Anabolic Steroid Overdrive:Pitfalls of Steroid Use
by Nick Evans, MD

Many people once believed that steroid use was limited to a few competitive athletes and bodybuilders, those who would risk their health to reach the top of their sport in order to claim titles, financial reward, and fame. This is not the case. Two of every three steroid users are recreational athletes with no intention of competing. The majority of steroid users take these drugs for personal reasons, seeking cosmetic improvement in their physiques. They just want to look buff at the gym or on the beach. The majority of steroid users are 20 to 40 years of age, but 10 percent of users are teens. Surveys indicate that 2 to 5 percent of high school students are using these drugs. The steroid habit can start at a young age and continue for 10 years or more.

Testosterone, the active ingredient in steroids, has two effects on the body: anabolic and androgenic. Testosterone's anabolic action builds body tissue by increasing lean muscle mass and bone density and reducing body fat. It ensures a positive nitrogen balance by stimulating protein synthesis and improving protein use. Testosterone's androgenic actions are responsible for the so-called secondary sex characteristics that turn boys into men. All those changes that occur to boys during puberty-voice deepening, oily skin, growth of body and facial hair, development of male sex organs, and increased sex drive occur because of a surge in teenage testosterone. A young adult male produces about 10 milligrams of testosterone each day, approximately 70 milligrams per week. The concentration of testosterone circulating in the blood is normally 300 to 1,000 nanograms per deciliter (ng/dl). The average level for adult men is about 500 ng/dl.

When discussing steroid doses, a distinction must be made between therapeutic doses aimed at restoring normal testosterone levels and the so-called supraphysiological doses used nonmedically for muscle building. The weekly dose for testosterone replacement is about 100 milligrams. According to scientific data, a weekly dose of at least 300 milligrams of testosterone is required for muscle building. This dose is equivalent to the combined testosterone levels of several men. Hence the term supraphysiological-more than the normal amount.

The results of recent scientific studies on testosterone are interesting. First, a 600-milligram weekly dose of testosterone enanthate taken over a 10-week period produces a gain of 14 pounds in fat-free muscle mass and a 40 percent increase in strength. Second, testosterone induced increases in muscle size are a result of muscle fiber hypertrophy, with an increase in the cross-sectional area of the muscle fibers. Third, these anabolic effects are dose-dependant.

Smaller doses of testosterone-125 milligrams per week or less-do not elevate the body's testosterone above normal levels. Only when the weekly dose of steroids is above 300 milligrams per week does the testosterone level climb above the normal range. A weekly 300-milligram dose triples the average testosterone level, and a weekly 600-milligram dose elevates the level up to six times the normal value. As a result, the 600-milligram dose almost doubles the muscle fiber cross-sectional area, thereby increasing muscle size.

Testosterone exerts this anabolic effect by acting directly on the muscle itself.The hormone binds to androgen receptors in the muscle cell, switching on protein synthesis and inducing muscle growth. Testosterone also has several complementary anabolic actions elsewhere in the body.It stimulates the release of growth hormone and exerts an anticatabolic effect that slows protein breakdown.Testosterone also has a behavioral effect on the brain that might positively influence training intensity, thus increasing muscle strength.

As a result of recent research efforts, testosterone is now being prescribed as medical treatment for AIDS-related wasting disorders and as hormone--replacement therapy in elderly men with low testosterone (the so-called male andropause). Testosterone has also been found to speed up the healing of muscle contusion injury and alleviate symptoms of depression in men.

When it comes to discussing muscle-building steroid regimens, there's one big problem-the information is not based on scientific clinical investigation. Underground steroid dose regimes are anecdotal, based on word-of-mouth testimonies. In the absence of medical guidance, steroid users have been left to their own devices. Drug doses and regimens have been developed through trial and error, passed down by veteran users or through underground steroid manuals written by self-proclaimed steroid gurus.

So what's going on behind the closed doors of the locker room? A few years ago, I carried out a survey of the anabolic steroid regimens of 100 male steroid users. The results revealed that steroid doses ranged from 250 to 3,200 milli-grams per week. The majority of users (88 percent) administered less than 1,000 milli-grams of steroids per week. Some bodybuilders who chose to be precise with their doses calculated them using this formula: one milligram of steroid per kilogram of body weight per day. To achieve these megadoses, most users combined two or more types of steroid, a process known as "stacking."

