In addition to the mentioned side effects several others have been reported. In both males and females acne are frequently reported, as well as hypertrophy of sebaceous glands, increased tallow excretion, hair loss, and alopecia. There is some evidence that anabolic steroid abuse may affect the immune system, leading to a decreased effectiveness of the defense system. Steroid use decreases the glucose tolerance, while there is an increase in insulin resistance. These changes mimic Type II diabetes. These changes seem to be reversible after abstention from the drugs.
Drug-induced and indeterminate acute liver failure (ALF) might be due to an autoimmune-like hepatitis that is responsive to corticosteroid therapy. The aim of this study was to evaluate whether corticosteroids improve survival in fulminant autoimmune hepatitis, drug-induced, or indeterminate ALF, and whether this benefit varies according to the severity of illness. We conducted a retrospective analysis of autoimmune, indeterminate, and drug-induced ALF patients in the Acute Liver Failure Study Group from 1998-2007. The primary endpoints were overall and spontaneous survival (SS, survival without transplant). In all, 361 ALF patients were studied, 66 with autoimmune (25 steroids, 41 no steroids), 164 with indeterminate (21 steroids, 143 no steroids), and 131 with drug-induced (16 steroids, 115 no steroids) ALF. Steroid use was not associated with improved overall survival (61% versus 66%, P = ), nor with improved survival in any diagnosis category. Steroid use was associated with diminished survival in certain subgroups of patients, including those with the highest quartile of the Model for Endstage Liver Disease (MELD) (>40, survival 30% versus 57%, P = ). In multivariate analysis controlling for steroid use and diagnosis, age (odds ratio [OR] per decade), coma grade (OR grade 2, grade 3, grade 4), MELD (OR ), and pH < (OR ) were significantly associated with mortality. Although steroid use was associated with a marginal benefit in SS overall (35% versus 23%, P = ), this benefit did not persistent in multivariate analysis; mechanical ventilation (OR ), MELD (OR ), and alanine aminotransferase () were the only significant predictors of SS. Conclusion : Corticosteroids did not improve overall survival or SS in drug-induced, indeterminate, or autoimmune ALF and were associated with lower survival in patients with the highest MELD scores. (H epatology 2014;59:612–621)
We praise professional athletes; we understand, although most do not perceive fully, steroid use is as much a part of professional sports as the ball used in the game. We worship the heroes of the silver screen; muscular ass-kicking heroes who are bigger than life; there’s a reason they look the way they do. Further and more importantly than any of the after mentioned examples, we live in a culture driven by success, driven and rewarded on the basis of performance, for this reason and this reason alone, steroid use will always be part of the American culture and a welcomed one by many.