Sustanon 250

Sustanon 250 is the trade name for a mixture (or ‘blend’) of 4 different variations of esterified Testosterone in a particular ratio. It typically contains: 30mg of Testosterone Propionate, 60mg of Testosterone Phenylpropionate, 60mg of Testosterone Isocaproate, and 100mg of Testosterone Decanoate for a total of 250mg worth of combined Testosterone esters (hence the number 250 in the name Sustanon 250). The idea in combining all of these different Testosterone esters is to provide a Testosterone drug that will provide the user with both a fast immediate release of Testosterone followed by a slower more extended release. The opposite of such a drug would be single forms of esterified Testosterone, such as a Testosterone Propionate product, which, of course, contains nothing but Testosterone Propionate in the vial.

Sustanon was developed and manufactured by Organon and it was in the early 1970s that it entered the market. The idea behind it was to provide a preparation of Testosterone that would have an advantage over single esterified Testosterone products in a medical and clinical setting. The idea here was also that of convenience, as Sustanon 250 requires more infrequent injections than does Testosterone Propionate or Testosterone Suspension, for example. What is interesting to note is that Sustanon 250 was never approved for use or sale in the United States, but Sustanon 250 remains a very popular drug on the international market. Sustanon 250 is most likely one of the most popular Testosterone preparations in use by bodybuilders and athletes. It was commonly thought that this was the case due to misconception that its more potent than single esterified forms of Testosterone, but this is not true. Esters attached to different anabolic steroids only affect the half-life and release time of whatever anabolic steroid they are bound to. In the case of Sustanon 250, there are four different esterified types of Testosterone to be considered – but Sustanon 250 is no more ‘potent’ of a Testosterone product than a straight Testosterone Enanthate preparation, for example.

The real true and primary reason for its popularity among athletes and bodybuilders is instead the amount of steroid one is getting for the money spent. A blend of four different esterified Testosterone variants is considered a great value for the money spent in comparison to the purchase of a single esterified Testosterone variant. However, over the years this price difference has not proven to be extremely advantageous over other forms of Testosterone. The sheer truth of the matter is that Sust 250 was not developed for athletes and bodybuilders, but instead with medical application in mind, and it is therefore an optimized product for those requiring medical treatment from it. The idea with this product was to provide patients with a far more convenient and comfortable dosing schedule where administration of the drug is concerned. Many patients prescribed it need only to worry about an injection every 3 – 4 weeks. As a bodybuilder or athlete, this is very unrealistic seeing as though athletes and bodybuilders would require injections of this product weekly, and blood plasma levels of Testosterone as a result would end up peaking to the same levels in the same amount of time that any other type of Testosterone product would end up doing. Therefore, the perceived benefits of Sustanon really do not apply to bodybuilders or athletes, or to individuals looking to use it for the purpose of performance/physique enhancement.

The properties of Sust 250 is what one would expect from any Testosterone preparation. It is important to remember that Sustanon 250 is simply only Testosterone with a mixture of different release times. Therefore, the typical properties and effects are exactly what any expectations would be from Testosterone.

Testosterone is literally the original anabolic steroid, produced naturally within all humans and most animal species. It is considered the safest anabolic steroid one could use, due to the fact that it is the hormone that each individual’s body already produces, already uses, and is already accustomed to. Therefore, the use of Testosterone for the purpose of performance and physique enhancement is simply the equivalent of introducing more of a hormone into the human body that it already manufactures and uses.

Steroids and Injecting Anabolics: The Highs, Lows and Woes

Anabolic steroids are drug versions of the male hormone testosterone. Like most drugs, steroids can be taken by mouth or delivered by intramuscular injection. Tablets are a convenient way of taking medications: You simply pop them into your mouth and swallow. Injectable drugs, on the other hand, are a little less convenient, as they require a needle, a syringe and a sharp pinch.

The side effects are similar for both tablet and injectable versions of steroids. Generally speaking, the health risks are predominantly dose-related'the bigger the dose, the greater the risk. But tablets and injections differ slightly when it comes to complications. Tablets are potentially more harmful to the liver. Any drug that is absorbed from the gut passes through the liver before it's distributed elsewhere in the body. And when taken in large amounts by mouth, some drugs cause liver damage. Examples include an acute overdose of acetaminophen (Tylenol) or long-term alcohol excess. Anabolic-steroid tablets can also upset liver function when taken in large doses, so many steroid users choose injectable forms of the drugs to minimize toxic effects on the liver. Injectable versions are placed into muscle and released directly into the bloodstream, without passing through the liver first. That means larger doses can be injected without making the liver take a big hit. There's a trade-off, however. Although the liver is partly spared drug toxicity, injections are not risk-free.

