they seemed a positive revolution in physical fitness.
If you trained for strength you quickly became stronger, if you trained for appearance you grew bigger, if you trained for endurance you could carry on longer; to all intents and purposes, the perfect renaissance drug. For a while they were arguably as central to any bodybuilder, athlete, action star, weightlifter or serious fitness fanatic’s workout regime as whichever piece of gym equipment you care to mention.
There were observable side effects of course, no drug is without them, but for most, as they were understood then, unsightly acne on the face or back, sporadic new hair growth in creative places and acute testicular shrinkage, were all a small (no pun intended) price to pay for such astounding results. But, in the 1990s, amid growing reports of steroid use’s connection to various life threatening conditions, the use of anabolic steroids in sports or without prescription was made illegal in both the U.S and U.K.
Anabolic-androgenic steroid, to give it its technical name, is an artificially produced replica of the body’s naturally occurring male hormone, testosterone. Testosterone is heavily involved in building bone density as well as muscle mass and strength, so when levels of it are topped up synthetically this process occurs more quickly and to a much greater extent.
Anabolic steroids can also help to block cortisol, a stress hormone released during exercise, which serves to break down muscle tissues leading to sore muscles and the need for recovery. With cortisol inhibited muscles suffer less damage during a workout out allowing them to recover faster and the user to train more often and for longer periods of time before becoming fatigued.
Anabolic steroids are used in the medical profession to treat conditions such as anaemia, stunted growth and delayed puberty, but crucially in no more than a physiologic dose, i.e. no more than the body would produce biologically under normal circumstances.
Though it’s true that higher levels of natural testosterone are increasingly thought to maintain health and vitality – naturally raised levels have been shown to help improve physical performance, battle depression, the effects of aging and conditions such as diabetes and cardiovascular disease – difficulties begin when science pushes testosterone past a body’s own maximum capacity for creation of the hormone.
Given steroids proven effectiveness, the ability to surpass this innate threshold is a real temptation for some, particularly in competitive fields. After all, if steroids produce impressive performances, by rights surely more steroids should equate more impressive performances? This is dangerous enough in sportspeople who might take enough steroids only until they win a race or a contest, but in the case of bodybuilders, with no set goal, whose only aim is ever bigger physiques, it’s of particular concern. Dr Harrison Pope, Professor of Psychiatry at Harvard Medical School reports in the course of study to have seen men taking five or six thousand milligrams of artificial testosterone per week, the equivalent of one hundred times the usual measure that the average male body would be making in that time.
The implications of testosterone taken in such extreme quantities are enormous. Testosterone plays a vital role in the body’s basic communication and regulatory systems; hormones even have a hand in determining how genes coded into a genome are used. In short if you drastically alter hormone levels and you risk changing the entire organism, it impacts everything.
Whereas the immediate transformative effects of wildly enhanced testosterone levels might be good for a couple of medals and a rosette or two in the short term, consequences over the longer term are altogether more troubling.
In 1991 NFL player Lyle Alzado announced he was dying from an inoperable brain tumour and publicly claimed in an issue of Sports Illustrated magazine that decades of steroid abuse were to blame. Since then dozens of studies have been carried out into the possible cancer causing properties of anabolic steroids and today WHO organization, the International Agency for Research on Cancer, lists them under Group 2A: Probably carcinogenic to humans. 9 out of 10 steroid veterans have also been shown to have severe scarring of the kidneys, similar to, though usually markedly worse than, that found in the morbidly obese. Owing to the way they’re metabolised, long term steroid use can gradually damage the liver too, raising the likelihood of problems such as hepatitis.
Steroids are moreover believed to bring about physical changes in the structure of the heart, for instance a thickening of the left ventricle which leads to a heightened risk of congestive heart failure, heart attack, cardiac arrhythmias and sudden cardiac death. Negative effects on cholesterol and blood pressure have also been observed in long time users. After a while, in an ironic sort of snap-back from the extreme masculine reputation anabolic steroids enjoy, most users to tend to eventually undergo a degree of feminisation.
As previously mentioned there is temporary testicular atrophy, but also problems with fertility, sexual function and gynecomastia, the accumulation of fat behind the nipples, causing increased breast tissue.
On the psychological front, the existence and frequency of ‘Roid Rage’ – a term coined in the 1980s to describe the dangerous spikes of aggression exhibited by those on steroids – is disputed, but in 2005 the medical journal CNS Drugs determined that “Significant psychiatric symptoms including aggression and violence, mania, and less frequently psychosis and suicide have been associated with steroid abuse.”
The following year in 2006 a Yale School of Medicine study showed that too high doses of testosterone can cause accelerated apoptosis (the dying of cells) in the brain and be a catalyst for severe personality changes such as those listed above. Lead researcher, professor of pharmacology and physiology at the school, Barbara Ehrlich said “These effects of testosterone on neurons will have long-term effects on brain function. Apoptosis is an important thing for the brain – the brain needs to weed out some of the cells. But when it happens too frequently, you lose too many cells and it causes problems.
