A Different Look At Steroid Side Effects
Good read, I may it a little easier by bolding what I felt was significant - RTB
Anecdotal accounts of harrowing side effects are not hard to find--everything from "'roid rage" to sketchy rumors of a female East German swimmer forced to undergo a sex change operation because of the irreversible effects of excess testosterone. But there are problems with the research that undergirds many of these claims. The media give the impression that there's something inevitably Faustian about taking anabolics--that gains in the present will undoubtedly exact a price in the future. Christopher Caldwell, writing recently in The Wall Street journal, proclaimed, "Doctors are unanimous that [anabolic steroids] increase the risk of heart disease, and of liver, kidney, prostate and testicular cancer."
This is false. "We know steroids can be used with a reasonable measure of safety," says Charles Yesalis, a Penn State epidemiologist, steroid researcher for more than 25 years, and author of the 1998 book The Steroids Game. "We know this because they're used in medicine all the time, just not to enhance body image or improve athletic performance." Yesalis notes that steroids were first used for medical purposes in the 1930s, some three decades before the current exacting standards of the Food and Drug Administration (FDA) were in place.
Even so, anabolic steroids or their derivatives are commonly used to treat breast cancer and androgen deficiencies and to promote red blood cell production. They are also used in emerging anti-aging therapies and to treat surgical or cancer patients with damaged muscle tissue.
Caldwell cites one of the most common fears: that anabolics cause liver cancer. There is dubious evidence linking oral anabolics to liver tumors, but athletes rarely take steroids in liquid suspension form. Users almost uniformly opt for the injectable or topical alternatives, which have chemical structures that aren't noxious to the liver. And as Yesalis observes, even oral steroids aren't causally linked to cancer; instead, some evidence associates them with benign liver tumors.
More specifically, it's C-17 alkylated oral steroids that are perhaps detrimental to liver function. But the evidence is equivocal at best. A 1990 computer-assisted study of all existing medical literature found but three cases of steroid-associated liver tumors. Of those three cases, one subject had been taking outrageously large doses of C-17 oral anabolics without cessation for five years, and a second case was more indicative of classic liver malignancy. It's also C-17 orals, and not other forms of steroids, that are associated with decreased levels of HDL, or "good" cholesterol. But, again, C-17s are almost never used for athletic or cosmetic purposes.
Another commonly held belief is that steroid use causes aggressive or enraged behavior. Consider the case of San Francisco Giants outfielder Barry Bonds, whose impressive late-career home run hitting and built-up physique have long raised observers' eyebrows. Last season, Bonds, long known for being irascible, had a dugout shoving match with teammate Jeff Kent. A few columnists, including Bill Lankhof of The Toronto Sun and Jacob Longan of the Stillwater News-Press, obliquely diagnosed "'roid rage" from afar. "There's very inconsistent data on whether 'roid rage even exists," says Yesalis. "I'm more open to the possibility than I used to be, but its incidence is rare, and the studies that concluded it does exist largely haven't accounted for underlying factors or the placebo effect."
Scientists are nearly unanimous that excessive testosterone causes aggression in animals, but this association begins to wither as you move up the evolutionary ladder. Diagnosing such behavior in athletes is especially tricky. "There's a certain degree of aggression that's not only acceptable but necessary in competitive sports," Yesalis says. "What's perhaps just the intensity that's common to many athletes gets perceived as steroid-linked outbursts."
Fears about steroid use also include other cancers, heart enlargement, increased blood pressure, elevated cholesterol levels, and musculoskeletal injuries. Upon closer examination, these too turn out to be overblown. Reports associating heart enlargement, or cardiomegaly, with steroid use often ignore the role of natural, non-threatening enlargement brought on by prolonged physical exertion, not to mention the effects of alcohol abuse. The relationship is unclear at best. Evidence supporting a link between steroids and ligament and tendon damage is weak, since steroid-related injuries are virtually indistinguishable from those occurring normally. And blood pressure problems, according to Yesalis, have been exaggerated. There is some associative evidence that steroid use can increase the risk of prostate cancer, but this link has yet to be borne out in a laboratory setting. No studies of any kind link the use of anabolics to testicular cancer.
Addiction is a legitimate concern, and Yesalis says a quarter to a half of those who use steroids solely to improve their body image exhibit signs of psychological dependence. "But in all my years of research," Yesalis continues, "I've only known three professional athletes who were clinically addicted to steroids." The distinction, he explains, is that professional athletes see steroids as little more than a tool to help them do their job--the way "an office worker views his computer." Once their playing days are over, almost all the athletes within Yesalis' purview "terminate their use of the drug."
One reason the health effects of steroids are so uncertain is a dearth of research. In the almost 65 years that anabolic steroids have been in our midst, there has not been a single epidemiological study of the effects of long-term use. Instead, Yesalis explains, concerns about extended usage are extrapolated from what's known about short-term effects. The problem is that those short-term research projects are often case studies, which Yesalis calls the "lowest life form of scientific studies." Case studies often draw conclusions from a single test subject and are especially prone to correlative errors.
"We've had thousands upon thousands [of long-term studies] done on tobacco, cocaine, you name it," Yesalis complains. "But for as much as you see and hear about anabolic steroids, they haven't even taken that step."
What about the research that has been done? At least some of it seems to yield engineered results. "The studies linking steroid use to cancer were performed by and large on geriatric patients," notes Rick Collins, attorney, former bodybuilder, and author of the book Legal Muscle, which offers an exhaustive look at anabolic steroid use under U.S. law. The hazard of such research is that side effects observed in an older patient could be the result of any number of physiological problems unrelated to steroid intake. Moreover, the elderly body is probably more susceptible to adverse reactions than the body of a competitive athlete.
Collins believes that some studies were performed with a conclusion in mind at the outset. "Their hearts were in the right place," says Collins. "Curtailing nonessential steroid use is a good and noble goal, but they undermined their efforts by exaggerating the dangers." Call it the cry-wolf effect.
For instance, it's long been dogma that use of anabolic steroids interferes with proper hepatic (liver) function and causes thickening of the heart muscle. However, a 1999 study at the University of North Texas found that it's not steroid use that causes these medical phenomena; rather, it's intense resistance training. Weight-lifting causes tissue damage, and, at high extremes, can elevate liver counts and thicken the left ventricular wall of the heart. Both disorders were observed in high-intensity weightlifters irrespective of steroid use. The researchers concluded that previous studies had "misled the medical community" into embellishing the side effects of use.
