In the category of the toxic side effects of anabolic/androgenic steroids, the potential effects on the liver are most apparent. These can manifest themselves in various dysfunctions of the liver. In the literature, cases have been mentioned where it came to a cholastasis (bile obstruction in the liver), a peliosis hepatis (bloodfilled cavities in the liver tissue, cysts), or liver cancer with the use of anabolic/ androgenic steroids. It is of great importance that these manifestations could almost exclusively be seen in those patients who previously had undergone a long-term steroid therapy and already had extensive liver damage or suffered from other internal diseases prior to the intake of steroids. It is of further interest that the administered steroid medication consisted almost exclusively of the 17-alpha alkylated, oral androgenic steroids. Especially the potentially liver-toxic substances methyltestosterne and oxymetholone were given in the course of therapy without suspension for several years. Evidence that steroids cause similar liver damage in healthy athlete3 could only be found in one or two rare cases, which is neither of statistic relevance nor allows for the preconception to expect liver damage by consumption of anabolic/androgenic steroids. "Insofar as a connection between steroid intake and tumor development could be established, until now, there is no evidence where testosterone or a testosterone ester is responsible for liver cancer. The reason had always been the androgen/anabolic with an alkyl substitute on the C-1 7 alpha of the steroid molecule... Accordingly it seems that testosterone and its esters are not (or are slightly) liver-toxic... Toxic liver damage: this, as mentioned above, is only expected with 17alpha alkyl derivatives... With a proper choice of the drug, there is no danger here." (From: Doping - verbotene Arzneimittel im Sport, Dirk Clasing, Manfred Donike, et al, pages 60 and 63). At this time it once again must be stressed that nearly all the liver-damaging results have been found in patients whose physicians prescribed steroids for the treatment of already existing, serious diseases. Although one cannot exclude the possibility of liver damage and delayed reaction in the future, empirical data shows that even with repeated, excessive, and prolonged intake of the potentially liver-toxic 1 7-alpha alkylated steroids by athletes, these symptoms rarely occur. In order to avoid any possible risks, one should. forego the use of I 7-alpha alkylated steroids. Since a total abandonment of these steroids is impossible for most athletes one should follow strict guidelines regarding the duration of intake and the dosage. Far-sighted athletes will therefore interrupt their steroid regimes in regular intervals by either stopping steroid intake alltogether or switching to a (potentially) non-toxic steroid (usually injectable). In many cases the problematic steroid will be combined with one or more "milder" steroids which interact in order to keep the dosage of the first at a moderate rate level without diminishing the effectiveness. In conclusion, one can say that the toxic, critical side effects on the liver occur mostly in those patients who have previously been ill and have received 1 7-alpha alkylated steroids as their treatment over longer periods of time.

It is recommended that athletes using oral steroids have their liver function routinely checked by a qualified physician.

The second category of possible undesirable side effects arising during the use of anabolic/androgenic steroids will be summarized under the term "hormone-induced side effects." Simplified, these are the side effects experienced (in various stages) by healthy athletes. Here, once again, one must also distinguish according to age and sex, since children, young adults, and women react more intensely to the exogenous ingestion of hormones than male adults. Since some side effects have been noticed in both men and women and young adults, we have dispensed with a gender and age-specific classification. The following information describes some of the most common hormone-induced side effects that may occur in association with the steroid consumption by athletes.

INHIBITION OF THE GONAD CYCLE:

Anabolic/androgenic steroids exert an inhibiting effect on the hypothalomohypophysial testicular axis (see chapter: The Significance and Function of Testosterone). This results in a suppression of the normal testicular function which may further result in a reduced testosterone production, a decreased spermatogenesis, and a testicular atrophy The degree of suppression depends on the duration of the steroid intake, the administered steroid, and the dosage of the steroid. During the beginning of steroid administration one may often notice an increase in libido which, in time can fall below normal standards. With the intermittent use of testosterone-stimulating substances, e.g. HCG, these problems may, in some cases, be avoided or at least reduced. Upon completion of the steroid regime, HCG is given to reactivate the testicular function. It should be mentioned that all these side effects are completely reversible. "…in all the cases, after the androgens/anabolics were discontinued, a restitutio ad integrum (a complete recovery to the original condition) occurred with regard to gonadotropins, size of testes, synthesis of the endogenous testosterones, and even spermatogenesis (!).

