The influence of anabolic steroids on physiologic processes and exercise: Difference between revisions

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= '''Cardiovascular Effects'''  =
= '''Cardiovascular Effects'''  =


Long-term use of supraphysiological doses of AAS has been associated with the development of pathological changes in the cardiovascular system. AAS users are at an increased risk of myocardial infarction, cardiomyopathy, sudden death, cardiovascular morbidity, and mortality when compared to non-users <ref name="Achar">Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. The American journal of cardiology. 2010;106(6):893-901. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111565/</ref>. AAS users have been shown to have a lower amount of heart rate variability (HRV) than non-users, putting them at an increased risk of autonomic cardiovascular dysfunction and ventricular arrhythmia <ref name="Maior">Maior A, Carvalho A, Marques-Neto S, Menezes P, Soares P, Nascimento J. Cardiac autonomic dysfunction in anabolic steroid users. Scandinavian journal of medicine &amp;amp;amp;amp; science in sports. 2013;23(5):548-55. http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2011.01436.x/full</ref>. Some evidence suggests a causal link between power athletes, body builders, and supraphysiological AAS use with atrial fibrillation (AF) <ref>Lau DH, Stiles MK, John B, Young GD, Sanders P. Atrial fibrillation and anabolic steroid abuse. International journal of cardiology. 2007;117(2):e86-e7. http://www.researchgate.net/profile/Martin_Stiles/publication/6469883_Atrial_fibrillation_and_anabolic_steroid_abuse/links/00b49528eb236dea49000000.pdf</ref>. This may be due to inter- and intra-atrial electromechanical delay. AAS users have been found to have a lower measurement of high frequency power, which is indicative of decresed vagal and parasympathetic activity in the heart<ref name="Maior" /><ref name="Hedman">Hedman A, Hartikainen J, Tahvanainen K, Hakumäki M. The high frequency component of heart rate variability reflects cardiac parasympathetic modulation rather than parasympathetic ‘tone’. Acta Physiologica Scandinavica. 1995;155(3):267-73. http://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+8619324</ref>.&nbsp;Reduced parasympathetic activity in the heart slows the recovery of heart rate post exercise<ref name="Maior" /><span style="line-height: 1.5em; font-size: 13.28px;">. However, the exact mechanism of how AAS abuse contributes to atrial electromechanical delay is poorly understood</span><ref>Akçakoyun M, Alizade E, Gündoğdu R, Bulut M, Tabakcı MM, Açar G, et al. Long-term anabolic androgenic steroid use is associated with increased atrial electromechanical delay in male bodybuilders. Biomed Res Int. 2014;2014:8. http://www.hindawi.com/journals/bmri/2014/451520/abs/</ref><span style="line-height: 1.5em; font-size: 13.28px;">.</span>  
Long-term use of supraphysiological doses of AAS has been associated with the development of pathological changes in the cardiovascular system. AAS users are at an increased risk of myocardial infarction, cardiomyopathy, sudden death, cardiovascular morbidity, and mortality when compared to non-users <ref name="Achar">Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. The American journal of cardiology. 2010;106(6):893-901. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111565/</ref>. AAS users have been shown to have a lower amount of heart rate variability (HRV) than non-users, putting them at an increased risk of autonomic cardiovascular dysfunction and ventricular arrhythmia <ref name="Maior">Maior A, Carvalho A, Marques-Neto S, Menezes P, Soares P, Nascimento J. Cardiac autonomic dysfunction in anabolic steroid users. Scandinavian journal of medicine &amp;amp;amp;amp;amp; science in sports. 2013;23(5):548-55. http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2011.01436.x/full</ref>. Some evidence suggests a causal link between power athletes, body builders, and supraphysiological AAS use with atrial fibrillation (AF) <ref>Lau DH, Stiles MK, John B, Young GD, Sanders P. Atrial fibrillation and anabolic steroid abuse. International journal of cardiology. 2007;117(2):e86-e7. http://www.researchgate.net/profile/Martin_Stiles/publication/6469883_Atrial_fibrillation_and_anabolic_steroid_abuse/links/00b49528eb236dea49000000.pdf</ref>. This may be due to inter- and intra-atrial electromechanical delay. AAS users have been found to have a lower measurement of high frequency power, which is indicative of decresed vagal and parasympathetic activity in the heart<ref name="Maior" /><ref name="Hedman">Hedman A, Hartikainen J, Tahvanainen K, Hakumäki M. The high frequency component of heart rate variability reflects cardiac parasympathetic modulation rather than parasympathetic ‘tone’. Acta Physiologica Scandinavica. 1995;155(3):267-73. http://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+8619324</ref>.&nbsp;Reduced parasympathetic activity in the heart slows the recovery of heart rate post exercise<ref name="Maior" /><span style="line-height: 1.5em; font-size: 13.28px;">. However, the exact mechanism of how AAS abuse contributes to atrial electromechanical delay is poorly understood</span><ref>Akçakoyun M, Alizade E, Gündoğdu R, Bulut M, Tabakcı MM, Açar G, et al. Long-term anabolic androgenic steroid use is associated with increased atrial electromechanical delay in male bodybuilders. Biomed Res Int. 2014;2014:8. http://www.hindawi.com/journals/bmri/2014/451520/abs/</ref><span style="line-height: 1.5em; font-size: 13.28px;">.</span>  


