Are All Steroids The Same?

For the last few months, discussion of steroids has dominated sports columns. While there is good reason to be concerned about the misuse of “steroids” as performance-enhancing substances, using the term steroids indiscriminately is misleading. Most people have used a steroid at some time in their life, whether it was cortisone for a rash or an inhaler containing a steroid for the treatment of asthma, and have not used a performance-enhancing steroid. There are many different types of steroids, and they all have different effects on the body and appropriate uses in medical treatment. This review serves to name the three main groups of steroids, describe their uses/misuses, and important side effects.

WHAT ARE THE DIFFERENT TYPES OF STEROIDS?

Corticosteroids    Produced naturally by the adrenal glands, this group of hormones has many different functions which influences metabolism, fluid and salt balance, and the bodies' response to inflammation and stress [1].

Estrogens and Progestogens    The group of hormones that are important for sexual maturation in women, maintaining the female reproductive system, and in pregnancy [1]. 

Androgens    The androgens, also called the anabolic-androgen steroids or simply “ anabolic steroids ”, include testosterone and synthetic substances related to testosterone. This group is the most notorious of the three groups discussed here because of their unapproved use in sports. The term anabolic-androgen refers to the two main effects that testosterone and its synthetic relatives have. Anabolic refers to the drug's effects on building skeletal muscle. Androgenic refers to the drug's effects on the growth and development of the male reproductive tract and the development of secondary sexual characteristics like facial hair and deepening of the voice [2].

WHY DO PEOPLE USE …?

Corticosteroids    The most common use of this group is in reducing the inflammatory response seen in conditions such as rheumatoid arthritis, osteoarthritis, asthma and certain skin conditions. Corticosteroids can be used briefly or chronically depending on the condition.

These steroids are found in creams and ointments for the treatment and/or control of rashes and itching (i.e. hydrocortisone). They are also found in oral forms such as prednisone and injectable forms such as decadron and solumedrol. Inhalers used in the treatment of asthma and emphysema may contain a corticosteroid (i.e. fluticasone or beclomethasone) [1].

Estrogens and Progestogens      The most common use of this group is in providing contraception while it is also used frequently in postmenopausal hormone therapy and in treating osteoporosis. Replacement therapy in patients deficient in either hormones is also common [1].

Androgens    Testosterone is the most common form of this group and is approved by the FDA (Food and Drug Administration) for use in men who cannot produce the steroid on their own and in certain types of female breast cancer. Testosterone is commonly given as a cream or patch that is applied to the skin.

The non-approved uses of anabolic-androgenic steroids are centered on athletic performance enhancement and cosmetic reasons. The desire to obtain more muscle mass is common in many sports and increasingly seen in younger individuals. The preparations used for muscle gain can be given as an injection into muscle, applied as a cream or given by mouth.

WHAT ARE THE SIDE EFFECTS?

Corticosteroids    With brief use there may be difficulty sleeping (insomnia) and there may be an elevation in blood sugar and/or blood pressure. Chronic use may result in more significant side effects including weight gain, muscle weakness, decreased resistance to infections, and osteoporosis [1].

Estrogens/Progestogens    The most common side effects include breast tenderness and weight changes while the more serious and less frequent side effects include blood clots, cardiovascular disease, and hastening the progression of breast and/or endometrial cancer [1].

Androgens   The side effects of anabolic-androgenic steroid abuse are numerous as the doses commonly used for muscle growth are far greater than those used in replacement therapy. The side effects include undesirable body changes such as breast development and genital shrinking in men, masculinization of the body in women, and acne and hair loss in both sexes.

Use of anabolic-androgenic steroids may be associated with psychologic and behavioral changes, including significant mood swings, aggressiveness, and paranoid delusions [2] .

Because of their illegal nature, there are few studies investigating the risks of anabolic-androgenic steroids. However, isolated reports have suggested that there is a higher risk of heart attacks, strokes, and liver disease associated with these steroids [2]. Anabolic-androgenic steroid users who share needles when they inject steroids are at risk for contracting infectious diseases such as HIV/AIDS, hepatitis B and C.

ARE THERE ANY SPECIFIC SIDE EFFECTS OF ANABOLIC-ANDROGENIC STEROIDS IN CHILDREN?

They may include early closure of the growth plates in long bones, early puberty, and damage to the reproductive organs including the testicles [1].

Brian Bast, D.O.

Dept. of Physical Medicine and Rehabilitation

Mount Sinai Medical Center

References:

For more information on this and related topics please review the following sites:

www.nida.nih.gov/

www.findarticles.com