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Int J Sports Med 2008; 29(8): 679-687
DOI: 10.1055/s-2007-965808
Clinical Sciences

© Georg Thieme Verlag KG Stuttgart · New York

Side Effects of Anabolic Androgenic Steroids Abuse

A. Bonetti1 , F. Tirelli1 , A. Catapano2 , D. Dazzi3 , A. Dei Cas3 , F. Solito1 , G. Ceda3 , C. Reverberi4 , C. Monica5 , S. Pipitone5 , G. Elia6 , M. Spattini1 , G. Magnati3
  • 1Department of Clinical Science, Curriculum of Sports Science and Physical Exercise, University of Parma, Parma, Italy
  • 2Department of Phamacologic Sciences, University of Milan, Milano, Italy
  • 3Department of Internal Medicine and Biomedical Sciences, University of Parma, Parma, Italy
  • 4Department of Heart and Cardiac Surgery, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
  • 5Central Laboratory, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
  • 6Infective Diseases Section, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
Further Information

Publication History

accepted after revision September 3, 2007

Publication Date:
14 November 2007 (online)

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Abstract

Long-term side effects of high doses of anabolic androgenic steroids self-administration were evaluated in this study. Twenty male bodybuilders, voluntarily starting steroid self-administration, were followed every 6 months over 2 years. Physical examination, haematological, metabolic and endocrine variables, semen analysis, hepatic and prostate ultrasound and echocardiographic evaluations were performed. LH values (baseline 3.43 ± 1.75) were suppressed at 18 (1.98 ± 1.99) (p = 0.026) and 24 (2.43 ± 2.17) (p = 0.026), and FSH (3.95 ± 2.01) at 6 (3.01 ± 2.16) (p = 0.031), 12 (2.45 ± 2.54) (p = 0.029), 18 (2.02 ± 2.29) (p = 0.032) and 24 (3.42 ± 2.64) (p = 0.032) months and SHBG (34.11 ± 10.88) values significantly lowered at 12 (24.81 ± 12.49) (p < 0.05), 18 (21.28 ± 11.15) (p < 0.01), 24 months (25.42 ± 11.16) (p < 0.01). A significant decrease in spermatozoa count (p < 0.01), and fertility index (p = 0.01) occurred. HDL-cholesterol (baseline 56.94 ± 13.54) was reduced at 18 (41.86 ± 14.17) (p < 0.01) and 24 (43.82 ± 18.67) (p < 0.05) months and Apo A-1 at 12 (p < 0.001), 18 (p = 0.05) and 24 (p = 0.05) months. The most important long-term adverse effects were lower fertility and the impairment of lipid profile associated with an increased cardiovascular risk.

