How Steroids Work and the Risks Involved

steroid risks

By Frank A. Melfa Author of Bodybuilding A Realistic Approach

This article will educate you about steroids and their potential effects on your body. I have used venerable sources to compile the best information possible. I have presented the information so that it could be easily understand and to help you make a more educated decision about using steroids rather than playing a game of Russian Roulette.

Before we get into how steroids work, let's define Anabolic steroids. The word anabolic simply means building up as opposed to catabolic that means breaking down. Anabolic steroids are manufactured or synthesized derivatives of the male hormone, testosterone. Testosterone has two main functions on the body, the anabolic effect and the androgenic effect.

1. The anabolic effect is responsible for growth, muscular development, and the masculine body contour of the adult male.

2. The androgenic effect stimulates the development of the male secondary characteristics after puberty, causing growth of the beard, pubic hair, development of the penis, and change of voice.

In order to understand how steroids work, you first need a brief lesson in pharmacology. Pharmacology is the study of drugs in your body. It is important for you to know exactly what happens when a drug enters your system to understand the effects that drugs have on your body, more specifically, the effects of anabolic steroids.

There are basically two types of effects drugs have on your body, therapeutic effects and non therapeutic effects. Therapeutic effects are the intended effects of a drug. Non therapeutic effects are simply the side effects or the adverse effects. In the case of steroids, the therapeutic effect would be to increase muscle size. The side effects are all the undesirable things that can occur. We will get into all the potential side effects of steroids later. For now, I want to educate you on how they work.

All drugs have their own way of working, or what is called, a mechanism of action. Most drugs' mechanisms of action involve drug receptors. Drug receptors are located on cells in your body. To understand this concept, all you need to do is first picture one of your cells and then picture an outlet, like the one on your wall. Now picture several of these outlets, better known as receptor sites, on the cells. These receptor sites or outlets located on or in your cells either trigger or block biological activity when stimulated or occupied. Drugs occupy, bind or plug into the outlets to either stimulate or block biological activity.

Biological activity means all the biochemical and physiological activities that normally occur in the body such as your heart rate. It is important to note that drugs do not create effects of their own, they change the biological processes already occurring in the body. For example, you have always had a heart rate, hopefully. Some drugs can change your heart rate by either speeding it up or slowing down.

Anabolic steroids work by stimulating the anabolic effect discussed earlier by binding or plugging into protein receptors in or on the cells that help create new proteins in the cells. This increased biological activity is called an increase in Ribonucleic Acid Activity (RNA Activity). The construction of new proteins helps increase muscle size and strength. Remember, this normally happens in the body. The steroids stimulate or increase this biological process by binding to the receptor sites on the protein cells.

Just to give you an idea of how other drugs work similarly: Aspirin works or relieves pain by binding to receptors on cells that are responsible for transmitting pain and inflammation. By binding on the pain receptors, aspirin blocks pain and inflammation. On the other hand, aspirin causes stomach upset by also blocking the production of a protective enzyme in the stomach.

A betablocker is a type of blood pressure medication that works by binding to beta receptors on your heart cells that have a direct effect on blood pressure. By binding to the beta receptors on the cells, they prevent the heart from working harder, which helps decrease blood pressure. On the other hand, betablockers sometimes cause fatigue and even impotence by blocking or stimulating other biological activities.

So remember, there is always a tradeoff!

Steroids are also known to increase nitrogen retention, another biological activity. Nitrogen is found in proteins where it plays an important role in the building of tissues. Those who use steroids have been known to have a positive nitrogen balance, a preferred state where intake of nitrogen from proteins is greater than excretion of nitrogen.

Once a drug enters the body, the body begins to process the drug that includes four processes:

1. absorption
2. distribution
3. metabolism
4. excretion


Drugs are usually administered either orally or intravenously.

When drugs are administered orally, absorption is much more complex than when administered intravenously. The drug has to bypass a number of barriers before it can get into the blood stream and do its thing. First, it must get past the acid in the stomach. Second, it must over come bacteria in the small intestines. Third, it must survive changes in the small intestines. Finally, it must survive the metabolism process in the liver known as the first pass effect.

During the first pass effect, blood travels to the liver as part of a filtering system where enzymes in the liver metabolize or change part of a drug before it enters the bloodstream. Enzymes are proteins that change drugs in the body and also help biochemical reactions occur as discussed above.

Drugs are absorbed faster when administered intravenously. They enter the blood stream immediately, and aren't absorbed like when taken orally. They bypass being metabolized by the liver, skipping the first pass effect.


The distribution process simply involves the transportation of drug throughout the blood stream.


Metabolism is the chemical change a drug goes through in the body. The major place where this takes place is in the liver. This is where most people run into problems with steroid usage that I will get into shortly.


