Physical Effects of Anabolic-androgenic Steroids in Healthy Exercising Adults: A Systematic Review and Meta-analysis

Abstract

Many athletes use anabolic-androgenic steroids (AAS) for physical enhancement but the magnitude of these gains and associated adverse effects has not been rigorously quantified. MEDLINE, EMBASE, Cochrane, SPORTDiscus, and PsycINFO were searched to identify randomized placebo-controlled trials of AAS in healthy exercising adults that reported one of the following outcomes: muscular strength, body composition, cardiovascular endurance, or power. Two authors appraised abstracts to identify studies for full-text retrieval; these were reviewed in duplicate to identify included studies. Study quality was assessed using the Cochrane method. Data were extracted in duplicate and pooled using the DerSimonian and Laird random effects model and to calculate the ratio of mean outcome improvement where possible. Pooled standardized mean difference (SMD) in muscle strength between AAS and placebo was 0.27 (95% confidence interval, 0.07-0.47; I = 12.7%; 21 studies). Change in strength was 52% greater in the AAS group compared to placebo. The SMD for change in lean mass between AAS and placebo was 0.62 (95% confidence interval, 0.35-0.89; I = 26%; 14 studies). Due to missing data, fat mass, cardiovascular endurance, power, and adverse effects were summarized qualitatively. Only 13 of 25 studies reported adverse effects including increased low density lipoprotein (LDL), decreased high density lipoprotein (HDL), irritability, and acne. In healthy exercising adults, AAS use is associated with a small absolute increase in muscle strength and moderate increase in lean mass. However, the transparency and completeness of adverse effect reporting varied, most studies were of short duration, and doses studied may not reflect actual use by athletes.

Anabolic-androgenic steroids and cardiovascular risk

“…First, a general limitation of these studies results from the information about AAS doses and cycles of use/abuse, which is self-reported, and it is difficult to objectively assess the exact data. [84] Additionally, because of the stacking effect from polydrug abuse, it is difficult to assess the toxic effects of AAS. [85] These studies only demonstrated AAS-related cardiovascular lesions by observing the morphological and functional differences between the experimental group and the control group, which did not clarify the causality between AAS intake and disease development.…”

Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

“…In fact, testosterone, by binding to AR, produces an increased production of IGF-1, a decreased expression of myostatin and the differentiation of pluripotent mesenchymal cells into a myogenic lineage. These mechanisms are involved in an increase in protein synthesis, a decrease in protein breakdown, the formation of new myotubes as well as the increase in myonuclei number, thereby leading to the increase in muscle mass, strength and exercise capacity [94].…”

An Overview of Performance Enhancing Drugs (PED’s) in Sports and WADA

“…3,9 Adverse effects: The most common adverse effects include abnormalities in lipid profile (decreased high density lipoproteins and increased low density lipoprotein) and hepatic enzymes (increased aspartate aminotransferase); and mood disturbances (irritability, psychotic symptoms and depression). 10 The serious adverse effects include infertility in males, masculinisation in females, cardiovascular risks, tumours of liver and kidney and premature skeletal maturation. 3 Other less common ones include acne, alopecia, injection site reactions, increased haematocrit and decreased testicular size.…”

“…3 Other less common ones include acne, alopecia, injection site reactions, increased haematocrit and decreased testicular size. 10…”