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Term Paper Anabolic Steroids

Research Report Series: Anabolic Steroid Abuse


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Source: NIDA Research Report Series: Anabolic Steroid Abuse, NIH Publication Number 00-3721, 1991, Reprinted 1994, 1996. Revised April, 2000
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Table of Contents (TOC)

From the Director
Chapter 1: What are anabolic steroids?
Chapter 2: What are steroidal supplements?
Chapter 3: What is the scope of steroid abuse in the United States?
Chapter 4: Why do people use anabolic steroids?
Chapter 5: How are anabolic steroids used?
Chapter 6: What are the health consequences of steroid abuse?
Chapter 7: What effects do anabolic steroids have on behavior?
Chapter 8: Are anabolic steroids addictive?
Chapter 9: What can be done to prevent steroid abuse?
Chapter 10: What treatments are effective for anabolic steroid abuse?
Glossary
References

Letter from the Director

Since the 1950s, some athletes have been taking anabolic steroids to build muscle and boost their athletic performance. Increasingly, other segments of the population also have been taking these compounds. The Monitoring the Future study, which is an annual survey of drug abuse among adolescents across the country, showed a significant increase from 1998 to 1999 in steroid abuse among middle school students. During the same year, the percentage of 12th-graders who believed that taking these drugs causes "great risk" to health, declined from 68 percent to 62 percent.

Studies show that, over time, anabolic steroids can indeed take a heavy toll on a person’s health. The abuse of oral or injectable steroids is associated with higher risks for heart attacks and strokes, and the abuse of most oral steroids is associated with increased risk for liver problems. Steroid abusers who share needles or use nonsterile techniques when they inject steroids are at risk for contracting dangerous infections, such as HIV/AIDS, hepatitis B and C, and bacterial endocarditis.

Anabolic steroid abuse can also cause undesirable body changes. These include breast development and genital shrinking in men, masculinization of the body in women, and acne and hair loss in both sexes.

These and other effects of steroid abuse are discussed in this Research Report, which is one of a series of reports on drugs of abuse. NIDA produces this series to increase understanding of drug abuse and addiction and the health effects associated with taking drugs.

We hope that this compilation of scientific information on anabolic steroids will help the public recognize the risks of steroid abuse.

Alan I. Leshner, Ph.D.
Director
National Institute on Drug Abuse


Chapter 1: What are anabolic steroids?

"Anabolic steroids" is the familiar name for synthetic substances related to the male sex hormones (androgens). They promote the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects), and also have some other effects. The term "anabolic steroids" will be used through-out this report because of its familiarity, although the proper term for these compounds is "anabolic-androgenic" steroids.

Anabolic steroids were developed in the late 1930s primarily to treat hypogonadism, a condition in which the testes do not produce sufficient testosterone for normal growth, development, and sexual functioning. The primary medical uses of these compounds are to treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection or other diseases.

During the 1930s, scientists discovered that anabolic steroids could facilitate the growth of skeletal muscle in laboratory animals, which led to use of the compounds first by bodybuilders and weightlifters and then by athletes in other sports. Steroid abuse has become so widespread in athletics that it affects the outcome of sports contests.





More than 100 different anabolic steroids have been developed, but they require a prescription to be used legally in the United States. Most steroids that are used illegally are smuggled in from other countries, illegally diverted from U.S. pharmacies, or synthesized in clandestine laboratories.


Chapter 2: What are steroidal supplements?

In the United States, supplements such as dehydroepian-drosterone (DHEA) and androstenedione (street name Andro) can be purchased legally without a prescription through many commercial sources including health food stores. They are often referred to as dietary supplements, although they are not food products. They are often taken because the user believes they have anabolic effects.

Steroidal supplements can be converted into testosterone (an important male sex hormone) or a similar compound in the body. Whether such conversion produces sufficient quantities of testosterone to promote muscle growth or whether the supplements themselves promote muscle growth is unknown. Little is known about the side effects of steroidal supplements, but if large quantities of these compounds substantially increase testosterone levels in the body, they also are likely to produce the same side effects as anabolic steroids.


Chapter 3: What is the scope of steroid abuse in the United States?

