Possible unwanted side effects

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Many androgens are capable of being metabolized to compounds which can interact with other steroid hormone receptors including the estrogen, progesterone, and glucocorticoid receptors, producing additional (usually) unwanted effects:

* Possible elevated blood pressure
* Cholesterol levels –Some steroids can cause a increase in LDL, Decreased HDL levels. This can cause a increase in risk of cardiovascular disease or coronary artery disease in men with high risk of bad cholesterol.
* Acne– Due to the stimulation of sebaceous gland
* Conversion to DHT (Dihydrotestosterone). This can accelerate or cause premature baldness and prostate cancer.
* Altered left ventricle morphology – AAS can induce an unfavourable enlargement and thickening of the left ventricle, which loses its diastolic properties with the mass increase. However the negative relation of left ventricle morphology to decreased cardiac function has been disputed.
* Hepatotoxicity – Caused particularly by oral anabolic steroid compounds which are 17-alpha-alkylated in order to not be destroyed by the digestive system.
* Gingival overgrowth - AAS is closely associated with significant levels of gingival enlargement.

Male-specific side effects

* Gynecomastia – Breast development in males. It is usually due to high levels of circulating estrogen. These high levels are the result of the increased level of conversion of testosterone to estrogen via the aromatase enzyme.
* Reduced sexual function and temporary infertility
* Testicular atrophy – Temporary side effect that is due to decreases in natural testosterone levels inhibiting spermatogenesis. As most of the mass of the testes is developing sperm, the size of the testicles usually returns to normal within a few weeks of discontinuing anabolic steroid use when spermatogenesis resumes.

Female-specific side effects

* Body hair increase
* Deepening of the voice
* Enlarged clitoris (clitoral hypertrophy)
* Temporary decrease in menstrual cycles

Adolescent-specific side effects

* Stunted growth – Abuse of the agents may prematurely stop the lengthening of bones (premature epiphyseal fusion through increased estrogen)
* Accelerated bone maturation
* Slight beard growth

An ideal anabolic steroid (a hormone with purely anabolic effects and no virilizing or other side effects) has been widely sought. Many synthetic anabolic steroids have been developed in an attempt to find molecules that produced a higher degree of anabolic rather than virilizing effects. Unfortunately, the most effective steroids known for increasing lean body mass also have the strongest androgenic characteristics.

Minimizing the side effect

Typically, bodybuilders, athletes and sportsmen who use anabolic steroids try to minimize the negative side effects. For example, users may increase their amount of cardiovascular exercise to help negate the effects of left ventricle hypertrophy.

Some androgens will aromatise and convert to estrogen, potentially causing some combination of the side effects listed above. During a steroid cycle users may take an aromatase inhibitor and/or a SERM; these drugs affect aromatisation and estrogen receptor binding respectively. The SERM tamoxifen, is of particular interest as it prevents binding to the estrogen receptor in the breast, reducing the risk of gynecomastia.

Furthermore, to combat the natural testosterone suppression and to restore proper HPTA function, what is known as 'post-cycle therapy' (PCT) is self prescribed. PCT takes place after the course of anabolic steroids. It typically consists of a combination of the following drugs, depending on which protocol is used:

* A SERM such as clomiphene citrate and/or tamoxifen citrate (this is the primary PCT drug).
* An aromatase inhibitor such as anastrozole.
* Human chorionic gonadotropin, hCG (this has become less common as it is now more often used throughout the cycle rather than after).

The aim of PCT is to return the body's endogenous hormonal balance to its original state within the shortest space of time.

Those prone to premature hair loss due to steroid use have been known to take the prescription drug finasteride for prolonged periods of time. Finasteride reduces the conversion of testosterone to DHT, the latter having much higher potency for alopecia. Finasteride is useless in the cases when steroid is not converted into a more androgenic derivative. Finasteride is also used as a masking agent by those who are subject to steroid testing.

 

Since anabolic steroids can be toxic to the liver or can cause increases in blood pressure or cholesterol, many users consider it ideal get frequent blood work tests and blood pressure tests to make sure their blood pressure or cholesterol are still within normal levels. Since anabolic steroids can increase cholesterol they increase the risk for heart attack in users. So it is generally considered mandatory for all users to get blood work while using anabolic steroids.