Anabolic steroids in athletics: How well do they work and how dangerous are they?
Pediatrics ; 5: Care was taken to align the echo image so that the annular motion was parallel to the TDI cursor. Associate Professor, MD Stefan Arver is acknowledged for consultation when selecting blood variables for analysis. Academic Medicine 72 5 , , J Drug Educ ;
We have to emphasize that this is the only ethically feasible approach to study long term effects of AAS abuse on athletes. Stal PS, Lindman R Characterisation of human soft palate muscles with respect to fibre types, myosins and capillary supply. We clearly demonstrated that long-term consumption of supraphysiologic doses of AAS is associated with higher values of inter- and intra-AEMD in healthy young bodybuilders. N Engl J Med ; Blood sample of 10 ml was collected from all subjects the same time in the morning after overnight fasting by venipuncture from the cubital vein.
Muscle hypertrophy is often evident by increased muscle fiber size and increased number of myonuclei. The latter is associated with satellite cell activation and myoblast infusion with the existing muscle fibers, leading to greater numbers of myonuclei in larger myofibers . In the present study, long term AAS supplementation was only associated with higher lean leg mass, but not with larger fiber size, indicating that muscle fiber hyperplasia may play a role in the muscle mass enhancement.
Coincidently, the number of myonuclei in type I fibers in the doped athletes was significantly higher than in the clean athletes, which may indicate satellite cell activation for muscle fiber hyperplasia. Not many studies have examined the effects of AAS on muscle capillaries. In a previous study of 20 weeks of graded testosterone enanthate injection 25, 50, , , or mg , Sinha-Hikim et al.
The authors suggested that it is not unlikely that a significant increase in capillaries takes longer than 20 weeks. In the present study, we observed more capillaries around both type I and type IIa fibers in the Doped athletes compared to the Clean group.
Importantly, when the parameter of capillaries per fiber CAF was calculated by fiber area CAFA , the significant difference in CAF between the two groups disappeared, indicating proportional and simultaneous increases in number of capillary around each fiber and in muscle fiber size in the Doped group.
These are the first results demonstrating an association between long term AAS supplementation and muscle capillarization. Consequently, AAS will enhance not only muscle strength, but also muscle endurance. It has been shown that combined administration of androgens and resistance training is associated with greater gains in lean body mass, muscle size, and maximal voluntary strength than either intervention alone .
However, some studies using lower AAS doses and shorter supplementation times have shown no gains in muscle strength  , regardless if lean body mass and muscle size were increased or not . Similarly, in the present study, the Doped group had higher lean leg mass, but lower leg strength.
It is worth to notice that compared to the Clean group, the Doped group presented larger variations in many of the measurements like leg lean mass Doped, AAS effects on muscles were stacking in some subjects but diminishing in the others.
This may explain, among other factors, the large variations in some of the measurements, and resulted in the non-significant differences between the two groups . Of course, the large variations in AAS dosage may also explain some of the variations.
Previous studies have shown that testosterone administration was associated with a dose-dependent increase in skeletal muscle mass, leg strength and power  ,  , . However, similar correlation between AAS dosage and leg lean mass or fat free body mass was not observed in the present study. One previous study has shown that days of transdermal testosterone treatment resulted in increase in leg press by 90 days but did not induce further improvement by days .
Another study by  has shown that major effects of AAS on muscle strength and lean body mass occurred over the first 12 months of testosterone administration to older men. In line with laboratory intervention studies  ,  , we observed that AAS dosage was significantly correlated with fiber area and nuclei number NIFA; Table 4. Some studies have shown more fiber size enhancement in type I fibers than in type IIa fibers both after short term  and long term  ,  AAS self-administration.
However, our results of fibre size changes in the doped athletes did not show similar fiber type specificity. Finally, if subject G, with extremely high AAS dose, was taken into calculation of correlation between AAS intake and maximal squat force relative to muscle fiber area, there seem to be an upper limit for AAS intake, beyond which further increase in AAS intake will suppress muscular adaptation and performance.
While all the Doped athletes have used AAS, the mix and quality of the substance are unknown. This may confound the estimation of AAS dosage as well as the effects on muscle morphology and performance. Additionally, post-study subjects de-coding revealed that Doped group was older and composed of athletes involved in bodybuilding and strongmen events, while Clean athletes were all power-lifters.
Consequently, training regiments were slightly different, even though all aiming at increasing muscle strength. Consequences for interpretation of data are several: To further explore the effects of long term AAS supplementation on skeletal muscles, more advanced techniques, such as proteomics and metabolomics should be applied in tissue analysing.