= '''Muscular System Effects'''  =
= '''Muscular System Effects'''  =


One of the primary efffects of anabolic-androgenous steroids (AAS) and the reason it is ustilized by many athletes is its ability to improve exercise and other physical performance. Studies suggest that administration of AAS increases skeletal muscle mass (hypertrophy) and protein synthesis, both responses of which are enhanced when AAS is given with resistance exercise <ref name="Tamaki">Tamaki T, Uchiyama S, Uchiyama Y, Akatsuka A, Roy RR, &amp;amp;amp;amp; Edgerton VR. Anabolic steroids increase exercise tolerance. American Journal of Physiology-Endocrinology And Metabolism. 2001;280(6):E973-E981.</ref>.&nbsp;A 1988 study found that stanozolol, an AAS, significantly increased type I muscle fiber size <ref name="stanozolol">Hosegood, J. L., &amp;amp;amp;amp;amp; Franks, A. J. (1988). Response of human skeletal muscle to the anabolic steroid stanozolol. BMJ : British Medical Journal, 297(6655), 1028–1029.</ref>. The authors of this study hypothesized that by enlarging type I fibers and therefore allowing athletes to exercise longer, AAS use would also lead to type II fiber hypertrophy <ref name="stanozolol" />. A study of 19 power lifters explained that although the proportion of type I and type IIA fibers were similar regardless of steroid use, the steroid users’ fibers had significantly larger areas&nbsp;<ref name="powerlifters">Kadi, F., Eriksson, A., Holmner, S., and Thornell, L-E (1999). Effects of anabolic steroids on the muscle cells of strength-trained athletes. Medicine &amp;amp;amp;amp;amp; Science in Sports &amp;amp;amp;amp;amp; Exercise, 31(11), 1528–1534.</ref>.  
One of the primary efffects of anabolic-androgenous steroids (AAS) and the reason it is ustilized by many athletes is its ability to improve exercise and other physical performance. Studies suggest that administration of AAS increases skeletal muscle mass (hypertrophy) and protein synthesis, both responses of which are enhanced when AAS is given with resistance exercise <ref name="Tamaki">Tamaki T, Uchiyama S, Uchiyama Y, Akatsuka A, Roy RR, &amp;amp;amp;amp;amp; Edgerton VR. Anabolic steroids increase exercise tolerance. American Journal of Physiology-Endocrinology And Metabolism. 2001;280(6):E973-E981.</ref>.&nbsp;A 1988 study found that stanozolol, an AAS, significantly increased type I muscle fiber size <ref name="stanozolol">Hosegood, J. L., &amp;amp;amp;amp;amp;amp; Franks, A. J. (1988). Response of human skeletal muscle to the anabolic steroid stanozolol. BMJ : British Medical Journal, 297(6655), 1028–1029.</ref>. The authors of this study hypothesized that by enlarging type I fibers and therefore allowing athletes to exercise longer, AAS use would also lead to type II fiber hypertrophy <ref name="stanozolol" />. A study of 19 power lifters explained that although the proportion of type I and type IIA fibers were similar regardless of steroid use, the steroid users’ fibers had significantly larger areas&nbsp;<ref name="powerlifters">Kadi, F., Eriksson, A., Holmner, S., and Thornell, L-E (1999). Effects of anabolic steroids on the muscle cells of strength-trained athletes. Medicine &amp;amp;amp;amp;amp;amp; Science in Sports &amp;amp;amp;amp;amp;amp; Exercise, 31(11), 1528–1534.</ref>.  


Two separate studies found that use of AAS increases exercise capacity, muscle endurance, and running endurance in rats. A 2001 study published by the American Journal of Physiology found that rats who were treated with AAS performed significantly better during a single exercise bout than rats in a control group. The researchers measured total amount of weight lifted, the total number of sets, 10RM, and the number of complete sets at 10RM <ref name="Tamaki" />. Rats in the steroid group performed 47%, 12%, 22%, and 81% better in these areas respectively as compared to the control group <ref name="Tamaki" />. The researchers stated that AAS treatment before a single bout of exhaustive weight-lifting exercise enhances the fatigue resistance in involved muscles and increases the protein synthesis in contractile and noncontractile components of the muscle <ref name="Tamaki" />. In a separate 1995 study published by the Official Journal of the American College of Sports Medicine it was found that rats treated with AAS who trained spontaneously increased sub-maximal running endurance as compared to rats who trained similarly but did not receive AAS treatment. The researchers stated that their study shows AAS treatment in combination with exercise delays fatigue during sub-maximal exercise which may be due to AAS induced muscle fiber transformations that which allow muscles to resist fatigue <ref>Van Zyl, C. G., Noakes, T. D., &amp;amp;amp;amp;amp;amp;amp;amp; Lambert, M. I. (1995). Anabolic-androgenic steroid increases running endurance in rats. Medicine and science in sports and exercise, 27(10), 1385-1389.</ref>.  
Two separate studies found that use of AAS increases exercise capacity, muscle endurance, and running endurance in rats. A 2001 study published by the American Journal of Physiology found that rats who were treated with AAS performed significantly better during a single exercise bout than rats in a control group. The researchers measured total amount of weight lifted, the total number of sets, 10RM, and the number of complete sets at 10RM <ref name="Tamaki" />. Rats in the steroid group performed 47%, 12%, 22%, and 81% better in these areas respectively as compared to the control group <ref name="Tamaki" />. The researchers stated that AAS treatment before a single bout of exhaustive weight-lifting exercise enhances the fatigue resistance in involved muscles and increases the protein synthesis in contractile and noncontractile components of the muscle <ref name="Tamaki" />. In a separate 1995 study published by the Official Journal of the American College of Sports Medicine it was found that rats treated with AAS who trained spontaneously increased sub-maximal running endurance as compared to rats who trained similarly but did not receive AAS treatment. The researchers stated that their study shows AAS treatment in combination with exercise delays fatigue during sub-maximal exercise which may be due to AAS induced muscle fiber transformations that which allow muscles to resist fatigue <ref>Van Zyl, C. G., Noakes, T. D., &amp;amp;amp;amp;amp;amp;amp;amp;amp; Lambert, M. I. (1995). Anabolic-androgenic steroid increases running endurance in rats. Medicine and science in sports and exercise, 27(10), 1385-1389.</ref>.  


