Steroid abuse as one of the causes for low testosterone is an extremely misunderstood topic.  It is true that anabolic steroids possess a bevy of potential side effects, among which is a temporary reduction in endogenous (natural) testosterone production, i.e. low testosterone.  It is also true that with the proper knowledge the vast majority of said side effects can be alleviated or completely reversed.  However, diminished endogenous testosterone secretion is not one of these possibly minimized or reversible side effects, as it must necessarily continue throughout the anabolic steroid cycle, and on until shortly after cycle discontinuation.  Low testosterone production is a condition that is inherent to anabolic steroid use, but for which there is some variance in the severity of testosterone suppression depending upon the actual androgenic number of the steroids utilized.

Often the popular media will propagate information that’s close to truth, as if it were the actual truth.  Sometimes this mistruth, is even supported by popular definitions which are also inexact, and incomplete.  For example, as cited above steroids (and all drugs) are accompanied by side effects, but the use of steroids (or any drug) does not necessarily constitute substance abuse.  Nevertheless when a topic, such as substance abuse, is defined differently by various sources it is easy to misrepresent facts in a way that seems logical, clear, and truthful.  For this reason, it is always best to use a superiorly valid and reliable source, one that is held in high esteem and therefore defies refutation.  In order to thoroughly comprehend what steroid abuse is (or would be), it is first necessary to delve into what it is not.

What Steroid Abuse Is Not

To the general public and the medical profession, steroid abuse is a condition that can be largely diagnosed by a physician the moment he walks into the examination room and lays eyes on a steroid user.  To a lesser degree, this same observation can be made at the gym or the beach by a seasoned gym goer.  For these populations, steroid abuse is characterized by a group of overtly apparent physical properties, which generally include:

• Seemingly inordinate muscle size (often sudden or progressive)
• Rapid or progressive weight gain
• Stretch marks on the skin of inner joints, particularly the elbows
• Excessive water retention; bloating that promotes a swollen appearance            throughout the body
• Bald or receding hairline reminiscent of male pattern baldness
• Atypically oily skin
• Persistent bad breath
• Gynecomastia; an abnormal increase in fatty breast tissue in males
• Thinning and/or shedding of hair throughout the scalp
• Small reddish and/or purplish acne breakouts on the face, back and shoulders

While it is true that all of these physical (along with a host of physiological, psychological, and social) side effects are indicative of anabolic steroid use, they alone do not necessarily constitute, nor should they be erroneously mislabeled as steroid abuse.  Every drug possesses the potential for side effects, i.e. those specific adverse effects that run alongside the drug’s intended curative or preventive qualities.  The mere fact that one experiences side effects, does not make one an abuser of steroids any more than it would an abuser of other drugs such as anti-anxiety/anti-depressants, stimulants, pain relievers, etc.

History:  How Steroids Became Stigmatized

So how is it that the popular media so deafeningly rewrites the medical book when it comes to anabolic steroids?  The answers are simple and at least twofold, in that they represent the same two reasons many such things become coveted and/or stigmatized throughout society, namely money and fear respectively.  It is, however, necessary to begin with a brief history lesson.  Scientists realized the potential of anabolic steroids soon after they appeared, and in 1939 German scientist Adolf Butenandt won the Nobel Prize in chemistry for his pioneering work on testosterone.  The early 1970’s fitness craze rode the coattails of the Olympics of the 1960’s, during which anabolic steroids burst onto the international athletics scene in grand fashion, due largely to the dominating success of the East Germans who admittedly (because it was not illegal at the time) made steroids a major part of their regimen.  Then in the 1976 Olympics in Montreal, East German athletes won 40 gold medals including 11 in Women’s Swimming.  These drugs suddenly captured the world’s attention, causing a dramatic shift towards fitness and bodybuilding.  Like two virtual heavyweights, in one corner Jack Lalanne, Jane Fonda, and Richard Simmons launched the fitness revolution, while names like Sergio Olivia, Lou Ferrigno, and the legendary Austrian Oak Arnold Schwarzenegger spearheaded professional bodybuilding from the other corner.  It is important to note that at this time anabolic steroids were not classified as controlled substances, and did not require a prescription.

