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Types of medical steroids: Topical corticosteroids – NHS

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Steroids – NHS

Steroids, also called corticosteroids, are anti-inflammatory medicines used to treat a range of conditions.

They’re different from anabolic steroids, which are often used illegally by some people to increase their muscle mass.

Types of steroids

Steroids come in many different forms.

The main types are:

Most steroids are only available on prescription, but a few (such as some creams or nasal sprays) can be bought from pharmacies and shops.

Side effects of steroids

Steroids do not tend to cause significant side effects if they’re taken for a short time or at a low dose.

But sometimes they can cause unpleasant side effects, such as an increased appetite, mood changes and difficulty sleeping. This is most common with steroid tablets.

The side effects will usually pass once you finish the treatment, but do not stop taking your medicine without speaking to your doctor. Stopping a prescribed course of medicine can cause further unpleasant side effects (withdrawal symptoms).

Read more about:

You can report any suspected side effect to the Yellow Card Scheme.

Uses for steroids

Steroids can be used to treat a wide range of conditions, including:

How steroids work

Steroids are a man-made version of hormones normally produced by the adrenal glands which are 2 small glands found above the kidneys.

When taken in doses higher than the amount your body normally produces, steroids reduce redness and swelling (inflammation). This can help with inflammatory conditions such as asthma and eczema.

Steroids also reduce the activity of the immune system, which is the body’s natural defence against illness and infection.

This can help treat autoimmune conditions, such as rheumatoid arthritis or lupus, which are caused by the immune system mistakenly attacking the body.

Page last reviewed: 14 January 2020
Next review due: 14 January 2023

Topical corticosteroids – NHS

Topical corticosteroids are a type of steroid medicine applied directly to the skin to reduce inflammation and irritation.

Topical corticosteroids are available in several different forms, including:

  • creams
  • lotions
  • gels
  • mousses
  • ointments
  • tapes and bandages
  • solutions

They’re available in 4 different strengths (potencies):

  • mild
  • moderate
  • potent
  • very potent

Mild corticosteroids, such as clobetasone, hydrocortisone skin cream and hydrocortisone for piles and itchy bottom, can often be bought over the counter from pharmacies.

Stronger types, such as beclometasone, betamethasone, clobetasol, fluticasone and mometasone, are only available on prescription.

Read about other types of corticosteroids, including tablets, capsules, inhalers and injected corticosteroids.

Corticosteroids should not be confused with anabolic steroids.

Conditions treated with topical corticosteroids

Conditions widely treated with topical corticosteroids include:

Topical corticosteroids cannot cure these conditions, but can help relieve the symptoms.

Who can use topical corticosteroids

Most adults and children can use topical corticosteroids safely, but there are situations when they are not recommended.

They should not be used if:

  • you have infected skin, unless advised by a doctor
  • you have certain skin conditions, including rosacea, acne and skin ulcers (open sores)

Most topical corticosteroids are considered safe to use during pregnancy or breastfeeding. However, you should wash off any steroid cream applied to your breasts before feeding your baby.

Very potent topical corticosteroids are not usually prescribed for pregnant or breastfeeding women, or for very young children. Sometimes you may be prescribed them under the supervision of a skincare specialist (dermatologist).

How to use topical corticosteroids

Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with the medicine. This will give details of how much to apply and how often.

Most people only need to use the medicine once or twice a day for 1 to 2 weeks. Occasionally a doctor may suggest using it less frequently over a longer period of time.

The medicine should only be applied to affected areas of skin. Gently smooth a thin layer onto your skin in the direction the hair grows.

If you’re using both topical corticosteroids and emollients, you should apply the emollient first. Then wait about 30 minutes before applying the topical corticosteroid.

Fingertip units

Sometimes, the amount of medicine you’re advised to use will be given in fingertip units (FTUs).

A FTU (about 500mg) is the amount needed to squeeze a line from the tip of an adult finger to the first crease of the finger. It should be enough to treat an area of skin double the size of the flat of your hand with your fingers together.

The recommended dosage will depend on what part of the body is being treated. This is because the skin is thinner in certain parts of the body and more sensitive to the effects of corticosteroids.