Conclusion: The effect of androgens/anabolics on the gonad cycle is reversible. Infertility is not always noticeable. The fear that athletes may be childless after the use of anabolics is ungrounded." (From: Doping - verbotene Arzncimittel im Sport, Dirk Clasing, Manfred Donike, et al, p. 61.)

WATER AND SALT RETENTION:

Most steroids cause a water and electrolyte imbalance in the body This results in an increased storage of water and sodium which further results in a swelling of tissue (edema). This process is desirable to a certain degree since the muscle cell, the joints, and connective tissue profit from it. The results are a quick and distinct increase of muscle size and volume, a strength gain, due to a better leverage ratio, a stronger connective tissue, and a "lubrication" of the joints which often guarantees injury-free training. The drawback is an increased water retention in the skin and blood. With the first it is more a cosmetic problem because the tissue especially under the eyes and the checks becomes puffy thus giving the athlete the typical bloated "off-seasonal full-moon steroid face". The second deposit is more serious because health problems may arise. Since the organ is overloaded with additional water, the heart and blood vessels must transport more fluid than normal through the body, thus possibly resulting in an elevated blood pressure. The degree of the water and salt retention depends, for the most part, on the type and dosage of the given steroid and on the predisposition of the individual. This factor is noticeable in both males and females.

FEMINIZATION:

Feminization can occur in male athletes in the form of breast swelling (gynecomastia), increased tendency toward fatty deposits, and extremely soft muscles. These symptoms are largely due to aromatization, meaning the partial conversion of a steroid into the female sex hormones (estrogen). The development of female characteristics may take place when the estrogen level increases significantly. Especially after discontinuing the steroid regime one finds this problem most aggravating since the athlete's androgen level is low but, at the same time, the estrogen level is elevated. In conjunction with this, it is interesting that estradiol (an estrogen) has an inhibiting effect on the male gonad cycle (see chapter: The Importance and Function of Testosterone). One can determine that an elevated estrogen level reduces the body's own testosterone production. The elevation of the estrogen level and the extent of feminization depend on the dosage and the type of steroids given. The determining factor, however, seems to be the constitution of each individual, since some show no gynecomastia while others already notice pain and swelling of the mammary gland with a dose of only 10 mg Dianabol/ day. The additive intake of anti-estrogens like Nolvadex, Proviron, or Fludestrin can be helpful in most cases. In general, after the steroids have been discontinued, the gynecomastia will slowly regress by itself. Since many are on the drugs year round, an operative removal of the undesired mammary tissue is no rarity. An elevated estrogen level is the "mortal enemy" of every competitive athlete because even with an. extremely low fatty content, one never really becomes hard. An excessive estrogen portion can directly negatively influence the psyche of the male athletes (see psychic changes).

CHANGES IN THE SKIN:

For the most part this is noticed with the developing of acne. An already existing acne may get worse or a non-existing acne may be evoked. Male athletes are less affected than female athletes. The development of acne and its extent here also depends largely upon the individual's constitution, the consumed steroids, and the dosage. The receptors of the sebaceous glands have a high affinity to DHT so that one must assume that steroids, which are partially transformed into DHT in the body, are the main cause. This may also be the reason why the injectable testosterone, followed by Anadrol and Dianabol, are the number one cause of acne. With the increased sebaceous gland production oily skin occurs and, in combination with bacteria and dead skin, the pores become clogged. This can further, depending on one's disposition, lead to blackheads, pimples, pustules (filled with pus), or even cystes. Males experience the acne mainly on the back, shoulders and chest, less in the face, whereas female athletes are mainly affected in the face and on back and shoulder. Not only is there damage to the body's largest organ, the skin, but the noticeable acne is, even for an outsider, a distinct sign of steroid use. For many, acne can also be a psychic strain, presenting problems especially then, when small scars and holes remain in the face. An acne which is localized to the face only, can be minimized with the local application of e.g. benzoyl peroxide or ointments containing antibiotics. If larger body areas are involved, LIV radiation (tanning studios) or the oral use of prescription drugs such as Tetracycline (antibiotic) or Accutane may be helpful. One must observe that oral antibiotics have an antianabolic effect and should, also, not be used in connection with sun exposure or LIV radiation. Females may permanently lose their normal, soft skintone since the skin can become large-pored and uneven due to the continued use of androgenic steroids, antiestrogens, and excessive sun exposure. Stretch marks and skin fissures in the shoulder/chest area, on the inside of the upper arm, and on the buttocks, are often seen in athletes using steroids. This usually results from too quick a weight increase since the skin cannot adapt quickly enough or stretch.