Key words

anabolic androgenic steroids - bodybuilders - side effects - doping

References

  • 1 Alen M, Rahkila P, Reinila M, Vihko R. Androgenic-anabolic steroid effects on serum thyroid, pituitary and steroid hormones in athletes.  Am J Sports Med. 1987;  15 357-361
    CrossrefPubMedSearch in Google Scholar
  • 2 Appleby M, Fisher M, Martin M. Myocardial infarction, hyperkalaemia and ventricular tachycardia in a young male body-builder.  Int J Cardiol. 1994;  44 171-174
    CrossrefPubMedSearch in Google Scholar
  • 3 Bagatell C J, Bremner W J. Androgens in men – uses and abuses.  N Engl J Med. 1996;  334 707-714
    CrossrefPubMedSearch in Google Scholar
  • 4 Baldi J C, Snowling N. Resistance training improves glycaemic control in obese type 2 diabetic men.  Int J Sports Med. 2003;  24 419-423
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Bhasin S, Storer T W, Berman N, Callegari C, Clevenger B, Phillips J, Bunnell T J, Tricker R, Shirazi A, Casaburi R. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men.  N Engl J Med. 1996;  335 1-7
    CrossrefPubMedSearch in Google Scholar
  • 6 Bhasin S, Woodhouse L, Storer T W. Proof of the effect of testosterone on skeletal muscle.  J Endocrinol. 2001;  170 27-38
    CrossrefPubMedSearch in Google Scholar
  • 7 Blue J G, Lombardo J A. Steroids and steroid-like compounds.  Clin Sports Med. 1999;  18 667-689
    CrossrefPubMedSearch in Google Scholar
  • 8 Borghouts L B, Keizer H A. Exercise and insulin sensitivity: a review.  Int J Sports Med. 2000;  21 1-12
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Boyardjiev N P, Gergieva K N, Massaldjieva R I, Gueorguiev S I. Reversible hypogonadism and azoospermia as a result of anabolic-androgenic use in a bodybuilder with personality disorder. A case report.  J Sports Med Phys Fitness. 2001;  40 271-274
    PubMedSearch in Google Scholar
  • 10 da Silva J A. Sex hormones and glucocorticoids: interactions with the immune system.  Ann NY Acad Sci. 1999;  876 102-117
    CrossrefPubMedSearch in Google Scholar
  • 11 de Luis D A, Aller R, Cuellar L A, Terroba C, Romero E. Anabolic steroids and gynecomastia. Review of the literature.  Ann Med Intern. 2001;  18 489-491
    PubMedSearch in Google Scholar
  • 12 De Piccoli B, Giada F, Benettin A, Sartori F, Piccolo E. Anabolic steroid use in body builders: an echocardiographic study of left ventricle morphology and function.  Int J Sports Med. 1991;  12 408-412
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 De Souza M J, Miller B E. The effect of endurance training on reproductive function in male runners. A ‘volume threshold’ hypothesis.  Sports Med. 1997;  23 357-374
    PubMedSearch in Google Scholar
  • 14 Deyssig R, Weissel M. Ingestion of androgenic-anabolic steroids induces mild thyroidal impairment in male body builders.  J Clin Endocrinol Metab. 1993;  76 1069-1071
    CrossrefPubMedSearch in Google Scholar
  • 15 Di Bello, Giorgi D, Bianchi M, Bertini A, Caputo M T, Valenti G, Furioso O, Alessandri L, Paterni M, Giusti C. Effects of anabolic-androgenic steroids on weight-lifters' myocardium: an ultrasonic videodensitometric study.  Med Sci Sports Exerc. 1999;  31 514-521
    CrossrefPubMedSearch in Google Scholar
  • 16 Dickerman R D, Pertusi R M, Zachariah N Y, Dufour D R, McConathy W J. Anabolic steroid-induced hepatotoxicity: is it overstated?.  Clin J Sport Med. 1999;  9 34-39
    CrossrefPubMedSearch in Google Scholar
  • 17 Dickerman R D, Schaller F, Zachariah N Y, McConathy W J. Left ventricular size and function in elite bodybuilders using anabolic steroids.  Clin J Sport Med. 1997;  7 90-93
    CrossrefPubMedSearch in Google Scholar
  • 18 Feigenbaum H. Echocardiology. Malvern, Pennsylvania; Lea & Febiger Eds. 1994