Steroids have not been shown to increase creatine concentrations in the muscle, red blood cell concentration, or serum liver enzyme concentrations as previously postulated.<ref name="BStorer">Bhasin S, Storer TW, Berman N, Callegari C, Clevenger B, Phillips J, et al. The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men.Abridged version: NEJM 1996;335:1–7.Full version: http://www.nejm.org/doi/pdf/10.1056/nejm199607043350101 (accessed 28 Oct 2015).</ref>&nbsp;One study found that injection of 600 mg of testoterone in adult males who did not exercise resulted in more fat free mass and a greater increase in strength than in individuals who incorporated resistance training but only took a placebo.<ref name="BStorer" />&nbsp;Some commonly reported side effects of steroid use, such as acne and breast tenderness, resulted in some of the subjects as well but most did not.<ref name="BStorer" />&nbsp;This would seem to indicate that individual physiological differences have a profound impact on how a person reacts to steroids.<br>  
Steroids have not been shown to increase creatine concentrations in the muscle, red blood cell concentration, or serum liver enzyme concentrations as previously postulated.<ref name="BStorer">Bhasin S, Storer TW, Berman N, Callegari C, Clevenger B, Phillips J, et al. The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men.Abridged version: NEJM 1996;335:1–7.Full version: http://www.nejm.org/doi/pdf/10.1056/nejm199607043350101 (accessed 28 Oct 2015).</ref>&nbsp;One study found that injection of 600 mg of testoterone in adult males who did not exercise resulted in more fat free mass and a greater increase in strength than in individuals who incorporated resistance training but only took a placebo.<ref name="BStorer" />&nbsp;Some commonly reported side effects of steroid use, such as acne and breast tenderness, resulted in some of the subjects as well but most did not.<ref name="BStorer" />&nbsp;This would seem to indicate that individual physiological differences have a profound impact on how a person reacts to steroids.<br>  
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Research indicates a significant correlation between prolonged AAS usage and upper extremity tendon rupture. Out of 88 AAS users, 17% had confirmed triceps or biceps tendon ruptures, whereas none of the non AAS users had upper extremity tendon ruptures&nbsp;&nbsp;<ref name="Kanayama">Kanayama G, DeLuca J, Meehan WP, Hudson JI, Isaacs S, Baggish A, et al. Ruptured Tendons in Anabolic-Androgenic Steroid Users. 2015;43(11):2638-44. http://ajs.sagepub.com/content/43/11/2638.short</ref> . No significant difference was found between the two groups concerning lower extremity tendon ruptures&nbsp; <ref name="Kanayama" /> . The mechanism of AAS-associated tendon rupture is not well understood. One hypothesis is that high doses of AAS use combined with intense muscular exercise may cause structural damage to the tendon themselves. All the evidence to date supporting this hypothesis comes from animal studies <ref name="Kanayama" />. One study found ultrastructural changes in tendons of mice treated with AAS <ref name="Michna">Michna H. Tendon injuries induced by exercise and anabolic steroids in experimental mice. International orthopaedics. 1987;11(2):157-62.fckLRhttp://link.springer.com/article/10.1007/BF00266702</ref>. Wood, Cooke, and Goodshipsaw documented changes in collagen fibril crimp angle and fibril length of rat tendons&nbsp;exposed&nbsp;to AAS <ref name="Wood">Wood T. O., Cooke P. H. and Goodship A. E. ThefckLReffect of exercise and anabolic steroids on the mechanical properties and crimp morphology of the rat tendon. Am. J. Sports Med. 1988; 16: 153-158</ref>. Marqueti et al. noticed inhibition of matrix tendon remodeling in rats&nbsp;<ref>Marqueti RC, Parizotto NA, Chriguer RS, Perez SE, Selistre-de-fckLRAraujo HS. Androgenic-anabolic steroids associated with mechanicalfckLRloading inhibit matrix metallopeptidase activity and affect the remodelingfckLRof the achilles tendon in rats. Am J Sports Med 34: 1274–1280, 2006.</ref>&nbsp;and Tsitsilonis et al. documented reduced maximal stress values in rodents treated with AAS <ref>Tsitsilonis, S., Chatzistergos, P. E., Mitousoudis, A. S., Kourkoulis, S. K., Vlachos, I. S., Agrogiannis, G., . . . Zoubos, A. B. (2014). Anabolic androgenic steroids reverse the beneficial effect of exercise on tendon biomechanics: an experimental study. Foot Ankle Surg, 20(2), 94-99. doi:10.1016/j.fas.2013.12.001</ref>. Others have found biomechanical changes in rat tendons causing tendon stiffness <ref name="Miles">Miles J. W., Grana W. A. and Egle D. et al. The effect of anabolic steroids on the biomechanical and histological properties of rat tendon. J. Bone Joint Surg. (Am.) 1992;74 A: 411-422</ref><ref name="Inhofe">Inhofe P. D., Grana W. A. and Egle D. et al. The effects of anabolic steroids on rat tendon: an ultrastructural, biomechanical and biochemical analysis. Am. J. Sports Med. 1995; 23: 227-232</ref>. However, direct evidence of structural changes in human tendons has not been demonstrated <ref name="Kanayama" />. A case-control study compared collagen ultrastructure, metabolism, and mechanical properties of patella tendons in 24 individuals assigned to three groups: resistance-trained AAS users (RTS), resistance-trained non-AAS users (RT), and a control group that was neither AAS user nor resistance-trained (CTRL). Higher patellar stiffness and tensile modulus was found in the RTS group; this finding could support changes in tendon remodeling, however, there was no significant difference in mechanical and material properties of the tendons between the RTS and RT group respectively <ref>Seynnes, O. R., Kamandulis, S., Kairaitis, R., Helland, C., Campbell, E. L., Brazaitis, M., . . . Narici, M. V. (2013). Effect of androgenic-anabolic steroids and heavy strength training on patellar tendon morphological and mechanical properties. J Appl Physiol (1985), 115(1), 84-89. doi:10.1152/japplphysiol.01417.2012</ref>. A competing hypothesis suggests that AAS use causes hypertrophy in the muscle without causing corresponding changes in the tendon tissue. In times of sudden or maximal stress the muscle becomes too strong for its tendon causing injury <ref name="Kanayama" />. Lastly, a study on retired National Football League (NFL) players found an association between AAS users and an increased likelihood of musculoskeletal injury, specifically ligamentous injuries <ref name="Horn">Horn, S., Gregory, P, Guskiewicz, KM. Self-reported anabolic-androgenic steroids use and musculoskeletal injuries. Am. J. Phys. Med. Rehabil. 2009; 88: 192-200.</ref>.<br>  
Research indicates a significant correlation between prolonged AAS usage and upper extremity tendon rupture. Out of 88 AAS users, 17% had confirmed triceps or biceps tendon ruptures, whereas none of the non AAS users had upper extremity tendon ruptures&nbsp;&nbsp;<ref name="Kanayama">Kanayama G, DeLuca J, Meehan WP, Hudson JI, Isaacs S, Baggish A, et al. Ruptured Tendons in Anabolic-Androgenic Steroid Users. 2015;43(11):2638-44. http://ajs.sagepub.com/content/43/11/2638.short</ref> . No significant difference was found between the two groups concerning lower extremity tendon ruptures&nbsp; <ref name="Kanayama" /> . The mechanism of AAS-associated tendon rupture is not well understood. One hypothesis is that high doses of AAS use combined with intense muscular exercise may cause structural damage to the tendon themselves. All the evidence to date supporting this hypothesis comes from animal studies <ref name="Kanayama" />. One study found ultrastructural changes in tendons of mice treated with AAS <ref name="Michna">Michna H. Tendon injuries induced by exercise and anabolic steroids in experimental mice. International orthopaedics. 1987;11(2):157-62.fckLRhttp://link.springer.com/article/10.1007/BF00266702</ref>. Wood, Cooke, and Goodshipsaw documented changes in collagen fibril crimp angle and fibril length of rat tendons&nbsp;exposed&nbsp;to AAS <ref name="Wood">Wood T. O., Cooke P. H. and Goodship A. E. ThefckLReffect of exercise and anabolic steroids on the mechanical properties and crimp morphology of the rat tendon. Am. J. Sports Med. 1988; 16: 153-158</ref>. Marqueti et al. noticed inhibition of matrix tendon remodeling in rats&nbsp;<ref>Marqueti RC, Parizotto NA, Chriguer RS, Perez SE, Selistre-de-fckLRAraujo HS. Androgenic-anabolic steroids associated with mechanicalfckLRloading inhibit matrix metallopeptidase activity and affect the remodelingfckLRof the achilles tendon in rats. Am J Sports Med 34: 1274–1280, 2006.</ref>&nbsp;and Tsitsilonis et al. documented reduced maximal stress values in rodents treated with AAS <ref>Tsitsilonis, S., Chatzistergos, P. E., Mitousoudis, A. S., Kourkoulis, S. K., Vlachos, I. S., Agrogiannis, G., . . . Zoubos, A. B. (2014). Anabolic androgenic steroids reverse the beneficial effect of exercise on tendon biomechanics: an experimental study. Foot Ankle Surg, 20(2), 94-99. doi:10.1016/j.fas.2013.12.001</ref>. Others have found biomechanical changes in rat tendons causing tendon stiffness <ref name="Miles">Miles J. W., Grana W. A. and Egle D. et al. The effect of anabolic steroids on the biomechanical and histological properties of rat tendon. J. Bone Joint Surg. (Am.) 1992;74 A: 411-422</ref><ref name="Inhofe">Inhofe P. D., Grana W. A. and Egle D. et al. The effects of anabolic steroids on rat tendon: an ultrastructural, biomechanical and biochemical analysis. Am. J. Sports Med. 1995; 23: 227-232</ref>. However, direct evidence of structural changes in human tendons has not been demonstrated <ref name="Kanayama" />. A case-control study compared collagen ultrastructure, metabolism, and mechanical properties of patella tendons in 24 individuals assigned to three groups: resistance-trained AAS users (RTS), resistance-trained non-AAS users (RT), and a control group that was neither AAS user nor resistance-trained (CTRL). Higher patellar stiffness and tensile modulus was found in the RTS group; this finding could support changes in tendon remodeling, however, there was no significant difference in mechanical and material properties of the tendons between the RTS and RT group respectively <ref>Seynnes, O. R., Kamandulis, S., Kairaitis, R., Helland, C., Campbell, E. L., Brazaitis, M., . . . Narici, M. V. (2013). Effect of androgenic-anabolic steroids and heavy strength training on patellar tendon morphological and mechanical properties. J Appl Physiol (1985), 115(1), 84-89. doi:10.1152/japplphysiol.01417.2012</ref>. A competing hypothesis suggests that AAS use causes hypertrophy in the muscle without causing corresponding changes in the tendon tissue. In times of sudden or maximal stress the muscle becomes too strong for its tendon causing injury <ref name="Kanayama" />. Lastly, a study on retired National Football League (NFL) players found an association between AAS users and an increased likelihood of musculoskeletal injury, specifically ligamentous injuries <ref name="Horn">Horn, S., Gregory, P, Guskiewicz, KM. Self-reported anabolic-androgenic steroids use and musculoskeletal injuries. Am. J. Phys. Med. Rehabil. 2009; 88: 192-200.</ref>.<br>  