Injection Problems

Sticking a needle into your body is not without risk'particularly if the person giving the injection hasn't been trained in the procedure. The common side effects of poor injection technique are as follows:

• Pain
• Bruising
• Scar-tissue buildup
• Nerve injury
• Infection or abscess
• HIV or hepatitis (from needle sharing)

Injection problems are unrelated to the type of drug inside the syringe. They are purely the result of the needle stick. It doesn't matter whether the syringe contains a steroid, growth hormone, insulin or synthol.

Pain. 
Intramuscular injection inflicts two forms of pain. The first is that sharp pinch as the needle penetrates the skin. The second is a deeper discomfort, as the injection pushes the muscle fibers apart, creating a pocket of fluid. The larger the volume of fluid, the greater the pain. Bigger muscles like the gluteals, or buttocks, and thighs can comfortably accommodate two to three milliliters of fluid. With smaller muscles like the shoulders one milliliter is about the limit. The fluid disappears as the drug gets absorbed, but the site remains slightly damaged and inflamed from the needle stick for a while longer. The degree of pain and how long the drug sits there depend on the type and brand of drug. For example, many steroid users report that injecting the drug Sustenon is like getting kicked in the butt by a horse. This long-acting, oil-based steroid sits in the muscle for several days, and the pain in the butt can last up to a week. If you inject into the same site within the space of a few days, you can double the amount of fluid, double the damage and double the pain. Water-based injectables like Winstrol are usually quicker-acting'they're more quickly absorbed and usually inflict less pain than the oil-based drugs.

Needle size also influences the amount of pain. Larger-diameter needles cause more damage than narrower ones. Needle diameter (in millimeters) is called the gauge. The larger the gauge, the finer the needle in thickness. Obviously, finer needles cause less tissue damage. The narrower the needle, however, the more difficult it is to push the fluid through, and the viscosity of oil-based steroids is simply too thick to pass through tiny needles. It's like a large pit bull trying to squeeze through a tiny cat door. And the small particles in some steroid suspensions, like Winstrol, can lodge in the barrel of small-diameter needles. As a rule of thumb, oil-based steroids can be injected with a 22-gauge (0.7 mm) needle, and the less viscous, water-based steroids can be delivered through 23- or 25-gauge needles. To improve comfort and safety with regular injections, it's better to use the smallest needle possible.

The length of the needle is also important. You need a 1 1/2-inch needle to deliver a deep intramuscular injection into larger muscles like the buttocks, whereas a shorter 5/8-inch or half-inch needle can be used to inject smaller muscles. If you sink a two-inch needle into a smaller muscle, you're likely to hit an underlying nerve or blood vessel.

Bruising. 
Every time a needle pierces muscle, a small amount of bleeding inevitably occurs. Under normal circumstances that's not a problem. But if the needle hits a blood vessel, the blood loss into the surrounding tissue can cause an unsightly (and painful) bruise, or hematoma. An injection-site bruise doesn't usually require treatment, but it will take a week or so to resolve. Bruising can be minimized by applying direct pressure on the injection site with a cotton swab or facial tissue. Keep pressing for a minute or two until you're sure the bleeding has stopped. Remember that a trained health-care worker draws back on the syringe before injecting. A back-flow of blood into the syringe indicates that the needle is in a blood vessel. Injecting an oil-based steroid directly into the bloodstream is hazardous, so the needle should be re-sited into muscle tissue before pushing the plunger.

Scar tissue.
An injection needle actually damages muscle. As it plunges inside, it inflicts a tiny hole that heals by forming a scar. A small slither of scar tissue from one injection is no big deal; however, repeated needle sticks eventually create a large area of scarring. And subsequent injections into the hard scarification become more difficult and painful. It's like trying to stick a needle through the sole of a leather shoe'you'll need a hammer to get that needle in your butt. What many bodybuilders don't realize is that scar tissue is not normal muscle tissue'it doesn't contract. It just sits there in the muscle like a golf ball.