When steroids again appeared in the Olympics, in sort of a pre- and post-test, they were here to stay.  Shortly after Canadian sprinter Ben Johnson won the 1988 Olympic gold medal and world record in the 100 meters, he failed an anabolic steroids drug test.  Upon admitting guilt and being stripped of his medals and record, Johnson later returned to elite sprinting as a substantially slower runner.  This served as unequivocal before and after proof that steroids were indeed highly effective, and they became a worldwide obsession.  Although this can never be proved, it is widely believed that governments around globe saw the potential pay day, and lobbied in secret to have these drugs added to the controlled substances list, not to protect the planet from so-called steroid abuse, but to control the purse strings of an emerging billion dollar industry.  After the Johnson scandal, U.S. congressional hearings were held to outlaw the nonmedical use of anabolic steroids.  Some major players in the industry, including the American Medical Administration (AMA), the Food and Drug Administration (FDA), and the Drug Enforcement Administration (DEA), all testified that steroids were not addictive, and did not meet the criteria for becoming controlled substances.  It was then that congressional lobbyists called on probably the biggest catalyst for fueling the fire for mandating controls on anabolic steroids, the mythical manic condition of ‘Roid Rage’.  Although a clinically unproven condition, there is a shred of truth to it.  In fact, less than a handful of steroids do possess the side effect of increased aggression.  However, such an effect in no way transforms a mild mannered Dr. Jekyll-like steroid user into the uncontrollable monster Mr. Hyde, as perpetrated by the popular media.  Firstly, this aggressive property is most often (in positive manner) channeled inwardly to increase the intensity of one’s workout, and not outwardly as an unmanageable threat to the general public.  Secondly, it is not a manic rage, but rather an increase in aggression meaning only individuals who are already hyper-aggressive even express the potential to be adversely affected.  Despite protests by the largest federal drug agencies in the nation (the AMA, FDA, and DEA), on November 29, 1990, the President George Bush signed into law the Anabolic Steroids Control Act of 1990 (Title XIX of Pub. L. 101-647), which became effective February 27, 1991.  This law established and regulated anabolic steroids as a class of drugs under schedule III of the Controlled Substances Act (CSA).

What Substance Abuse Is

Steroid users tend to fall into one of three categories:  1) those who know how to use them and do so responsibly; 2) those who know a little and use them haphazardly; and 3) those who don’t know anything and use them ignorantly.  No one knows the numbers or can accurately place percentages on any of the three, but the latter two are understandably more prone to steroid abuse.  In general, the side effects incurred during steroid use are temporary.  Veteran steroid users, wield anabolics in much the same way physicians do, by effectively controlling the dosage, frequency, and duration of the drugs.  For such users, the majority of experienced side effects often occur within the first few weeks of use, persisting throughout the steroid cycle, and on until the compound has completely evacuated the body during the post-cycle.  Depending on the half-life (amount of time drugs remain in the system) of the steroids used, this time period can be as little as a few weeks or as much as a couple months after the cycle concludes.  Conversely, novice users either are unaware of how to properly manage these three controlling variables, or are completely oblivious to them.  It is such use that approaches the actual criterion for drug/substance abuse.  Side effects for these individuals can have a lasting and a potentially harmful impact, more specifically in the area of low testosterone.

‘Steroid abuse’ is a term that warrants an accurate definition.  According to the Mayo Clinic, “Prescription drug abuse is the use of a prescription medication in a way not intended by the prescribing doctor, such as for the feelings you get from the drug.”  A definition this general classifies drug abuse as everything from taking a friend’s prescription painkiller for one’s own backache to snorting or injecting ground-up pills to get high.  Other definitions more closely support that drug abuse possesses an ongoing compulsion, despite the negative consequences, regardless of drug type, i.e., illicit/recreational drugs or controlled substances.  However, substance abuse which really doesn’t by definition include non-addictive anabolic steroids at all, is more holistically defined by the established barometer for clinical addictions (throughout the medical community) by the Diagnostic and Statistical Manual of Mental Disorders – the official manual published by the American Psychiatric Association which lists all psychiatric and psychological disorders and their diagnostic criteria. Its fifth edition, commonly known as the DSM-5, was released at the Association’s Annual Meeting in May 2013.  The following is an excerpt from this manual, which details the criterion official for addiction:

A.  A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household)
2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of  intoxication, physical fights) 

How Steroid Abuse Can Affect Low Testosterone

Thus, until a drug user of any addictive substance starts to experience a diminished quality of life, biologically, physically, psychiatrically, and/or socially (s)he is merely a drug user…not an abuser of said drug.  The vast majority of anabolic steroid users do not meet the above criterion, primarily because contrary to popular belief steroids (as testified by the AMA, FDA, and DEA) are not addictive.  However, due largely to the aforementioned latter categories of steroid users, i.e. those who know a little [about anabolic steroids] and use them haphazardly, and those who don’t know anything and use them ignorantly there exists a very real danger regarding low testosterone.

