DefMetalLifter
MuscleChemistry Registered Member
Bodybuilding Science: Get a (Steroid) Physical
Bodybuilders and doctors don’t mix. Most physicians believe bodybuilding is at best a renegade sport and at worst an unethical mire of drug use and sociopathic ideals. 1 In response, bodybuilders view the medical community with skepticism and distrust, particularly after the failed attempt by health professionals and the pharmaceutical industry to convince people that “use of anabolic steroids will not enhance athletic performance.” Sadly, each group could learn from the other, but unless certain changes are made, bodybuilders will continue to be underserved by medicine and the therapeutic benefits of anabolic steroids will remain unexplored.1-5
As it stands, bodybuilders don’t approach physicians for advice when considering steroid use, or even during a cycle when side effects arise, leading most physicians to believe performance drug use and abuse is a minor issue. Thus, the majority of doctors do not educate themselves in matters related to sports performance or physique enhancement; frankly, veterinarians are more likely to be schooled and experienced in matters of steroid use. This situation needs to be addressed, as numerous studies have found that large numbers of Americans have used, or are currently using, anabolic steroids.5-10
Choosing to use steroids is not a light decision as there are problems experienced by nearly every athlete, every cycle; fortunately, most of these are cosmetic and temporary, though some can be permanent and possibly even fatal. This series offers guidance in monitoring some of the more common health risks, focusing on adult male users. It does not address the risks faced by females or adolescents, which can be permanent, severe and disfiguring.4,11-13 Also, it does not address health problems associated with complementary performance drugs, such as growth hormone, diuretics, stimulants, etc.
Is There a Doctor in the House, Uh… Gym?
Selecting the right physician is the key decision. If a physician in your area has dealt with other users in the past and is open-minded about steroid use, this would be ideal.4,14,15 However, few physicians have an interest, let alone experience, in this area. So, other factors must be considered. Some physicians are, or were, athletes and if they played at a college level, they likely were exposed to steroids either by personal use or the experiences of teammates. There are even a few bodybuilding physicians, though the majority are dedicated drug-free bodybuilders. Regardless, a physician with personal interest in athletics is more likely to be aware of health issues central to steroid use. While there are excellent physicians of both genders, a male physician is generally going to be a more suitable match for the adult, male steroid user.
Though any physician can order the blood work and lab tests that are part of a thorough work-up, a comprehensive history and physical exam are essential to evaluating the risks and side effects experienced during a cycle. Look for a physician trained as either an internal medicine specialist or a general practitioner. Perhaps the best choice would be an anti-aging specialist, as this group is very pro-active in the treatment of the elderly and middle-aged with hormonal and nutritional therapy, including testosterone therapy. Anti-aging physicians may be very open to evaluating a self-treating athlete, but many may be offended, as they are very protective of their professional reputations, not wanting to be discredited by affiliating with bodybuilders and black market steroids.
Keeping it Hush-Hush
Celebrities and athletes are usually advised not to use their regular physician or his office for any steroid-related visits and to self-pay rather than submitting the costs to insurance. Some even go to the extent of using false names and identification. Medical records are permanent and a history of drug abuse may cause a later denial of medical insurance or a sharp increase in premiums.16 Lastly, it would be best to find a private clinic, not one affiliated with a university or medical center; the fewer partners the better. The reason for this is that many physicians do not agree with aiding steroid use in any measure and partners in a busy practice would quickly raise an argument against providing care. Also, a small staff is more likely to be discreet and maintain patient confidentiality. Despite the legal patient-doctor privilege, gossip and rumors still spread in clinics, going home to the secretary’s husband or the receptionist’s aerobics class. Your medical records are only as confidential as the least professional member of the office staff.
Once you’ve found a doctor, knowing what to ask and answer will benefit both of you. The first thing to consider is, are you going to be honest? As mentioned above, revealing a history of steroid use will be documented in the medical chart. Some bodybuilders go to the doctor’s office claiming to be using pro-hormones, like androstenedione, attributing any complaints to those legal supplements. However, veiling the truth may mislead the doctor; ideally, he should be aware of any relevant history or habits.
