Anabolic Steroids

Anabolic steroids are a class of natural and synthetic steroid hormones that promote cell growth and division, resulting in growth of several types of tissues, especially muscle and bone. Different anabolic steroids have varying combinations of androgenic and anabolic properties, and are often referred to in medical texts as AAS (anabolic/androgenic steroids). Testosterone is the most potent natural anabolic steroid, while dihydrotestosterone is the most potent natural androgen. Anabolic steroids are often used by athletes as performance enhancing substances.

Anabolic and virilizing effects
Anabolic steroids produce both anabolic and virilization (also known as androgenic) effects. Most anabolic steroids work in two simultaneous ways. First, they work by binding the androgen receptor and increasing protein synthesis. Second, they also reduce recovery time by blocking the effects of the stress hormone, cortisol, on muscle tissue. As a result, catabolism of the body's muscle mass is greatly reduced.

Examples of anabolic effects:
 * Increased protein synthesis from amino acids
 * Increased muscle mass and strength
 * Increased appetite
 * Increased bone remodeling and growth
 * Stimulation of bone marrow increasing production of red blood cells

Examples of virilizing/androgenic effects:
 * Growth of the clitoris (clitoral hypertrophy) in females and the penis in male children (the adult penis does not grow indefinitely even when exposed to high doses of androgens)
 * Increased growth of androgen-sensitive hair (pubic, beard, chest, and limb hair)
 * Increased vocal cord size, deepening the voice
 * Increased libido
 * Suppression of endogenous sex hormones
 * Impaired spermatogenesis

Unwanted side effects
Many androgens are metabolized to estrogenic compounds which bind to estrogen receptors, producing additional (usually) unwanted effects:
 * Elevated blood pressure
 * Cholesterol levels – Increased LDL, Decreased HDL levels
 * Acne– Due to the stimulation of sebaceous glands
 * Reduced sexual function and temporary infertility
 * Conversion to DHT (Dihydrotestosterone) resulting in premature baldness.
 * Increased aggression – While very rare, increased aggression with possible psychiatric symptoms such as violence, mania, and psychosis - Known informally as "roid rage"
 * Enlargement of the heart – The heart is a muscle and thus affected by the muscle-building qualities of the hormones. The enlargement increases the risk of an adverse cardiac event occurring in later life.
 * Liver damage – Caused particularly by oral anabolic steroid compounds which are 17-alpha-alkylated in order to not be destroyed by the digestive system.
 * Gingival overgrowth - Allows plaque bacterias to create periodontal infection.

Male-specific side effects

 * Gynecomastia – Abnormal breast development, due to aromatization.
 * Testicular atrophy – Temporary side effect that is reversible provided the treatment is not too long.
 * Prostate cancer – Heavy steroid use can affect hormone-sensitive tissue and organs, in particular, the prostate, causing increased risk of prostate cancer; the enlargement is a result of conversion of anabolic steroids into DHT by 5-alpha-reductase

Female-specific side effects
Permanent virilizing side effects include
 * Body hair increase
 * Deepening of the voice
 * Enlarged clitoris (clitoral hypertrophy)
 * Temporary decrease in menstrual cycles

Adolescent-specific side effects
An ideal anabolic steroid (a hormone with purely anabolic effects and no virilizing or other side effects) has been widely sought. Many synthetic anabolic steroids have been developed in an attempt to find molecules that produced a higher degree of anabolic rather than virilizing effects. Unfortunately, the most effective steroids known for increasing lean body mass also have the strongest androgenic characteristics.
 * Stunted growth – Abuse of the agents may prematurely stop the lengthening of bones (premature epiphyseal fusion through increased estrogen)
 * Accelerated bone maturation
 * Slight beard growth

Medical uses
Anabolic steroids were tried by physicians for many purposes in the 1940s and 1950s with varying success. Disadvantages outweighed benefits for most purposes, and in recent decades medical use in North America and Europe has been restricted to a few conditions.