Site injection with the oil implant synthol'a practice I call 'spot welding'also creates scar tissue. The muscle tissue becomes inflamed, eventually forming a bump of scar tissue that resembles a tumor. The spot weld doesn't contract: It's false, a fake bulge, the kind you see on a padded bra.

So how can you minimize scar tissue buildup? You've got to reduce the number of injections in the same area. Give your poor butt a rest. There are several ways to achieve this: Stop injecting (duh!), cut back on injectable drugs, or rotate injection sites. Employing an injection-site rotation means using a different site each time you inject, thereby avoiding injecting into the same area for at least a week or two. To illustrate that point, let's say that you require regular intramuscular injections for a legitimate medical reason. The qualified technician would select a different injection site each time.

For example: injection

1. right buttock; injection 
2. left buttock; injection 
3. right thigh; injection 
4. left thigh; injection 
5. right buttock again; and so on. 

Get the idea?

Nerve damage.
Be warned that injecting into other muscle sites is not as risk free as it may seem. Over the years I've treated a number of bodybuilders with injection-related complications. It's scary how bodybuilders play their own version of Russian roulette with steroid injections, blindly stabbing different bodyparts without knowing the location of nerves and blood vessels. Most muscles are intimately adjacent to nerves, blood vessels and other important anatomical structures. For instance, the radial nerve lies immediately under the triceps horseshoe, the sciatic nerve under the lower portion of your glutes and the quadriceps teardrop directly over the lining of the knee joint. If your misplaced needle hits an artery or vein, the extra blood loss creates a good-sized bruise. Strike a nerve with your needle, and it feels like an electric shock. The damaged nerve can result in loss of feeling and muscle weakness.

So what are the safe injection sites? Unfortunately, an in-depth anatomy lesson is beyond the scope of this article, but medical texts will tell you that the three commonly used safe sites for administering intramuscular injections are as follows:

• the upper outer quadrant of the gluteal (buttocks) muscle
• the outer aspect of the mid-to-upper thigh
• the outer portion of the deltoid (shoulder) muscle.

Infection.
Another possible side effect of poor injection technique is infection. That usually results from accidental contamination of a needle. All injections should be given using a sterile technique in a clean environment, without contaminating the end of the needle. The locker room of your local gym doesn't qualify as a sterile area.

Cleansing the skin with an alcohol swab can help reduce the risk of infection. If the needle does get dirty after it's removed from the sterile packaging, then there's a risk of introducing a bacterial infection under your skin. That can develop into an abscess filled with pus, which usually needs to be lanced or surgically removed. Fake or counterfeit steroids that have not undergone proper sterilization can also increase the risk of bacterial infection.

How can you tell when an injection site is infected? Well, the area is painful, swollen, red and warm to the touch. As the days pass, an infection gradually gets worse rather than better. In contrast, the pain and redness from a noninfected injection-site irritation resolves within a few days. If you don't get treatment for an infected injection site, the infection can spread, causing you to feel generally unwell, with a fever. If you reach that stage, you need to see a doctor right away.

Hepatitis and HIV.
A more serious complication arises from sharing needles. That hazardous practice risks the transmission of HIV (AIDS) and hepatitis B or C. During the 1980s there were a few reported cases of HIV infection in bodybuilders sharing needles, but let's hope no one is crazy enough to share these toys nowadays.

If everybody jumped off a cliff, would you? Or would you stop for a moment and look before you leaped, considering the consequences of your actions, rather than regret your decision when it's too late? Self-administering anabolic steroids is illegal, and so is the unlawful possession of needles and syringes. If you don't have some form of medical training, administering intramuscular injections can be risky, so please make safe, sensible decisions. If you do run into any problems, seek the advice of a medical doctor immediately.

What to eat when using Anabolic Steroids

Anabolic steroids have a ‘building’ effect on the body. They increase synthesis of cellular and sub-cellular structures and are responsible for the increase of overall muscle mass. Steroids have widespread use and indications; they also have powerful adverse effects on almost all systems of the body and should therefore be administered carefully and if possible, locally. Systemic steroid administration is a critical thing and should be done very carefully and only after prescription of a doctor. Systemic administration is either through antral route (oral) or parentral route (intramuscular).

Protein-rich diet
Steroids increase synthesis of proteins in the body. The overall result is increase in muscle mass and this lean body mass increasing effect of the steroids is the reason athletes all over the world use it so frequently. Increase in muscle mass is naturally accompanied by the increase in muscle strength. This is also the reason of steroid administration in people with debilitating diseases like AIDS or chronic hepatitis.