Assuming the doctor is aware of the purpose of your visit, he should begin by learning your medical history, including some information about your parents and relatives. Primarily, he should inquire about any early deaths in the family from heart disease, stroke, blood clots or cancer. It’s important for him to be able to determine if there is an increased genetic risk of certain diseases that may be worsened by steroid use. Healthy bodybuilders and powerlifters have died from strokes, heart attacks and cancer at an early age; possibly they were unaware that they were at high risk for a fatal consequence.3,17-29
If your relatives have a history of blood clots, heart attacks, stroke, high blood pressure or cancer of the prostate or breast, it’s likely that you are at a much higher risk of suffering a more serious, even fatal event. Your personal history is even more crucial, as it serves as a predictor of potential trouble. Anyone who has ever suffered from any kind of bleeding or clotting condition, or has been diagnosed with cancer of any sexual organ (prostate, testicles, breast), would be a fool to even entertain the thought of using steroids.4
The Exam— and Yes, You Will Bend Over
Since the majority of young adults are healthy, a physical examination would be the next part of the evaluation. There may be changes present, particularly if the patient is currently “on” steroids; these should be noted, followed, and if necessary, treated. The physical begins by taking the “vital signs”, the most important of which is blood pressure. People with high blood pressure should not start a cycle, as this condition will be aggravated by the steroids and may become dangerously high.19,21,22,30 Your blood pressure should be checked at every office visit.
The skin is the most obvious site of the exam, as acne is very common with steroid use.5,31-34 If it’s present, a topical soap or ointment may be prescribed. Some people may wish to consider Accutane, an oral pill used for severe acne, but this should not be prescribed, as its liver toxicity is well known. Further, the coloration of the skin and the cornea (the whites of the eyes) should be checked for any signs of yellowing. Yellowing of the skin or cornea is a sign that the liver is failing to clear a protein called “bilirubin”, likely due to a blockage of bile flow.19 This may lead to gall stones or liver cell damage and requires an immediate stop to all steroid use. If caught early, this condition should clear in a matter of days to weeks. If left unattended, it can lead to permanent liver damage.
The nipples should be felt and inspected for gynecomastia, a growth of female-like breast tissue. This will present as a tender swelling under the nipple and growth will continue as long as it is stimulated by androgen excess and may require surgery.19,34-36 Aromatase inhibitors are drugs used by bodybuilders to prevent and even reverse gynecomastia; few, if any, physicians have prescribed them for this use.
The testicles will be felt, even measured, to determine the degree of testicular shrinkage and to monitor recovery post-cycle.5,11,34,35 Many males fail to achieve normal testicle size and function for weeks to months after discontinuing steroids. Low testosterone levels or sperm counts may persist, requiring the use of hCG to restore testicle function and fertility.19,37 This is a good time to discuss any problems relating to sexual function, as many bodybuilders experience a low libido or impotence off-cycle.5,34,38 Erections and sexual desire should return to normal as testicular function is restored, though this is not guaranteed.
The often-feared prostate exam needs to be performed, as the prostate is uniquely sensitive to androgens, and may swell enough to interfere with urine flow.39 Cancer of the prostate is more aggressive when exposed to androgens; thus, any irregularities noted in the prostate exam should be closely followed.3 If the prostate is swollen to the extent that it interferes with urine flow, steroid use should stop. The prostate swelling should reduce off-cycle; if it persists, finasteride may be prescribed.
Lastly, any injection sites should be checked for signs of infection. Abscesses are common with intramuscular injections, particularly when performed by inexperienced people.40 A lecture about needle sharing should be part of the initial visit. There is absolutely no reason for sharing needles with your training partner, dealer or friends. This is an extremely high-risk behavior that may transfer the viruses known to cause AIDS or hepatitis.41,42
Beyond the Office Physical
A brief history and physical exam should be able to screen for most of the obvious health risks associated with steroid use, though some hidden risks will only be revealed through blood work and lab tests, which will be covered next month. Further, there are many reported cases of psychiatric (mental and emotional) problems that have occurred in steroid users, including very threatening and serious issues such as attempted suicide, addiction and spouse abuse.5,30,43-49
It’s difficult to predict who may be most vulnerable to a mental or emotional crisis, either during a cycle or off-cycle. In the ideal world, athletes would undergo a psychological screening exam before their first cycle, but realistically, few people would expose themselves to such an exam or be receptive to being told they are not mentally fit. The best option may be to schedule frequent visits with the physician, making him aware of any personality changes noted either by you or by your family and friends.