Recent evidence suggests that steroid abuse among adolescents is on the rise. The 1999 Monitoring the Future study, a NIDA-funded survey of drug abuse among adolescents in middle and high schools across the United States, estimated that 2.7 percent of 8th- and 10th-graders and 2.9 percent of 12th-graders had taken anabolic steroids at least once in their lives. For 10th-graders, that is a significant increase from 1998, when 2.0 percent of 10th-graders said they had taken anabolic steroids at least once. For all three grades, the 1999 levels represent a significant increase from 1991, the first year that data on steroid abuse were collected from the younger students. In that year, 1.9 percent of 8th-graders, 1.8 percent of 10th-graders, and 2.1 percent of 12th-graders reported that they had taken anabolic steroids at least once.



From 1998 to 1999, the Monitoring the Future Survey reported an increase in lifetime use of steroids among 10th-graders and a decrease in perceived risk of harm among seniors.



Few data exist on the extent of steroid abuse by adults. It has been estimated that hundreds of thousands of people aged 18 and older abuse anabolic steroids at least once a year.

Among both adolescents and adults, steroid abuse is higher among males than females. However, steroid abuse is growing most rapidly among young women.


Chapter 4: Why do people use anabolic steroids?

One of the main reasons people give for abusing steroids is to improve their performance in sports. Among competitive bodybuilders, steroid abuse has been estimated to be very high. Among other athletes, the incidence of abuse probably varies depending on the specific sport.

Another reason people give for taking steroids is to increase their muscle size and/or reduce their body fat. This group includes some people who have a behavioral syndrome (muscle dysmorphia) in which a person has a distorted image of his or her body. Men with this condition think that they look small and weak, even if they are large and muscular. Similarly, women with the syndrome think that they look fat and flabby, even though they are actually lean and muscular.

Some people who abuse steroids to boost muscle size have experienced physical or sexual abuse. They are trying to increase their muscle size to protect themselves. In one series of interviews with male weightlifters, 25 percent who abused steroids reported memories of childhood physical or sexual abuse, compared with none who did not abuse steroids. In a study of women weightlifters, twice as many of those who had been raped reported using anabolic steroids and/or another purported muscle-building drug, compared to those who had not been raped. Moreover, almost all of those who had been raped reported that they markedly increased their bodybuilding activities after the attack. They believed that being bigger and stronger would discourage further attacks because men would find them either intimidating or unattractive.





Finally, some adolescents abuse steroids as part of a pattern of high-risk behaviors. These adolescents also take risks such as drinking and driving, carrying a gun, not wearing a helmet on a motorcycle, and abusing other illicit drugs.

While conditions such as muscle dysmorphia, a history of physical or sexual abuse, or a history of engaging in high-risk behaviors may increase the risk of initiating or continuing steroid abuse, researchers agree that most steroid abusers are psychologically normal when they start abusing the drugs.


Chapter 5: How are anabolic steroids used?

Some anabolic steroids are taken orally, others are injected intramuscularly, and still others are provided in gels or creams that are rubbed on the skin. Doses taken by abusers can be 10 to 100 times higher than the doses used for medical conditions.

Steroid abusers typically "stack" the drugs, meaning that they take two or more different anabolic steroids, mixing oral and/or injectable types and sometimes even including compounds that are designed for veterinary use. Abusers think that the different steroids interact to produce an effect on muscle size that is greater than the effects of each drug individually, a theory that has not been tested scientifically.

Often, steroid abusers also "pyramid" their doses in cycles of 6 to 12 weeks. At the beginning of a cycle, the person starts with low doses of the drugs being stacked and then slowly increases the doses. In the second half of the cycle, the doses are slowly decreased to zero. This is sometimes followed by a second cycle in which the person continues to train but without drugs. Abusers believe that pyramiding allows the body time to adjust to the high doses and the drug-free cycle allows the body’s hormonal system time to recuperate. As with stacking, the perceived benefits of pyramiding and cycling have not been substantiated scientifically.


Chapter 6: What are the health consequences of steroid abuse?


Possible Health Consequences of Anabolic Steroid Abuse

Anabolic steroid abuse has been associated with a wide range of adverse side effects ranging from some that are physically unattractive, such as acne and breast development in men, to others that are life threatening, such as heart attacks and liver cancer. Most are reversible if the abuser stops taking the drugs, but some are permanent.

