Introduction
Steroids are categorized broadly as corticosteroids and anabolic androgenic steroids (AAS). Anabolic steroids are man made derivatives of the male sex hormone testosterone. The drugs elevate the concentration of hormone testosterone stimulating protein synthesis. This results to increase muscle strength, mass, size and improvement in appearance. They are often used for cosmetics, especially by the athletes and teenagers to improve their sporting strength (Hoffman & Ratamess, 2006).
Corticosteroids are steroids used medically to treat medical complications. This type of steroids is derived from cholesterol in the adrenal gland. It is used to treat a variety of complications, including asthma, chronic lung illness, and dermal complications. Furthermore, corticosteroids are used to treat allergic reactions such as poison ivy (Klein et al., 2001).
Anabolic Steroids
The cosmetics use of steroids has serious side effects and is prohibited internationally. Some examples of anabolic steroids include Anatrofin, Decadurabolin, Bolasterone, Annadrol, Gamma Hydroxybutalite, and Annaxvar. The drugs are swallowed as tablets or liquid or through injection by users. They are taken in patterns namely “cycling”. Anabolic steroids can cause liver tumors, jaundice, high blood pressure, and psychological disorders. Build-up of steroids in the system may lead to cardiovascular complications, renal failure, and hypertension. It also causes sterility and irreversible modification of individual’s morphology such as shrinking of testicles and breasts in male and females respectively (Barness, 2006).
Ergogenic effects associated with anabolic steroids use include increased body mass, muscle size and reduced body fat. It also increases muscle strength and power enhancing quick recovery between work outs and injury. The steroids also increase protein synthesis and muscle endurance. Moreover, it causes erythropoiesis and hematocrit. Occasionally, it is found to increase bone mineral density, glycogen storage, increased lipolysis and neural transmission. Steroids also reduce muscle damage and increase pain in tolerance and modification of behavior (Hartgens & Kuipers, 2004).
Abuse of the steroids causes adverse effects for instance; they cause cardiovascular complications because of changes in the lipid profile and elevation of blood pressure thereby decreasing myocardial function. In the endocrine system, the drugs cause gynecomastia and reduce sperm count. Sometimes, it may cause testicular atrophy or worse still, impotence and transient sterility. Steroids are also said to cause dermatological complication such as acne and male pattern baldness. In musculoskeletal system, steroids abuse results to premature epiphyseal plate closure with increased risk of tendon tears. It also causes intramuscular abscesses. Non-clinical use of the drug could also result to hepatic failure through increased risk of liver tumors and liver damage. In the reproductive systems and genitourinary system, it causes reduced sperm count and testicular size in male whilst in female; it leads to menstrual irregularities, clitoromegaly and masculization. Gynecomastia and libido changes are other complications experienced by both sex. Additionally, abuse of anabolic steroids may result to mania, aggressiveness, aggression, and mood swings (Hoffman & Ratamess, 2006).
Recent studies indicate that individuals using and abusing steroids are from different cultures and ethnicities. The major reason is for physical benefits. By the year 2000, almost 2.5% of 12th graders showed signs of use of steroids. The percentage had almost doubled by 2002 and stood at 4%.
Treatment for steroids abusers is at its infant stages. Researchers are urged to continuously develop as much information as possible regarding this habit. The existing mode of treatment uses persuasion as the method to help drug abusers. It is done mainly by showing the individuals the destructive effects these drugs have on one’s body. This method has yielded positive results in getting individuals to stop using the drugs (Anton & Rodriguez, 2011).
Use of Steroids for Clinical Treatments
With the brief discussion above, is there a clinical role of anabolic steroids? Undoubtedly, steroids enhance muscle strength and lean tissue accruement. Benefits of self-administering anabolic steroids are still not clear. However, the medical community accepts partially the potential clinical use of these androgens. For example, in recent years, clinicians have increasingly used anabolic steroids to increase lean tissue and improve daily functional performance in AIDS patients. Like wise, patients receiving dialysis and those with chronic obstructive pulmonary disease and those recovering from the myocardial infarction show great improvement on AAS clinical treatment. Research also shows a positive effect on muscle contusion injuries healing (Hoffman & Ratamess, 2006).
