Anabolic Steroid Overdrive:Pitfalls of Steroid Use
Part 2
by Nick Evans, MD

This article is continued from the April 2004 issue of New Living Magazine.
Click here for Part 1

Testicle Shrinkage: When you use anabolic steroids, your body senses a testosterone overload, and your testes stop making testosterone. Like many other body tissues, the testes function on the "use it or lose it" principle. When they're out of work, they shrink in size (atrophy). So while you're stomping around the mall trying on new oversized shirts and baggy pants, you might also have to purchase a multipack of extra small underwear. The only way to halt this period of self-induced testicular unemployment is to stop using steroids. Your testes will eventually regain their original size, but it will take six months or more of being steroid free. Some steroid users try to expedite this process by using such drugs as human chorionic gonadotrophin (Pregnyl) or clomiphene citrate (Clomid). These fertility drugs can kick-start sleeping testes back into action, but the effect is only temporary. The bottom line is that if you toy with testosterone, your testicles get tiny. You can't use juice and have a handful of big nuts at the same time.

Gynecomastia: The development of excessive breast tissue affects one in three male steroid users. What happens is that some of that extra testosterone circulating through your body gets converted to the hormone estrogen, which can lead to the development of a couple of female appendages. For many steroid users, this side effect is reversible-when they quit using the drugs, the gynecomastia disappears-but this isn't always the case. Treatment for gynecomastia is the antiestrogen drug tamoxifen (Nolvadex), 20 milligrams daily. This prescription-only medication can be used to treat gynecomastia or prevent it from occurring in the first place. Persistent cases of gynecomastia that resist drug treatment usually require surgical excision.

Skin changes: Testosterone is converted into dihydrotestosterone (DHT), a by-product that makes the skin more oily, which causes acne. DHT can also accelerate male-pattern baldness. The prescription drug finasteride (Propecia or Proscar) might help block the conversion of testosterone to DHT. Steroids can also affect skin elasticity, inflicting stretch marks as the muscles balloon in size.

Withdrawal: Steroid-induced problems don't end when you finish a steroid cycle. At least 70 percent of steroid users report symptoms of withdrawal after quitting the drug. Withdrawal symptoms include loss of muscle size and strength, fatigue, reduced sex drive, and depression. Because steroids suppress your own hormone production, when you discontinue the drugs your testosterone level drops into your boots. That is, coming off the juice leaves you with the testosterone level of a toddler. It's no surprise that you feel as weak as a kitten when you stop taking steroids. Your muscles shrink, your strength falls off, and you lose interest in sex.

Addiction: The knee-jerk reaction to withdrawal is to score some more steroids pretty damn quick. You crave the rush of all that testosterone pumping through your veins, and this does represent a form of psychological (and physical) drug dependence. Sure, it's tough pedaling a bicycle to the gym when you're used to driving a tank-but you've got to step down sometime or risk devastating consequences.

People once thought that anabolic steroids damaged tendons. Recent scientific evidence has shown this is not true. Anabolic steroids do not damage or weaken tendons. These drugs can make tendons mechanically stiffer and less elastic, but similar changes are induced in tendons by regular exercise. Anabolic steroids neither reduce tendon strength nor inflict any significant biochemical or anatomical alterations in tendon tissue. A word of caution, though. Anabolic steroids can increase muscular strength dramatically within a few weeks. Tendons, meanwhile, require longer to adapt (because they have a poorer blood supply). To avoid tendon injury, increase weight gradually to allow tendons time to get stronger.

That guy at the gym who's the size of a gorilla might be big and strong, but don't congratulate him with a pat on the butt after his 600 pound bench press because his ass hurts from all those steroid needles. Needle stick injections are a big part of the steroid game. Nine of 10 steroid users inject muscle-building drugs; along with all those needle sticks comes a selection of injection-related problems.

Like most drugs, anabolic steroids can be taken by mouth or delivered via intramuscular injection. Tablets are a convenient way of taking medications-you simply pop them in your mouth and swallow. By contrast, injectable drugs require a needle, a syringe, and a sharp stick. The side effects of steroids are similar for both tablet and injectable versions of the drug. Generally speaking, the health risks are predominantly dose-related-the bigger the dose, the greater the risk. However, tablets and injections differ slightly when it comes to complications.

