Examination of the adverse effects of anabolic steroids

It is advisable to ask about steroid abuse if the patient’s symptoms seem to stem from the adverse effects of anabolic-androgenic steroids. The fear of being stigmatized is sometimes associated with the use of doping substances and the patient won’t necessarily want to talk about his/her use openly. This article describes what a doctor should examine when the adverse effects caused by steroid use are suspected.

Adverse effects of anabolic steroids

General symptoms

• The effects on moods can vary from pleasure to depression or expressions of aggressiveness.

Dermal symptoms

• Acne
• Dermal swelling

Liver function

• Steroids disturb the liver function (users usually have very abnormal results from liver tests)
• Liver tumors

Heart and blood vessels

• Steroids raise blood pressure, thicken the aortic wall and can damage the heart
• Steroids worsen cholesterol values (good cholesterol decreases and bad cholesterol increases)
• The risks of coronary artery disease, heart infarct and sudden death of a cardiac origin increase strongly

Male sexual functions

• Sperm production decrease in testicles (infertility)
• Prostate enlargement
• With prolonged use testicles shrink and the risk of prostate cancer increases
• Breasts grow
• Sexual desire may increase initially, but usually after use, impotence appears

Female sexual functions

• Menstrual problems
• Decrease of breast size
• Voice gets lower
• The clitoris grows
• Womb shrinks.

The basic examination

The following tests are suitable for the basic examination of anabolic substances users:

Liver function

• ALAT (liver enzyme from the blood)
• Ultrasound examination of the liver gives more exact information about liver tissue structure

Sex hormones and fertility

      For men

• Sperm analysis from semen
• Testo (testosterone) and FSH (follicle-stimulating hormone) from a blood sample
• In recovery phase, LH (luteinizing hormone) from a blood sample

      For women

• Information about the menstrual cycle if menstruation has stopped for a long time
• Testo (testosterone), Estrad (estradiol, female hormone) and FSH (follicle-stimulating hormone) from a blood sample

Fat metabolism

• Over-all cholesterol
• Bad cholesterol (LDL-KOL)
• Good cholesterol (HDL-KOL)
• Triglyceride value (Trigly), from a blood sample

Thyroid gland function

• TSH (thyroid stimulating hormone) from a blood sample

Heart and circulatory system

• Blood pressure (RR) measurement
• Electrocardiogram (ECG)
• X-ray photograph of lungs (thorax X-ray)
• Cardiac ultrasound is an excellent examination to find any thickening of the heart wall or abnormal heart structure.

Other

• Depression and dependence can be evaluated by standardized questionnaires.
• Use of unclean needles causes the risk of liver inflammation (hepatitis) and HIV infection. These infections can be detected by laboratory tests.

The patient should remember that the doctor is obliged to maintain confidentiality. Tell your reliable doctor about steroid use so further examinations will be easier.

Olli J Heinonen
Professor, Specialist Doctor of Sports Medicine
Paavo Nurmi Centre
University of Turku