Most lay people don't realize that anabolic steroids are essentially synthetic versions of testosterone. True, they vary on how androgenic (their ability to influence physical sex characteristics) they are and how anabolic (how much they stimulate growth) they are, but they're all pretty much just testosterone wearing different chemical hats and different pairs of flashy pants.
Quite obviously, there's a sizeable subsection of athletes – bodybuilders in particular – that have been using staggering amounts of these testosterone analogs for a long time and doctors have finally begun to take notice of them.
The news isn't good. According to a study conducted by American cardiologists, large amounts of steroids, taken for lengthy periods of time, seem to wreak havoc on the heart. Paradoxically, low levels of the papa steroid – testosterone – also seem to play havoc on the heart, but for different reasons. How the hell does a weightlifting fella' win?
Anabolic steroids cause muscles to grow. The heart, while it's a different kind of muscle than skeletal muscle, is still a muscle. Hence, it too can be spurred to grow when introduced to anabolic steroids.
While growth of the heart doesn't instinctually sound like a bad thing, it can cause the walls of the heart to thicken to the point where they lose pliability and have difficulty pumping blood. Think of how difficult it would be to squeeze ketchup out of a Nalgene bottle and you'll get the picture.
Secondly, long-term use of anabolic steroids has been implicated in increased coronary atherosclerosis.
Doctors scavenged around for 86 male steroid users, all of whom had been moose-ing up with illegal steroids for an average of seven years. All were dedicated bodybuilders. They also recruited 54 non-steroid using lifters. The cardiovascular systems of both groups were analyzed and compared.
The docs then measured the capacity of their hearts to pump blood, along with the degree of plaque that was gumming up their blood vessels. There were four primary findings:
- AAS (anabolic-androgenic steroid) users demonstrated substantial impairment of the left ventricular systolic function.
- AAS users also showed impaired left ventricular diastolic functioning.
- AAS users showed significantly more hypertrophy of the left ventricle than non-users.
- AAS use was associated with increased coronary atherosclerosis, and the degree of atherosclerosis correlated with how long they'd been using. In fact, the degree of plaque found in their hearts was pretty scary.
The group of non-steroid users exhibited generally normal readings on all tests. The longer lifters took steroids, the worse it got. While the blood vessels of users might not have exhibited that much change during the first 6 or 7 years, things snowballed, or should I say fatballed, after that.
If there's any good news in this report, it's that those lifters who were off-cycle during the study showed better left ventricular systolic ejection (how forcefully the blood squirts out of the heart), suggesting that some of the damage may be reversible.
The authors of the study concluded the following:
"In aggregate, our findings suggest that long-term AAS use is associated with adverse cardiovascular phenotypes characterized by both myocardial pathology and coronary artery pathology, which may represent a clinically substantial and largely unrecognized public health problem."
If taking large amounts of synthetic testosterone is bad, so is having low levels of natural testosterone. A huge meta analysis in JAMA examined the results of over 100 testosterone studies and determined that low testosterone levels can severely affect heart health, often manifesting itself in the following ways:
- Higher risk of cardiovascular disease
- Narrowing of carotid arteries
- Increased incidence of angina
- Abnormal EKGs
- More frequent congestive heart failure
If anything can be gleaned from these reports, it's that moderation is the smart way to go. If you decide to use AAS, do them for a short, pre-defined cycle and then back off.
And, if you have any symptoms of low testosterone, get thee to a doc and demand a blood test to find out if you're low. (Just because you test "normal," though, doesn't mean you are normal. Again, go by your symptoms.)
If your doc thinks testosterone replacement therapy is right for you, remember that anything over 200 mg. a week is, in fact, a small steroid cycle, designed more for putting on muscle than for your health.
- Baggish AL et al. Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use. Circulation. 2017 May 23;135(21):1991-2002. PubMed.
- Vigen R et al. Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels. JAMA. 2013 Nov 6;310(17):1829-36. PubMed.