For adults, the recommended FTUs to be applied in a single dose are:

  • 0. 5 FTU for genitals
  • 1 FTU for hands, elbows and knees
  • 1.5 FTUs for the feet, including the soles
  • 2.5 FTUs for the face and neck
  • 3 FTUs for the scalp
  • 4 FTUs for a hand and arm together, or the buttocks
  • 8 FTUs for the legs, including the foot, chest, or back

For children, the recommended FTUs will depend on their age. A GP can advise you on this.

Side effects of topical corticosteroids

If you use them correctly, topical corticosteroids rarely have serious side effects.

The most common side effect of topical corticosteroids is a burning or stinging sensation when the medicine is applied. However, this usually improves as your skin gets used to the treatment.

Less common side effects can include:

  • worsening or speading of a skin infection you already have
  • inflamed hair follicles (folliculitis)
  • thinning of the skin, which can make the affected skin more vulnerable to damage; for example, you may bruise more easily
  • stretch marks, which are likely to be permanent, although they’ll probably become less noticeable over time
  • contact dermatitis, which is a skin irritation caused by a mild allergic reaction to the substances in a particular topical corticosteroid
  • acne, or worsening of acne
  • rosacea, which is a condition that causes the face to become red and flushed
  • changes in skin colour – this is usually more noticeable in people with dark skin
  • excessive hair growth on the area of skin being treated

Side effects are more likely if you’re:

  • using a more potent corticosteroid
  • using it for a very long time, or over a large area

The elderly and very young are more vulnerable to side effects.

If potent or very potent topical corticosteroids are used for a long time or over a large area, there’s a risk of the medicine being absorbed into the bloodstream and causing internal side effects, such as:

This is not a full list of all the possible side effects. For more information on side effects, see the leaflet that comes with the medicine.

Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you’re taking. It’s run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA).

See the Yellow Card Scheme for more information.

Page last reviewed: 15 January 2020
Next review due: 15 January 2023

Corticosteroids

What are corticosteroids?

Corticosteroids are man-made drugs that closely resemble cortisol, a hormone that your adrenal glands produce naturally. Corticosteroids are often referred to by the shortened term “steroids.” Corticosteroids are different from the male hormone-related steroid compounds that some athletes abuse.

What are some types of steroids?

Some corticosteroid medicines include cortisone, prednisone and methylprednisolone. Prednisone is the most commonly used type of steroid to treat certain rheumatologic diseases (like rheumatoid arthritis or lupus).

How are steroids given?

Steroid medications are available in several forms that vary in how easily they dissolve or how long they stay in the body.

Steroids might be given locally, to the precise place where a problem exists, or systemically, which means throughout the “system” or body.

Examples of local steroid treatments include joint injections, eye drops, ear drops and skin creams. Systemic steroid treatments include oral medicines (given by mouth) or medicine that is delivered directly into a vein (intravenously or IV) or muscle (intramuscularly). Systemic steroids circulate through the bloodstream to various body sites.

When possible, local steroid treatments are prescribed instead of systemic steroids to reduce the risk of side effects.

How do steroids work?

Steroids work by decreasing inflammation and reducing the activity of the immune system. Inflammation is a process in which the body’s white blood cells and chemicals can protect against infection and foreign substances such as bacteria and viruses. In certain diseases, however, the body’s defense system (immune system) doesn’t function properly. This might cause inflammation to work against the body’s tissues and cause damage. Signs of inflammation include:

  • Redness.
  • Warmth.
  • Swelling.
  • Pain.

Steroids reduce the production of chemicals that cause inflammation. This helps keep tissue damage as low as possible. Steroids also reduce the activity of the immune system by affecting the way white blood cells work.

When are steroids given?

Steroids are used to treat many conditions in which the body’s defense system doesn’t work properly and causes tissue damage. Steroids may be the main therapy for certain diseases. For other conditions, steroids might only be used sparingly or when other measures have not been successful.

Steroids are used in the treatment for certain rheumatologic inflammatory conditions, such as:

How are steroids beneficial?