Most data on the long-term effects of anabolic steroids on humans come from case reports rather than formal epidemiological studies. From the case reports, the incidence of life-threatening effects appears to be low, but serious adverse effects may be under-recognized or under-reported. Data from animal studies seem to support this possibility. One study found that exposing male mice for one-fifth of their lifespan to steroid doses comparable to those taken by human athletes caused a high percentage of premature deaths.

Hormonal system

Steroid abuse disrupts the normal production of hormones in the body, causing both reversible and irreversible changes. Changes that can be reversed include reduced sperm production and shrinking of the testicles (testicular atrophy). Irreversible changes include male-pattern baldness and breast development (gynecomastia). In one study of male bodybuilders, more than half had testicular atrophy, and more than half had gynecomastia. Gynecomastia is thought to occur due to the disruption of normal hormone balance. In the female body, anabolic steroids cause masculinization. Breast size and body fat decrease, the skin becomes coarse, the clitoris enlarges, and the voice deepens. Women may experience excessive growth of body hair but lose scalp hair. With continued administration of steroids, some of these effects are irreversible.

Musculoskeletal system

Rising levels of testosterone and other sex hormones normally trigger the growth spurt that occurs during puberty and adolescence. Subsequently, when these hormones reach certain levels, they signal the bones to stop growing, locking a person into his or her maximum height.

When a child or adolescent takes anabolic steroids, the resulting artificially high sex hormone levels can signal the bones to stop growing sooner than they normally would have done.

Cardiovascular system

Steroid abuse has been associated with cardiovascular diseases (CVD), including heart attacks and strokes, even in athletes younger than 30. Steroids contribute to the development of CVD, partly by changing the levels of lipoproteins that carry cholesterol in the blood. Steroids, particularly the oral types, increase the level of low-density lipoprotein (LDL) and decrease the level of high-density lipoprotein (HDL). High LDL and low HDL levels increase the risk of atherosclerosis, a condition in which fatty substances are deposited inside arteries and disrupt blood flow. If blood is prevented from reaching the heart, the result can be a heart attack. If blood is prevented from reaching the brain, the result can be a stroke.

Steroids also increase the risk that blood clots will form in blood vessels, potentially disrupting blood flow and damaging the heart muscle so that it does not pump blood effectively.

Liver

Steroid abuse has been associated with liver tumors and a rare condition called peliosis hepatis, in which blood-filled cysts form in the liver. Both the tumors and the cysts sometimes rupture, causing internal bleeding.

Skin

Steroid abuse can cause acne, cysts, and oily hair and skin.

Infection

Many abusers who inject anabolic steroids use nonsterile injection techniques or share contaminated needles with other abusers. In addition, some steroid preparations are manufactured illegally under non-sterile conditions. These factors put abusers at risk for acquiring life-threatening viral infections, such as HIV and hepatitis B and C. Abusers also can develop infective endocarditis, a bacterial illness that causes a potentially fatal inflammation of the inner lining of the heart. Bacterial infections also can cause pain and abscess formation at injection sites.


Chapter 7: What effects do anabolic steroids have on behavior?


Case reports and small studies indicate that anabolic steroids, particularly in high doses, increase irritability and aggression. Some steroid abusers report that they have committed aggressive acts, such as physical fighting, committing armed robbery, or using force to obtain something. Some abusers also report that they have committed property crimes, such as stealing from a store, damaging or destroying others’ property, or breaking into a house or a building. Abusers who have committed aggressive acts or property crimes generally report that they engage in these behaviors more often when they take steroids than when they are drug-free.

Some researchers have suggested that steroid abusers may commit aggressive acts and property crimes not because of steroids’ direct effects on the brain but because the abusers have been affected by extensive media attention to the link between steroids and aggression. According to this theory, the abusers are using this possible link as an excuse to commit aggressive acts and property crimes.

One way to distinguish between these two possibilities is to administer either high steroid doses or placebo for days or weeks to human volunteers and then ask the people to report on their behavioral symptoms. To date, four such studies have been conducted. In three, high steroid doses did produce greater feelings of irritability and aggression than did placebo; but in one study, the drugs did not have that effect. One possible explanation, according to researchers, is that some but not all anabolic steroids increase irritability and aggression.