Doctors and bodybuilders have never shared a close relationship in the United States. There is a long history of mistrust and suspicion but unless this changes, millions of Americans may be denied proper health care. It would be wise for users to recruit a physician to help monitor their health when using anabolic steroids, as there are many health risks, both physical and mental, which could be prevented or treated by a qualified doctor. The second article in this series will describe the lab tests that should be run in order to detect any hidden risks not revealed during the history and physical portion of the exam.
References
1. Kutscher EC, Lund BC, et al. Anabolic steroids: A review for the clinician. Sports Med 2002;32(5):285-96.
2. Yesalis CE, Bahrke MS. Anabolic-androgenic steroids. Current issues. Sports Med 1995 May;19(5):326-40.
3. Hickson RC, Ball KL, et al. Adverse effects of anabolic steroids. Med Toxicol Adverse Drug Exp 1989 Jul-Aug;4(4):254-71.
4. Shahidi NT. A review of the chemistry, biological action, and clinical applications of anabolic-androgenic steroids. Clin Ther 2001 Sep;23(9):1355-90.
5. Narducci WA, Wagner JC, et al. Anabolic steroids—a review of the clinical toxicology and diagnostic screening. J Toxicol Clin Toxicol 1990;28(3):287-310.
6. Tricker R, O’Neill MR, et al. The incidence of anabolic steroid use among competitive bodybuilders. J Drug Educ 1989;19(4):313-25.
7. Stilger VG, Yesalis CE. Anabolic-androgenic steroid use among high school football players. J Community Health 1999 Apr;24(2):131-45.
8. Curry LA, Wagman DF. Qualitative description of the prevalence and use of anabolic androgenic steroids by United States powerlifters. Percept Mot Skills 1999 Feb;88(1):224-33.
9. Street C, Antonio J, et al. Androgen use by athletes: a reevaluation of the health risks. Can J Appl Physiol 1996 Dec;21(6):421-40.
10. Windsor RE, Dumitru D. Anabolic steroid use by athletes. How serious are the health hazards? Postgrad Med 1988 Sep 15;84(4):37-8,41-3,47-9.
11. Kibble MW, Ross MB. Adverse effects of anabolic steroids. Clin Pharm 1987 Sep;6(9):686-92.
12. Wu FC. Endocrine aspects of anabolic steroids. Clin Chem 1997 Jul;43(7):1289-92.
13. Franke WW, Berendonk B. Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government. Clin Chem 1997 Jul;43(7):1262-79.
14. Dickhuth HH, Berg A, et al. [Doping—also a problem in general practice?] Fortschr Med 1989 Sep 30;107(28):585-8.
15. Blue JG, Lombardo JA. Steroids and steroid-like compounds. Clin Sports Med 1999 Jul;18(3):667-89.
16. Cotlar MJ. Androgen-androgenic steroids, the athlete, and mortality. J Insur Med 2001;33(3):251-6.
17. Parssinen M, Seppala T. Steroid use and long-term health risks in former athletes. Sports Med 2002;32(2):83-94.
18. Ferenchick GS. Anabolic/androgenic steroid abuse and thrombosis: is there a connection? Med Hypotheses 1991 May;35(1):27-31.
19. Mottram DR, George AJ. Anabolic Steroids. Ballieres Best Pract Res Clin Endocrinol Metab 2000 Mar;14(1):55-69.
20. Huie MJ. An acute myocardial infarction occurring in an anabolic steroid user. Med Sci Sports Exerc 1994 Apr;26(4):408-13.
21. Sullivan ML, Martinez CM, et al. The cardiac toxicity of anabolic steroids. Prog Cardiovasc Dis 1998 Jul-Aug;41(1):1-15.
22. Catlin DH, Murray TH. Performance-enhancing drugs, fair competition, and Olympic sport. JAMA 1996 Jul 17;276(3):231-7.
23. Nieminen MS, Ramo MP, et al. Serious cardiovascular side effects of large doses ofanabolic steroids in weight lifters. Eur Heart J 1996 Oct;17(10):1576-83.