Excretion is simply the removal of drug from the body. The kidneys are responsible for most drug excretion through the urine. Some drugs such as steroids are excreted by the liver. Drugs are also excreted through the breast, skin and lungs. You will see how drug excretion directly relates to the adverse effects of steroids.

Side Effects

The amount of drug that enters the body will determine the two effects we discussed early, the therapeutic effect and the side effect, also called toxic effect. Therapeutic effects, the desirable effects, are not always dose related. This means that 400 milligrams of aspirin may work as well as 800 milligrams to cure a headache. A doctor's goal is to administer the lowest effective dose because side effects are dose related: The higher the dose, the greater the side effects. If 400 milligrams of a drug will cure your headache, why take 800 milligrams?

Anabolic steroids are very toxic to the liver where they are metabolized and excreted. You better believe that the side effects from steroids are dose related. There are many bodybuilders who take more steroids than they need to see the desired results. There is no need to take five tablets when one is just as effective.

The biggest risk you take with steroids is damage to the liver. The liver is the most versatile and amazing organ in the body. Every minute, about three pints of blood pass through the liver. At any time, the liver contains about 10% of all the blood in the body. It helps the blood digest food substances and excretes waste materials, toxins, steroids, estrogen, and other hormones. It also stores sugar and glycogen, iron, copper, vitamin A, several of the B vitamins, and Vitamin D and also produces proteins. Without a properly working liver, you are in big trouble!

When steroids, such as Anadrol 50, are taken orally, they need to be detoxified by the liver through the metabolism process discussed above. The liver works harder to eliminate poisonous substances and toxins produced by steroids. As a result, hepatitis or inflammation of the liver can occur. Hepatitis can easily lead to cirrhosis of the liver, a condition of progressive scarring. Cirrhosis is a disease so severe, that it kills all the liver cells, causing liver failure.

Steroids can also disease the heart. The blood carries basically two types of cholesterol, HDL (high density lipoproteins) the good cholesterol and LDL (low density lipoproteins) the bad cholesterol. The good cholesterol helps get rid of the bad cholesterol. The bad cholesterol is responsible for clogging arteries. Lower levels of HDL and higher levels of LDL directly correlate to heart attacks. Steroids increase the level of LDL and decrease the level of HDL. Studies have shown that steroid users have lower levels of HDL and higher levels of LDL.

Another very common side effect related to steroids is gynecomastia, better known as "bitch tits." Gynecomastia is a condition where small tumors develop near the nipple area of the chest, giving a female breast-like appearance. This condition occurs when steroids change to estrogen, the female hormone, during the metabolism process. The higher levels of estrogen enlarge the mammary glands in the male chest. The development of mammary glands in the nipples is regulated by estrogen. Estrogen is secreted in the form of milk by the pituitary gland (located in the brain) and is excreted via the breast. This condition in steroid users usually requires surgery to correct. It is very painful and can disfigure your chest permanently.

Women who take anabolic steroids suffer more from the side effects than men. That's because steroids mimic the male hormone, testosterone, which naturally exists in the male body. It doesn't exist in women. The female hormone is estrogen. If estrogen was injected in men, we would see more changes than if injected in women. Women who abuse steroids experience what is called virilization. This means taking on male characteristics such as deepening of the voice, hair growth on the arms, legs, back, and other unusual places. On the other hand, women experience male pattern baldness.

To prevent irreversible changes in women, drug use must be stopped immediately once these changes are first detected. Some of these changes are irreversible even after prompt discontinuance of steroids. Women also experience menstrual irregularities.

Acne is also a very common side effect of steroids and once again more prevalent in woman than in men. Since steroids are also excreted through the skin, the result is a high level of bacteria on the skin. This leads to severe acne mainly found on the chest and back. In some cases, the acne results in heavy scar tissue that can leave the skin distorted for life.

Since drugs are also excreted through the lungs, bad breath can also be a side effect. It may not be as serious a side effect as the others, but can prove to be very embarrassing.

Some steroid users justify the use of injectable steroids because they bypass the metabolism process in the liver or the first pass effect discussed earlier. However, even injectable drugs are excreted by the liver, where serious damage can occur.

Infections are very common among steroid users who choose to inject. The area of penetration is very susceptible to infection when skin surrounding the point of injection is not clean. Infection occurs when the syringe is not sterile or is reused..

Sterile abscess is yet another common occurrence from injecting. An abscess develops from injecting the syringe in the same spot repeatedly causing a build-up of scar tissue and pus. These abscesses, if not treated properly, grow, get infected, and need to be surgically removed.

Speaking of infections, cases of AIDS have been reported among steroid users who share the same syringes!