Most people relate anabolic steroids to high intensity training done by elite athletes. However, the idea has also come about to combine this drug with therapy to help the older population rehabilitate following hip replacement surgery. Anabolic Steroids can boost muscle development and increase other factors that relate to range of motion and strength in athletes. Experts agree with the perception that this will correspond with the older population when it comes to recovering from hip surgery <ref name="Farooqi">Farooqi, V., Van Den Berg, M., Cameron, I.Anabolic steroids for rehabilitation after hip fracture in older people. The Cochran Collaboration. 2013:</ref>. Anabolic steroids may also improve frailty. A randomized controlled study of 274 elderly men with frailty concluded that administering testosterone may improve quality of life by improving strength, physical function, and body composition. <ref name="frailty">Srinivas-Shankar, U., Roberts, S. A., Connolly, M. J., O'Connell, M. D. L., Adams, J. E., Oldham, J. A., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Wu, F. C. W. (2010) Effects of Testosterone on Muscle Strength, Physical Function, Body Composition, and Quality of Life in Intermediate-Frail and Frail Elderly Men: A Randomized, Double-Blind, Placebo-Controlled Study. The Journal of Clinical Endocrinology &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Metabolism, 95(2), 639-650. doi:10.1210/jc.2009-1251</ref> Researchers are interested in this concept and will continue to look into how anabolic steroids can be used to help the older population recover from hip surgery and improve overall quality of life.<br>  
Most people relate anabolic steroids to high intensity training done by elite athletes. However, the idea has also come about to combine this drug with therapy to help the older population rehabilitate following hip replacement surgery. Anabolic Steroids can boost muscle development and increase other factors that relate to range of motion and strength in athletes. Experts agree with the perception that this will correspond with the older population when it comes to recovering from hip surgery <ref name="Farooqi">Farooqi, V., Van Den Berg, M., Cameron, I.Anabolic steroids for rehabilitation after hip fracture in older people. The Cochran Collaboration. 2013:</ref>. Anabolic steroids may also improve frailty. A randomized controlled study of 274 elderly men with frailty concluded that administering testosterone may improve quality of life by improving strength, physical function, and body composition. <ref name="frailty">Srinivas-Shankar, U., Roberts, S. A., Connolly, M. J., O'Connell, M. D. L., Adams, J. E., Oldham, J. A., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Wu, F. C. W. (2010) Effects of Testosterone on Muscle Strength, Physical Function, Body Composition, and Quality of Life in Intermediate-Frail and Frail Elderly Men: A Randomized, Double-Blind, Placebo-Controlled Study. The Journal of Clinical Endocrinology &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Metabolism, 95(2), 639-650. doi:10.1210/jc.2009-1251</ref> Researchers are interested in this concept and will continue to look into how anabolic steroids can be used to help the older population recover from hip surgery and improve overall quality of life.<br>  