Corticosteroid use in medical fields has increased dramatically in the last decade. This type of steroids is derived from cholesterol in the adrenal glands. Natural corticosteroids affect directly or indirectly most of the tissues in the body, especially those involved in enzyme secretion in the body. Having first isolated from the adrenal cortex in 1935, the first cortisone was synthesized in mid 1940s. It was used for treatment of rheumatoid arthritis (RA) in 1948. Since then, corticosteroids have been widely used to treat rheumatologic diseases such as systemic lupus erythematosus (SLE), Sarcoidosis, and temporal arteritis. Furthermore, it has been used on a number of pulmonary diseases, including asthma, chronic obstructive pulmonary disease, and interstitial fibrosis. They have also been used in ophthalmology (Alderson, 2009). Corticosteroids have been widely used to treat many orthopedic problems including tenditis, fibroditis, fasciitis, bursitis, stenosing tenosynovitis nerve compression syndromes, and ligament injuries. Additionally, they play a major role in immunosuppressive therapy, especially during organ transplantation. Also, steroids are used as anti-inflammatory agents in treatment of a number of infectious diseases such as Pneumocytstis carinii pneumonia (PCP) and Tuberculosis meningitis. Moreover, Steroids acyclovir has been used during surgical facial nerve decompression in Bell’s palsy (Grogan & Gronseth, 2001). Topical nasal steroids supplement antibiotics in the primary therapy for chronic sinusitis. Nasal steroids treat inflammation in the nasal region thereby reducing edema of the osteaomeatal complex. Topical nasal steroids are considered safe for chronic use (Becker, 2003).
Epidural steroid injections have been proven for treatment of acute and sub acute sciacta (radicular pain of the low back due to degeneration). Epidural steroid injections have been clinically established to be effective in short term management of low back pain especially if the pain is associated with symptoms of nerve root irritation and when the pain remains unresponsive to other conservative treatments such as pharmacotherapy and physical exercise. However, Epidural steroid injection efficacy for other lumbar spine indications is yet to be proven (Anon, 2006). Based to a great extent on case reports and theory, use of steroids cover is accepted for dental patients on long term steroids medication (Gibson & Ferguson, 2004).
However, it is indispensable that chronic use of any type of steroid is associated with development of risks of certain health complications. It affects immune system by affecting all lines of defense. On the first line of defense, it causes delayed healing of bruises and atrophy. It also causes increased release of neutrophils from the bone marrow but reduces their migration to the inflammatory sites. This in turn inhibits chemotaxis. Research also shows that very high doses of steroid inhibit phagocytosis and intracellular killing. Furthermore, on immune system, chronic use of corticosteroids causes lymphocytopenia and selectively depletes the circulation of T- lymphocytes. On monocyte macrophage, the drug may cause monocytopenia and decreased chemotaxis. High doses of steroids also alter phagocytisis and bacterial activity and decrease the production of cytokines and inteleukin 1 (Klein et al., 2001). This immune suppression makes it easier for one to get opportunistic infections such as Herpes Zoster Virus (HSV), Cytomegalovirus (CMV), Epstein – Barr virus (EBV), adenovirus, influenza, and parainfluenza virus. Additionally, they are at risk of developing multidermatomal shingles, cuteneous dissemination, and Varicella Zoster Pneumonitis. Therefore, use of steroids to treat infectious mononucleosis should be avoided unless the patient is experiencing severe complications (Dickens, Nye & Rickett, 2008).
Conclusion
Undoubtedly, anabolic androgenic steroids in supratherapeutic doses increase muscular strength and lean body. The widespread use of large doses of AAS has resulted to huge adverse effects of great concern, including libido changes, infertility, and cardiovascular failure and most importantly, the strong effects exerted on psyche and behavior.
Although medical practitioners have lagged in promoting the use of anabolic steroids as part of the treatment plan in fighting diseases that involve muscle wasting, enough research indicates the potential positive effects on use of the drug to certain diseased population. However, use of steroids to treat infectious mononucleosis should be avoided at all cost unless the patient is experiencing severe complications.
References
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