Again, we have to emphasize that the current study design is hard to be replicated in laboratory due to the extreme doses and duration of AAS supplementation.
Associate Professor, MD Stefan Arver is acknowledged for consultation when selecting blood variables for analysis. Conceived and designed the experiments: Contributed to the writing of the manuscript: Click through the PLOS taxonomy to find articles in your field. Abstract The effects of long-term over several years anabolic androgen steroids AAS administration on human skeletal muscle are still unclear. September 10, This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
Introduction Testosterone and other anabolic androgen steroids AAS are used by increasing population of professional and recreational athletes with the intention to increase muscle size and improve muscle strength  — . Materials and Methods Ethics Statement All participants were informed about the design of the study and written informed consent was obtained from all participants.
Subjects To investigate the long term effects of AAS supplementation on athletes, we recruited 17 strength training elite athletes through personal contact.
Self-reported intake of banned substances in the Doped group. Blood samples Blood sample of 10 ml was collected from all subjects the same time in the morning after overnight fasting by venipuncture from the cubital vein. Muscle samples Skeletal muscle biopsies were obtained from the vastus lateralis muscle using standard needle or forceps biopsy technique  , .
Statistical analysis Normal distribution of data was tested using the Shapiro-Wilk's test and visually inspected through normal quantile plot. Results Maximal muscle strength and anthropometry Group values of maximal muscle strength and anthropometry were presented in Table 2.
Muscle morphology Group values of measurements were presented in Table 2. Hormone level Because most blood hormone concentration were not normally distributed, data was analysed by non-parametric statistics Wilcoxon signed rank, Chi 2 approximation , and presented as median and minimum - maximum Table 3. Correlation analysis Table 4 was the results of correlation analysis between AAS dosage and all the other measurements.
Regression models for the effects of AAS intake on muscle performance. Correlations between AAS dosage and measured variables. Discussion The main findings of the study were that the doped athletes had higher lean mass, capillary density and myonuclei density, but lower maximal squat force relative to muscle mass and to fiber area, compared to the clean athletes.
AAS dose-dependent muscular adaptations Previous studies have shown that testosterone administration was associated with a dose-dependent increase in skeletal muscle mass, leg strength and power  ,  , .
Author Contributions Conceived and designed the experiments: Crit Care Med Eur J Endocrinol Thiblin I, Petersson A Pharmacoepidemiology of anabolic androgenic steroids: Kuhn CM Anabolic steroids. Recent Prog Horm Res J Strength Cond Res Int J Sports Med J Steroid Biochem Mol Biol J Clin Endocrinol Metab Ann Intern Med Friedl K Effect of anabolic steroid use on body composition and physical performance.
Anabolic Steroids in Sport and Exercise. Am J Physiol Endocrinol Metab LA areas and volumes were measured in the apical four-chamber and two-chamber views at ventricular end-systole maximum LA size and mean values of area and volume were obtained. LA mean volume was indexed to body surface area BSA [ 22 ].
Mitral inflow velocities were evaluated by pulsed-wave Doppler echocardiography with the sample volume placed at the tip of the mitral leaflets from the apical four-chamber view.
Diastolic peak early and peak late transmittal flow velocity, peak to peak velocities , and isovolumic relaxation time IVRT were measured [ 24 ]. Care was taken to align the echo image so that the annular motion was parallel to the TDI cursor. In apical 4-chamber view, the pulsed Doppler sample volume was subsequently placed at the level of LV lateral mitral annulus, septal mitral annulus, and right ventricular RV tricuspid annulus. The myocardial peak systolic and early diastolic velocity and late diastolic velocity were obtained from the septum, the lateral wall of the left ventricle, and the annulus of the right ventricle.
The Em global and Am global velocities were derived by averaging the velocities from the 2 mitral annular sites.
Atrial electromechanical delay AEMD was measured as the interval between the onset of the P wave on the electrocardiogram and the beginning of late diastolic Am wave at the lateral mitral annulus PA atrial electromechanical coupling lateral , septal mitral annulus PA septum , and RV tricuspid annulus PA tricuspid.
Values were averaged over three consecutive beats. In AEMD measurements, intraobserver variability was assessed in 20 selected subjects at random from the patient study group by repeating the measurements under the same basal conditions.