This is only possible if sufficient raw material is present. The raw materials required for protein synthesis are amino acids. These amino acids are acquired from the daily diet. Animal proteins are similar to human proteins. These proteins after consumption are broken down into their component parts. These component parts are then used for building human proteins. It is necessary to eat all sorts of meat including mutton, beef and chicken to stay healthy. Other sources of animal protein include eggs, milk, yogurt, cheese, etc.

Other types of amino acids can also be obtained from pulses but plant proteins are not as beneficial as the animal proteins. Their amino acid content differs remarkably. However, for complete protein diet, both types of amino acids are required.

Eat sufficient Cholesterol
Steroid hormones have a cholesterol nucleus in their structure. This means cholesterol is necessary for the synthesis of steroid hormones in the body. When on the steroid hormone therapy, it is important to take cholesterol rich diet so that the hormone synthesis within the body also boosts up. Substances rich in cholesterol include egg yolk and dry fruits like cashews, pistachios, and almonds.

Too much cholesterol is however, not recommended. This is because if blood cholesterol is very high, it starts depositing in blood vessels. This might cause arterial occlusion and can be even more harmful if the rough surface of cholesterol plaque activates coagulation system of the body. The resulting blood clot will decrease the diameter of the blood vessel even more and may even dislodge and form embolus in the arteries of the brain or lungs.

Consumption of Complex Carbohydrates
Consumption of complex carbs is important. Fiber adds bulk to your food and prevents constipation. By adding bulk, it also prevents over-eating. Consumption of simple sugars depends upon the condition of the patient. If steroid production in the body is less, simple sugars are recommended. Simple sugars increase insulin levels in the blood, which in turn boosts estrogen production. These carbohydrates are however, contra-indicated in people undergoing steroid cycle management to control the excess amounts of steroid hormones being produced in the body.

Caloric requirement with steroid therapy
Caloric requirements increase when on steroid therapy. This is because insulin levels in the body increase and these increased levels decrease the blood sugar making the person feel hungry. Instead of eating abundantly three times a day, eat small infrequent meals. Splitting your daily food into six and seven small meals is helpful and results in a much better utilization of the energy reserves of the body.

Foods rich in Potassium
Steroids cause blood potassium levels to deplete. Potassium is a very important cation. It is necessary for maintaining resting membrane potential and so prevents muscles from contracting or the nerves from firing impulses in the absence of sufficient stimulation. It is better to incorporate potassium rich foods in your daily diet like apricot, peaches, dates, and milk. Low potassium levels can cause abnormalities pumping of the heart. This can lead to arrhythmias in severe conditions and may even prove fatal.

Foods which neutralize HCL
Steroids can also be taken orally. A number of harmful effects like candidiasis accompanies oral intake of steroids . Candidiasis is oral thrush caused by yeast of normal flora called Candida albicantes, which are normally non-pathogenic, but manifests as oral or vaginal thrust or skin wounds. When the immunity of the patient is compromised, steroids blunt the rapidity and intensity of the immune response and therefore make the person prone to innumerable infections.

Moreover, steroids irritate the gastric mucosa. Due to this, HCL secretion increases and mucous lining of the stomach becomes prone to damage. It is best to eat foods like yogurt and milk, which neutralizes stomach acid and protects the epithelium from corrosion.

It is best to avoid foods that can further harm the GIT mucosa, including:

• Spicy foods
• Fruits rich in citric acid like oranges, lemons
• Fizzy drinks and alcohol
• Coffee and tea. Caffeine and theophylline present in coffee and tea respectively, stimulate gastric glands and thus increase production of gastric acid.

Do not take non-selective COX inhibitors or COX-1 inhibitors. These are drugs like aspirin. By inhibiting COX (or cyclooxygenase enzyme), they block the synthesis of protective prostaglandins which maintain the integrity of the gastric mucosa. In the absence of these prostaglandins, the mucosa becomes prone to damage by acidity.

Go for less salty items

Steroids alter the homeostasis of the body that results in salt and water retention and potential edema may be seen at sites where skin is loose such as on ankles, scrotum and eyelids. This can be controlled and prevented from being aggravated if low-salt diet is used. Avoid adding salt to curry or any other meal you consume. This has additional importance for hypertensive individuals as salt raises blood pressure. This increase in blood pressure is also due to the retention of water caused by increased salt intake. Avoid cheese, salted nuts, peanut butter and sausages as these contain a lot of salt in them.