PSYCHIC CHANGES:

Men and women especially with the use of androgenic steroids, high dosages and long-term consumption, can develop aggressive behavior. The advantage of this is that one can train harder and more intensely. The disadvantage is that some cannot properly cope with this, thus letting their aggressions out on others. They become easily irritated, impatient, and inclined toward quick temper and anger outbursts. In extreme cases this can lead to an increase in the use of violence which has caused the breakup of relationships and marriages. Remarkable is that some male athletes using steroids (can) become depressive. The cause for this may be the fact that these athletes tend to transform a considerable amount of the consumed steroids into estrogens. one can explain the mood swings and depressions with the known fact that the male hypothalamus reacts to the female hormone estradiol. The supposition that steroids would make athletes psychically dependent and, after their discontinuance, evoke withdrawal symptoms, is not totally wrong. Those who press 400 pounds on the bench with the aid of steroids and then, after discontinuing the substance, press only 360 pounds, then 320 pounds, and after a some time only 300 pounds, can suffer problems with their ego. Many athletes simply forget that the performance cannot remain at the same level without steroid use. In the traditional sense, steroids are not habit forming.

GASTROINTESTINAL SYMPTOMS:

These are - associated solely with the use of oral, I 7-alpha alkylated steroids. Some athletes suffer from epigastric fullness, diarrhea, nausea or even vomiting. Other athletes cannot take steroids in tablet form, since even with the ingestion of Winstrol or Primobolan they feel ill. in some cases this problem can be resolved by taking the tablets with each meal.

BALDNESS:

Steroids can quicken the balding process in those with a genetic predisposition. The receptors of the scalp have a high affinity to dihydrotestosterone (DHT), therefore, steroids are also considered the main cause of acne since the steroids convert largely into DHT Here also the injectable testosterone and Anadrol are in first place. Also steroids that are derivatives of DHT, e.g. Masteron or Primobolan, can promote baldness. This can result in a receding hairline or a general thinning of the hair. Females can, in rare cases, also suffer from this. One must classify these side effects as irreversible, since the chances of recurring hair growth are slim. It must, once again, be stressed that anabolic/androgenic steroids do not automatically cause baldness but can speed up this process in those with a hereditary predisposition for hair loss.

CARDIOVASCULAR DEFECTS:

Anabolic/androgenic steroids are also linked with cardiovascular defects. This theory is supported by the fact that steroids actually can elevate the cholesterol and triglyceride levels. At the same time it has been noticed that a decrease of the HDL value and an increase of the LDL value are possible. HDL (high density lipoprotein) protects the arteries by eliminating the excess, unused cholesterol which has been deposited on the arterial walls, and by transporting it to the liver where it is then metabolized. For this reason a high HDL level is-desirable, whereas athletes taking steroids have a low HDL level and thus are exposed to an increased risk of cardiovascular defects and heart disease. An increase of the LDL values, on the other hand, is undesirable since LDL brings about exactly the opposite effect, by promoting the cholesterol deposits in the arterial walls. Consequently, steroids can cause an overall unfavorable situation: high cholesterol level, low HDL and high LDL values. For this reason athletes should regularly have their triglyceride and cholesterol levels checked, in order to avoid following into this high risk group - In combination with the generally used mass-buildup diet (lots of calories, lots of fat, fast food, and sweets) this possible risk is also increased. Other unfavorable factors are stress, high blood pressure, weight increase, a bad aerobe predispostition, and smoking. Here, once again, it seems that the steroid choice, the dosage, the duration of intake, and especially the constitution of the individual, play an important part in the development of defects. It has been shown that the changed values practically return to their original values within several weeks after steroid termination. Although older athletes are usually more at risk, one cannot exclude defects in younger people and females. It is still not clarified, if the increased glucose intolerance and elevated cortisone level possibly brought about by steroids, contribute to the development of cardiovascular defects.

