ANABOLIC STEROIDS: A PRIMER
By William Llewellyn
(Reprinted with permission of Muscular Development Magazine)
I think it is fairly commonly known that in spite of, or perhaps even as a direct result of, all the sentiment against steroid use in the media these days, steroid use is on the rise globally. Occasionally you see a tangible indicator of this fact, as was the case last week when I was giving a speech in the UK on steroid use. I was asked to provide some insight into anabolic steroids at the NCIDU-06 Conference (National Conference on Injecting Drug Use), and in the process had learned just why the group was so eager to gain a better understanding of these drugs. Apparently, across the UK more new patients are entering needle exchange programs that use anabolic steroids than are addicted to heroin or other narcotics, the main focus of this program in the first place. Clearly, things are changing in the UK with regard to steroid use, and I think this growth mirrors what is happening in most countries as well.
For the conference I was charged with succinctly summarizing anabolic steroids in a 25-minute presentation, not an easy task. I did my best to whittle down a tight speech that would touch on the most important aspects of steroid use – an overview of what these drugs were and how they worked, a short look at their very long history in modern medicine, and discussion of the popularly cited health risks, and a plan for “harm reduction” as it would apply to the steroid user. I realized in forming my outline that it would be perfect to develop a detailed “primer” article on steroids from, and that is what I have decided to do this month for Muscular Development. At the expense of disappointing some of my readers looking for a more technical discussion, this month we are going to take a well needed but slight detour, for a basic overview of these drugs and what would be considered “safer” steroid use today.
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OVERVIEW
All anabolic steroids come from Testosterone. Testosterone is the primary male sex hormone, and is responsible for a number of functions in the body. These functions are quite numerous, although the primary (for our purposes here) can be placed in one of three categories. The first are the anabolic actions of testosterone. These actions include the building and maintenance of skeletal muscle tissue, increasing the retention of calcium in the bones, and stimulating the production of red blood cells via renal erythropoietin. It is these actions of testosterone that are often discussed when we speak of the “constructive” properties of this hormone. Testosterone also has androgenic properties, which focus on the development and maintenance of secondary male sexual characteristics. This includes such things as stimulating body and facial hair growth, increasing libido, and supporting sperm quality and quantity. Lastly, testosterone also provides an estrogenic component. Estrogen and testosterone are structurally very similar, and the body regularly converts testosterone to estrogen. Testosterone actually serves as a principle source of estrogen in men, where it plays a number of important physiological roles.
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MEDICAL APPLICATIONS FOR ANABOLIC STEROIDS
Anabolic steroids, which are all forms of or functional derivatives of testosterone, have been used medically for a wide number of different purposes since their time of inception. Currently, the main clinical uses for these drugs are fairly small, and can be included in one of six categories.
Hypogonadism – This is a general term referring to the low production of testosterone in males, a hormone of gonadal origin. Low testosterone levels can be caused by a number of different things, including illness, injury, aging, or even a natural genetic predisposition for low androgen output. Given the expanding attention paid to declining androgen levels with aging (Andropause), hypogonadism is the principle use for anabolic/androgenic steroids in modern medicine.
Osteoporosis – This refers to a disorder in which the bones become increasingly porous and brittle, often resulting in fractures. This weakening of the bones often occurs with aging, but can also be association with certain hormonal disorders. Estrogens are often used with postmenopausal women to combat osteoporosis, as these hormones can often block the loss of calcium in the bones. Anabolic steroids, however, can offer en even stronger effect, significantly increasing the retention of calcium in a percentage of such patients.

Anemia – Red blood cell deficient anemia was once a common application for certain anabolic steroids, owing to the fact that these drugs increase the output of erythropoietin. Erythropoietin is a principle stimulator of red blood cell production, making these class of drugs fairly effective treatment options. Recently years have brought forth recombinant erythropoietin, which is far more efficient at stimulating red blood cell production and is not accompanied by the same androgenic side effect. Although anabolic steroids are still used for this purpose, and likely will indefinitely, anemia is a slowly declining focus of medical anabolic steroid use.
Tissue Healing/Injuries and Burns – The anabolic properties of these drugs sometimes lends them to be useful in aiding recovery from burns or injury. At one time in history this was a widely prescribed use for steroids, although during the 1990’s there was a great recession in this application for the drugs. Recent years and more positive studies seem to have revived interest in this use of steroids.
Breast Cancer – Androgens and estrogens have opposing roles on the growth of mammary tissue in humans. Likewise, certain hormone-responsive breast cancers can be positively affected by the application of anabolic/androgenic steroids. These drugs are usually applied only as secondary medications with postmenopausal women whose cancer is deemed inoperable.
Anti-wasting – Lean body mass is important for maintaining optimal health, and many diseases starve the body by hindering the ability to maintain normal muscle mass. Wasting is commonly associated with HIV infection, for example, and here anabolic steroids have been applied with excellent success, often revitalizing an otherwise frail patient. Recent years have seen great expansion in this use of steroids.