Anabolic Steroid Side Effects

Anabolic steroids are effective in enhancing athletic performance. The trade off, however, is the occurrence of adverse side effects which can jeopardize health. Since anabolic steroids have effects on several organ systems, a myriad of side effects can be found. In general, the orally administered anabolic steroids have more adverse effects than parenterally administered anabolic steroids. In addition, the type of AS is not only important for the advantageous effects, but also for the adverse effects. Especially the AS containing a 17-alkyl group have potentially more adverse affects, in particular to the liver. One of the problems with athletes, in particular strength athletes and bodybuilders, is the use of oral and parenteral anabolic steroids at the same time ("stacking"), and in dosages which may be several (up to 40 times) the recommended therapeutical dosage. The frequency and severity of side effects is quite variable. It depends on several factors such as type of drug, dosage, duration of use and the individual sensitivity and response.

Liver Function

Anabolic steroids may exert a profound adverse effect on the liver. This is particularly true for orally administered anabolic steroids. The parenterally administered anabolic steroids seem to have less serious effects on the liver. Testosterone cypionate, Testosterone enanthate and other injectable anabolic steroids seem to have little adverse effects on the liver. However, lesions of the liver have been reported after parenteral nortestosterone administration, and also occasionally after injection of testosterone esters. The influence of anabolic steroids on liver function has been studied extensively. The majority of the studies involve hospitalized patients who are treated for prolonged periods for various diseases, such as anemia, renal insufficiency, impotence, and dysfunction of the pituitary gland. In clinical trials, treatment with anabolic steroids resulted in a decreased hepatic excretory function. In addition, intra hepatic cholestasis, reflected by itch and jaundice, and hepatic peliosis were observed. Hepatic peliosis is a hemorrhagic cystic degeneration of the liver, which may lead to fibrosis and portal hypertension. Rupture of a cyst may lead to fatal bleeding.

Benign (adenoma's) and malign tumors (hepatocellular carcinoma) have been reported. There are rather strong indications that tumors of the liver are caused when the anabolic steroids contain a 17-alpha-alkyl group. Usually, the tumors are benign adenoma's, that reverse after stopping with steroid administration. However, there are some indications that administration of anabolic steroids in athletes may lead to hepatic carcinoma. Often these abnormalities remain asymptomatic, since peliosis hepatis and liver tumors do not always result in abnormalities in the blood variables that are generally used to measure liver function.

Anabolic steroids use is often associated with an increase in plasma activity of liver enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (AP), lactate dehydrogenase (LDH), and gamma glutamyl transpeptidase (GGT). These enzymes are present in hepatocytes in relatively high concentrations, and an increase in plasma levels of these enzymes reflect hepatocellular damage or at least increased permeability of the hepatocellular membrane.

In longitudinal studies of athletes treated with anabolic steroids, contradictory results were obtained on the plasma activity of liver enzymes (AST, AST, LDH, GGT, AP). In some studies, enzymes were increased, whereas in others no changes were found. When increases were found, the values were moderately increased and normalized within weeks after abstinence. There are some suggestions that the occurrence of hepatic enzyme leakage, is partly determined by the pre-treatment condition of the liver. Therefore, individuals with abnormal liver function appear to be at risk.

Anabolic Steroids and the Male Reproductive System

Anabolic steroids are derivatives of testosterone, which has strong genitotropic effects. For this reason, it will not be surprising that side effects include the reproductive system. Application of anabolic steroids leads to supra-physiological concentrations of testosterone or testosterone derivatives. Via the feed back loop, the production and release of luteinizing hormone (LH) and follicle stimulation hormone (FSH) is decreased.

Prolonged use of anabolic steroids in relatively high doses will lead to hypogonadotrophic hypogonadism, with decreased serum concentrations of LH, FSH, and testosterone.

There are strong indications that the duration, dosage, and chemical structure of the anabolic steroids are important for the serum concentrations of gonadotropins. A moderate decrease of gonadotropin secretion causes atrophy of the testes, as well as a decrease of sperm cell production. Oligo, azoospermia and an increased number of abnormal sperm cells have been reported in athletes using AS, resulting in a decreased fertility. After stopping anabolic steroids use, the gonadal functions will restore within some months. There are indications, however, that it may take several months.