= '''Neurological Effects'''  =
= '''Neurological Effects'''  =


AAS use is associated with positive and negative psychological effects. AAS abuse and dependence is a potential problem among AAS users, especially those using it for performance or aesthetic purposes. AAS may increase beta-endorphin levels, decrease cortisol levels, and increase ACTH levels, which may lead to an increase in positive associations with exercise<ref name="Hildebrandt">Hildebrandt, T., Shope, S., Varangis, E., Klein, D., Pfaff, D. W., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Yehuda, R., (2014). Exercise Reinforcement, Stress, and b-endorphins: An initial examination of exercise in anabolic-androgenic steroid dependence. Drug and Alcohol Dependence, 139, 86-92. doi: 10.1016/j.drugalcdep.2014.03.008</ref>.&nbsp; The increase in endorphin levels and exercise reinforcement may contribute to AAS dependence and abuse<ref name="Hildebrandt" />. AAS dependence is characterized by increases in AAS cycles, higher doses, and increases in psychological disorders, such as increased aggression<ref name="Piacentino">Piacentino, D., Kotzalidis, G. D., Del Casale, A., Aromatario, M. R., Pomara, C., Girardi, P., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sani, G. (2015). Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review. Current Neruopharmacology, 13(1), 101-121. doi: 10.2174/1570159X13666141210222725.</ref>. Depression and suicide can be caused by off-cycles of AAS or withdrawal from AAS use.&nbsp; The risk for depression and suicide may be caused by the decrease in endorphin levels and changes in the reward systems of the brain. AAS can cause or exaccerbate anxiety disorders, schizophrenia, and eating disorders<ref name="Piacentino" />.&nbsp; The psychopathology of AAS is theorized to be caused by direct or indirect changes in the central nervous system, including changes to intracellular receptors and neruotransmitter receptors. These changes may influence hormone and neurotransmitter levels, such as serotonin or GABA, and lead to changes in depression, anger, or stress<ref name="Piacentino" />. AAS use may contribute to motivation and positive experiences with exercise, but it can lead to negative effects that are long-lasting and decreases in motivation to exercise.<br>  
AAS use is associated with positive and negative psychological effects. AAS abuse and dependence is a potential problem among AAS users, especially those using it for performance or aesthetic purposes. AAS may increase beta-endorphin levels, decrease cortisol levels, and increase ACTH levels, which may lead to an increase in positive associations with exercise<ref name="Hildebrandt">Hildebrandt, T., Shope, S., Varangis, E., Klein, D., Pfaff, D. W., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Yehuda, R., (2014). Exercise Reinforcement, Stress, and b-endorphins: An initial examination of exercise in anabolic-androgenic steroid dependence. Drug and Alcohol Dependence, 139, 86-92. doi: 10.1016/j.drugalcdep.2014.03.008</ref>.&nbsp; The increase in endorphin levels and exercise reinforcement may contribute to AAS dependence and abuse<ref name="Hildebrandt" />. AAS dependence is characterized by increases in AAS cycles, higher doses, and increases in psychological disorders, such as increased aggression<ref name="Piacentino">Piacentino, D., Kotzalidis, G. D., Del Casale, A., Aromatario, M. R., Pomara, C., Girardi, P., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sani, G. (2015). Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review. Current Neruopharmacology, 13(1), 101-121. doi: 10.2174/1570159X13666141210222725.</ref>. Depression and suicide can be caused by off-cycles of AAS or withdrawal from AAS use.&nbsp; The risk for depression and suicide may be caused by the decrease in endorphin levels and changes in the reward systems of the brain. AAS can cause or exaccerbate anxiety disorders, schizophrenia, and eating disorders<ref name="Piacentino" />.&nbsp; The psychopathology of AAS is theorized to be caused by direct or indirect changes in the central nervous system, including changes to intracellular receptors and neruotransmitter receptors. These changes may influence hormone and neurotransmitter levels, such as serotonin or GABA, and lead to changes in depression, anger, or stress<ref name="Piacentino" />. AAS use may contribute to motivation and positive experiences with exercise, but it can lead to negative effects that are long-lasting and decreases in motivation to exercise.<br>  