Tablets are potentially more harmful to the liver. Any oral drug absorbed from the gut passes through the liver before it's distributed elsewhere in the body. When taken in large doses by mouth, tablet versions of anabolic steroids can upset liver function. For this reason, many steroid users choose injectable forms of the drug to minimize toxic effects on the liver. Injectable versions of the drug are placed into muscle and released directly into the bloodstream, bypassing the liver. This means that larger doses can be injected without the liver taking a big hit. But there's a trade-off. Although the liver is partly spared drug toxicity, sticking a needle into your body is not without risk, especially if the person giving the injection has not been trained to perform the procedure. Injection problems are unrelated to the type of drug inside the syringe. They are purely the result of the needle stick. Common side effects of poor injection technique are pain, bruising, scar tissue build-up, nerve injury, infection or abscess, and HIV or hepatitis from sharing needles.

Intramuscular injection inflicts two forms of pain. The first is that sharp stick as the needle penetrates the skin. The second is a deep discomfort as the injection pushes the muscle fibers apart, creating a little pocket of fluid. The larger the volume of fluid, the greater the pain. Bigger muscles such as the buttocks and thighs can comfortably accommodate two to three milliliters of fluid. In smaller muscles, such as the shoulders, one milliliter is about the maximal limit of comfort. The fluid disappears as the drug is absorbed, but the site remains slightly damaged and inflamed from the needle stick for a while longer. If you inject into the same site within the space of a few days, you can cause a double jeopardy situation. Double the fluid, double the damage, double the pain.

Some bodybuilders attempt to fix holes in their physiques with a zap of oil. Injecting muscles with products such as Synthol gives an illusion of size but does not induce muscle growth. The fake size isn't muscle tissue-it's a bubble of oil, an injectable implant. Site injection with Synthol-a practice I call "spot welding"-is a temporary fix. The spot weld doesn't contract. The muscle tissue becomes inflamed, eventually forming a bump of scar tissue that resembles a tumor of mutant muscle.

It's scary how bodybuilders play their own version of Russian roulette with steroid injections, blindly stabbing different body parts without knowing the location of nerves and blood vessels. Site injection is a common practice by bodybuilders. Steroids are injected directly into lagging muscle groups to induce a localized increase in size. The problem is most muscles are intimately adjacent to nerves, blood vessels, and other important anatomical structures. For instance, the radial nerve lies immediately under the triceps horseshoe, the sciatic nerve passes under the lower portion of your gluteals, and the axillary nerve lies beneath the deltoid muscle. If your misplaced needle hits an artery or vein, the extra blood loss creates a good-sized bruise. Striking a nerve with your needle feels like an electric shock. The damaged nerve can result in loss of feeling and muscle weakness.

Another possible side effect of poor injection technique is infection, which usually results from accidental contamination of a sterile needle, reusing needles, or sharing injection equipment or multidose vials with another person. All injections should be given using a sterile technique in a clean environment without contaminating the end of the needle.The locker room of your local gym does not qualify as a sterile area! Cleansing the skin with an alcohol swab can reduce the risk of infection. If the needle does get dirty after being removed from the sterile packaging, you run the risk of introducing a bacterial infection under your skin. This infection can develop into an abscess filled with pus, which usually needs to be lanced or surgically removed. Fake or counterfeit steroids that have not undergone proper sterilization can also increase the risk of bacterial infection. A more serious infection complication can arise from sharing needles. This hazardous practice risks the transmission of the HIV virus and hepatitis B or C.

Although short-term use of low doses of testosterone appears relatively safe, the potential health risks of long-term steroid use are still being researched. As the dose and duration of steroid use escalates, so do the health risks. Relatively minor side effects evolve into bigger problems, manifesting as irreparable heart or liver damage, high blood pressure, stroke, or heart attack. If everybody jumped off a cliff, would you follow them? Self administering anabolic steroids is illegal and dangerous. As with any drug, there's use, and there's abuse. The old saying "everything in moderation" surely applies here. The chances are good that at least one in three readers of this book have used anabolic steroids. If you choose to use these drugs, stick with lower doses and take adequate off cycles. Remember that bodybuilding is supposed to be a healthy pastime, not a fast track to an early demise. In the next chapter, we'll look at some of the nutritional supplements that offer a safe method of enhancing your physique.

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.