When inflammation threatens to damage critical body organs, steroids can be organ-saving and in many instances, life-saving. For example, steroids may prevent the worsening of kidney inflammation, which could lead to kidney failure in people who have lupus or vasculitis. For these patients, steroid therapy might eliminate the need for kidney dialysis or transplantation.

Low doses of steroids might provide significant relief from pain and stiffness for people with rheumatoid arthritis. Short-term use of higher doses of steroids might help a person recover from a severe flare-up of arthritis.

How will my doctor decide if steroids are the right treatment?

The decision to prescribe steroids is always made on an individual basis. Your healthcare provider will consider your age, physical activity, and other medicines you are taking. Your provider will also make sure you understand the potential benefits and risks of steroids before you start taking them.

The potential benefits and risks of steroids vary with:

  • The nature and severity of the disease being treated.
  • The presence or absence of other treatment alternatives.
  • The presence or absence of other significant medical problems.

What are the possible side effects of steroids?

The chance of side effects depends on the dose, type of steroid and length of treatment. Some side effects are more serious than others. Common side effects of systemic steroids include:

These side effects are the most common side effects. All possible side effects are not included. Always contact your doctor if you have questions about your personal situation.

Does everyone have side effects?

Not all patients will develop side effects. How often any side effect occurs varies from person to person.

If steroid use is brief (from a few days to a few weeks), it is possible that none of the listed side effects will occur. The side effects listed here generally do not occur when occasional steroid injections are given for arthritis, tendonitis or bursitis. However, if steroid use involves high doses and is prolonged (for a few months to several years), an increase in the number of side effects might occur. The prolonged use of high dose steroids is justified only for severe illnesses that represent serious risks to the patient.

How can the side effects of steroids be minimized?

To minimize the side effects of steroids, healthcare providers follow several guidelines:

  • Use steroids only when necessary.
  • Watch the patient closely to detect early signs of serious side effects.
  • If possible, use local steroids for local problems.
  • Use the smallest dose needed to control the disease.
  • Reduce the dose gradually as long as the disease remains under control.
  • Monitor blood pressure and blood sugar often and treat if necessary.
  • Monitor bone density and prescribe medications and supplements to help bone health.

There are other ways to prevent certain side effects, and these need to be discussed individually with your healthcare provider.

Prednisone and other corticosteroids: Balance the risks and benefits

Prednisone and other corticosteroids

Weigh the benefits and risks of corticosteroids, such as prednisone, when choosing a medication.

By Mayo Clinic Staff

Corticosteroid drugs — including cortisone, hydrocortisone and prednisone — are useful in treating many conditions, such as rashes, inflammatory bowel disease and asthma. But these drugs also carry a risk of various side effects.

How do corticosteroids work?

When prescribed in doses that exceed your body’s usual levels, corticosteroids suppress inflammation. This can reduce the signs and symptoms of inflammatory conditions, such as arthritis, asthma or skin rashes.

Corticosteroids also suppress your immune system, which can help control conditions in which your immune system mistakenly attacks its own tissues.

How are corticosteroids used?

Corticosteroid drugs are used to treat rheumatoid arthritis, inflammatory bowel disease (IBD), asthma, allergies and many other conditions. These drugs also help suppress the immune system in order to prevent organ rejection in transplant recipients. Corticosteroids also treat Addison’s disease, a relatively rare condition where the adrenal glands aren’t able to produce even the minimum amount of corticosteroid that the body needs.

Corticosteroids are administered in many different ways, depending on the condition being treated:

  • By mouth. Tablets, capsules or syrups help treat the inflammation and pain associated with certain chronic conditions, such as rheumatoid arthritis and lupus.
  • By inhaler and intranasal spray. These forms help control inflammation associated with asthma and nasal allergies.
  • In the form of eyedrops. This form helps treat swelling after eye surgery.
  • Topically. Creams and ointments can help heal many skin conditions.
  • By injection. This form is often used to treat muscle and joint signs and symptoms, such as the pain and inflammation of tendinitis.

What side effects can corticosteroids cause?

Corticosteroids carry a risk of side effects, some of which can cause serious health problems. When you know what side effects are possible, you can take steps to control their impact.