Black market steroids pose yet another risk. Many individuals have been arrested for making fake steroids in their basement. The risk here is that you don't know what you are administering in your body. Hopefully it could be only cooking oil, but there have been reported cases of rat poisoning.

Severe muscle tears are very common among steroid users. Steroids quickly enhance muscle mass and strength allowing for individuals to use much heavier weights than before. Tendons and ligaments, tissues that hold muscle to bone, do not strengthen in relation to the muscles, causing them to tear, sometimes off the bone! They just cannot withstand the added pressure from the heavier weights. It is not unusual to hear that someone using steroids increased their bench press by 100 pounds in a matter of 2 months. This drastic change in strength is too much for the tendons and ligaments to handle. So they tear, sometimes requiring surgery to repair the damage.

A recent study of 284 steroid users showed that over 80% of all side effects were caused by two powerful and highly used steroids, Anadrol and injectable testosterone.

Anadrol-50 (oxymetholone) CIII 50 mg tablets: In the first edition of my book, I wrote that Anadrol was no longer available. That might have been a mistake, because it is available from a company called Unimed Pharmaceuticals. One thing I wasn't mistaken about was its potency and side effects. Anadrol is known as the most powerful oral steroid in the bodybuilding community, but its toxicity is ignored.

Anadrol is an anabolic steroid derived from testosterone. It has both anabolic and androgenic effects. It is indicated for patients with anemia due to deficient red blood cell production. Anemia is not a disease, but rather a symptom of various diseases. Anadrol helps restore red blood cells. It works like most other anabolic steroids by binding to androgenic receptors on protein cells (see beginning of this chapter for full explanation of how this leads increase muscle size). Anadrol like other anabolic agents also improves nitrogen balance which may help with the utilization of protein-building.

The CIII after the name means that it is a schedule three drug. The Food and Drug Administration (FDA) schedules drugs based on its abuse or addiction potential. The schedule is between I and IV. The lower the number, the higher the potential for abuse. The higher the number the lower the abuse potential. Narcotic drugs such as heroin and hallucinogens are schedule I drugs. Drugs like antidiarrheals are schedule V.

The warnings, precautions, and adverse reactions fill up most of the package insert. Hepatis, blood-filled cysts on the liver, liver failure, intra-abdominal hemorrhage, liver cell tumors, malignant tumors, blood lipid changes which includes an increase in the low density lipoprotein (bad cholesterol) and a decrease in the high density lipoproteins (good cholesterol).

Some of the precautions include signs of virilization (deepening of the voice, excessive hair growth, acne, enlargement of the clitoris). Its own package insert even states that some of these side effects can be irreversible. The list goes on and on.

The recommended daily dose for children and adults with anemia is 1-5 mg/kg/ body weight per day. The package insert also states that the usual effective dose is 1-2 mg/kg/day. That means you have to figure out your weight in kilograms by converting from pounds to kilograms and then multiplying that number by 1-5 milligrams or 1-2 kilograms. For example, if you weight 150 pounds, you have to divide 150 by 2.2 kg because 1 kilogram equals 2.2 pounds. 150 divided by 2.2 equals 68 kg. Now you have to multiply 68 kg by 1 to 5 mg. Let's use two milligrams as an example. 68 times 2 equals 136 milligrams per day or 3 tablets a day. The only problem with this example is that there is no usual effective dose for people who decide that they want to use Anadrol for muscle building purposes. I remember people telling me that they saw results with 1 tablet a day. So you are taking a big risk with side effects and the black market. There's always that chance of getting fake drugs. Anadrol is supplied in bottles of 100 white-scored tablets imprinted with 8633 and UNIMED (NDC0051-8633-33).

Testosterone Cypionate is still manufactured by Upjohn and Starr Pharmaceuticals. It's an oil based injectable form of testosterone that is highly androgenic and anabolic and a very effective muscle builder. One common quality among the testosterone drugs is that they retain a lot of water in the body. Those who overuse testosterone have that puffy look especially in the face. A bodybuilder's common dosage is about four ccs per week, two ccs twice per week.

Testosterone Enanthate: The difference between Enanthate and Cypionate is that Enanthate has a longer life and only has to be injected once every 10 to 12 days. Both Cypinonate and Enanthate come in 200 mg/ml 10 cc vials.

Testosterone Propionate is very similar to Cypionate, but does not stay in your system as long as Cypionate.

Testosterone Suspension is a water soluble, powdery-white, injectable. It resembles the drug Winstrol V. Like Winstrol, it is said to be very painful when injected. Because it is water soluble, it is fast acting and does not stay in the body for more than one day leading to more frequent injections.