Our results suggest that the responses to elevated testosterone can be compared with pathophysiological conditions.”
While it would be naïve to think that steroid misuse ceased completely after they were legislated against, a combination of more stringent drug testing in sport, greater awareness of the hazards and their generally being less openly available, was thought to have stemmed the problem somewhat.
However, the issue was brought back into sharp focus once again in 2012, when cyclist Lance Armstrong – notably himself a onetime cancer sufferer – was stripped of his seven Tour De France titles and given a lifetime ban from the sport for protracted use of a cocktail of performance enhancing drugs, anabolic-androgenic steroids significant among them.
As I write this, an investigation has also been launched into allegations that the respected athletics coach Alberto Salazar may have given U.S 10,000m record holder and reigning silver medallist, Galen Rupp, synthetic testosterone.
Though to suggest this perceived re-emergence is limited to elite athletes is to misunderstand the problem. A 2014 study published in The Annals of Epidemiology found that 3.3% of the world’s population have tried anabolic steroids at least once; the most users being based in the Middle East, followed by South America, the U.S.A and Europe.
According to the Mayo Clinic, about 3 million people in the U.S use anabolic steroids. The National Institute of Drug Abuse reports that hundreds of thousands of adults are believed to take steroids at least once a year, including approximately 2% of high school seniors. In 2011, Dr Michael .J. Scott, clinical associate professor of dermatology at Western University of Health Sciences, warned of a surge in non-athletes presenting with skin complaints traditionally recognised to be the first signs of regular steroid use.
He advised dermatologists across the United States to be vigilant for these early stage symptoms and attempt to make suspected users more aware of the risks.
This is not a uniquely American phenomenon however. If anything in Britain the escalation is even more startling. According to the National Institute for Clinical Excellence, the number of people in England and Wales currently taking anabolic steroids stands at approximately 60,000 people between the age of 16 and 59. Yet those on the front line who often come into contact with users feel that in reality the problem is much greater and more widespread.
“It is a big underestimate,” reports Professor Julien Baker, an expert in steroid use from the University of the West of Scotland.
“There are needle exchanges in Cardiff and Glasgow which say they’ve seen a 600% increase for steroid users over 10 years. The real figure is definitely in the hundreds of thousands.”
This opinion backed up by a 2013 intervention by the Crime Reduction Initiative which reported a 645% increase in steroid users at its needle exchanges in England, up from 290 in 2010 to 2161 in 2013. Despite steroids illegality in the U.K and U.S, both the internet age and a subculture of use within gyms have done much to restore ease of access. Some surveys have suggested that there are gyms in Britain where as many as 60-100% of regular attenders use steroids. Joseph Keane manager of the Bridge Project drug charity in Bradford, England claims the practise is ‘smashing through the roof’ and cites needle exchanges in the city of Middlesbrough dealing with upwards of 2000 people, the majority of whom are on steroids.
“It’s everywhere,” he said. “I could go into any gym and find a steroid user. Even fitness clubs, the posh ones.” In March of 2015 British publication the Sunday Times stated that police seized steroids every 36 minutes in 2012-13, a 30% increase on the previous year.
So might the resurgence in steroid use be in response to a reconsideration of old data, or possibly a dropping off of new data regarding the dangers? Doubtful. On the contrary, new research is emerging all the time which helps us more fully understand how the effects of steroids manifest themselves.
For example some work into the subject, conducted just this month suggests that it is no longer merely long term consequences users need be wary of.
A study led by Dr Tom Heffernan of Northumbria University’s Psychology Department, took a sample of around 100 gym clients and examined the comparative recall ability of roughly 50 participants who don’t take steroids against 50 who do. The test covered three standardized categories of memory: retrospective memory (for example the ability to remember names and facts) prospective memory, (relating to say, remembering to keep an appointment or send an important email) and lastly what’s called mental executive function (taking to do with how often you might become confused or forget how to perform a task half way through).
Across the board those who worked out naturally – in what must have been an intensely satisfying role reversal – significantly outperformed those who exercised on steroids. The latter were found to be 28% more forgetful in terms of their retrospective memory, 39% worse off when it came to prospective memory and there was a 32% deficit in mental executive function.
Although the rest of us might take a crumb of comfort from knowing that before those on steroid can put us to shame on the rowing machine, they have to remember where it is first; for users, these results should be a warning that health complications may not be merely worries for the future. Dr. Heffernan’s findings demonstrate a degree of real-time,
So why, in the face of such continued damning evidence, do rates of steroid use continue to spiral? More than likely the answer is to an extent reflected in the results of a study published in The Journal of the American Medical Association, which took a national sample of adolescent boys and found that nearly 18% of them are highly concerned with their weight or physique. Of the boys worried about their weight approximately half were focused solely on gaining muscle compared to a third who desired primarily thinness.