Side effects of oral corticosteroids

Because oral corticosteroids affect your entire body instead of just a particular area, this route of administration is the most likely to cause significant side effects. Side effects depend on the dose of medication you receive and may include:

  • Fluid retention, causing swelling in your lower legs
  • High blood pressure
  • Problems with mood swings, memory, behavior, and other psychological effects, such as confusion or delirium
  • Upset stomach
  • Weight gain, with fat deposits in your abdomen, your face and the back of your neck

When taking oral corticosteroids longer term, you may experience:

  • Elevated pressure in the eyes (glaucoma)
  • Clouding of the lens in one or both eyes (cataracts)
  • A round face (moon face)
  • High blood sugar, which can trigger or worsen diabetes
  • Increased risk of infections, especially with common bacterial, viral and fungal microorganisms
  • Thinning bones (osteoporosis) and fractures
  • Suppressed adrenal gland hormone production that may result in a variety of signs and symptoms, including severe fatigue, loss of appetite, nausea and muscle weakness
  • Thin skin, bruising and slower wound healing

Side effects of inhaled corticosteroids

When using an inhaled corticosteroid, some of the drug may deposit in your mouth and throat instead of making it to your lungs. This can cause:

  • Fungal infection in the mouth (oral thrush)
  • Hoarseness

If you gargle and rinse your mouth with water — don’t swallow — after each puff on your corticosteroid inhaler, you may be able to avoid mouth and throat irritation. Some researchers have speculated that inhaled corticosteroid drugs may slow growth rates in children who use them for asthma.

Side effects of topical corticosteroids

Topical corticosteroids can lead to thin skin, red skin lesions and acne.

Side effects of injected corticosteroids

Injected corticosteroids can cause temporary side effects near the site of the injection, including skin thinning, loss of color in the skin, and intense pain — also known as post-injection flare. Other signs and symptoms may include facial flushing, insomnia and high blood sugar. Doctors usually limit corticosteroid injections to three or four a year, depending on each patient’s situation.

Reduce your risk of corticosteroid side effects

To get the most benefit from corticosteroid medications with the least amount of risk:

  • Ask your doctor about trying lower doses or intermittent dosing. Newer forms of corticosteroids come in various strengths and lengths of action. Ask your doctor about using low-dose, short-term medications or taking oral corticosteroids every other day instead of daily.
  • Talk to your doctor about switching to nonoral forms of corticosteroids. Inhaled corticosteroids for asthma, for example, reach lung surfaces directly, reducing the rest of your body’s exposure to them and leading to fewer side effects.
  • Ask your doctor if you should take calcium and vitamin D supplements. Long-term corticosteroid therapy may cause thinning bones (osteoporosis). Talk with your doctor about taking calcium and vitamin D supplements to help protect your bones.
  • Take care when discontinuing therapy. If you take oral corticosteroids for a long time, your adrenal glands may produce less of their natural steroid hormones. To give your adrenal glands time to recover this function, your doctor may reduce your dosage gradually. If the dosage is reduced too quickly, your adrenal glands may not have time to recover and you may experience fatigue, body aches and lightheadedness.
  • Wear a medical alert bracelet. This or similar identification is recommended if you’ve been using corticosteroids for a long time.
  • See your doctor regularly. If you’re taking long-term corticosteroid therapy, see your doctor regularly to check for side effects.

Weigh the risks and benefits of corticosteroids

Corticosteroids may cause a range of side effects. But they may also relieve the inflammation, pain and discomfort of many different diseases and conditions. Talk with your doctor to help you better understand the risks and benefits of corticosteroids and make informed choices about your health.

 

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Show references

  1. Ritter JM, et al. The pituitary and the adrenal cortex. In: Rang & Dale’s Pharmacology. 9th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 28, 2020.
  2. Grennan D, et al. Steroid side effects. JAMA. 2019; doi:10.1001/jama.2019.8506.
  3. Saag KG, et al. Major side effects of systemic glucocorticoids. https://www.uptodate.com/contents/search. Accessed Oct. 28, 2020.
  4. Saag KG, et al. Major side effects of inhaled glucocorticoids. https://www.uptodate.com/contents/search. Accessed Oct. 28, 2020.
  5. Roberts WN, et al. Joint aspiration or injection in adults: Complications. https://www.uptodate.com/contents/search. Accessed Oct. 28, 2020.
  6. Nieman LK. Pharmacologic use of glucocorticoids. https://www.uptodate.com/contents/search. Accessed Oct. 28, 2020.
  7. AskMayoExpert. Long-term glucocorticoid therapy. Mayo Clinic; 2019.
  8. Wilkinson JM (expert opinion). Mayo Clinic. Nov. 20, 2020.