    Search in Google Scholar
  • 19 Fineschi V, Baroldi G, Monciotti F, Paglicci R L, Turillazzi E. Anabolic steroid abuse and cardiac sudden death: a pathologic study.  Arch Pathol Lab Med. 2001;  125 253-255
    PubMedSearch in Google Scholar
  • 20 Geyer H, Parr M K, Mareck U, Reinhart U, Schrader Y, Schanzer W. Analysis of non-hormonal nutritional supplements for anabolic-androgenic steroids – results of an international study.  Int J Sports Med. 2004;  25 124-129
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Guezzenec C Y. Doping: effectiveness, consequences, prevention.  Am Endocrinol. 2001;  65 33-41
    PubMedSearch in Google Scholar
  • 22 Hartgens F, Cheriex E C, Kuipers H. Prospective echocardiographic assessment of androgenic-anabolic steroids effects on cardiac structure and function in strength athletes.  Int J Sports Med. 2003;  24 344-351
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Hermans M P, Levy J C, Morris R J, Turner R C. Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes.  Diabetologia. 1999;  42 678-687
    CrossrefPubMedSearch in Google Scholar
  • 24 Inigo M A, Arrimadas E, Arroyo D. 43 cycles of anabolic treatment studies in atletes: the uses and secondary effects.  Rev Clin Esp. 2001;  200 133-138
    PubMedSearch in Google Scholar
  • 25 Ivy J L. Role of exercise training in the prevention and treatment of insulin resistance and non-insulin-dependent diabetes mellitus.  Sports Med. 1997;  24 321-336
    CrossrefPubMedSearch in Google Scholar
  • 26 Jin B, Turner L, Walters W A, Handelsman D J. The effects of chronic high dose androgen or estrogen treatment on the human prostate.  J Clin Endocrinol Metab. 1996;  81 4290-4295
    CrossrefPubMedSearch in Google Scholar
  • 27 Karila T A, Karjalainen J E, Mantysaari M J, Viitasalo M T, Seppala T A. Anabolic androgenic steroids produce dose-dependant increase in left ventricular mass in power athletes, and this effect is potentiated by concomitant use of growth hormone.  Int J Sports Med. 2003;  24 337-343
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Korkia P, Stimson G V. Indications of prevalence, practice and effects of anabolic steroid use in Great Britain.  Int J Sports Med. 1997;  18 557-562
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Kuhn C M. Anabolic steroids.  Recent Prog Horm Res. 2002;  57 411-434
    CrossrefPubMedSearch in Google Scholar
  • 30 Levenhagen D K, Carr C, Carlson M G, Maron D J, Borel M J, Flakoll P J. Postexercise protein intake enhances whole-body and leg protein accretion in humans.  Med Sci Sports Exerc. 2002;  34 828-837
    CrossrefPubMedSearch in Google Scholar
  • 31 MacIndoe J H, Perry P J, Yates W R, Holman T L, Ellingrod V L, Scott S D. Testosterone suppression of the HPT axis.  J Investig Med. 1997;  45 441-447
    PubMedSearch in Google Scholar
  • 32 Mahan L K. Escott Stump Krause's Food, Nutrition and Diet Therapy. Philadelphia, PA; WB Saunders 1996: 403-423
    Search in Google Scholar
  • 33 Mauras N, Hayes V, Welch S, Rini A, Helgeson K, Dokler, Veldhuis M JD, Urban R J. Testosterone deficiency in young men: marked alterations in whole body protein kinetics, strength, and adiposity.  J Clin Endocrinol Metab. 1998;  83 1886-1892
    CrossrefPubMedSearch in Google Scholar
  • 34 Millman R B, Ross E J. Steroid and nutritional supplement use in professional athletes.  Am J Addict. 2003;  12 (Suppl 2) S48-S54
    CrossrefPubMedSearch in Google Scholar
  • 35 Moldoveanu A I, Shephard R J, Shek P N. The cytokine response to physical activity and training.  Sports Med. 2001;  31 115-144
    Search in Google Scholar