 * Bone marrow stimulation: For decades, anabolic steroids were the mainstay of therapy for hypoplastic anemias not due to nutrient deficiency, especially aplastic anemia. Anabolic steroids are slowly being replaced by synthetic protein hormones (such as epoetin alfa) that selectively stimulate growth of blood cell precursors.
 * Growth stimulation: Anabolic steroids were used heavily by pediatric endocrinologists for children with growth failure from the 1960s through the 1980s. Availability of synthetic growth hormone and increasing social stigmatization of anabolic steroids led to discontinuation of this use.
 * Stimulation of appetite and preservation of muscle mass: Anabolic steroids have been given to people with chronic wasting conditions such as cancer and AIDS.
 * Induction of male puberty: Androgens are given to many boys distressed about extreme delay of puberty. Testosterone is now nearly the only androgen used for this purpose but synthetic anabolic steroids were often used prior to the 1980s.
 * Used for gender dysmorphia: whereby secondary male characteristics (puberty) are initiated in female-to-male diagnosed patients. Most commonly used testosterone derivatives are Sustanon and Testosterone Enanthate which cause the voice to deepen, increased bone and muscle mass, facial hair, increased levels of red blood cells and clitorial enlargement.

Administration
Anabolic steroids should never be injected by persons unfamilar with safe injection sites and practices. Steroids are commonly injected IM (intramuscularly) with 1-1.5" 18-25 gauge needles. Common injection sites include the buttocks, shoulders and thighs. The triceps and biceps also have been used, however, this practice can be dangerous. Care must be taken to maintain cleanliness when injecting. Infection and disease can result if careless procedures are used. Care must also be taken when selecting an injection site. The sciatic nerve runs right up the back of each leg and up the middle of both buttocks. Blood vessels are also abundant in other areas. Injections into nerves will be extremely painful and dangerous. Injection into vessels is dangerous as well, as this can cause an embolism or other complications. Common amounts used at any one time are typically on the order of a few tens of mg/day (for oral steroids) to several hundred mg/day (for injectable steroids.) As with any drug, increasing the dosage increases the risk of the above side effects.

Use and abuse in athletics and bodybuilding
These drugs are used by track and field athletes, weight lifters, bodybuilders, shot putters, cyclists, professional baseball players, professional wrestlers, and others to give them a competitive advantage, and improve their physical appearance or to allow them to better compete with others who have a physical advantage, perhaps from a more fortunate natural endowment of endogenous steroids or from steroid use as well. Steroid use to obtain competitive advantage is prohibited by the rules of the governing bodies of many sports, and officially condoned by none.

According to the 1999 Monitoring the Future study, the percentage of eighth, tenth, and twelfth graders in the United States who reported using steroids at least once in their lives increased steadily over the preceding four years (an average of 1.8 % in 1996, 2.1 % in 1997, 2.3 % in 1998, and 2.8% in 1999). In addition, steroid use to enhance athletic performance is no longer limited to high school males: a 1998 Pennsylvania State University study found that 175,000 high school girls nationwide reported taking steroids at least once in their lifetime. The National Institute on Drug Abuse found that 3.4% of all high school seniors report using steroids at least once in 2005. Nearly 2% of 8th graders admitted to using steroids

Illegal trade in anabolic steroids
Since anabolic steroids are often produced in different countries than in which they are distributed, they must be smuggled across international borders. Like most significant smuggling operations, sophisticated organized crime is involved, often in conjunction with other smuggling efforts (including other illegal drugs).

Unlike psychoactive recreational drugs such as cannabis and heroin, there have not been many high profile cases of individual smugglers of anabolic steroids being caught.

Production
Anabolic steroids need sophisticated pharmaceutical processes and equipment to produce, so they are produced by legitimate pharmaceutical companies or underground laboratories with large overheads.

In the 1990s most US producers such as Ciba, Searle and Syntex stopped making and marketing anabolic steroids within the US. However, in many other regions, particularly Eastern Europe, they are still produced in quantity. European anabolic steroids are the source of most medical grade anabolic steroids sold illegally in North America.

However, anabolic steroids are still in wider use for veterinary purposes, and many illegal anabolic steroids are actually veterinary grade.

Common problems associated with illegal drug trades, such as chemical substitutions, cutting, and diluting, affect illegal anabolic steroids such that when it reaches distribution the quality may be questionable or possibly dangerous.

Distribution
The majority of illegal anabolic steroids are distributed by interested parties (i.e. bodybuilders and athletes who themselves are users), rather than organised crime gangs. Anabolic steroids are sometimes dealt by contacts made at fitness centres and on athletic teams. However, the majority of anabolic steroids are obtained through contacts established through internet bodybuilding discussion forums. Typically, the potential buyer registers an anonymous handle and seeks out a "source" through forum moderators or on-line veterans. Once a source is found, the buyer contacts the individual through anonymous e-mail and requests a product and price list. The transaction then proceeds through private courier or U.S. mail. Increased seizures and the availability of high quality gray market alternatives such as IGF-1 would be likely to lead to a decrease in traditional anabolic steroid usage.