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Corticosteroids | NHS inform

Corticosteroids are powerful medications that can sometimes have a wide range of side effects.

They will only be used if the potential benefits are thought to outweigh this risk.

The risk of experiencing side effects largely depends on:

  • the type of steroid you’re taking – steroid tablets (oral corticosteroids) are more likely to cause side effects than inhalers or injections
  • the dose – the higher the dose, the greater the risk of developing side effects
  • the length of treatment – for example, you’re more likely to develop side effects if you take steroid tablets for more than three weeks
  • your age – young children and the elderly are more likely to experience side effects

Some of the main side effects are listed below, but this is not a complete list. To learn about all the possible side effects of your medication, read the patient information leaflet that comes with it.

Steroid inhalers

Inhaled steroids usually have few or no side effects if used at normal doses. However, they can sometimes cause:

Rinsing your mouth out with water after using your medication can help to prevent oral thrush, and using a device called a spacer with your medication can help to prevent many of the other problems.

There is also some evidence that steroid inhalers used by people with chronic obstructive pulmonary disease (COPD) can increase the risk of chest infections such as pneumonia. Discuss this with your health professional if you’re concerned.

Inhaled steroids at high doses can sometimes cause some of the more serious side effects that are more often linked with steroid tablets (see below), but this is rare.

Steroid injections

Steroids that are injected into muscles and joints may cause some pain and swelling at the site of the injection. However, this should pass within a few days.

Steroid injections can also cause muscle or tendon weakness, so you may be advised to rest the treated area for a few days after the injection. Other possible side effects can include infections, blushing, and thinning and lightening of the skin in the area where the injection is given.

Because of the risk of side effects, steroid injections are often only given at intervals of at least 6 weeks and a maximum of 3 injections into one area is usually recommended.

Steroids that are injected into a blood vessel (intravenous steroids) may sometimes cause some of the more widespread side effects described below.

Steroid tablets

Short, occasional courses of steroid tablets taken for no longer than three weeks are very unlikely to cause troublesome side effects.

It’s sometimes necessary, however, for them to be taken for longer periods. In these cases, you’re more likely to develop troublesome side effects, although this is not inevitable.

Steroid tablets taken for longer than 3 weeks can potentially cause:

  • increased appetite – which can potentially lead to weight gain if you find it difficult to control what you eat
  • acne
  • rapid mood swings and mood changes – such as becoming aggressive, irritable and short-tempered with people
  • thin skin that bruises easily
  • muscle weakness
  • delayed wound healing
  • a combination of fatty deposits that develop in the face, stretch marks across the body and acne – known as Cushing’s syndrome
  • weakening of the bones (osteoporosis)
  • diabetes (or they may worsen existing diabetes)
  • high blood pressure
  • glaucoma and cataracts (eye conditions)
  • stomach ulcers – you may be prescribed an additional medication called a proton pump inhibitor (PPI) to reduce this risk
  • mental health problems, such as depression, suicidal thoughts, anxiety, confusion and hallucinations – see your GP if you experience any of these problems
  • increased risk of infections, particularly chickenpox, shingles and measles – avoid close contact with anyone who has an infection and seek medical advice immediately if you think you may have been exposed
  • reduced growth in children

Most side effects should improve if you’re able to reduce your dosage or eventually stop taking the medication.  

You may have regular checks and tests for conditions such as diabetes, high blood pressure and glaucoma if you need to take steroid tablets on a long-term basis.

Side-effects, uses, time to work

As with all medicines, some people will have side effects. These are more likely if you’re on a high dose or if you’re taking steroids for a long time.

The person treating you will make sure you’re on the lowest possible dose to keep your condition under control. You might also be given a drug called a proton pump inhibitor or another medicine to protect your stomach.

