Anabolic steroids are occasionally prescribed to help AIDS patients gain weight and to treat some types of severe anemia. These drugs are also used illegally by some athletes to improve performance, and by others to get a more muscular appearance. Anabolic steroids have dangerous physical and psychological side effects. These may be more dangerous in young adults because they can stop growth, and in females they can cause permanent changes in the voice and genitals.
After stopping these drugs, people can experience severe depression and moodiness. Injections of anabolic steroids carry the risk for infection with AIDS or hepatitis if needles are shared. Anabolic steroids obtained without a prescription are unreliable and may contain additional substances and may not even contain the steroids.
Anabolic steroid use causes decreased levels of HDL or “good” cholesterol, increased levels of LDL or “bad” cholesterol, and serious liver toxicity within 12 weeks, according to a study that measured the effects of anabolic steroids on men with HIV wasting ailment.
The researchers found that as expected, anabolic steroids lead to gains in both lean corpse mass and fat in men with HIV wasting.
“This is all right information for people with devastating wasting illnesses, who suffer from the effects of loss of muscle mass and whose most immediate danger is that they will die of their disease,” observes Grunfeld. “But for people who aren’t this sick and who take anabolic steroids, there may be serious problems if these complications occur.” Grunfeld, who is also a professor of medicine at the University of California, San Francisco, observes that “the biggest use of these steroids today is among body builders and athletes, who take these drugs to build muscle, but who could wind up with significantly damaged hearts and livers.”
The randomized, double-blind trial among 262 HIV-positive men was the largest study of its type on men with HIV-associated weight loss, according to the study authors. For the first 12 weeks of the trial, the men were randomly assigned to receive everyday doses of either 20, 40, or 80 milligrams of the anabolic steroid oxandrolone or a placebo. They were allowed to receive open-label oxandrolone for the second 12-week interval.
Grunfeld says the adverse effects of the steroids were clear-cut within the first 12 weeks. “HDL plummets. LDL goes up. This predisposes people to an increased risk of heart assail. Furthermore, we found grade III and grade IV liver toxicity in some men, which means a very significant risk of serious liver harm.” The men’s testosterone levels were also depressed. These effects were not seen in men taking placebo, according to Grunfeld.
The researchers observed that in men with the most wasting, the 20 milligram dose was more effectual than higher doses in promoting heaviness gain. Subjects who weighed more and were healthier - and were therefore more like athletes who use the drugs, observes Grunfeld - required higher doses to gain heaviness. This is significant, he says, because it demonstrates in healthy people, “you need a higher dose to get a benefit - and the higher the dose, the more the toxicity.” Based on observed changes in HDL and LDL, Grunfeld estimates that heart attack risk would be increased 58 percent among men attractive 20 milligrams of oxandrolone per day, two-fold with a 40 milligram daily dose, and three-fold with 80 milligrams. “Add smoking or hypertension, and the risk becomes really serious,” he says.
The ability to promote gains in both muscle and fat makes these drugs unique among the medications used for HIV wasting disease, notes Grunfeld. He says that among patients with serious wasting illnesses, the benefits of immediate heaviness gain could still potentially outweigh the risks of longer-term heart and liver damage. For these patients, he says, it is significant to have a store of fat as well as muscle mass, because “opportunistic infections burn up muscle if there’s no fat there. The more fat you have, the less muscle you burn.” Nonetheless, he notes, “We would still terminate the medication among anyone who has grade III or grade IV liver toxicity.” Grunfeld, who has no further plans to study steroids, says he would like to see the current study validated in two future studies by other investigators. The first would look exclusively at the 20 milligram dose in patients with important wasting, because “it may travail and have less toxicity.” The second would investigate whether the same toxic effects occur in healthy individuals who take anabolic steroids.