In bodybuilding, where usually high dosages are uses, after stopping steroid use, often choriogonadotropins are administered to stimulate testicular function. The effectiveness of this therapy is unknown.

The various studies suggest that using more than one type of anabolic steroid at the same time ("stacking") causes a stronger inhibition of the gonadal functions than using one single anabolic steroid. After abstention from anabolic steroids these changes in fertility usually reverse within some months. However, several cases of have been reported in which the situation of hypogonadism lasted for more than 12 weeks.

A well known side effect of anabolic steroids in males is breast formation (gynecomastia). Gynecomastia is caused by increased levels of circulating estrogens, which are typical female sex hormones. The estrogens estradiol and estrone are formed in males by peripheral aromatization and conversion of anabolic steroids. The increased levels of circulation estrogens in males stimulate breast growth. In general, gynecomastia is irreversible.

Anabolic steroids may affect sexual desire. Although few investigations on this issue have been published, it appears that during anabolic steroids use sexual desire is increased, although the frequency of erectile dysfunction is increased. This may seem contradictory, but sexual appetite is androgen dependent, while erectile function is not. Since sexual desire and aggressiveness are increased during anabolic steroids use, the risk of getting involved in sexual assault may be increased.

Anabolic Steroids and the Female Reproductive System

In the normal female body small amounts of testosterone are produced, and as in males, artificially increasing levels by administration of anabolic steroids will affect the hypothalamic-pituitary-gonadal axis. An increase in circulating androgens will inhibit the production and release of LH and FSH, resulting in a decline in serum levels of LH, FSH, estrogens and progesterone. This may result in inhibition of follicle formation, ovulation, and irregularities of the menstrual cycle. The irregularities of the menstrual cycle are characterized by a prolongation of the follicular phase, shortening of the luteal phase or amenorrhea. Although these changes are generally more pronounced in younger women, large inter-individual responsiveness to anabolic steroids exists. The effects of anabolic steroids dosages as generally used in sport, on the hypothalamic-pituitary-gonadal axis in females are hardly studied.

Other side effects of anabolic steroid use in females are increased sexual desire and hypertrophy of the clitoris. The few systematic studies that have been conducted suggest that the effects are similar to the effects in patients, treated with anabolic steroids.

Anabolic steroid use by pregnant women may lead to pseudohermaphroditism or to growth retardation of the female fetus. Anabolic steroid use may even lead to fetal death. However, these side effects have not been studied systematically. It is likely that the severity of the side effects is related to the dosage, duration of use and the type of the drug.

Additional side effects of anabolic steroids specifically in women are acne, hair loss, withdrawal of the frontal hair line, male pattern boldness, lowering of the voice, increased facial hair growth, and breast atrophy. The lowering of the voice, decreased breast size, clitoris hypertrophy and hair loss are generally irreversible. Females using anabolic steroids may develop masculine facial traits, male muscularity, and coarsening of the skin.

When anabolic steroids are administered in growing children side effects include virilization, gynecomastia, and premature closure of the epiphysis, resulting in cessation of longitudinal growth.

Serum Lipoproteins and the Cardiovascular System

Anabolic steroids also affect the cardiovascular system and the serum lipid profile. Relatively few studies have been done to investigate the effect of anabolic steroids on the cardiovascular system. No longitudinal studies have been conducted on the effect of anabolic steroids on cardiovascular morbidity and mortality.

Most of the investigations have been focused on risk factors for cardiovascular diseases, and in particular the effect of anabolic steroids on blood pressure and on plasma lipoproteins. In most cross-sectional studies serum cholesterol and triglycerides between drug-free users and non-users is not different. However, during anabolic steroid use total cholesterol tends to increase, while HDL-cholesterol demonstrates a marked decline, well below the normal range. Serum LDL-cholesterol shows a variable response: a slight increase or no change. The response of total cholesterol seems to be influenced by the type of training that is done by the athlete. When a great deal of the exercise consists of aerobic exercise, the increasing effect of anabolic steroids is counterbalanced by an exercise-induced increasing effect, which may result in a net decline in total cholesterol. Aerobic training does not seem to be able to offset the steroid-induced decline in HDL-cholesterol and its subfractions HDL-2, and HDL-3.