Anabolic steroids have been reported also to cause other behavioral effects, including euphoria, increased energy, sexual arousal, mood swings, distractibility, forgetfulness, and confusion. In the studies in which researchers administered high steroid doses to volunteers, a minority of the volunteers developed behavioral symptoms that were so extreme as to disrupt their ability to function in their jobs or in society. In a few cases, the volunteers’ behavior presented a threat to themselves and others.

In summary, the extent to which steroid abuse contributes to violence and behavioral disorders is unknown. As with the health complications of steroid abuse, the prevalence of extreme cases of violence and behavioral disorders seems to be low, but it may be underreported or underrecognized.


Chapter 8: Are anabolic steroids addictive?

An undetermined percentage of steroid abusers become addicted to the drugs, as evidenced by their continuing to take steroids in spite of physical problems, negative effects on social relations, or nervousness and irritability. Also, they spend large amounts of time and money obtaining the drugs and experience withdrawal symptoms such as mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and the desire to take more steroids. The most dangerous of the withdrawal symptoms is depression, because it sometimes leads to suicide attempts. Untreated, some depressive symptoms associated with anabolic steroid withdrawal have been known to persist for a year or more after the abuser stops taking the drugs.


Chapter 9: What can be done to prevent steroid abuse?

Early attempts to prevent steroid abuse concentrated on drug testing and on educating students about the drugs’ adverse effects. A few school districts test for abuse of illicit drugs, including steroids, and studies are currently under way to determine whether such testing reduces drug abuse.

Research on steroid educational programs has shown that simply teaching students about steroids’ adverse effects does not convince adolescents that they personally can be adversely affected. Nor does such instruction discourage young people from taking steroids in the future. Presenting both the risks and benefits of anabolic steroid use is more effective in convincing adolescents about steroids’ negative effects, apparently because the students find a balanced approach more credible and less biased, according to the researchers. However, the balanced approach still does not discourage adolescents from abusing steroids.

A more sophisticated approach has shown promise for preventing steroid abuse among players on high school sports teams. In the ATLAS program, developed for male football players, coaches and team leaders discuss the potential effects of anabolic steroids and other illicit drugs on immediate sports performance, and they teach how to refuse offers of drugs. They also discuss how strength training and proper nutrition can help adolescents build their bodies without the use of steroids. Later, special trainers teach the players proper weightlifting techniques. An ongoing series of studies has shown that this multicomponent, team-centered approach reduces new steroid abuse by 50 percent. A program designed for adolescent girls on sports teams, patterned after the program designed for boys, is currently being tested.


Chapter 10: What treatments are effective for anabolic steroid abuse?

Few studies of treatments for anabolic steroid abuse have been conducted. Current knowledge is based largely on the experiences of a small number of physicians who have worked with patients undergoing steroid withdrawal. The physicians have found that supportive therapy is sufficient in some cases. Patients are educated about what they may experience during withdrawal and are evaluated for suicidal thoughts.

If symptoms are severe or prolonged, medications or hospitalization may be needed.

Some medications that have been used for treating steroid withdrawal restore the hormonal system after its disruption by steroid abuse. Other medications target specific withdrawal symptoms for example, antidepressants to treat depression, and analgesics for head-aches and muscle and joint pains.

Some patients require assistance beyond simple treatment of withdrawal symptoms and are treated with behavioral therapies.


Glossary

Addiction: A chronic, relapsing disease, characterized by compulsive drug-seeking and use and by neurochemical and molecular changes in the brain.

Anabolic effects: Drug-induced growth or thickening of the body’s nonreproductive tract tissues - including skeletal muscle, bones, the larynx, and vocal cords - and decrease in body fat.

Analgesics: A group of medications that reduce pain.

Androgenic effects: A drug’s effects upon the growth of the male reproductive tract and the development of male secondary sexual characteristics.

Antidepressants: A group of drugs used in treating depressive disorders.

Cardiovascular system: The heart and blood vessels.

Hormone: A chemical substance formed in glands in the body and carried in the blood to organs and tissues, where it influences function, structure, and behavior.

Musculoskeletal system: The muscles, bones, tendons, and ligaments.