VIRILIZATION:

This term refers to the possible masculinization that females may sustain due to the ingestion of anabolic/androgenic steroids. As in male athletes, steroids also cause a suppression of the gonad cycle in females. The hypophysial excretion of HDL and FSH is inhibited which results in a secondary amenorrhea, meaning absence or abnormal cessation of the mensis. This side effect is reversible after the steroid has been discontinued. Visible signs of a virilization can be acne vulgaris (simple acne), hirsutism (excessive bodily and facial hair), alopecia (androgen-induced loss of hair), and changes of the skin structure similar to the males'. These side effects are usually considered reversible but, depending on predisposition or with the consumption of high dosages of mostly androgenic steroids and with extended usage, there is a possibility that these changes may remain after the steroid has been discontinued. The same is to be said about a possible clitorihypertrophy. The first sign of virilization is often a slight change in the voice in form of hoarseness. A deepening of the voice is irreversible and usually remains life long. in women one must also take a possible increase in the libido into account. Some females become increasingly aggressive during steroid intake only to fall into a depressive state after steroids are discontinued. The increased aggressiveness is due to the elevated androgen level, whereas the possible depression is suggestive of an estrogen rebound which occurs after the steroid regime has been discontinued. Since the estrogen production is suppressed by the LH and FSH inhibition, a significant elevation in production can follow. If steroids are taken during pregnancy, there is the possibility of a masculinization of the female fetus. The occurrence and manifestation of these side effects depends largely on genetic factors, the dosages, the length of consumption, and the type of steroids given. In spite of all the known excellent, performance-enhancing effects of anabolic/androgenic steroids in female athletes, one must weigh the risk against the gain, since many of the potential side effects are not reversible.

GROWTH DEFICIT:

The use of anabolic/androgenic steroids can stunt the growth potential of children and adolescents. It is interesting to note that often there is a short-term accelerated growth of the bones. With continued ingestion one must count on a premature closure of the epiphysial cartilage which leads to a growth stunt and ultimately results in a decrease in the normal predicted height. Further growth is impossible making this an irreversible side effect. Young athletes who, because of their extreme ambition have decided to take steroids should, for this reason, reconsider. The only steroid that does not cause this serious problem is Oxandrolone (see also Oxandrolone), so one hopes that its producer does not remove it from the market.

PROSTATE HYPERTROPHY:

Steroids can cause prostate enlargement. Since prostate problems occur mainly in older males, it is advisable that athletes over forty should refrain from taking strong androgenic steroids. Most steroid manufacturers recommend "regular rectal exams of the prostate as required in physicals."

HIGH BLOOD PRESSURE:

The occurrence of high blood pressure is often noticed in athletes taking steroids. One of the major causes is probably the increased cardiovascular strain brought about by the pronounced water and salt retention. The increased body weight of many of the athletes who cat large quantities of food and work out on heavy movements such as squats or bench presses where the breath is held, can be contributing factors. The blood pressure should be measured regularly to ensure that the value is not higher than 130/90.

CARDIAC HYPERTROPHY:

The existence of a direct connection between steroid consumption and a cardio-muscular hypertrophy has not yet been established. it is true that athletes using steroids generally have an enlarged (more efficient) heart than non-athletes; however, one must not forget the fact that athletes have an enlarged (more efficient) heart to begin with due to the higher activity rate of any athlete. Increased training already increases the heart size. But misuse of steroids may cause pathological enlargement of the heart, or the left ventricle growing lout of proportion to the rest of the heart.

KIDNEY DAMAGE:

The kidneys are under more strain during steroid intake. They are involved in the filtration and excretion of toxic by-products. A high blood pressure as well as variations in the water and electrolyte balance of the body can lead to long-term changes in the kidney's function. A Wilm's tumor, a fast-growing kidney tumor normally only seen in infants and children has been noticed in certain rare cases in athletes using steroids. It is doubtful if there is a direct connection between the two. It is certain though, that during steroid consumption several athletes may develop a dark-colored urine and, in extreme cases, even blood in the urine. The former Finaject and today's Parabolan, in particular, seem to have a toxic effect on the kidney function.

Other possible side effects that may occur during the use of anabolic/androgenic steroids are a prolonged bleeding time, headaches, nausea, feeling poorly, increased risk of injuring muscles, joints and connective tissue, anaphylactic shock (life-threatening reaction), and abscesses secondary to injection.

The occurrence of side effects is different from one athlete to another. Factors such as age, gender, constitution, the respective physical and psychic condition of the individual, as well as the dosage, the length of intake, and the selection of the steroid play an important part in the development and seriousness of side effects.

(Parts care of of Anabolicreview.com)