The precise effect of anabolic steroids on LDL-cholesterol is unknown yet. It appears that anabolic steroids influence hepatic triglyceride lipase (HTL) and lipoprotein lipase (LPL). Males usually have higher levels of HTL, while females have higher LPL activity. HTL is primarily responsible for the clearance of HDL-cholesterol, while LPL takes care of cellular uptake of free fatty acids and glycerol. Androgens and anabolic steroids stimulate HTL, presumably resulting in decreased serum levels of HDL-cholesterol.

The effect of anabolic steroids on triglycerides is not well known. It is suggested that relatively low doses do not affect the serum triglyceride levels, while it cannot be excluded that higher doses elicit an increase.

No unanimity exists about the influence of anabolic steroids on arterial blood pressure. The response is most probably dose dependent. There is some data suggesting that high doses increase diastolic blood pressure, whereas low doses fail to have a significant effect on diastolic blood pressure. Increases in diastolic blood pressure normalize within 6-8 weeks after abstinence from anabolic steroids. It appears that repeated intermittent use of anabolic steroids does not affect diastolic blood pressure during drug free periods.

There is evidence that the use of anabolic steroids does elicit structural changes in the heart and that the ischemic tolerance is decreased after steroid use. Echocardiographic studies in bodybuilders, using anabolic steroids, reported a mild hypertrophy of the left ventricle, with a decreased diastolic relaxation, resulting in a decreased diastolic filling. Some investigators have associated cardiomyopathy, myocardial infarction, and cerebro-vascular accidents with abuse of anabolic steroids. However, a possible causal relationship could not been proved, because longitudinal studies that are necessary to prove such a relationship, have not been conducted yet. There is convincing evidence that oral administration of anabolic steroids has stronger adverse effects on the mentioned variables than parenteral administration.

Although the effects of anabolic steroids have an unfavorable influence on the risk factors for cardiovascular disease, no data are available about the long term effects. Most of the mentioned effects appear to reverse within 6-8 weeks after abstention. It is unknown, however, whether the structural changes as reported in the heart, are reversible as well.

Psychological Effects

Administration of anabolic steroids may affect behavior. Increased testosterone levels in the blood are associated with masculine behavior, aggressiveness and increased sexual desire. Increased aggressiveness may be beneficial for athletic training, but may also lead to overt violence outside the gym or the track. There are reports of violent, criminal behavior in individuals taking anabolic steroids. Other side effects of anabolic steroids are euphoria, confusion, sleeping disorders, pathological anxiety, paranoia, and hallucinations.

Anabolic steroid users may become dependent on the drug, with symptoms of withdrawal after cessation of drug use. The withdrawal symptoms consist of aggressive and violent behavior, mental depression with suicidal behavior, mood changes, and in some cases acute psychosis. At present it is unknown which individuals are particularly at risk. It is likely that great individual differences in responsiveness may exist. Some individuals try to minimize the withdrawal affects by administration of human choriogonadotropins (hCG), in order to enhance endogenous testosterone production. However, it is unknown in how far the hCG administration is successful in ameliorating the withdrawal effects.

Additional Side Effects

In addition to the mentioned side effects several others have been reported. In both males and females acne are frequently reported, as well as hypertrophy of sebaceous glands, increased tallow excretion, hair loss, and alopecia. There is some evidence that anabolic steroid abuse may affect the immune system, leading to a decreased effectiveness of the defense system. Steroid use decreases the glucose tolerance, while there is an increase in insulin resistance. These changes mimic Type II diabetes. These changes seem to be reversible after abstention from the drugs.

There are some case reports suggesting a causal relationship between anabolic steroid use and the occurrence of Wilms tumor, and prostatic carcinoma. In the literature also sleep apnea has been reported, which has been associated with AS-induced increased in hematocrit, leading to blood stasis and thrombosis.

AS use may affect thyroid function. Administration of anabolic steroids has been found to decrease thyroid stimulation hormone (TSH), and the products of the thyroid gland. In addition, thyroid binding globulin (TBG). These changes reversed within weeks after discontinuation of anabolic steroids use.

A serious consequence of anabolic steroids use may be the multiple drug abuse. On the one hand athletes use different kinds of drugs in an attempt to counterbalance the side effects: hCG, thyroid hormones, anti-estrogens, anti-depressants. On the other hand people try to support the anabolic effects of anabolic steroids by using additional anabolic hormones as for instance: different types of anabolic steroids at the same time, growth hormone, insulin, erythropoietine, and clenbuterol. Because most of this takes place outside the official medical circuit, it is likely that these practices may lead to serious conditions.