24. Ferenchick GS, Hirokawa S, et al. Anabolic-androgenic steroid abuse in weight lifters: evidence for activation of the hemostatic system. Am J Hematol 1995 Aug;49(4):282-8.
25. Laroche GP. Steroid anabolic drugs and arterial complications in an athlete—a case history. Angiology 1990 Nov;41(11):964-9.
26. Kennedy MC, Lawrence C. Anabolic steroid abuse and sudden cardiac death. Med J Aust 1993 Mar 1;158(5):346-8.
27. Melchert RB, Welder AA. Cardiovascular effects of androgenic-anabolic steroids. Med Sci Sports Exerc 1995 Sep;27(9):1252-62.
28. Frankle MA, Eichberg R, et al. Anabolic androgenic steroids and a stroke in an athlete: case report. Arch Phys Med Rehabil 1988 Aug;69(8):632-3.
29. McCarthy K, Tang AT, et al. Ventricular thrombosis and systemic embolism in bodybuilders: etiology and management. Ann Thor Surg 2000 Aug;70(2):658-60.
30. Graham S, Kennedy M. Recent developments in the toxicology of anabolic steroids. Drug Saf 1990 Nov-Dec;5(6):458-76.
31. Kiraly CL, Alen M, et al. Effect of androgenic and anabolic steroids on the sebaceous gland in power athletes. Acta Derm Venereol 1987;67(1):36-40.
32. Kiraly CL, Collan Y, et al. Effect of testosterone and anabolic steroids on the size of sebaceous glands in power athletes. Am J Dermatopathol 1987 Dec;9(6):515-9.
33. Strauss RH. Anabolic steroids. Clin Sports Med 1984 Jul;3(3):743-8.
34. O’Sullivan AJ, Kennedy MC, et al. Anabolic-androgenic steroids: medical assessment of present, past and potential users. Med J Aust 2000 Sep 18;173(6):323-7.
35. Pope HG, Katz DL. Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes. Arch Gen Psychiatry 1994 May;51(5):375-82.
36. Reyes RJ, Zicchi S, et al. Surgical correction of gynaecomastia in bodybuilders. Br J Clin Pract 1995 Jul-Aug;49(4):177-9.
37. Anonymous. Male Infertility due to anabolic steroids. Prescrire Int 1999 Apr;8(40):54.
38. Moss HB, Panzak GL, et al. Sexual functioning of male anabolic steroid abusers. Arch Sex Behav 1993 Feb;22(1):1-12.
39. Wemyss-Holden SA, Hamdy FC, et al. Steroid abuse in athletes, prostatic enlargement and bladder outflow obstruction—is there a relationship? Br J Urol 1994 Oct;74(4):476-8.
40. Rich JD, Dickinson BP, et al. Abscess related to anabolic-androgenic steroid injection. Med Sci Sports Exerc 1999 Feb;31(2):207-9.
41. Alen M. [Use and abuse of androgens and anabolic steroids.] Nord Med 1993;108(6-7):176-9.
42. Aitken C, Delalande C, et al. Pumping iron, risking infection? Exposure to hepatitis C, hepatitis B and HIV among anabolic-androgenic steroid injectors in Victoria, Australia. Drug Alcohol Dependence 2002 Feb 1;65(3):303-8.
43. Bahrke MS, Yesalis CE, et al. Psychological and behavioural effects of endogenous testosterone and anabolic-androgenic steroids. An update. Sports Med 1996 Dec;22(6):367-90.
44. Pope HG, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use. Am J Psychiatry 1988 Apr;145(4):487-90.
45. Brower KJ, Blow FC, et al. Anabolic-androgenic steroid dependence. J Clin Psychiatry 1989 Jan;50(1):31-3.
46. Macleod AD. Sports Psychiatry. Aust N Z Psychiatry 1998 Dec;32(6):860-6.
47. Su TP, Pagliaro M, et al. Neuropsychiatric effects of anabolic steroids in male normal volunteers. JAMA 1993 Jun 2;259(21):2760-4.
48. Perry PJ, Anderson KH, et al. Illicit anabolic steroid use in athletes: a case series analysis. Am J Sports Med 1990 Jul-Aug;18(4):422-8.
49. Choi PY, Pope HG. Violence toward women and illicit anabolic steroid use. Ann Clin Psychiatry 1994 Mar;6(1):21-5.