= '''Psychological Effects'''  =
= '''Psychological Effects'''  =


<br>
<br>  


= '''References'''  =
= '''References'''  =


<references />
<references />

Revision as of 02:42, 2 December 2015

Introduction  [edit | edit source]

Anabolic-androgenic steroids (AAS) are a group of synthetic compounds that mimic the effects of testosterone in the body[1]. AAS are often abused by individuals to utilize their anabolic effect with the intended purpose of increasing lean muscle mass. AAS can have profound effects on the cardiovascular system with extended abuse.

Cardiovascular Effects[edit | edit source]

Long-term use of supraphysiological doses of AAS has been associated with the development of pathological changes in the cardiovascular system. AAS users are at an increased risk of myocardial infarction, cardiomyopathy, sudden death, cardiovascular morbidity, and mortality when compared to non-users [2]. AAS users have been shown to have a lower amount of heart rate variability (HRV) than non-users, putting them at an increased risk of autonomic cardiovascular dysfunction and ventricular arrhythmia [3]. Some evidence suggests a causal link between power athletes, body builders, and supraphysiological AAS use with atrial fibrillation (AF) [4]. This may be due to inter- and intra-atrial electromechanical delay. AAS users have been found to have a lower measurement of high frequency power, which is indicative of decresed vagal and parasympathetic activity in the heart[3][5]. Reduced parasympathetic activity in the heart slows the recovery of heart rate post exercise[3]. However, the exact mechanism of how AAS abuse contributes to atrial electromechanical delay is poorly understood[6].

Muscular System Effects[edit | edit source]

One of the primary efffects of anabolic-androgenous steroids (AAS) and the reason it is ustilized by many athletes is its ability to improve exercise and other physical performance. Studies suggest that administration of AAS increases skeletal muscle mass (hypertrophy) and protein synthesis, both responses of which are enhanced when AAS is given with resistance exercise [7]. A 1988 study found that stanozolol, an AAS, significantly increased type I muscle fiber size [8]. The authors of this study hypothesized that by enlarging type I fibers and therefore allowing athletes to exercise longer, AAS use would also lead to type II fiber hypertrophy [8]. A study of 19 power lifters explained that although the proportion of type I and type IIA fibers were similar regardless of steroid use, the steroid users’ fibers had significantly larger areas [9].

Two separate studies found that use of AAS increases exercise capacity, muscle endurance, and running endurance in rats. A 2001 study published by the American Journal of Physiology found that rats who were treated with AAS performed significantly better during a single exercise bout than rats in a control group. The researchers measured total amount of weight lifted, the total number of sets, 10RM, and the number of complete sets at 10RM [7]. Rats in the steroid group performed 47%, 12%, 22%, and 81% better in these areas respectively as compared to the control group [7]. The researchers stated that AAS treatment before a single bout of exhaustive weight-lifting exercise enhances the fatigue resistance in involved muscles and increases the protein synthesis in contractile and noncontractile components of the muscle [7]. In a separate 1995 study published by the Official Journal of the American College of Sports Medicine it was found that rats treated with AAS who trained spontaneously increased sub-maximal running endurance as compared to rats who trained similarly but did not receive AAS treatment. The researchers stated that their study shows AAS treatment in combination with exercise delays fatigue during sub-maximal exercise which may be due to AAS induced muscle fiber transformations that which allow muscles to resist fatigue [10].

Steroids have not been shown to increase creatine concentrations in the muscle, red blood cell concentration, or serum liver enzyme concentrations as previously postulated.[11] One study found that injection of 600 mg of testoterone in adult males who did not exercise resulted in more fat free mass and a greater increase in strength than in individuals who incorporated resistance training but only took a placebo.[11] Some commonly reported side effects of steroid use, such as acne and breast tenderness, resulted in some of the subjects as well but most did not.[11] This would seem to indicate that individual physiological differences have a profound impact on how a person reacts to steroids.

