Warning Signs for Athletes And Bodybuilders: The Adverse Effects of Anabolic Steroids

Madhavi K, B. Optom

Contact Lens Fellow, Sankara Nethralaya Academy, Chennai, India

Introduction:

Anabolic-androgenic steroids (AAS) are drugs that resemble testosterone, which primarily enhances the growth of skeletal muscle and masculine sexual attributes in both the genders.⁽¹⁾ They are commonly prescribed by doctors to treat delayed puberty and to improve muscle mass in people with low muscle count. However, owing to its function, a large number of professional, amateur sportsmen and bodybuilders use anabolic steroids and other medications to improve their performance, a practice known as doping.

These drugs enhance lean muscle mass and strength, which tend to positively affect the athlete’s performance, thus increasing their self-esteem and confidence. These also help to speed up muscle recovery after intensive training, which improves their skills and translates to their better performance. ⁽²⁾ A study reported the global prevalence of AAS usage to be 3.3%. Higher rates were found in western countries compared to other regions. ⁽³⁾ For the purpose of “fair conduct” of competition and to protect the athletes from the side-effects of such medications, the international Olympics committee and United states Olympic committee has prohibited the usage of AAS in sports tournaments and was declared illegal in 1974. ⁽⁴⁾

Adverse effects of prolonged AAS usage:

 Prolonged usage of AAS can give rise to various systemic, ocular, and psychologic adverse effects, which cause fatal consequences, are listed as follows:

• In men, the levels of luteinizing hormone and follicle stimulating hormones decrease, which in turn reduces testosterone production and give rise to testicular atrophy. Also, the androgens get converted to oestradiol and oestrogen, which gives rise to feminine characteristics, one of which is increase in breast tissue (gynecomastia) ^(3,5)
• In women, irregular menstrual cycles, development of muscular characteristics like deepening of the voice, male-pattern baldness, increased body hair growth (hirsutism), etc. Hormonal changes are noted in insulin and thyroid hormones in both men and women. ⁽⁵⁾
• Hepatic dysfunction, jaundice, liver tumours tend to occur. Other systemic adverse effects include Thrombosis, hypertension, reduction in high-density lipoprotein (HDL) and increase in low-density lipoprotein (LDL), also myocardial infarction and stroke. ⁽⁵⁾
• Cases of central serous retinopathy and branch retinal vein occlusions, the former appearing as a consequence of stress and irritability which is one of psychological adverse effects of the drug, and the latter occurring as ocular manifestation of cardiovascular effects of drug are also noted. ^(6,7) Also, risks of steroid induced cataract and glaucoma can be present.
• Over aggressiveness, irritability, mood swings are some of the psychological adverse effects of the drugs. Abrupt withdrawal of the usage of drugs also give rise to the adverse effects that have been mentioned, along with depression, anxiety, and other serious psychological problems which would need immediate medical care and rehabilitation. ⁽⁵⁾

Conclusion:

Even though AAS drugs boost the competitiveness of athletes and bodybuilders, if used in an uncontrolled manner without proper consultation from a doctor, it can cause serious effects on the overall health, just like any other steroid medicines. Hence, their usage in any sort of tournament is declared illegal. Those who test positive for doping with such drugs would be banned from participating in future events. In an optometrist’s perspective to manage the ocular side effects, insisting on regular eye check-up to the athletes, especially to monitor their intraocular pressure and posterior segment evaluation can be emphasised.

References:

1. 2024, March 21. Anabolic Steroids and Other Appearance and Performance Enhancing Drugs (APEDs). Retrieved from https://nida.nih.gov/research-topics/anabolic-steroids on 2024, July 10
2. Wenbo, Z., & Yan, Z. (2023). The Uses of Anabolic Androgenic Steroids Among Athletes; Its Positive and Negative Aspects- A Literature Review. Journal of Multidisciplinary Healthcare, 16, 4293–4305. https://doi.org/10.2147/JMDH.S439384
3. Reyes-Vallejo, Current use, and abuse of anabolic steroids,Actas Urológicas Españolas (English Edition),Volume 44, Issue 5,2020,Pages 309-313,ISSN 2173-5786
4. Fitch, K. D. (2008). Androgenic-anabolic steroids and the Olympic Games. Asian Journal of Andrology, 10(3), 384–390.
5. Maravelias, C., Dona, A., Stefanidou, M., & Spiliopoulou, C. (2005). Adverse effects of anabolic steroids in athletes. Toxicology Letters, 158(3), 167–175.
6. Zor, K. R., Küçük, E., Çınaroğlu, S., & Biçer, G. Y. (2022). The Use of Androgens for Doping in Bodybuilding, and Ocular Side Effects: A Case Report. Retina-Vitreus/Journal of Retina-Vitreous, 31(3).
7. Damasceno, E. F., Neto, A. M., Damasceno, N. A. P., Horowitz, S. A. P., & De Moraes Junior, H. V. (2009). Branch retinal vein occlusion and anabolic steroids abuse in young bodybuilders. Acta ophthalmologica, 87(5), 580-581.