Anabolic steroid use necessarily causes the temporary suppression of Hypothalamic-Pituitary-Testicular Axis (HPTA) – the relationship between these glands and their production of testosterone.  One of the main reasons steroid users cycle (use for a period and discontinue for a period) these compounds is to restore normal HPTA functioning.  Typically speaking, the longer steroids are used, the longer it takes for HPTA to recover or normalize.  It is therefore safe to say that abnormally long anabolic steroid use at dosages high enough to promote anabolism (muscle building/physique- and performance-enhancement) can have a negative effect on the restoration of endogenous testosterone production.

Although there aren’t clinical studies for such use, former MBL All-Star Jose Canseco serves as the quintessential case study.  In a brilliant 2008 documentary (that is no longer available), the Arts and Entertainment channel provided a candid view of the after effects of what Canseco described as “twenty-five years of continuous steroid use with a few small breaks”.  In this tell-all documentary, he described (long after steroid discontinuation, but undisclosed the exact time frame) experiencing a range quit typical hypogonadic side effects including mood swings, an almost non-existent libido, random bouts of erectile dysfunction, depression that would naturally stem from such conditions, and a general lack of wellbeing.  The viewer was privileged to go into the examination room with Jose, and to hear the results of a blood test that returned testosterone score in the mid-100’s (a score of 300 is the lower limit for normalcy yet far below optimal).  His physician informed him that the best course of action was to start him on testosterone, to which he adamantly disagreed until he was told that it would be AndroGel – a topical preparation, applied to the skin that is absorbed transdermally through the skin into the capillaries and other blood vessels.  Amid what seemed a very sad commentary, viewers glimpsed a time lapsed sequence of Jose’s activities (phone calls, errands, photo shoots, speaking engagements, book signings, etc.).  Upon returning for the results of his follow-up blood test, the physician expressed shock that his testosterone levels had barely moved and stated that his dosages should have been far more impactful.  The end of the documentary showed cited that Jose was recently detained at the Mexican border for attempting to smuggle in human chorionic gonadotropin (HCG) – a hormone that is primarily used to treat infertility in women by stimulating the release of the egg during ovulation, and also supports the normal development of an egg while within a woman’s ovary.  Jose was right to try this compound, and it is remarkable that he couldn’t just get a domestic prescription for it based on his condition because the secondary clinical uses for HCG (brand names Novarel, Ovidrel, Pregnyl) include moderating testosterone levels, increasing sperm count, and treating undescended testicles (testicles have not dropped down into the scrotum normally) in young boys, all conditions that can be caused by a pituitary gland disorder, which is an integral part of HPTA functioning and consequently testosterone secretion.

In summation, and in accord with the cross-referenced facts that:  1) a search of the U.S. National Library of Medicine National Institutes of Health returned no studies or articles wherein responsible anabolic steroid administration caused permanent or even extended damage to HPTA or other long-term side effects; 2) steroids were never considered addictive medications by any of the governing U.S. administrations; and 3) in light of the egregious manner in which the term ‘Steroid Abuse’ is consistently misapplied, one cannot legitimately state that responsible cycling of anabolic steroids for performance-enhancement purposes constitutes abuse.  However, it is still possible for severe irresponsible use of these hormones to potentially cause lasting adverse side effects, including persistent low testosterone levels.

REFERENCE LIST

• DEPARTMENT OF JUSTICE
• Drug Enforcement Administration
• Classification of Three Steroids as Schedule III Anabolic Steroids Under the Controlled Substances Act [Federal Register: April 25, 2008 (Volume 73, Number 81)]
• http://www.deadiversion.usdoj.gov/fed_regs/rules/2008/fr0425.htm
• NobelPrize.org
• The Nobel Prize in Chemistry 1939
Adolf Butenandt, Leopold Ruzicka
• http://www.nobelprize.org/nobel_prizes/chemistry/laureates/1939/butenandt-facts.html
• Mayo Foundation for Medical Education and Research
• Prescription Drug Abuse, Definition
• Mayo Clinic Staff
• http://www.mayoclinic.com/health/prescription-drug-abuse/DS01079
• Definition for Substance Abuse
• Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)
• American Psychiatric Association
• IAAF Bans Johnson for Life After His 2d Doping Offense
• The New York Times
• Ian Thomen
• March 6, 1993
• http://www.nytimes.com/1993/03/06/sports/06iht-ben_.html