Some of the side effects of steroids are shown below:

Tablets, liquids and soluble tablets 

  • weight gain and increased appetite
  • stomach pains, indigestion or heartburn
  • sleep problems
  • changes in mood
  • bruising easily
  • thinning of the skin
  • stretch marks.

Creams and gels

  • stinging or burning where the cream has been applied
  • changes in skin colour
  • thinning of the skin
  • stretch marks
  • increased hair growth where the cream has been applied.

Eye drops and ointments

  • stinging or burning in eyes after putting drops in
  • a funny taste in the mouth after putting drops in.

Treatment with steroids may cause changes in mood – you may feel very high or very low. This may be more common in people with a previous history of mood disturbance. If you’re worried about this, talk to the person who is prescribing your steroids about it.

Taking steroid tablets for a long time can make you more likely to get infections. If you feel feverish or unwell, or develop any new symptoms after starting steroids, it’s important to tell your doctor or rheumatology nurse.

See your doctor or the person treating you straight away if you develop chickenpox, shingles or measles, or if you come into contact with someone who has any of these illnesses. Sometimes these diseases can be severe in people who are taking steroids, and you might need to have other treatment before you start to get better.

Steroids taken for a long time can also cause your muscles to become weaker, and they might occasionally affect periods in women.

Carrying a steroid card

If you’re taking high doses of steroids, or if you’re on them for more than three weeks, you’ll need to carry a steroid card. This will have information on your dose and how long you’ve been taking them for.

Your doctor, rheumatology nurse or pharmacist should give you a steroid card if you need one. Make sure any change to your dose of steroid is updated on the card.

Steroid treatment can stop the body producing natural hormones, which can be dangerous if you get ill, have an accident or need an operation. Keeping the card with you will help any other doctor who treats you to manage your care correctly.

If you have any questions or concerns about this, talk to the healthcare professional who prescribed your steroids.

Other complications

Steroid creams and eye drops don’t usually cause serious side effects, but if you take them for a long time or at a high dose, the medication could be absorbed into your blood and increase the risk of side effects that normally only occur with steroid tablets.

Steroids can sometimes affect diabetes, high blood pressure or epilepsy, so you’ll have your blood pressure and blood sugar levels checked from time to time. The person treating you might change the dose of your medications if needed. Steroids can sometimes cause diabetes or raised blood sugar in people who haven’t previously had this condition.

Steroids can affect the eyes, for example by making glaucoma worse or causing cataracts. They can also cause a problem with your eyes known as serous chorioretinopathy (see-russ core-ee-oh-ret-in-op-ath-ee), which happens when fluid collects in part of the eye. If you notice any changes in your eyesight, such as your vision becoming blurry, be sure to let your doctor know as soon as possible.

Sometimes steroids can cause another condition known as Cushing’s syndrome. This can cause thinning of the skin, stretch marks, and the face to become rounder, but it usually clears up once steroids are stopped.

In children and teenagers, steroids can sometimes cause growth to slow down, so they’ll need to have their height checked regularly. If growth is slowed, they might be referred to a specialist doctor for advice.

Managing side effects

Because steroids can cause you to put on weight or have an increased appetite, it’s important to keep an eye on your weight while taking them. Making sensible food choices and including some physical activity in your daily routine should help you avoid putting on weight.

Steroids can weaken bones, which can lead to a condition known as osteoporosis. This condition makes it more likely that you’ll fracture your bones, sometimes after very minor falls or bumps.

Your doctor may advise you to take drugs called bisphosphonates, or calcium and vitamin D supplements, along with the steroids to help prevent this. Regular exercise, especially things that involve your bones carrying the weight of your body, such as walking, can also help to reduce the risk of getting osteoporosis.

You should also make sure you get enough calcium in your diet, and avoid smoking and drinking too much alcohol.

Pharmacology, Complications, and Practice Delivery Issues

Ochsner J. 2014 Summer; 14(2): 203–207.