Steroids tend to be used in cycles lasting from 4 to 12 weeks. Regular steroid users allow a 4- to 6-week gap between cycles to clear the system. Approximately half of the study group stated that their total annual steroid use amounted to more than six months each year. A handful of bodybuilders admitted to continuous steroid use for 52 weeks of the year without ever coming off the drugs.

In my survey, the most popular drug used was Nandrolone decanoate (used by over 80 percent), followed by injectable testosterones, such as Sustenon 250. Dianabol tablets came in third. A combination of injectable and oral steroids was used by 85 percent of this group, 11 percent used injectable drugs exclusively, and 4 percent used tablets only. In other words, the vast majority (96 percent) of steroid users choose intramuscular injections.

Drug use by steroid users is not confined to anabolic steroids. Apparently, 9 out of 10 steroid users have a polypharmaceutical palate, taking a mix of muscle-shaping drugs in addition to stacking different brands of steroids. These steroid-accessory drugs are used for a variety of reasons and can be grouped according to their desired effect.

Thermogenic fat-burning drugs such as clenbutarol, ephedrine, and thyroid hormone are common among steroid users. Nonsteroid anabolic agents such as growth hormone and insulin are gaining in popularity, particularly among competitive bodybuilders. Diuretics are used in an attempt to flush out sub-cutaneous body water prior to competition, and peculiar products such as Synthol are injected into lagging body parts to improve muscle symmetry and proportion. Medication also is taken to reduce side effects associated with steroid use. For example, the antiestrogen drug Tamoxifen (Nolvadex) is used to prevent or treat steroid-induced gynecomastia. Human chorionic gonadotrophin (HCG) is sometimes used to kick-start suppressed endogenous testosterone at the end of a steroid cycle to minimize muscle loss and withdrawal symptoms during the off cycle.

Many of these steroid accessory drugs are potentially more dangerous than the steroids themselves. The unsupervised use of insulin, diuretics, and thyroxine can precipitate a number of medical emergencies. It's a worrisome trend that healthy young bodybuilders take more drugs than their elderly grandparents with multiple medical ailments.

Because of their potential health risks, anabolic steroids are classed as illegal drugs and banned by many sporting organizations. The fact is that testosterone, the active ingredient in anabolic steroids, does work. It boosts muscle mass and turbocharges your sex drive. The problem is that testosterone, like any other drug, has potentially harmful effects.

How dangerous are these drugs? Are we to believe the shocking media reports of steroid-related deaths and the scare tactics employed by health professionals? If steroids are so dangerous, how come thousands of bodybuilders use them? Let's examine the hazards of steroid use in more detail.There are many potential side-effects associated with anabolic and androgenic steroids. Testosterone's anabolic action builds muscle, but its androgenic properties can adversely affect several body systems, including the cardiovascular, hormonal, reproductive, gastrointestinal, and nervous systems, as well as the skin. I've scanned the medical literature and compiled a list of all the possible complications of anabolic steroids.

If you take anabolic steroids, what are the odds of developing a complication? The answer isn't straightforward because many factors determine the frequency and severity of side effects. In several short term medical studies, a 600-milligram weekly dose of testosterone caused no serious side effects in healthy adult men. Although this is a revelation in terms of steroid safety, we must interpret the data with caution. First, the studies lasted less than three months. Second, a 600 milligram dose is moderate in comparison to what many bodybuilders use, often over long periods. One thing we do know is that the bigger the dose and the longer the duration of steroid use, the greater the health risk.

The bottom line is that anabolic steroid users have an 80 percent chance of experiencing at least one of these common complications: acne, gynecomastia, testicle shrinkage, stretch marks, fluctuating sex drive, withdrawal symptoms, or drug dependence. You might be thinking that these common steroid-induced complications are not real side effects-they're nothing more than a minor inconvenience. In fact, most steroid users accept these problems as necessary evils in the pursuit of size, and rather than quit using steroids, they use other drugs to combat the unwanted symptoms. Some of the problems are reversible and disappear when steroid use is discontinued. Other effects, such as hair loss, stretch marks, and acne scars, can be permanent.

Excerpted with permission from Men's Body Sculpting by Dr. Nick Evans, MD, an orthopedic surgeon and sports medicine physician in Los Angeles. Evans is also a bodybuilder, fitness model, and regular magazine columnist. Visit for more information.