Only 15% were purely focused on thinness. “There are some males who do want to be thinner and are focused on thinness, but many more are focused on wanting bigger or at least more toned and defined muscles. That’s a very different physique.” reports Dr Alison Field, an associate professor of paediatrics at Boston Children’s Hospital and the lead author of the study. Media pressure on women to look a certain way is nothing new, but amidst a new wave of action movies, featuring stars with large muscles and toned physiques, often rated suitable for viewers as young as 12, 15 or 18 may feel the gender imbalance has evened out in the worst possible way.
The fitness industry increasingly chooses names such as ‘The Thor Workout’ or ‘The Superman Workout’ to draw in clients, with plenty of success. In 2006, the year the film ‘300’ was released, Google searches for ‘how do I get a six pack?’ were up 300%. “The media has become more of an equal opportunity discriminator,” says Dr. Raymond Lemberg, a Prescott, Arizona-based clinical psychologist and an expert on male eating disorders, “Men’s bodies are not good enough anymore either.”
In the U.K too, young men appear to be central to the steroid revival. There is anecdotal evidence of users as young of 13 and 15 injecting anabolic steroids to try to bulk up “The vast majority of people we see use steroids for image reasons,” says Gary Beeny, who works in a steroid clinic in the Ancoats district of Manchester, England. “It used to be much more limited; only the really big, muscular guys went anywhere near steroids.
Now it can be anybody who goes to a gym and speaks to people. The network of supply and demand is very advanced.” It’s not just the frequency of use that is bothering experts; it’s also the frightening new way they’re being utilised. ““People used to do cycles of six to eight weeks. Now they’ll often stay on all the time. As a young man what you’re essentially doing is switching off your natural, biological level of testosterone and then expecting it to come back when you stop using steroids” continues Beeny.
It almost goes without saying that the repercussions of taking large quantities of a hormone with the power to alter development are further complicated in a body which has not yet finished the process naturally. In adolescent steroid abuse there is the scope for all the aforementioned side effects as well as the possibility of stunted growth and altered maturation speeds.
Even those in their 20s though could be setting their body on a developmentally skewed path which can be difficult, if not impossible for it to recover from.
Amplified pressure on men to appear muscular, in the eyes of many, is to blame for the growth in a psychological condition which in 1997 was first identified as ‘muscle dysmorphia’, or more colloquially ‘Bigorexia.’
As these names suggest, the disorder is an offshoot of body dysmorphia, whereby sufferers lose rational perspective on the appearance of their own body, endlessly pursuing a certain physical ideal which they will never feel they have adequately achieved, regardless of how they actually appear in reality. In the case of muscle dysmorphia this unattainable perfection takes the form of evermore seeking to amass evermore muscle bulk.
Once in the grip of this obsession typically neither the reassurances of friends and family, nor the real health risks to self can dissuade the individual. Like conditions such as anorexia, there a various theories as to the root cause of muscle dysmorphia.
Underlying psychological vulnerabilities, childhood trauma and cultural influences have all been hypothesised as potential triggers, but there is also the possibility of a biological factor; namely serotonin deficiency. Serotonin is a chemical found in the body which acts as a neurotransmitter, regulating mood and social behaviour.
Higher levels of serotonin can elevate mood, giving a sort of natural high, and we know that one of the best ways to stimulate this is through exercise. Studies have shown that anything that makes us feel good has the potential to become addictive and working out is no exception. So although steroids may not be directly to blame for muscle dysmorphia; the implications of a fragile mental state, which compels you to keep exercising and building up irrespective of safe, natural limits, introduced to a substance which allows you to, are catastrophic.
It is true that higher testosterone is hugely beneficial and raising levels within natural parameters is encouraged, but your body has the thresholds it does for a reason.
Try to synthetically break through these boundaries and you risk upsetting a finely tuned hormonal balance which directly or indirectly affects every aspect of how we function. Bizarrely as our understanding of the health threat posed by anabolic steroid continues to move forward, our attitude would seem to be moving backwards. The culturally driven anxiety of men to appear muscular or perform better, added to new avenues of access, have arguably contributed to a kind of Spandexless rerunning of the 80s love affair with steroids.
Defenders of artificial hormones would doubtless point to science’s relative inability to as yet produce large amount of cause and effect material on the subject, but as we’ve seen, there is more than enough up-to-date research to give legitimate cause for concern, both in terms of long and short term side effects of steroids and the growing numbers exposed to them for cosmetic or competitive purposes.
Mounting evidence from numerous scientific fields would suggest that any case for the safe use of steroids outside of controlled medicine may be pumped up to a degree which would make any bodybuilder worth their singlet green with envy.
Overwhelmingly the advice coming from those who understand male physiology best, to any fitness enthusiast tempted by the outwardly incredible performance enhancing results of steroids, remains that the best thing they can start exercising is restraint.