William Ericson-Neilsen

1Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA

Alan David Kaye

2Departments of Anesthesiology and Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA

1Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA

2Departments of Anesthesiology and Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA

Address correspondence to Alan David Kaye, MD, PhD, Professor and Chairman, Department of Anesthesiology, Professor, Department of Pharmacology, Louisiana State University Health Sciences Center, 1542 Tulane Ave., Room 656, New Orleans, LA 70112, Tel: (504) 568-2319, Email: [email protected]Copyright © Academic Division of Ochsner Clinic FoundationThis article has been cited by other articles in PMC.

Abstract

Background

Since their identification nearly 80 years ago, steroids have played a prominent role in the treatment of many disease states. Many of the clinical roles of steroids are related to their potent antiinflammatory and immune-modulating properties.

Methods

This review summarizes the basic pharmacology, complications, and practice delivery issues regarding steroids.

Results

Clinically relevant side effects of steroids are common and problematic. Side effects can occur at a wide range of doses and vary depending on the route of administration. The full spectrum of side effects can be present even in patients taking low doses.

Conclusions

Practitioners must be aware that these drugs might exacerbate a preexisting condition or present a new medical condition. Knowledge of the clinical implications of prescribing these agents is critical.

Keywords: Adrenal cortex hormones, diabetes mellitus, drug-related side effects and adverse reactions, glucocorticoids, medication therapy management, mineralocorticoids

INTRODUCTION

Since their identification in 1935, steroids have served a wide range of uses. Initially, these isolates from adrenal glands were thought to be useful only in patients suffering from Addison disease.1 Today, many of the clinical roles of steroids are related to their potent antiinflammatory and immune-modulating properties. Clinically relevant side effects of steroids are common and problematic, ranging from a minor case of acne to Cushing syndrome that can result in diabetes mellitus and potentially life-threatening heart disease if untreated.2 Side effects can occur at a wide range of doses and vary depending on the route of administration.1

The term steroid applies to a wide range of molecules with varying physiological effects. More specifically, corticosteroids are a class of chemicals encompassing both laboratory-synthesized and naturally produced hormones. Glucocorticoids, in general, regulate metabolism and inflammation; mineralocorticoids regulate sodium and water levels. Corticosteroids fall along a spectrum from exclusively glucocorticoid effects to exclusively mineralocorticoid effects, and steroid compounds are selected based on their appropriateness for a given treatment. For example, although a compound may possess potent antiinflammatory properties, it may additionally have mineralocorticoid activity that adversely affects blood pressure.

CORTICOSTEROID METABOLISM AND CLINICAL ROLE

Although corticosteroid metabolism is complicated by enzyme induction, protein binding, molecular interconversion, and interaction with endogenous cortisol, corticosteroids are generally metabolized by the hepatic P450 system.3 Direct application (eg, topical, intraarticular, inhaled, or epidural) of these agents to sites of inflammation bypasses the liver and its first-pass effect.

Chronic oral glucocorticoid use is common in patients with rheumatoid arthritis, chronic obstructive pulmonary disease, systemic lupus erythematosus, inflammatory bowel disease, and asthma.4 Side effects of chronic use include bruising, muscle weakness, weight gain, skin changes, sleep disturbances, cataracts, and pathologic fractures.4 Glucocorticoid administration can also have psychiatric side effects: mood disorders, anxiety, delirium, and panic disorder. Psychotropic medication may be required to treat these symptoms, but the prognosis is favorable once the glucocorticoids are reduced or discontinued.5-7 Adverse effects occur in up to 90% of patients who take glucocorticoids for >60 days.4 These side effects, including the more serious fractures and cataracts, occur even in patients taking low (≤7.5 mg/d) dosages.4,8

Glucocorticoids affect bone mineralization by inhibiting calcium absorption in the gastrointestinal tract and shifting signaling-molecule production to favor bone resorption.8 Recommendations for preventing glucocorticoid-induced osteopenia and its subsequent complications and comorbidities include supplementing calcium with vitamin D for glucocorticoid doses ≥5 mg/d and starting bisphosphonates when indicated by densiometric evaluation.8

