Most people have misconceptions regarding steroids and believe that steroids are harmful drugs or drugs used illicitly for body transformation. But the truth is that steroids serve many different bodily functions, which we will explain in this article.
Steroid drugs are broadly classified into Corticosteroids and Anabolic steroids.
Corticosteroids serve many direct or indirect actions in the human body. They are further divided into Glucocorticoids and Mineralocorticoids.
The actions of Glucocorticoids in different body parts include:
- In Protein, Carbohydrate, and Fat metabolism: Glucocorticoids promote gluconeogenesis, the release of glucose from the liver, and inhibit glucose uptake by tissues. Glucocorticoids also cause the breakdown of proteins and promote amino acid mobilization from the peripheral tissues.
- However, in fat metabolism, glucocorticoid actions are indirect; it promotes the breakdown of lipids (lipolysis). The breakdown of TGs is also enhanced. It causes a redistribution of fat depots of the body. Fat in the body’s peripheral parts is metabolized and deposited over the body’s central parts- face, neck, and shoulders. This is because adipocytes in the peripheral parts are more sensitive to glucocorticoid facilitated lipolysis.
- Calcium metabolism and water excretion: Glucocorticoid inhibits intestinal absorption and enhances renal excretion of Ca2+, leading to Calcium loss from the body; glucocorticoids also facilitate water excretion from the kidney independent of Na+ transport.
- Glucocorticoids increase blood pressure by the effect of vasoconstriction in the body and help in myocardial contractility.
- Glucocorticoids also help in normal muscular activity.
- Glucocorticoid increases the secretion of gastric acid and pepsin in the digestive system.
- Glucocorticoids suppress inflammatory responses in the body irrespective of the type of insult; it is a non-specific suppressor of inflammation- meaning it is effective in different inflammation steps. The cardinal signs of inflammation-pain swelling, redness are suppressed. This function of Glucocorticoid forms the basis of most of its clinical use.
- Glucocorticoids suppress all kinds of hypersensitization and allergic phenomena. At a very high dose, it interferes with almost every step of the body’s immunological response. Still, at a therapeutic dose, the production of antibodies is spared.
As a consequence of these actions, it can be used to reverse certain pathologies and help in treating conditions such as:
- Arthritis: Osteoarthritis, Rheumatic Arthritis
- Bronchial asthma
- Autoimmune diseases: Inflammatory Bowel Disease, Lupus, etc…
- Allergic skin conditions
- Heart Failure
- Adrenal Insufficiency Syndromes
- Malignancies by virtue of its immune suppressive actions
- Patients receiving organ transplants to decrease the chances of organ rejection.
Prednisone is a steroid that is mostly used to treat many inflammatory conditions and is considered an essential medication by the WHO. Other corticosteroids also commonly used are Prednisolone, Methylprednisolone, Cortisone, Budesonide, Triamcinolone, Betamethasone, and Dexamethasone.
Side effects of Glucocorticoids by virtue of the same actions in the body include:
- Hyperglycemia and insulin insensitivity
- Osteoporosis due to its Ca excreting property
- Increased blood pressure
- Increased gastric acid and pepsin, leading to increased susceptibility to develop Gastric ulcers.
- Increased susceptibility to infections due to its immune and inflammation suppressing action.
A long term side effect of using excess exogenous glucocorticoids is Cushing syndrome; it is a disease characterized by:
- Buffalo hump
- Development of purple striae in the abdomen
- Delayed wound healing and frequent infection
- Decreased libido
- Menstrual irregularities in women.
- Bone weakening and Osteoporosis
Therefore, glucocorticoids must not be indiscriminately used and should be used only under the doctor’s prescription. Even when in use, the dose should be gradually tapered.
The principal mechanism of mineralocorticoid action is increasing Na+reabsorption in the Distal convoluted tubule and associated K+ and H+ excretion. This function of the Mineralocorticoid helps in maintaining the correct composition of Extra Cellular Fluid volume in the body. Its deficiency leads to the build-up of extra K+ and H+ ions in the blood leading to hyperkalemia and acidosis in the body.
Fludrocortisone is a potent mineralocorticoid showing glucocorticoid actions as well. It is used in the treatment of:
- Cerebral salt wasting syndrome
- Addison’s disease
- Congenital adrenal hyperplasia
Apart from its use in the treatment of these conditions, Fludrocortisone can also be used to diagnose Conn’s Syndrome. Fludrocortisone suppression test is done to confirm Conn’s Disease (which is an aldosterone-producing adrenal adenoma)
Side effects of mineralocorticoids are mainly due to their water and sodium retaining properties. They include:
- Edema and swelling of the body
- Hypokalemic acidotic state in the body
- Increase in blood pressure.
