Anabolic Steroids

Anabolic steroids may be taken orally or intramuscularly by body builders or other individuals who want to enhance their physical appearance. Research has shown that injections of testosterone enanthate increase muscle size and strength, especially when combined with exercise (83). To achieve the desired effect, different steroids are taken in cycles, with rest periods in between, a regime known as "stacking," or, alternatively, increasing doses of the same steroid are taken, a so-called drug pyramid (84). Most of the steroids sold in the United Kingdom are counterfeit rather than produced by legitimate pharmaceutical companies. Consequently, they may contain a different steroid from the

Pharmacological Actions of Cannabis in Man (in Therapeutic Dosage Range)

Central nervous system

Psychological effects

Euphoria, dysphoria, anxiety, depersonalization, precipitation/aggravation of psy

chotic states

Effects on perception

Heightened sensory perception, distortion of space and time sense, misperceptions,

hallucinations

Effects on cognition and

Fragmentation of thoughts, mental clouding, memory impairment, global impairment

psychomotor performance

of performance especially in complex and demanding tasks

Effects on motor function

Increased motor activity followed by inertia and incoordination, ataxia, dysarthria,

tremulousness, weakness and muscle twitching

Analgesic effects

Similar in potency to codeine (nonopioid mechanism)

Tolerance

To most behavioral and somatic effects, including the euphoria with chronic use

Dependence/abstinence

Rarely observed; symptoms include disturbed sleep, decreased appetite, restlessness,

syndrome

irritability, and sweating

Cardiovascular system

Heart rate

Tachycardia with acute dosage; bradycardia with chronic use

Peripheral circulation

Vasodilation, conjunctival redness, postural hypotension

Respiratory system

Ventilation

Small doses stimulate; large doses suppress

Bronchodilatation

Coughing but tolerance develops

Adapted from ref. 81.

Adapted from ref. 81.

one indicated on the bottle, and scant reliance can be placed on the reported dose because they may have little or no steroid in them at all (85).

General effects of anabolic steroids (86) include baldness, acne (typically affecting the shoulders and upper back), raised blood pressure and heart rate, fluid retention, and a reduction in high-density lipoprotein cholesterol. Long-term effects include an increased risk of thrombosis. Gynecomastia may occur, and the prostate gland may swell, resulting in impaired micturition. Most of these effects are dose dependent and more likely with prolonged administration.

While the drug is being taken, there is a significant reduction in testosterone production by the testes so that sperm output and quality are decreased, and a return to normal can take many months after drug use is stopped. The effect on sex drive is variable, but overall it seems that the sex drive increases at the beginning of a steroid-using cycle, and then decreases to below normal after several weeks of use. Drive may remain below normal levels even after the drug is stopped, until such time as the testes start producing testosterone again. There may also be a reduction in size of the testicles (87).

In women, menstrual irregularities are reported, with permanent enlargement of the clitoris. There may also be growth of facial and body hair, male pattern baldness, and decreased breast size. Abuse of sex steroids by recreational body builders may be an unrecognized cause of subfertility (88).

Liver function tests may show abnormalities that usually return to normal once the drug is stopped. Drug-induced jaundice can be caused by temporarily impaired excretory function, and peliosis hepatitis, in which the liver tissue is replaced by blood-filled cysts, may occur, as can liver tumors (89) and Wilms' tumor.

Initial use may result in stimulatory effects, such as increased confidence, decreased fatigue, heightened motivation, agitation, irritability, and insomnia, which may progress to argumentative and aggressive behavior and major mood disturbances including depression, mania, and hypomania (90,91). "Roid rage," which may be associated with violent crimes (92), requires a high dose of steroids over several weeks, as may occur when "stacking."

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