Placebo: An inactive substance, used in experiments to distinguish between actual drug effects and effects that are expected by the volunteers in the experiments.

Sex hormones: Hormones that are found in higher quantities in one sex than in the other. Male sex hormones are the androgens, which include testosterone; and the female sex hormones are the estrogens and progesterone.

Withdrawal: Symptoms that occur after chronic use of a drug is reduced or stopped.


References

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Bronson, F.H., and Matherne, C.M. Exposure to anabolic-androgenic steroids shortens life span of male mice. Medicine and Science in Sports and Exercise 29(5): 615-619, 1997.

Brower, K.J. Withdrawal from anabolic steroids. Current Therapy in Endocrinology and Metabolism 6: 338-343, 1997.

Elliot, D., and Goldberg, L. Intervention and prevention of steroid use in adolescents. The American Journal of Sports Medicine 24(6): S46-S47, 1996.

Goldberg, L., et al. Anabolic steroid education and adolescents: Do scare tactics work? Pediatrics 87(3): 283-286, 1991.

Goldberg, L., et al. Effects of a multidimensional anabolic steroid prevention intervention: The Adolescents Training and Learning to Avoid Steroids (ATLAS) Program. Journal of the American Medical Association 276(19): 1555-1562, 1996.

Goldberg, L., et al. The ATLAS program: Preventing drug use and promoting health behaviors. Archives of Pediatrics and Adolescent Medicine 154: 332-338, 2000.

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The Medical Letter on Drugs and Therapeutics. Creatine and androstenedione-two "dietary supplements." 40(1039): 105-106, 1998.

Middleman, A.B, et al. High-risk behaviors among high school students in Massachusetts who use anabolic steroids. Pediatrics 96(2): 268-272, 1995.

Pope, H.G., Jr., Kouri, E.M., and Hudson, M.D. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men. Archives of General Psychiatry 57(2): 133-140, 2000.

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Porcerelli, J.H., and Sandler, B.A. Narcissism and empathy in steroid users. American Journal of Psychiatry 152(11): 1672-1674, 1995.

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Anabolic Steroids

If someone guaranteed you amazing results in the weight room with minimal effort by just taking a pill would you take it? You probably would! But, if you knew that these pills could potentially knock 20 years off your life. Would you take it then? You would be suprised to find out how many people would answer yes to that question. In the past three decades, steroids have become a serious problem, more than ever in the athletic field. It is reported that over 3 million athletes and bodybuilders alone have used anabolic steroids . Steroids are a drug that include the male sex hormones, principally, testosterone and estrogen, the female sex hormone. To begin quite simply, it is apparent to most people that men tend to be larger than women. Indeed, a clear cut example of a difference between the sexes is the relative muscle mass. In men the most important growth builder is testosterone, which is made from the cells of the testes. Approximately 8 mg of testosterone is created daily, most of which is metabolized by the liver and excreted through the body in urine form. Testosterone is also present in the blood plasma of women, being derived from the ovaries and adrenal glands, in amounts roughly 30 times less than that found in men. Among the many effects of these androgens is the general growth on the body tissues and an increase in muscle strength. One of the main effects of anabolic steroids is to increase the number of red blood cells and muscle tissue without producing much of the androgenic effects of testosterone.

Steroids have been around since the 1950`s and have been used by athletes as a means of improving appearance, muscle mass and strength. The first people to use anabolic steroids for athletic enhancement were the Russians who discovered the drug and had great success. Soon after scientists discovered how to make artificial testosterone and eliminate some of the dangerous side effects. This is when anabolic steroids were first born. Since then they have become very available in almost every country and local gym. Steroids were first developed for medical purposes. They're used in controlling inflammation, strengthening weakened hearts, preventing conception, and alleviating symptoms of arthritis and asthma. There are only three legal uses for steroids, treatment for certain forms of cancer, pituitary dwarfism, and serious hormone disturbances. Unfortunately research has shown that steroids have been abused in almost every kind of sport including professional football, power lifting and bodybuilding. Athletes can use anabolic steroids in two different forms. The first is oral, which is a tablet to be swallowed. Oral steroids allow the body to store more creatine phosphate (short term energy source). The second form is an injectible which is a liquid injected into the muscle. This form of the drug promotes protein synthesis. Whether taken by injection or the pill it increases strength and endurance. Steroids also help in the healing process of muscular tissue by first injuring them, then the muscles heal quicker adding more fiber and increasing their bulk. Athletes are also more prone to use steroids due to the inexpensive cost of the drug. A ten week cycle of artificial testosterone costs only about one hundred dollars. Steroids are also very hard to trace because of their water base composition. They can pass through the body within two days. All these benefits of steroids help a athlete become more competitive and increase their chance of being a winner. Of course everybody wants better biceps and triceps but when using steroids to achieve this goal there is a large price to pay.