Minimizing the side effects
Typically, bodybuilders, athletes and sportsmen who use anabolic steroids try to minimize the negative side effects. For example, users may increase their amount of cardiovascular exercise to help negate the effects of left ventricle hypertrophy.

Some androgens will aromatise and convert to estrogen, potentially causing some combination of the side effects listed above. During a steroid cycle users may take an aromatase inhibitor and/or a SERM; these drugs affect aromatisation and estrogen receptor binding respectively. The SERM tamoxifen, is of particular interest as it prevents binding to the estrogen recepetor in the breast, reducing the risk of irreversible gynecomastia.

Furthermore, to combat the natural testosterone suppression and to restore proper HPTA function, what is known as 'post-cycle therapy' (PCT) is self prescribed. PCT takes place after the course of anabolic steroids. It typically consists of a combination of the following drugs depending on which protocol is used:


 * A SERM such as clomiphene citrate and/or tamoxifen citrate (this is the primary PCT drug).
 * An aromatase inhibitor such as anastrozole.
 * Human chorionic gonadotropin, HCG (this has become less common as it is now more often used throughout the cycle rather than after).

The aim of PCT is to return the body's endogenous hormonal balance to its original state within the shortest space of time.

Those prone to premature hairloss due to steroid use have been known to take the prescription drug finasteride for prolonged periods of time. Finasteride reduces the conversion of testosterone to DHT, the latter having much higher potency for alopecia. Finasteride is useless in the cases when steroid is not converted into a more androgenic derivative. Finasteride is also used as a masking agent by those who are subject to steroid testing.

History
Anabolic steroids are believed to have been inadvertently discovered by German scientists in the early 1930s, but at the time the discovery was not considered significant enough to warrant further study. The first known reference to an anabolic steroid in a US weightlifting/bodybuilding magazine is testosterone propinate in a letter to the editor in Strength and Health magazine in 1938. In the 1950s, scientific interest was rekindled, and methandrostenolone (Dianabol) was approved for use in the United States by the federal Food and Drug Administration in 1958 after promising trials had been conducted in other countries.

By the early 1990s several pharmaceutical companies stopped manufacturing or marketing the products in the United States, including Ciba, Searle, Syntex and others.

In addition, an entire market for counterfeit drugs emerged at this time. Never seen in the previous 30 years of their availability on the U.S. market, computers and scanning technology made the ease of counterfeiting legitimate products by utilizing their original label design, and the market was flooded with products that contained everything from mere vegetable oil to toxic substances which unsuspecting users injected into themselves, of which some died as a result of blood poisoning, methanol poisoning or subcutaneous abcess.

Concerns over the growing illicit market and the prevalence of abuse, combined with the possibility of harmful longterm effects of steroid use, led the U.S. Congress in 1991 to place anabolic steroids into Schedule III of the Controlled Substances Act (CSA). The CSA defines anabolic steroids as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promotes muscle growth. Most illicit anabolic steroids are sold at gyms, competitions, and through the mail. For the most part, these substances are smuggled into the United States. In addition, a significant number of counterfeit products are sold as anabolic steroids, particularly via mail order from websites posing as overseas pharmacies.

On January 20, 2005, the Anabolic Steroid Control Act of 2004 took effect, amending the Controlled Substance Act to place both anabolic steroids and prohormones on a list of controlled substances, making possession of the banned substances a federal crime.

List of anabolic compounds commonly used as ergogenic aids

 * Testosterone (attached to various esters enanthate, cypionate, propinate or suspended in oil or water)
 * Methandrostenolone / methandienone (Dianabol)
 * Nandrolone / Nor-testosterone (Deca-durabolin)
 * Boldenone (Equipoise)
 * Stanozolol (Winstrol)
 * Oxymetholone (Anadrol-50)
 * Oxandrolone (Anavar)
 * Fluoxymesterone (Halotestin)
 * Trenbolone (Fina)
 * Methenolone Enanthate (Primobolan)

NB: many of these products are no longer available from the original manufacturer and are now manufactured by "underground" laboratories in the United States, Mexico, and Canada, but are still widely available in certain countries, in most cases from a subsidiary of the original manufacturer (e.g. Schering, Organon).