  • 36 Nieminen M S, Ramo M P, Viitasalo M, Heikkila P, Karjalainen J, Mantysaari M, Heikkilä J. Serious cardiovascular side effects of large doses of anabolic steroids in weight lifters.  Eur Heart J. 1996;  17 1576-1583
    CrossrefPubMedSearch in Google Scholar
  • 37 Nindl B C, Kraemer W J, Deaver D R, Peters J L, Marx J O, Heckman J T, Loomis G A. LH secretion and testosterone concentrations are blunted after resistance exercise in men.  J Appl Physiol. 2001;  91 1251-1258
    PubMedSearch in Google Scholar
  • 38 Palatini P, Giada F, Garavelli G, Sinisi F, Mario L, Michieletto M, Baldo-Enzi G. Cardiovascular effects of anabolic steroids in weight-trained subjects.  J Clin Pharmacol. 1996;  36 1132-1140
    CrossrefPubMedSearch in Google Scholar
  • 39 Parssinen M, Kujala U, Vartiainen E, Sarna S, Seppala T. Increased premature mortality of competitive powerlifters suspected to have used anabolic agents.  Int J Sports Med. 2000;  21 225-227
    Thieme ConnectPubMedSearch in Google Scholar
  • 40 Pluim B M, Zwinderman A H, van der Laarse A, van der Wall E E. The athlete's heart. A meta-analysis of cardiac structure and function.  Circulation. 2000;  101 336-344
    CrossrefPubMedSearch in Google Scholar
  • 41 Sader M A, Griffiths K A, McCredie R J, Handelsman D J, Celermajer D S. Androgenic anabolic steroids and arterial structure and function in male bodybuilders.  J Am Coll Cardiol. 2001;  37 224-230
    CrossrefPubMedSearch in Google Scholar
  • 42 Società Italiana di Nutrizione Umana .Italian Recommended Dietary Allowance (LARN). Milano; EDRA 1998: 20-74
    Search in Google Scholar
  • 43 Stolt A, Karila T, Viitasalo M, Mantysaari M, Kujala U M, Karjalainen J. QT interval and QT dispersion in endurance athletes and in power athletes using large doses of anabolic steroids.  Am J Cardiol. 1999;  84 364-366
    CrossrefPubMedSearch in Google Scholar
  • 44 Striegel H, Simon P, Wurster C, Niess A M, Ulrich R. The use of nutritional supplements among master athletes.  Int J Sports Med. 2006;  27 236-241
    Thieme ConnectPubMedSearch in Google Scholar
  • 45 Tagarakis C V, Bloch W, Hartmann G, Hollmann W, Addicks K. Anabolic steroids impair the exercise-induced growth of the cardiac capillary bed.  Int J Sports Med. 2000;  21 412-418
    Thieme ConnectPubMedSearch in Google Scholar
  • 46 Urhausen A, Holpes R, Kindermann W. One- and two-dimensional echocardiography in bodybuilders using anabolic steroids.  Eur J Appl Physiol. 1989;  58 633-640
    CrossrefPubMedSearch in Google Scholar
  • 47 van Breda E, Keizer H A, Kuipers H, Wolffenbuttel B H. Androgenic anabolic steroid use and severe hypothalamic-pituitary dysfunction: a case study.  Int J Sports Med. 2003;  24 195-196
    Thieme ConnectPubMedSearch in Google Scholar
  • 48 Wadler G I. Drug use update.  Med Clin North Am. 1994;  78 439-455
    PubMedSearch in Google Scholar
  • 49 Warnick G R, Benderson J, Albers J J. Dextran sulfate-Mg2+ precipitation procedure for quantitation of high-density-lipoprotein cholesterol.  Clin Chem. 1982;  28 1379-1388
    PubMedSearch in Google Scholar
  • 50 Wilson J D. Androgen abuse by athletes.  Endocr Rev. 1988;  9 181-199
    CrossrefPubMedSearch in Google Scholar
  • 51 Wolfe R R. Protein supplements and exercise.  Am J Clin Nutr. 2000;  72 551S-557S
    PubMedSearch in Google Scholar
  • 52 Zuliani U, Bernardini B, Catapano A, Campana M, Cerioli G, Spattini M. Effects of anabolic steroids, testosterone, and HGH on blood lipids and echocardiographic parameters in body builders.  Int J Sports Med. 1989;  10 62-66
    Thieme ConnectPubMedSearch in Google Scholar

Prof. Antonio Bonetti

Department of Clinical Science, Curriculum of Sports Science and Physical Exercise
University of Parma

Via Gramsci

43100 Parma

Italy

Fax: + 39 05 21 98 54 68

Email: antonio.bonetti@unipr.it