The influence of anabolic steroids on physiologic processes and exercise

Introduction  [edit | edit source]

Anabolic-androgenic steroids (AAS) are a group of synthetic compunds 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.


Psychological Effects[edit | edit source]

Anabolic steroids are drugs that have many neuropsychiatric effects in addition to the more commonly known effects they have on skeletal muscles. Anabolic steroids cause not only negative feelings like intense anger, but also some positive moods. Some of the negative feelings people have resulting from the use of anabolic steroids include irritability, mood swings, violent feelings, anger, and hostility. [need reference] Among the positive feelings related to steroid use include euphoria, increased energy, and sexual arousal. Steroids are also linked to other cognitive symptoms like distractibility, forgetfulness, and confusion. These effects of steroid use occur independently of other factors. These impacts on mood could have either positive or negative effects on exercise, depending on feelings of the person exercising.

Muscular System Effects[edit | edit source]

Steroids have not been shown to increase creatine concentrations in the muscle, red blood cell concentration, or serum liver enzyme concentrations as previously postulated.[2] 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.[2] 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.[2] 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 [3]. 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 [3]. No significant difference was found between the two groups concerning lower extremity tendon ruptures [3]. A study on retired National Football League (NFL) players found an association between AAS users and an increased likelihood of ligamentous injuries[4]. In rats, training combined with AAS use has shown to inhibit matrix tendon remodeling[5] and reduce maximal stress values[6]. 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, resistance-trained non-AAS users, and a control group that was neither AAS user or resistance-trained. Higher patellar stiffness and tensile modulus was found with long-term heavy resistance training and AAS abuse compared to non-AAS users[7].  


Most people relate anabolic steroids to high intense 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.[8] Unfortunately, there has not been enough significant evidence found for this to be proven true. 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[9]. 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.



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Cardiovascular Effects[edit | edit source]

Long-term use of supraphysiological doses of AAS use has been attributed to an increase risk of pathological changes in the cardiovascular system that can result in: myocardial infarction, cardiomyopathy, sudden death, cardiovascular morbidity, and mortality when compared to non-users[10]. 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[11]. Some evidence suggests a causal link between power athletes, body builders, and supraphysiological AAS use with atrial fibrillation (AF)[12]. This may be due to inter- and intra-atrial electromechanical delay, however, the exact mechanism of how AAS abuse contributes to atrial electromechanical delay is poorly understood[13]. AAS users have also been found to have a lower measurement of high frequency power, which is indicative of decresed vagal and parasympathetic activity in the heart[11][14]. Reduced parasympathetic activity in the heart slows the recovery of heart rate post-exercise[11].


Neurological Effects[edit | edit source]

AAS use is associated with positve and negative psychological effects. AAS abuse and dependance is potential problem among AAS users, espeacially those using it for peformance or aesthetic purposes. AAS may increase beta-endorphin levels, decrease cortisol levels, and increase ACTH levels, which may lead to an increase in positvie associations with exercise[15].  The increase in endophin levels and exercise reinforcement may contribute to AAS dependence and abuse[15]. AAS dependence is characterized by increases in AAS cycles, higher doses, and increases in psychological disorders, such as increased aggression[16]. 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 endorphine levels and changes in the reward systems of the brain. AAS can cause or exaccerbate anxiety disorders, schizophrenia, or eating disorders[16].  The psychopathology of AAS is theroized to be caused by direct or indirect changes in the central nervous system, including changes to intracellular receptors and neruotransmitter receptors. These changes may influences hormone and neurotransmitter levels, such as serotonin or GABA, and lead to changes in depression, anger, or stress[16]. AAS use may contribute to motivation and postive experiences with exercise, but it can lead to negative effects that are long-lasting and decreases in motivation to exercise.




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. ↑ 2.0 2.1 2.2 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).
  3. ↑ 3.0 3.1 3.2 Kanayama, G., DeLuca, J., Meehan, W. P., Hudson, J. I., Isaacs, S., Baggish, A., . . . Pope, H. G. (2015). Ruptured Tendons in Anabolic-Androgenic Steroid Users. 43(11), 2638-2644. doi: 10.1177/0363546515602010
  4. ↑ Akcakoyun, M., Alizade, E., Gundogdu, R., Bulut, M., Tabakci, M. M., Acar, G., . . . Emiroglu, M. Y. (2014). Long-term anabolic androgenic steroid use is associated with increased atrial electromechanical delay in male bodybuilders. Biomed Res Int, 2014, 451520. doi:10.1155/2014/451520fckLRHorn, S., Gregory, P., & Guskiewicz, K. M. (2009). Self-reported anabolic-androgenic steroids use and musculoskeletal injuries: findings from the center for the study of retired athletes health survey of retired NFL players. Am J Phys Med Rehabil, 88(3), 192-200. doi:10.1097/PHM.0b013e318198b622
  5. ↑ 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.
  6. ↑ 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
  7. ↑ 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
  8. ↑ Farooqi, V., Van Den Berg, M., Cameron, I., & Crotty, M., (2013). Anabolic steroids for rehabilitation after hip fracture in older people. The Cochran Collaboration.
  9. ↑ Srinivas-Shankar, U., Roberts, S. A., Connolly, M. J., O'Connell, M. D. L., Adams, J. E., Oldham, J. A., & 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 & Metabolism, 95(2), 639-650. doi:10.1210/jc.2009-1251
  10. ↑ 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 Sep 15;106(6):893-901. PubMed PMID: 20816133. Pubmed Central PMCID: PMC4111565. Epub 2010/09/08. eng.
  11. ↑ 11.0 11.1 11.2 Maior A, Carvalho A, Marques-Neto S, Menezes P, Soares P, Nascimento J. Cardiac autonomic dysfunction in anabolic steroid users. Scandinavian Journal Of Medicine & Science In Sports [serial on the Internet]. (2013, Oct), [cited November 12, 2015]; 23(5): 548-555. Available from: SPORTDiscus with Full Text.
  12. ↑ D. H. Lau, M. K. Stiles, B. John, S. Shashidhar, G. D. Young,fckLRand P. Sanders, “Atrial fibrillation and anabolic steroid abuse,”fckLRInternational Journal of Cardiology, vol. 117, no. 2, pp. e86–e87,fckLR2007.
  13. ↑ Akcakoyun, M., Alizade, E., Gundogdu, R., Bulut, M., Tabakci, M. M., Acar, G., . . . Emiroglu, M. Y. (2014). Long-term anabolic androgenic steroid use is associated with increased atrial electromechanical delay in male bodybuilders. Biomed Res Int, 2014, 451520. doi:10.1155/2014/451520
  14. ↑ Hedman AE, Hartikainen JE, Tahvanainen KU, Hakumaki MO. The high frequency component of heart rate variability reflects cardiac parasympathetic modulation rather than parasympathetic 'tone'. Acta physiologica Scandinavica. 1995 Nov;155(3):267-73. PubMed PMID: 8619324. Epub 1995/11/01. eng.
  15. ↑ 15.0 15.1 Hildebrandt, T., Shope, S., Varangis, E., Klein, D., Pfaff, D. W., & 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
  16. ↑ 16.0 16.1 16.2 Piacentino, D., Kotzalidis, G. D., Del Casale, A., Aromatario, M. R., Pomara, C., Girardi, P., & Sani, G. (2015). Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review. Current Neruopharmacology, 13(1), 101-121. doi: 10.2174/1570159X13666141210222725.
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