- CARDIOVASCULAR SYSTEM:
– Reduction of HDL, increased LDL/TC => atheromatic index distortion (> 5) => increased risk of acute myocardial infarction (AMI)
– Cardiomegaly & Left Ventricular Hypertrophy (larger left ventricular mass, left ventricular index and interventricular septum thicknesses) => chronic heart failure, hypertension
– Altered endothelial integrity of coronary arteries => spasm, in combination with nicotine => ischemia (angina pectoris), chronic heart disease
– Increased serum levels of sodium & calcium=> arrhythmias (atrial/ventricular)
Most frequent causes of cardiovascular mortality in bodybuilders:
1) Heart arrhythmia (ventricular tachycardia) from CNS stimulants abuse, or hyperkalemia (elevated serum potassium), due to spirolactone abuse
2) AMI, as a result of poor atheromatic profile
3) Chronic heart failure, as a result of Left Ventricular Hypertrophy, mostly from Somatropin-Somatomedin C abuse (GH/IGF1)
- LIVER-BILIARY TRACT:
– Pharmaceutical hepatitis: Elevation of liver enzymes-transaminases (SGOT, SGPT/AST, ALT), mainly by 17 alkylated AAS per os (oxandrolone, stanozolone, methadrostenolone, oxymetholone, methyltestosterone, methyltrienolone-M3).
These elevations attributed to the intake of oral steroids are usually asymptomatic, transient and return to baseline levels within several weeks after cessation.
– Cholestasis => obstructive jaundice.
Clinical symptoms include nausea, fatigue, itching followed by dark-brownish urine (elevated urobilinogen) and jaundice (yellowing of the eye’s sclera, skin-elevated bilirubin).
Jaundice can be prolonged, even if AAS are discontinued.
Serum elevations of cholestatic markers (ALP, GGT, bilirubin-direct/indirect) are present.
GGT is the most distinctive enzyme for the detection of hepatic dysfunction.
Risk for varicose bleeding in the esophagus, since the venous plexus is seriously damaged.
– Hepatic peliosis (hemorrhagic cysts in hepatic lobes) => structural changes => severe liver dysfunction.
This rare syndrome is potentially reversible, under the discontinuation of AAS.
Otherwise hepatic rupture => sudden abdominal pain and severe internal bleeding => haemoperitoneum and vascular collapse
– Hepatocellular carcinoma, where liver transplantation is the therapy of choice for selected patients without the possibility of extrahepatic metastasis.
It should be noted that, during the autopsy of Andreas Munzer in 1996, multiple tumors in walnut size were found, on the surface of his liver.
- URINARY SYSTEM (KIDNEYS):
– AAS have a direct toxic effect on glomeruli => elevation of urea (> 50mg/dl), creatinine (> 1.5mg/ dl) => azotemia, uremia => mild renal insufficiency
– Protein and creatine supplements with a high protein intake of >300 g/day increase glomerular filtration rates and are associated with focal segmental glomerulosclerosis and acute tubular necrosis.
– During precontest preparation & glycogen depletion phase, the high consumption of animal protein (>3gr/kg) => ammoniaimia (Skin and sweat get a characteristic heavy odor of ammonia).
As known, ammonia is a waste product in urea cycle, being toxic to brain’s function.
– Ketosomes are detected in a biochemical analysis, as a result of a high protein-low carbohydrate dieting => exhalation of ketones (rotten apple smell)
– Excessive over-training causing rhabdomyolysis (CPK>1000) => microscopic hematuria (pinkish color), cylinders, proteinuria => acute tubular necrosis
– An acidic environment in the kidneys (pH<5) along with the increase of calcium retention (nandrolone abuse) => kidney stones
– Kidney tumors (Wilm’s tumor or nephroblastoma)
- REPRODUCTIVE SYSTEM (SEX GLANDS)
– Suppression of the HPTA => primary hypogonadism (normal/elevated levels of LH, FSH, low levels of total and free testosterone), which gradually turns into secondary (low levels of total and free testosterone, low levels of FSH,LH) or late onset hypogonadism => testicular atrophy, reduce in semen production and quality, oligo – or azoospermia, changes in libido => infertility
– Gynecomastia
– Hypertrophy of the prostate gland (BPH) => interruption during night sleep for urination (nichtouria), difficulty during the start of urination and the leakage of a small amount of urine on the underwear
– Malignant hyperplasia of prostate gland
– Masculinisation in women (acne, hirsutism, changes in libido, voice deepening, clitoris enlargement, menstrual irregularities and reduction of the breasts)
- HEMATOPOIETIC AND HAEMOSTATIC SYSTEM:
– Elevation of Hematocrit-Hemoglobin (erythrocytosis effect) => increase in blood viscosity => epistaxis (nose bleeding), raise in blood pressure and risk for thrombotic stroke => atherosclerosis => rupture of cerebral aneurism
– Prolonged coagulation time (PT, APTT, INR) => inadequate hemostatic ability
- NEUROLOGICAL – PSYCHIATRIC:
– AAS induced neurotoxicity.
A wide range of psychiatric side effects induced by the use of AAS such as episodes of insomnia, aggression (physical and verbal), irritability, anxiety, neurosis, mood swings-emotional instability, hypomania, manic episodes, depression, bipolar disorder and psychosis (delusions, agitation, ideas of reference, hallucinations, misconceptions).
It should be noted that, the profound effects on mental and behavior are correlated to the severity of abuse in terms of dosage and time period, the psychiatric background of the user, his personality and genetic predisposition.
- IMMUNE SYSTEM:
– At high doses and long-term abuse => disruption of T-lymphocytes of the thymus and spleen => susceptibility to infections Nandrolone and oxymethelone abuse trigger the production of pro-inflammatory cytokines (IL-1b/TNF-a). These cytokines are involved in autoimmune and/or inflammatory diseases.
– Chronic AAS abuse => immunoglobulins (IgG, IgM, IgA, IgD, IgE) deficiency and in combination with over training-diet, decrease in white blood cells (WBCs) number
– AAS abuse crushes on anti-inflammatory (catabolic) cortisol, therefore reduces immune system.
- CARCINOGENESIS:
– Hepatocellular carcinoma
– Malignant hyperplasia of prostate gland
– Nephroblastoma or Wilm’s tumor)