Androgenic effects of steroids and why they can be less than great

Yesterday I wrote a brief explanation of the anabolic effects of certain types of steroids, and mentioned the fact that they make you "more manly". The post was also almost an advertisement for the drugs, which was unintentional; I just haven't got on to why you probably shouldn't take them yet.



Rather than being called 'anabolic steroids', the full name of the subset of drugs I've been talking about is 'anabolic-androgenic steroids', or AAS. The whole group of effects that I omitted are represented by the second A. These have a much broader range than the anabolic ones, and change depending on gender and stage of development. They include enlargement of the clitoris and infant penis (bizarrely, it causes the opposite in adult males), testicles, increased body & facial hair, decreased actual hair, and changes in the voice & libido. In puberty they stunt growth (amongst other things), and in fetal development they lead to emphasised male features in females, and vice versa.

All of these effects are largely effected through transcription of various genes, like before with the increased muscle mass. However, the androgen receptors that the steroids bind to also mess around with proteins outside of the nucleus, which control ion transport in and out of cells.

What I really wanted to focus on in this post was the pros and cons of AAS. Obviously some people would view increased muscle mass as an advantage in its own right, and that definitely is a positive effect for body builders using them. In a medical setting, that particular use of the drugs are more helpful to people with problems that have led to them having a massively decreased muscle mass - AIDS and some cancers can have this effect. In such situations, it's important to give the patient as much help with getting enough muscle to be able to move, to help them help themselves. This applies to things like people rehabilitating part of their body after a long period of inaction (e.g. following surgery) as well.
All AASes (definitely the correct plural form) have a ratio of anabolic to androgenic effects. It's worked out by castrating two groups of rats, giving one group the drug, then weighing the prostate gland and a specific muscle of all of them. The group without the drugs are used as a baseline, to work out the mean increase in mass of both - the increase of the prostate gland is representative of the androgenic effects and the muscle is representative of anabolism. With this information, doctors can select the drug that will have the effects they desire.
AASes with proportionally higher levels of androgenic effects can help to treat diminished function of the testes, to boost a patient's levels of adrogens.

Onto the cons: one major downer on the whole thing is that steroids can cause hypertrophy not only of the skeletal muscles, but also of cardiac muscles. You then have the situation caused by hypertension, where there is too much muscle for the coronary arteries to support, so some muscle dies, which is a heart attack. On a more minor note, because AASes include testosterone, which increases oil production, users can get acne. An excess of testosterone gets converted into estradiol by an enzyme. Estradiol is typically a female hormone, and leads to gynecomastia - moobs. Most of the list of symptoms I gave above were also bad for the user (in most situations). Perhaps the worst is that it's addictive, so these symptoms are hard to escape from, and if you do try to quit, withdrawal symptoms make it very hard. Interestingly, there have been no reported incidences of dependence when AASes have been used therapeutically, only when they are used to become more muscly. As far as I know, no one's sure why that is yet.