MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions

Abstract

Anabolic androgenic steroids (AASs) are appearance and performance-enhancing drugs (APEDs) used in competitive athletics, in recreational sports, and by body-builders. The global lifetime prevalence of AASs abuse is 6.4% for males and 1.6% for women. Many AASs, often obtained from the internet and dubious sources, have not undergone proper testing and are consumed at extremely high doses and in irrational combinations, also along with other drugs. Controlled clinical trials investigating undesired side effects are lacking because ethical restrictions prevent exposing volunteers to potentially toxic regimens, obscuring a causal relationship between AASs abuse and possible sequelae. Because of the negative feedback in the regulation of the hypothalamic-pituitary-gonadal axis, in men AASs cause reversible suppression of spermatogenesis, testicular atrophy, infertility, and erectile dysfunction (anabolic steroid-induced hypogonadism). Should spermatogenesis not recover after AASs abuse, a pre-existing fertility disorder may have resurfaced. AASs frequently cause gynecomastia and acne. In women, AASs may disrupt ovarian function. Chronic strenuous physical activity leads to menstrual irregularities and, in severe cases, to the female athlete triad (low energy intake, menstrual disorders and low bone mass), making it difficult to disentangle the effects of sports and AASs. Acne, hirsutism and (irreversible) deepening of the voice are further consequences of AASs misuse. There is no evidence that AASs cause breast carcinoma. Detecting AASs misuse through the control network of the World Anti-Doping Agency (WADA) not only aims to guarantee fair conditions for athletes, but also to protect them from medical sequelae of AASs abuse.

The multiple roles of steroids and anabolic steroids and its relations to cardiovasular and musculoskeletal pathology: a brief review

“…Such disorders concern stunted growth, among adolescents, where bone maturation becomes fast and then stops at an early age 45 , liver tumors, several conditions regarding sex characteristics, disorders of the reproductive system, and finally, abnormal enlargement of the heart muscles and blood lipid abnormalities which lead to cardiovascular ailments 46 . The overuse of steroids is revealed overwhelmingly by volatility, acne, rapid muscle augmentation and, additionally, male-type hair growth, deepening of the voice and enlargement of the clitoris in teen girls and young women 47 . It is strongly recommended that children fully understand the concept of using anabolic steroids which involves health risk, the possibility of legal trouble and the feeling of fraud and responsibility on the whole.…”

Subchronic nandrolone administration reduces cardiac oxidative markers during restraint stress by modulating protein expression patterns

“…AAS abuse, because of their anabolic effects, is detrimental to health [2][3][4][5]; nonetheless, AASs are widely used by athletes to increase muscle mass and power or enhance physical endurance [6]. Human and animal studies have reported discordant results regarding the cardiac and metabolic complications of AAS abuse [5,[7][8][9][10][11], with some suggesting that testosterone improves myocardial lipid metabolism [12] and may act as a cardioprotectant and coronary vasodilator comparable to conventional antiischemic drugs [13,14].…”

Determination of letrozole, anastrozole and exemestane by capillary zone electrophoresis

“…Also, ANA, LET and EXE are included in the Word Anti-Doping Agency Prohibited List [7]; these drugs are used in combination with anabolic steroids to prevent the onset of gynecomastia by estrogenic excess; aromatase inhibitors are also used by doped athletes as post cycle therapy in order to promote restoration of hypothalamic-pituitary-testicular axis integrity [8,9].…”