To test the interobserver variability, we performed the measurements offline from video recordings by a second observer. The intraobserver and interobserver variability for TDI calculated from 20 consecutive patients were 5. Continuous variables are expressed as mean standard deviation and categorical data are expressed as percentages.
Statistical comparison of quantitative data was performed by unpaired -test. Multiple regression analysis was used to identify significant predictors of inter- and intra-AMED. Thus, all predetermined independent variables that correlated with a value of less than 0. A value of 0. All statistical studies were carried out with the SPSS program version The characteristics of the subjects are listed in Table 2. No differences between groups emerged from age, height, weight, BSA, blood pressure, or heart rate.
Table 3 shows the details of the echocardiographic analysis. LV mass index, interventricular septal thickness, LV posterior wall thickness, and relative diastolic wall thickness were significantly greater in AAS users than in nonusers and sedentary controls.
Transmitral Doppler echocardiography data of LV diastolic function are listed in Table 2. No significant differences were found in peak and peak between AAS users and nonusers. However, drug-using bodybuilders exhibited longer isovolumetric relaxation times and lower ratio of than their drug-free counterparts.
Global and were significant difference in ASS users compared to nonusers versus , ; versus , , resp. Table 4 shows the atrial electromechanical intervals measured at the lateral, septal, and RV annulus by the tissue Doppler method. Interatrial and intra-atrial EMD values were significantly higher in the AAS using bodybuilders compared with those in the nonusers versus , ; versus , , resp.
There was also correlation between global , global , and inter-AMED , ; , , resp. Furthermore, it has been reported that myocardial infarction, cardiomyopathy, sudden death, cardiovascular morbidity, and mortality have significantly increased in long-term AAS using bodybuilders more than nonusers [ 28 ].
In addition, arrhythmic events were described secondary to the long-term intake of AAS. Although AF is the most frequently observed arrhythmia, ventricular arrhythmias were also described [ 8 — 11 , 29 ].
However, it is not clear that AAS using bodybuilders are more prone to rhythm disturbances compared with nonusers. The prolongation of intra- and inter-AEMD and the inhomogeneous propagation of sinus impulses are well-known electrophysiologic characteristics of the atria which is prone to fibrillation [ 12 , 13 ].
Also, Roshanali and colleagues have found that atrial electromechanical interval is a predictor of AF emerging after coronary artery bypass grafting and demonstrated that the preoperative administration of amiodarone to patients having longer atrial electromechanical interval has decreased the postoperative atrial fibrillation incidence [ 33 ]. Furthermore, De Vos et al. There are several studies that indicate impairment of LV diastolic function, which is known to play a role in the pathogenesis of AF [ 17 , 34 , 35 ], which was also found to be impaired in AAS using athletes [ 4 — 7 ].
When left ventricular diastolic dysfunction occurs, emptying of the left atrium is impaired as well. Following impaired left ventricular diastolic relaxation, there is increased atrial contribution to the mitral flow in the left ventricular diastolic flow, thus leading to atrial overstretching and enlargement [ 36 ]. The left atrium diameter is known to be correlated with cardiovascular events and is a risk factor for AF [ 37 ].
In this study, the left atrial diameters of the AAS user and nonuser groups were similar. However, the presence of left ventricular diastolic dysfunction in AAS user athletes is a controversial issue. Underground steroid handbook II.
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Testosterone replacement therapy of hypogonadal men with major depressive disorder: J Clin Psychiatry ; Increased aggressive responding in male volunteers following the administration of gradually increasing doses of testosterone cypionate. Drug Alcohol Depend ; Effects of chronic testosterone administration in normal men: J Clin Endocrinol Metab ; Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: Arch Gen Psychiatry ; Neuropsychiatric effects of anabolic steroids in male normal volunteers.
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Iamges: anabolic steroids google scholar
Effects of an anabolic steroid metandienone on spermatogenesis. J Am Coll Cardiol ; Increased aggressive responding in male volunteers following the administration of gradually increasing doses of testosterone cypionate.
However, the effects of AAS dosage on skeletal muscles have never been studied over a period of several years. Semin Liver Dis ; 7:
Blood samples Blood sample of 10 ml steroidd collected from all subjects the same test prop npp cutting cycle in the morning after overnight fasting by venipuncture from the cubital vein. Journal of general internal medicine 19 12, To investigate the long term anabolic steroids google scholar of AAS supplementation on athletes, we recruited 17 strength training elite athletes through personal contact. The effects of testosterone on body weight and composition in the rat J Googe 57 xxiv-xxv, Google Scholar. Int J Sports Med
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