The biological and clinical science of anabolic steroids including Testosterone remains a moving target. Despite limited high-quality research, especially in humans, our knowledge in this area continues to evolve, thanks to the many physicians and members of the fitness community who continue to share their information in both formal clinical settings and public forums. As we slowly tear down the social and legal barriers surrounding the use of anabolic steroids, we bring the degree of transparency that is needed to achieve man’s valid desire for an improved quality of life without sacrificing longevity.

 

When not monitored by a qualified physician, anabolic steroids can increase blood production and blood thickness to a point that raises blood pressure and causes clots (heart attacks, pulmonary embolisms, and strokes); some bodybuilders who don’t see a physician keep track of their blood thickness levels and get regular phlebotomies, or donate blood on a regular basis, and that’s undoubtedly mitigating harm, as it prevents a fatal clot, although they are at risk of having iron deficiency.

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At certain doses, and in men with genetic susceptibility, or who are older, anabolic steroids may have a detrimental effect on the kidney; this effect reduces its ability to dump extra salt from the body and occasionally leads to a chronic irreversible kidney disease called FSGS. Either way, this leads to high blood pressure, which in turn damages the heart and the blood vessels that feed it.

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Since anabolic steroids increase appetite, they can also lead to increased carbohydrate consumption, which in turn raises blood pressure and increases the risk of many other conditions. 

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All anabolic agents, including both Steroids such as Testosterone as well as proteins/peptides such as Human Growth Hormone (HGH), have an anabolic effect on the heart muscle, in addition to skeletal muscle.

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At physiologic levels, these hormones exert a direct beneficial anabolic effect that is likely to help the heart adapt to the anabolic needs of the body. This is a physiologic type of heart enlargement. Think of it as a bigger heart to handle bigger biceps! They also exert an indirect anabolic effect by making the heart muscle more responsive to the anabolic effect of exercise itself. The function of the heart as a pumping organ in these cases is either unaffected or improved.

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At higher levels, these hormones exert a pathologic type of anabolic effect that predisposes the heart to abnormal electric rhythms that may cause sudden death at any point in time, with or without emotional or physical exertion; it could be during sleep, during dinner, or while watching TV. Functionally, this type of heart enlargement reduces the pumping capacity of the heart, causing symptoms such as progressively worsening shortness of breath with exertion. Very often, men who use high doses of anabolics don’t realize they have this condition. They may attribute their exertional fatigue to overtraining at the gym, or they simply don’t perform aerobically demanding activities that would unmask their underlying condition. Strength/resistance training (AKA “weightlifting”) is vastly different from aerobic/endurance (AKA “cardio”) exercise; a man might look very muscular and strong on the outside, capable of carrying heavy weights, but may have difficulty swimming a few laps in the pool. This type of heart enlargement can be diagnosed by an affordable ultrasonographic cardiac test called an echocardiogram. When diagnosed at an early stage, it may be reversible; at later stages, it may be irreversible, but there are things we can do to improve quality of life and longevity; in medicine, this is the principle of harm reduction.

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Whether on typical Testosterone Replacement Therapy doses or on extreme black market bodybuilding doses, all men who use anabolic steroids should have a nonjudgmental physician who is experienced in andrology and connected to a network of nonjudgmental specialists such as cardiologists and urologists.

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You can reduce harm by consulting a qualified physician, avoiding consistent use of high doses, avoiding non-bioidentical anabolics, and obtaining a cardiac ultrasound every few years to assess the presence of adverse structural changes that might have occurred from long-term anabolic steroids.

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Another harm reduction method is the use of Rapamycin, a drug that can prevent and counterbalance many of the adverse effects of long-term anabolic steroids. I prescribe Rapamycin to all the patients who are at risk.

 

If you are on non-bioidentical steroids, hopefully, I can persuade you that we may get great results with bioidentical ones and at lower doses. Even if you don’t join our vitality program, we can aim for maximal harm reduction; I know you’re getting your labs checked on your own, and I know you’re getting your blood dumped every few months, and your blood pressure is good. But as I explained above, there are other adverse effects to monitor, and there are affordable harm-reduction tools at our disposal.

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I wish you the best of health!

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