The drugs that most common athletes use are androgen-anabolic steroids, fake versions of testosterone. They retain nitrogen which helps in the synthesis of protein and the creation of new tissue. But because they are imitators of the male hormone, they tend to change the secondary sex characteristics. In men, steroids cause shrinkage of the testicles, decrease in sperm count, sterility, impotence, prostate enlargement and growth of female breast. Some of these side effects can not be reversed. Men who use steroids may become more or less interested in sex. The most severe effect of anabolic steroids is on the liver, this is called peliosis hepatis or blood filled cysts in the liver. If the cysts rupture they can cause liver failure which can kill a person. In women, steroids contribute to the growth of facial hair, enlargements of the clitoris, shrinkage of the uterus, sterility, deepening of the voice, decrease in breast size and irregularity of the menstrual cycle. In both men and women hair loss, liver ailments, acne, atherosierosis and cancer are very common. . When injected one risks the chances of developing hematoma and contracting AIDS .This dangerous drug shortens the life span up to twenty years and increases the chance of obtaining diabetes, cardiovascular diseases and hypertension. The side effects and reactions from using anabolic steroids are endless.

Along with the physical problems there are also mental reactions associated with the usage of steroids. This drug becomes very addictive and damaging to the mind. It causes violent episodes which an athlete can claim a legal insanity defense to it. They get so wrapped up psychologically that the negative effects doesn't matter to them. Research has also discovered that steroids cause psychotic side effects sometimes referred to as "roid rages". Along with these are wild, aggressive, combative behavior, depression, listlessness and delusions during and after performance. Even though the game is over athletes want to continue competing. Steroids mentally destroy the brain and ability to reason. Overall the usage of steroids is very damaging to the human body. Even though it physically builds up the body for better performance the risks of use are enormous. Steroids physically deteriorate and mentally destroy the body.

You would think that with all the above listed problems that can arise out of the use of these steroids, the individual would leave them entirely alone but this is not the case. Besides this, and to add to the risk, the top muscle men take doses far and above that which is prescribed and if they cannot get enough to take the quantity they wish they will get prescriptions from several doctors so that their quantity is almost limitless. This is where the real danger lies with these individuals. They are not satisfied to take the drug over a short period of time and as prescribed, but rather they take them over long periods and in much greater quantities because only in this manner do you gain the incredible size that some of the fellows possess today. Small quantities over short periods do not bring the same results and this is the prime reason they are so dangerous, simply because the user resorts to excess to achieve his goal. While these drugs are never recommended for healthy people, a number of physicians will write prescriptions anyway. It has been estimated that as many as 47% of weight lifters, and who knows how many bodybuilders, have received the drug from physicians and all of them were on a dosage that was two to four times greater than the recommended dosage.

In conclusion, steroids have a great impact on one's body. But, you can't say that two people will have the exact same effect while using the drug. Steroids help the body put on muscle and add strength in the short term. In the long run, steroids can have numerous negative effects on the body and can even cause death. When you take steroids you are playing with fire and are going to get burned. If you want to get in shape and improve your looks and strength the best possible way is to have a proper diet and adequate training time. This has been proven over and over again that it is the safest and most efficient way of getting healthy. Next time you see a bodybuilder with those huge 20inch biceps you will now know that his body is not as healthy as it looks. Further, there are now questions as to the validity of the testing procedure used to examine the potency of the anabolic steroids presently on the market shelves. This would suggest that the anabolic steroids may have but a fraction of their reported protein anabolic activity giving further support to the idea that improved nutrition may be the major cause of the observed effects of these steroids. It may well be that lifters through out this country are taking a big chance with their health for a very small result.

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