Research indicates a significant correlation between prolonged AAS usage and upper extremity tendon rupture. Out of 88 AAS users, 17% had confirmed triceps or biceps tendon ruptures, whereas none of the non AAS users had upper extremity tendon ruptures  [12] . No significant difference was found between the two groups concerning lower extremity tendon ruptures  [12] . The mechanism of AAS-associated tendon rupture is not well understood. One hypothesis is that high doses of AAS use combined with intense muscular exercise may cause structural damage to the tendon themselves. All the evidence to date supporting this hypothesis comes from animal studies [12]. One study found ultrastructural changes in tendons of mice treated with AAS [13]. Wood, Cooke, and Goodshipsaw documented changes in collagen fibril crimp angle and fibril length of rat tendons exposed to AAS [14]. Marqueti et al. noticed inhibition of matrix tendon remodeling in rats [15] and Tsitsilonis et al. documented reduced maximal stress values in rodents treated with AAS [16]. Others have found biomechanical changes in rat tendons causing tendon stiffness [17][18]. However, direct evidence of structural changes in human tendons has not been demonstrated [12]. A case-control study compared collagen ultrastructure, metabolism, and mechanical properties of patella tendons in 24 individuals assigned to three groups: resistance-trained AAS users (RTS), resistance-trained non-AAS users (RT), and a control group that was neither AAS user nor resistance-trained (CTRL). Higher patellar stiffness and tensile modulus was found in the RTS group; this finding could support changes in tendon remodeling, however, there was no significant difference in mechanical and material properties of the tendons between the RTS and RT group respectively [19]. A competing hypothesis suggests that AAS use causes hypertrophy in the muscle without causing corresponding changes in the tendon tissue. In times of sudden or maximal stress the muscle becomes too strong for its tendon causing injury [12]. Lastly, a study on retired National Football League (NFL) players found an association between AAS users and an increased likelihood of musculoskeletal injury, specifically ligamentous injuries [20].

Most people relate anabolic steroids to high intensity training done by elite athletes. However, the idea has also come about to combine this drug with therapy to help the older population rehabilitate following hip replacement surgery. Anabolic Steroids can boost muscle development and increase other factors that relate to range of motion and strength in athletes. Experts agree with the perception that this will correspond with the older population when it comes to recovering from hip surgery [21]. Anabolic steroids may also improve frailty. A randomized controlled study of 274 elderly men with frailty concluded that administering testosterone may improve quality of life by improving strength, physical function, and body composition. [22] Researchers are interested in this concept and will continue to look into how anabolic steroids can be used to help the older population recover from hip surgery and improve overall quality of life.

Neurological Effects[edit | edit source]

AAS use is associated with positive and negative psychological effects. AAS abuse and dependence is a potential problem among AAS users, especially those using it for performance or aesthetic purposes. AAS may increase beta-endorphin levels, decrease cortisol levels, and increase ACTH levels, which may lead to an increase in positive associations with exercise[23].  The increase in endorphin levels and exercise reinforcement may contribute to AAS dependence and abuse[23]. AAS dependence is characterized by increases in AAS cycles, higher doses, and increases in psychological disorders, such as increased aggression[24]. Depression and suicide can be caused by off-cycles of AAS or withdrawal from AAS use.  The risk for depression and suicide may be caused by the decrease in endorphin levels and changes in the reward systems of the brain. AAS can cause or exaccerbate anxiety disorders, schizophrenia, and eating disorders[24].  The psychopathology of AAS is theorized to be caused by direct or indirect changes in the central nervous system, including changes to intracellular receptors and neruotransmitter receptors. These changes may influence hormone and neurotransmitter levels, such as serotonin or GABA, and lead to changes in depression, anger, or stress[24]. AAS use may contribute to motivation and positive experiences with exercise, but it can lead to negative effects that are long-lasting and decreases in motivation to exercise.

Psychological Effects[edit | edit source]


References[edit | edit source]

