How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabolic and cardiovascular health

Abstract

It is estimated 6.4% of males and 1.6% of females globally use anabolic-androgenic steroids (AAS), mostly for appearance and performance enhancing reasons. In combination with resistance exercise, AAS use increases muscle protein synthesis resulting in skeletal muscle hypertrophy and increased performance. Primarily through binding to the androgen receptor, AAS exert their hypertrophic effects via genomic, non-genomic and anti-catabolic mechanisms. However, chronic AAS use also has a detrimental effect on metabolism ultimately increasing the risk of cardiovascular disease (CVD). Much research has focused on AAS effects on blood lipids and lipoproteins, with abnormal concentrations of these associated with insulin resistance, hypertension and increased visceral adipose tissue (VAT). This clustering of interconnected abnormalities is often referred as metabolic syndrome (MetS). Therefore, the aim of this review is to explore the impact of AAS use on mechanisms of muscle hypertrophy and markers of MetS. AAS use markedly decreases high-density lipoprotein cholesterol (HDL-C) and increases low-density lipoprotein cholesterol (LDL-C). Chronic AAS use also appears to cause higher fasting insulin levels and impaired glucose tolerance and possibly higher levels of VAT; however, research is currently lacking on the effects of AAS use on glucose metabolism. While cessation of AAS use can restore normal lipid levels, it may lead to withdrawal symptoms such as depression and hypogonadism that can increase CVD risk. Research is currently lacking on effective treatments for withdrawal symptoms and further long-term research is warranted on the effects of AAS use on metabolic health in males and females.

Generating evidence on the use of Image and performance enhancing drugs in the UK: results from a scoping review and expert consultation by the Anabolic Steroid UK network

“…The continuation or resumption of AAS use driven by symptoms of hypogonadism [ 97 – 100 ] was a significant finding, together with wider issues related to sexual health [ 101 ]. Harms associated with IPED use were commonly described [ 18 , 19 , 102 , 103 ], together with the risk environment [ 6 ] and efforts by individuals to mitigate these adverse consequences [ 104 ].…”

“…While the evidence base related to harms stemming from AAS use has developed over the last 5 years, there needs to be a continued focus on specific adverse effects for the full range of IPEDs [ 18 , 19 , 65 , 117 , 123 ], so that policy makers have a comprehensive understanding of the drivers and motives for use and cessation, and the associated harms for AAS [ 6 , 79 , 91 , 114 , 117 , 124 ] and other IPEDs [ 15 , 57 – 61 , 64 , 68 , 73 , 104 , 122 , 128 ]. We should also develop the evidence and increase our understanding of the issues associated with the diverse populations that use IPEDs [ 95 , 105 ].…”

“…Unlike the evidence that is specific to the AAS environment in the UK, much of our knowledge in relation to the pharmacological effects of IPEDs is generalisable from research around the world and includes an increasing body of evidence highlighting physical and psychological harms stemming from AAS use. While harms to major organs and systems, in particular the heart and cardiovascular, have long been associated with the use of AAS [ 16 ], it is only over the last decade that the significance of long-term, high-dosage AAS has become apparent [ 17 – 19 ]. Alongside the recognised physical and mental health impacts, new concerning evidence is emerging in relation to long-term use being associated with structural changes to the brain, deviant brain aging, and impaired cognition.…”

Targeted Metabolomics to Assess Exposure to Environmental Chemicals of Concern in Japanese Quail at Two Life Stages

“…Asymmetric dimethylarginine and pentose-phosphate demonstrated the biggest changes following TB in the adult liver ( Table 1 ). The elevated concentration of asymmetric dimethylarginine could have resulted from an increase of low-density lipoprotein cholesterol due to TB exposure [ 17 , 18 ]. In addition, the observed glutathione depletion in adult Japanese quail liver samples could have been a function of TB metabolism [ 13 ].…”

The Cardiac Effects of Performance-Enhancing Medications: Caffeine vs. Anabolic Androgenic Steroids

“…The doses are often 5-15 times higher than recommended levels, with athletes experiencing a higher probability of adverse cardiovascular events that includes stroke and myocardial infarction (MI) [9]. Preceding these events are hypertension and left ventricular (LV) hypertrophy, both independent predictors of cardiovascular mortality and morbidity [10,11]. There are, however, many obstacles to the investigation of the dangers of AASs, due to the dose never being reliably known, to polypharmacy or the ethical restrictions of conducting research studies [6].…”