Steroid Use

Irritable, angry, aggressive, but feeling strong and invincible, Mr. A, 32, a bodybuilder and prison guard, stopped at a convenience store to call his boss. Car trouble on the way to work.. He would be late.

-With permission of Steve Michalik. Mr. Michalik, a former Mr. America and Mr. Universe, once used steroids and suffered as a result. He is now an energetic and outspoken opponent of steroid abuse.

Mr. A was taking his fifth cycle of anabolic-androgenic steroids (abbreviated in this article as "steroids"), and he was "stacking," combining high doses of several different steroids, sometimes referred to by the slang term "juice." The woman working at the convenience store noted his uniform and joked, "You officers use my phone so much, I ought to start charging for it." Mr. A was strangely disturbed by this remark. He felt that the woman had criticized and demeaned him, and he was obsessed by the remark that afternoon and throughout the night. He slept poorly. His wife could not reassure him.

'Roid Rage

Later, he said that he wanted to "scare the lady in return for that remark she made to me." In the morning Mr. A drove back to the convenience store and forced the woman into his car. She fought back, biting his hand and grabbing his revolver which fired through the windshield. Although he subdued her and drove away, when the car stopped she bolted from the car. He shot her in the back as she fled, leaving her permanently paralyzed. Mr. A was later arrested, tried, and sentenced to twenty years in prison. After his arrest and withdrawal from steroids, he developed major depression which resolved in a month.

This case and several other cases of homicide or near-homicide by anabolic steroid abusers are presented in an article by Dr. Harrison Pope, Jr., and Dr. David Katz in the January 1990 Journal of Clinical Psychiatry. In another example, a 23 year old man, a bodybuilder, developed mood changes, aggressiveness, and explosive anger while taking anabolic steroids. To intimidate people, he began to bite chunks out of aluminum cans and rip phones off walls. He was later convicted of murder for beating a hitchhiker to death. A 24 year old man, also a bodybuilder, developed a similar syndrome while taking anabolic steroids and tried to kill his former fiancée.

Performance Enhancement by Steroids

Anabolic-androgenic steroids are derived from the male hormone testosterone. "Anabolic" refers to the muscle building effects of these drugs, and "androgenic" refers to the drugs' enhancement of male sexual characteristics such as hair growth and deepening of the voice. Steroids increase muscle mass, strength, and athletic performance.

Adverse Effects

Steroids can cause serious adverse health effects. Side effects most often noted by abusers themselves are acne, increased sex drive, increased body hair, and aggressive behavior. There may be unfavorable changes in blood lipids which have the potential to damage the heart and blood vessels. High dose steroids usually cause temporary infertility. Some steroids may cause liver problems. Tendon rupture and gynecomastia (enlargement of the male breasts) may occur.

Females who abuse steroids may develop baldness, deepening of the voice, and enlargement of the clitoris, all of which may be permanent.

Steroid abusers have an increased risk of heart attacks and suicide. There have been many reports of a variety of other serious health problems associated with steroid abuse, but for many of these problems, it is difficult to know whether steroids are the direct cause.

Psychiatric Effects of Steroids

Psychiatric effects of steroids can include aggression, hostility, violence, mood disturbances such as depression or an abnormally elevated mood, and even psychosis. Psychosis is a serious mental disorder characterized by loss of contact with reality, often with disturbed behavior, hallucinations, paranoia, and other symptoms. Dependence on steroids can occur, and withdrawal symptoms may be seen in some abusers after they stop the drugs.

How Buff Can You Get Without Steroids?

There is a limit to the muscularity athletes can achieve without drugs. The degree of muscularity can be measured by the fat-free mass index (FFMI). In one study, researchers measured FFMI values in a group of athletes, some of whom used anabolic steroids (Kouri EM, Pope HG Jr, Katz DL, Oliva P, Clinical Journal of Sports Medicine 1995;5:223) Men who did not lift weights usually had an FFMI between 18 and 21. FFMI values were in the low 20s (range 21 to 25) in bodybuilders who did not use steroids. Steroid users had FFMI values in the upper 20s or even low 30s. Nonusers all had FFMI values less than 25.0, while many of the steroid users were well above this limit.

In the same study, FFMI values were estimated from photographs of Mr. America winners from the pre-steroid era, 1939 to 1959, and from photographs of a group of modern bodybuilders pictured between 1989 and 1994 in bodybuilding magazines. The Mr. America winners’ FFMI averaged 25.4, but the modern bodybuilders’ FFMI values were all higher than this.

Thus, fat-free mass index (FFMI) may help determine whether an athlete is using anabolic steroids. An FFMI over 25 is extremely likely to indicate anabolic steroid use, although a number of steroid users may have an FFMI below this value.

Steroid Abuser and Non-Abuser charteristics

Steroid User and Non-User - charteristics in pictures

Physical effects of anabolic steroid use. These photographs compare a "natural" bodybuilder who has never used anabolic steroids (left) with a man who has used large doses of anabolic steroids over several years (right). Both men are 67 in. tall and have 7 percent body fat. The man on the left weighs 170 lbs and represents approximately the maximum degree of muscularity obtainable without drugs. His fat-free mass index (FFMI) is 25.4. The man on the right weighs 213 lbs. and has a fat-free mass index (FFMI) of 31.7. Note that the muscle hypertrophy from steroid use is particularly marked in the upper body in the pectoralis, deltoid, trapezius, and biceps muscles. Any man significantly more muscular than the man on the left has almost certainly abused anabolic steroids.

-Kaplan & Sadock's Psychiatry. 8^th ed. Philadelphia: Lippincott Williams & Wilkins; 2005: p. 1323. courtesy of Dr. Harrison Pope and Lippincott Williams & Wilkins.

While the FFMI may represent a useful screening test for anabolic steroid abuse, the definitive test is the detection of steroids or their metabolic products in the blood or urine.

Why Would Anyone Abuse Such Dangerous Drugs?

The media report almost daily on the ongoing scandal of steroid abuse in professional sports. It’s easy to understand the reasons for steroid abuse by intensely competitive professional athletes. They are often willing to risk serious adverse health effects for an improved appearance or for increased strength and athletic performance. Some nonprofessional athletes abuse steroids for similar reasons.

Steroid abuse by athletes should remind us of similar choices made by nonathletes to sell their souls or well-being for money, power, sex, fame, professional achievement, or other goods. Hopefully, better information about the adverse health effects of anabolic-androgenic steroids will convince more people to forgo this dangerous form of drug abuse.

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