  1. National Institute on Drug Abuse. Anabolic Steroids. http://www.drugabuse.gov/publications/drugfacts/anabolic-steroids (accessed November 10, 2015)
  2. Achar S, Rostamian A, Narayan SM. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm. The American journal of cardiology. 2010;106(6):893-901. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111565/
  3. 3.0 3.1 3.2 Maior A, Carvalho A, Marques-Neto S, Menezes P, Soares P, Nascimento J. Cardiac autonomic dysfunction in anabolic steroid users. Scandinavian journal of medicine &amp;amp;amp;amp; science in sports. 2013;23(5):548-55. http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2011.01436.x/full
  4. Lau DH, Stiles MK, John B, Young GD, Sanders P. Atrial fibrillation and anabolic steroid abuse. International journal of cardiology. 2007;117(2):e86-e7. http://www.researchgate.net/profile/Martin_Stiles/publication/6469883_Atrial_fibrillation_and_anabolic_steroid_abuse/links/00b49528eb236dea49000000.pdf
  5. Hedman A, Hartikainen J, Tahvanainen K, Hakumäki M. The high frequency component of heart rate variability reflects cardiac parasympathetic modulation rather than parasympathetic ‘tone’. Acta Physiologica Scandinavica. 1995;155(3):267-73. http://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+8619324
  6. Akçakoyun M, Alizade E, Gündoğdu R, Bulut M, Tabakcı MM, Açar G, et al. Long-term anabolic androgenic steroid use is associated with increased atrial electromechanical delay in male bodybuilders. Biomed Res Int. 2014;2014:8. http://www.hindawi.com/journals/bmri/2014/451520/abs/
  7. 7.0 7.1 7.2 7.3 Tamaki T, Uchiyama S, Uchiyama Y, Akatsuka A, Roy RR, &amp;amp;amp;amp; Edgerton VR. Anabolic steroids increase exercise tolerance. American Journal of Physiology-Endocrinology And Metabolism. 2001;280(6):E973-E981.
  8. 8.0 8.1 Hosegood, J. L., &amp;amp;amp;amp;amp; Franks, A. J. (1988). Response of human skeletal muscle to the anabolic steroid stanozolol. BMJ : British Medical Journal, 297(6655), 1028–1029.
  9. Kadi, F., Eriksson, A., Holmner, S., and Thornell, L-E (1999). Effects of anabolic steroids on the muscle cells of strength-trained athletes. Medicine &amp;amp;amp;amp;amp; Science in Sports &amp;amp;amp;amp;amp; Exercise, 31(11), 1528–1534.
  10. Van Zyl, C. G., Noakes, T. D., &amp;amp;amp;amp;amp;amp;amp;amp; Lambert, M. I. (1995). Anabolic-androgenic steroid increases running endurance in rats. Medicine and science in sports and exercise, 27(10), 1385-1389.
  11. 11.0 11.1 11.2 Bhasin S, Storer TW, Berman N, Callegari C, Clevenger B, Phillips J, et al. The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men.Abridged version: NEJM 1996;335:1–7.Full version: http://www.nejm.org/doi/pdf/10.1056/nejm199607043350101 (accessed 28 Oct 2015).
  12. 12.0 12.1 12.2 12.3 12.4 Kanayama G, DeLuca J, Meehan WP, Hudson JI, Isaacs S, Baggish A, et al. Ruptured Tendons in Anabolic-Androgenic Steroid Users. 2015;43(11):2638-44. http://ajs.sagepub.com/content/43/11/2638.short
  13. Michna H. Tendon injuries induced by exercise and anabolic steroids in experimental mice. International orthopaedics. 1987;11(2):157-62.fckLRhttp://link.springer.com/article/10.1007/BF00266702
  14. Wood T. O., Cooke P. H. and Goodship A. E. ThefckLReffect of exercise and anabolic steroids on the mechanical properties and crimp morphology of the rat tendon. Am. J. Sports Med. 1988; 16: 153-158
  15. Marqueti RC, Parizotto NA, Chriguer RS, Perez SE, Selistre-de-fckLRAraujo HS. Androgenic-anabolic steroids associated with mechanicalfckLRloading inhibit matrix metallopeptidase activity and affect the remodelingfckLRof the achilles tendon in rats. Am J Sports Med 34: 1274–1280, 2006.
  16. Tsitsilonis, S., Chatzistergos, P. E., Mitousoudis, A. S., Kourkoulis, S. K., Vlachos, I. S., Agrogiannis, G., . . . Zoubos, A. B. (2014). Anabolic androgenic steroids reverse the beneficial effect of exercise on tendon biomechanics: an experimental study. Foot Ankle Surg, 20(2), 94-99. doi:10.1016/j.fas.2013.12.001
  17. Miles J. W., Grana W. A. and Egle D. et al. The effect of anabolic steroids on the biomechanical and histological properties of rat tendon. J. Bone Joint Surg. (Am.) 1992;74 A: 411-422
  18. Inhofe P. D., Grana W. A. and Egle D. et al. The effects of anabolic steroids on rat tendon: an ultrastructural, biomechanical and biochemical analysis. Am. J. Sports Med. 1995; 23: 227-232
  19. Seynnes, O. R., Kamandulis, S., Kairaitis, R., Helland, C., Campbell, E. L., Brazaitis, M., . . . Narici, M. V. (2013). Effect of androgenic-anabolic steroids and heavy strength training on patellar tendon morphological and mechanical properties. J Appl Physiol (1985), 115(1), 84-89. doi:10.1152/japplphysiol.01417.2012
  20. Horn, S., Gregory, P, Guskiewicz, KM. Self-reported anabolic-androgenic steroids use and musculoskeletal injuries. Am. J. Phys. Med. Rehabil. 2009; 88: 192-200.
  21. Farooqi, V., Van Den Berg, M., Cameron, I.Anabolic steroids for rehabilitation after hip fracture in older people. The Cochran Collaboration. 2013:
  22. Srinivas-Shankar, U., Roberts, S. A., Connolly, M. J., O'Connell, M. D. L., Adams, J. E., Oldham, J. A., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Wu, F. C. W. (2010) Effects of Testosterone on Muscle Strength, Physical Function, Body Composition, and Quality of Life in Intermediate-Frail and Frail Elderly Men: A Randomized, Double-Blind, Placebo-Controlled Study. The Journal of Clinical Endocrinology &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Metabolism, 95(2), 639-650. doi:10.1210/jc.2009-1251
  23. 23.0 23.1 Hildebrandt, T., Shope, S., Varangis, E., Klein, D., Pfaff, D. W., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Yehuda, R., (2014). Exercise Reinforcement, Stress, and b-endorphins: An initial examination of exercise in anabolic-androgenic steroid dependence. Drug and Alcohol Dependence, 139, 86-92. doi: 10.1016/j.drugalcdep.2014.03.008
  24. 24.0 24.1 24.2 Piacentino, D., Kotzalidis, G. D., Del Casale, A., Aromatario, M. R., Pomara, C., Girardi, P., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sani, G. (2015). Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review. Current Neruopharmacology, 13(1), 101-121. doi: 10.2174/1570159X13666141210222725.