Anabolic Steroid Use, Misuse And Addiction Introduction Anabolic steroids have an important role to play in the treatment of medical conditions. There is, however, an illicit use of anabolic steroids. Today, most athletes, involved in sports activities that require greater strength, take anabolic steroids to increase their weight and strength. These sports include competitive sports like weight lifting, wrestling, and other strength based contests. In addition, people who are obsessed about having a “perfect” physical appearance also misuse anabolic steroids. The number of individuals using anabolic steroids for sports or to improve their looks is growing. This increased use of anabolic steroids is driven by the perception that they may give a person an edge when it comes to sports activities. Unfortunately, many individuals use anabolic steroids without regard for the disastrous impacts it can have on their bodies. Anabolic Steroids And Testosterone: An Overview Anabolic steroids are an androgenic hormone, and is also known by its proper name anabolic-androgen steroids (AAS). Testosterone is a natural anabolic steroid and it is the primary sex hormone in males. In order to understand anabolic steroids, it is important to know how testosterone works. Testosterone is vital for the development of reproductive organs like the prostate and testes. It enhances male sexual features such as increased bone mass, muscles and body hair growth.1 Testosterone also promotes health and overall wellbeing. For example, it helps ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 1 prevent osteoporosis. Many abnormalities in the body, such as bone loss or frailty, are associated with testosterone deficiency.2 Synthetic anabolic steroids are an artificial form of the male hormone testosterone. The two major impacts they have on the body are 1) an anabolic impact (the muscle building effect), and 2) an androgenic impact (the masculinizing effect).3 Anabolic steroids differ from corticosteroids such as prednisolone and cortisone. Corticosteroids do not deliver masculinizing or muscle building results. These corticosteroids are prescribed for asthma patients and people having skin problems. They are often medically prescribed as anti-inflammatories.4 Testosterone Formation and Impact Testosterone is produced by the adrenal glands, testes, placenta and ovaries. It is made from cholesterol through a complicated process that takes place in the steroid-producing glands. The total testosterone production in an adult male is around 7 milligrams per day.5 The stimulus for the formation of testosterone arises in the brain, specifically in the hypothalamus. The hypothalamus is a part of the brain where various hormones are produced. These hormones are linked to the function of other glands. For example, the hypothalamus secretes Gonadotrophin Releasing Hormone (GnRH), which is sent to the pituitary gland by special veins called the portal system. Once transmitted, the pituitary gland forms Luteinizing Hormone (LH). Luteinizing Hormone is then released into the blood.6 This hormone is sent to the testis, which is the gland where Leydig cells produce testosterone from stored cholesterol. ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 2 The feedback mechanism in the pituitary gland controls the rate of hormone production and it is regulated by the blood level of testosterone. With an increase in this level, the secretion of GnRH and LH hormone is reduced or may stop completely. This results in a decline in hormone production. If the opposite happens, i.e., if testosterone blood levels fall, then pituitary secretion is enhanced. In this way, the body maintains an equilibrium in hormone levels. Mode of Mechanism After the formation and secretion of testosterone into the blood stream, a greater percentage of the hormone is tied to protein as it is sent throughout the body. Only the untied or free-state testosterone is biologically active.5 The free-state testosterone in the blood makes up around 1 to 3 percent of the total amount of hormone found in circulation so only 1 to 3 percent of the testosterone level in the blood can interact with tissue receptors. Testosterone’s half-life (the time it takes for half of a substance to degrade or decay) is around 10 minutes. Once testosterone reaches the cell, it is turned into 5 alpha di-hydrotestosterone (DHT). The hormone is then bound to androgen receptors (AR) present in the cells. Finally, it is transported into the nucleus where critical muscle building reactions take place.7 Receptors for injectable or oral steroids works in the same manner. The actual protein production is based on the cell where the reaction takes place. Hence, a muscle cell may only produce muscle protein, irrespective of the kind of anabolic steroid used. After the formation of this complex material, it is then sent to the nucleus activating the ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 3 genes to form the appropriate proteins. These proteins are released into the cytoplasm of the cell to carry out their function. The features of the specific cell impact the response; for example, muscle cells only make muscle proteins and prostate cells are only able to form prostate protein due to steroid use. Variations in different drugs occur because of the impact of excess substances being freed into the bloodstream. Excess substances impact other organs like the brain. This may lead to abnormal emotional reactions.8 There is a limited number of receptors in a cell. Once the receptors are saturated, they are unable to combine with additional material, therefore limiting the anabolic impact of excessive doses and extended courses. This is called the refractory stage. Studies reveal that some steroids might bind to several receptors at a time. The most common receptor is the glucocorticoid receptor, where steroids replace cortisone. Corticosteroids impact the brain by breaking down tissues, and any hindrance in this activity is helpful for body building.9 Once the steroid course ends, the reverse action is initiated and an increase in catabolism results because of corticosteroids being used by the receptors again. This might be one of the reasons behind the weight loss experienced by some steroid users at the end of their course. After the metabolization of steroid in the nucleus, it is taken from the cell and degraded in the liver, where it is excreted in the urine or bile. The excreted byproducts differ from one androgen to another. These products are identified in sports through drug testing. The liver uses ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 4 testosterone fast, making it powerless as an oral anabolic agent until it is tied with another radical. For testosterone to be used orally, a chemical group is included with the molecule to enable its absorption in the stomach and to pass through the liver.10 This leads to an increased time frame of the testosterone action enabling more active substance to be in contact with the muscle cells. Impact of Testosterone Testosterone is vital for the development of external genitalia prior to birth and for the formation of sexual differentiation. These are the androgenic impacts of testosterone. In the puberty stage, it causes growth of masculine features like the deepening of the voice, muscularity, development of hair and secondary sexual characteristics. Testosterone secretion is increased in puberty leading to lightening of long bones and finally their closure of epiphyses. It also enhances the sebaceous glands secretions. The other major impact of testosterone is anabolic and the enhanced muscle growth that results.11 This muscle growth is the major attraction for athletes. All steroids hold androgenic and anabolic actions and the review of the chemical structure of widely used anabolic steroids shows these similarities. How do Anabolic Steroids Work? The following diagram explains how steroids work, starting with brain signals to produce testosterone that is eventually released into the bloodstream where they attach to certain cell receptors and function to regulate the production of testosterone.12 ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 5 The brain transmits chemical signals to the testes, intriguing them to form testosterone. The testes produce testosterone, which is then released into the bloodstream. Once they are the part of the bloodstream, anabolic steroids function like natural testosterone, to a great extent, adding to that which is already formed by testes. Testosterones are attached to MUSCLE cells, which boost growth. Testosterones are attached to receptors in different cells causing varied effects in the body. The brain identifies the levels of testosterone in the blood via a feedback mechanism and controls the amount produced. Anabolic Steroid Drug Prescribing And Use When anabolic steroids are prescribed for a person to use, he or she must have a full understanding of its positive and negative effects. For the non-medical user, the expectations may be unrealistic. Every person has different genetic structure. Diet regulation, stress, training and illness determine the body’s response to anabolic steroids. Steroids are usually given in cycles and are taken in stacks. Stacking implies a practice of using various drugs simultaneously. Stacking is ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 6 common among steroid users and can also include the use of other drugs besides steroids. Cycling refers to a steroid usage pattern, where drugs are being taken in cycles of a period for weeks followed by a drug free tenure. A key factor is the number and spread of androgen receptors in the muscles.13 There is no exact pattern of distribution of receptors but a majority of people have a greater concentration in their upper body, leading to a greater response in the arms than in the legs. The number slightly increases with the growth of muscle and this might be the reason why some athletes face greater pains with later courses.