Anabolic steroids are steroidal androgens that include testosterone and other synthetic androgens structurally and functionally similar to the male sex hormone. This is the class of steroids that has brought much infamy to steroids, but it serves many medicinal purposes also.
Natural testosterone is produced by the testis in males. The action of this class of steroids in the body include:
- Development of sex organs and secondary sex characters in males. Testosterone is responsible for all the changes in a boy at puberty, including the growth in genitals and secondary sex characters like the development of pubic, axillary hair, and beard and mustache. It leads to a thickened skin and increased preponderance to acne formation by blockage of the face’s highly functioning sebaceous glands.
- It leads to the development of the larynx and deep hoarse voice. It increases male libido and male aggressiveness.
- Testosterone regulates spermatogenesis and sperm maturation in men.
- It has anabolic action on the skeletal system and is responsible for a male pubertal growth spurt and a small extent in females. It causes rapid bone growth in puberty, both in length and in the girth of the bone.
- Testosterone also promotes muscle building when complemented by exercises. This property of steroid is commonly exploited by athletes and those seeking immediate muscle growth. The use of testosterone also increases appetite.
- It accelerates the process of erythropoiesis.
In cases where the circulating testosterone in the body is deficient, it can lead to symptoms such as:
- Decreased libido and reduced frequency of sexual intercourse
- Flushing of skin
- Erectile dysfunction
- Osteoporosis and bone weakening
- Decreased strength
- Absence of body hair
- Lethargy and Fatigue
Therapeutic uses of Adrenal androgens:
- Androgen deficiency syndrome
- Primary and Secondary hypogonadism
- Has shown benefit in Blood glucose management in men over 45 years
- Prevent osteoporosis and increase sexual vigor in postmenopausal women.
Synthetic androgens are used in cases when the circulating testosterone in the body is low. It can replace endogenous androgens via patches, tablets, capsules, creams, gels, or injections. Common synthetic androgens include Methyltestosterone, Fluoxymesterone, testosterone undecanoate.
Side effects of Androgens include:
- Excessive weight gain
- Male pattern baldness
- Excess body hair and acne
- Menstruation irregularities and virilization in female
- Frequent and sustained painful erection at the start of the treatment
- Stunting of stature if given at an early age
- Cholestatic jaundice is a common complication encountered with Methyltestosterone
- Gynecomastia in younger patients with liver disease
- It can worsen epilepsy, migraine, and sleep apnea
The clinical efficacy and safety of androgens should be assessed after 3-6 months of commencing androgen therapy and yearly thereafter.
In addition to these side effects, there are conditions in which the use of androgens is contraindicated. They include:
- Kidney and liver disease
- Prostate carcinoma
- Carcinoma of male breast
- Benign prostatic hyperplasia
- During pregnancy, as it may masculinize a female fetus.
- Coronary artery disease
- Congestive heart failure
- Elderly male above 65 years of age
It is the illicit use of Androgen, especially for its anabolic properties, by recreational bodybuilders and athletes to enhance performance. The first case of illicit androgen abuse was recorded in the 1950s among professional bodybuilders. It has rapidly spread to many sports and beyond, reaching even the general public seeking to quickly increase body size.
Long term abuse of androgens has been linked to high rates of morbidity and mortality. They have toxic effects on the myocardial cells; high doses of anabolic steroids produce dyslipidemia and increase thrombosis risk. They also produce vasospasm by their effects on vascular nitric oxides.
Other complications long-term abusers of the drug face are that it inhibits endogenous testosterone production and spermatogenesis in the male and inhibits LH and FH in females, leading to sexual dysfunction, infertility, and depression. Males may also develop shrunken testicles.
Research shows that the need for androgen reinforcement is mediated by the serotonin and dopamine neurotransmitter system in the brain. 30% of long term androgen abusers develop a dependence on it despite the adverse medical and psychological effects it has on them.
Unsafe injection of anabolic steroids risks contracting HIV and Hepatitis B. Manic episodes and roid rage develop with chronic use for performance enhancement.
Muscle hypertrophy produced by these androgens is not balanced by compensatory adaptation at joints, tendons, and ligaments, increasing their susceptibility to joint and tendon damages.
Acne in different parts of the body and shedding of hair can also take place. Features of water retention also have been seen. There is an increased risk of hepatic cancers, as well.
Studies have shown the mortality ratio of steroid abusers to non-users is considerably higher. The most common cause of death in abusers include suicide, myocardial infarction, hepatic tumors, and non- Hodgkin’s Lymphoma. Furthermore, the risks associated with chronic androgen abuse are yet to be fully understood.
Proper and strict drug testing is essential to curb the incidences of androgen abuse in athletes.