Below is a description of other common steroids used by bodybuilders and other athletes:

Anavar: (Oxandrin) is also an oral anabolic steroid manufactured by G.D. Searle and marketed by BTG Pharmaceuticals. It is supplied in 2.5 mg tablets. The package insert states that Oxandrin is indicated as adjunctive therapy to promote weight gain after weight loss following extensive surgery, chronic infections, or severe trauma. It is also indicated for people who can't gain weight for no logical reasons. Daily dose varies from 2.5 mg 2 to 4 times per day or as much as 20 mg per day. This drug has always been a favorite among bodybuilder because of its "cutting up" effects. I really don't know if that is really the case because as far as I'm concerned, the only way to get really cut up is by losing bodyfat. Only bodybuilders can tell you their experiences. What amuses me in the package insert is where it states, "ANABOLIC STEROIDS HAVE NOT BEEN SHOWN TO ENHANCE ATHLETIC ABILITY." The reason that is included is because there have not been any studies done on athletes. But we all know that they do work. Anavar is definetely not as powerful as Anadrol 50, but that just maybe because of the dose. Anadrol is 50 mg and Anavar is only 2.5 mg per pill. And Anavar has the same risks as Anadrol. Most oral anabolic steroids have the same warnings in the package inserts.

Durabolin (nandrolone phenpropionate) This product is still listed in the Physician Desk Reference Guide, but with no information accept that it's supplied in 25 mg/ml-5mL vials and 50mg/ml-2 mL vials. Deca was known to be the most commonly used injectable and also the most popular counterfeit steroid in the black market. Deca is known to have low levels of androgen qualities and is considered safe among steroid users. It is known as a cutting up drug rather than a bulking drug among steroid users. It is also responsible for faster recuperation time between workouts because of its high nitrogen retention qualities.

Dianabol (methandrostenolone) This oral drug was one of the first and most popular muscle building steroid used by bodybuilders and other athletes. It was discontinued years ago. So if you know anyone that claims to have it; it's fake.

Equipoise (boldenone undecylenate) If you remember what the prefix Equi means from your SAT's, then you will know that this injectable steroid is made for horses and ironically used by bodybuilders and other athletes. It is an oil based steroid derived from testosterone with high anabolic and moderate androgen levels. Equipoise is very popular with bodybuilders because of its cutting up abilities and low risk of side effects.

Finajet (trembolone) Another oil based veterinarian steroid from Europe. It has very high levels of androgen that can be toxic to the liver and kidneys. Frequent injections of about 1 cc of Finajet are taken by bodybuilders every other day because it is said to be used by the body quickly.

Parabolan (trenbolone) Usually pronounced "power bone" is a French steroid that is popular because it does not convert to estrogen and is known for its cutting and building qualities. Parabolan is an injectable that comes in 76 mg per 1.5 cc ampules.

Winstrol V (stanozolol) is a very popular steroid among bodybuilders known for it's cutting up capabilities. Winstrol is still available in tablets and injectable forms by Sanofi Winthrop Pharmaceuticals. It is a synthetic derivative of testosterone.

Winstrol is indicated to decrease the frequency and severity of angioedema. This is an attack where skin breaks out in an itchy rash or hives. The package insert includes a black box warning about peliosis hepatis, liver tumors, liver failure and blood lipid changes. The black box warning means patients have experienced these side effects. Peliosis hepatis is a condition when the liver tissue is replaced with blood-filled cysts that has lead to liver failure. The blood lipid changes mean that Winstrol has been found to increase low-density lipoproteins (the bad cholesterol) and decrease high-density lipoproteins (the good cholesterol).

Growth Hormone

Growth Hormone or GH has been another more recent muscle building enhancer with few known side effects used by bodybuilders and other athletes today. Human growth hormone is produced by the pituitary gland. The pituitary gland is located at the base of the brain and is responsible for promoting growth and the functioning of all endocrine glands.

Currently, Eli Lilly and Genetech and Serono pharmaceuticals, manufacture injectable forms of growth hormone that is therapeutically equivalent to human growth hormone of the pituitary gland. Eli Lilly makes Humatrope (Somatropin). Genetech makes Nutropin (Somatropin) and Protropin (somatrem). Serono makes another version of (Somatropin) called Serostim. They are all indicated for long-term treatment of children who have growth failure due to an inadequate secretion of normal growth hormone. It stimulates linear and skeletal growth. It also results in an increase in both the number and size of muscle cells. Serostim, is the only one that is indicated for AIDS wasting. That is, AIDS patients' lean body mass burns away, including muscle and organ tissue, instead of fat.

The most common side effects are musculoskeletal discomfort that includes pain, swelling, and or stiffness and swelling of the hands and feet. These side effects are usually mild to moderate, and usually subside when treatment is discontinued.

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