Because of their effects on insulin resistance, glucocorticoids are the most common cause of drug-induced diabetes mellitus. 9 Screening guidelines using a fasting glucose ≥126 mg/dL or HbA1c ≥6.5% are suitable for diagnosing steroid-induced diabetes; however, per American Diabetes Association guidelines, results should be confirmed via repeat testing.9 Management is similar to that of type 2 diabetes mellitus; treatment options progress from single agent to double agent to insulin ± another agent, based upon fasting glucose measurements and glucose control.9 In patients with preexisting diabetes, blood sugars should be measured more often than in patients without preexisting diabetes, and medications should be adjusted to maintain adequate control.9

Cushing syndrome and adrenal suppression have been observed in patients taking oral, intraarticular, epidural, inhaled, nasal, ocular, and topical glucocorticoid preparations.8,9 These side effects become more likely with longer durations of treatment and higher dosages.8,9

Mineralocorticoid activity causes the retention of sodium and free water and the excretion of potassium. 2 Derangements in mineralocorticoid production can manifest with abnormalities in any of these areas. Hyponatremia, hyperkalemia, and hypotension are present to varying degrees in mineralocorticoid-deficient states (eg, various congenital adrenal hyperplasias and aldosterone synthase deficiency), whereas the inverse is present in mineralocorticoid-excess states (eg, Conn syndrome). Because endogenous glucocorticoids also have activity at mineralocorticoid receptors, signs and symptoms of mineralocorticoid excess can be seen in cases of excess glucocorticoid production (eg, Cushing syndrome).2

CORTICOSTEROID PREPARATIONS

Steroid injections are associated with side effects related to dosage, duration of administration, added ingredients or contaminates, and particle size. Particulate steroids present a theoretical risk of occluding vessels depending on the size of particulate aggregates.10 Common additives in steroid preparations, such as benzyl alcohol and ethylene glycol, have been implicated in case reports and studies of complications following epidural steroid administration. 10,11 Dexamethasone and betamethasone sodium phosphate are pure liquids, whereas methylprednisolone, triamcinolone, and betamethasone are solutions, and their particle size depends upon the type of preparation and dosage. Studies have shown that transforaminal dexamethasone is just as effective at 4 mg as it is at 8 mg and 12 mg and that nonparticulate steroid preparations are just as effective as particulate preparations in treating cervical radicular pain.12,13 Methylprednisolone and triamcinolone are the drugs most commonly used for epidural steroid injections. Common side effects of epidural steroid injections are paresthesia, pain on injection, intravascular injection, bleeding, and dysesthesia.12 The most serious complications of epidural steroid injections are related to intravascular injections. Intraarterial injections may occur even with a negative aspirate and have been shown to potentially cause paraplegia.14 Although the use of computed tomography guidance instead of conventional fluoroscopy provides a better image of relevant anatomy, it does not assure avoidance of these adverse events. 14

Topical corticosteroids (2.5% ointment, triamcinolone 0.1% ointment, and clobetasol propionate 0.05% foam) achieve more effective skin concentrations than oral prednisone.15 Side effects, including skin thinning, color change, and systemic effects, can be expected with topical application of corticosteroids and increase in a dose-dependent manner.16 Inhaled corticosteroids have evolved into a mainstay of therapy for moderate to severe asthma. Effectiveness and systemic bioavailability vary with each corticosteroid molecule and dosage, but in general, systemic effects are minimized with proper administration.17 Common side effects of inhaled corticosteroids include gingival irritation and oral candidiasis, as well as the many systemic effects associated with corticosteroid use.17,18

Fludrocortisone is a synthetic corticosteroid that has potent mineralocorticoid effects.2 It has been used clinically to achieve the mineralocorticoid effects of sodium and water retention in cases of cerebral salt wasting, orthostatic hypotension, and adrenocortical insufficiency in Addison disease. 19-21 Potassium wasting is a common side effect of fludrocortisone administration, and electrolyte levels should be monitored while a patient is undergoing fludrocortisone administration.21

The potencies of corticosteroids vary widely, with synthetic compounds generally retaining greater antiinflammatory potency and weaker salt-retaining properties; these potencies are summarized in the .

Table.

Basic Potency, Duration of Action, and Equivalent Dose of Typical Steroid Preparations

MECHANISTIC PHARMACOLOGY AND PHYSIOLOGY OF STEROIDS

The antiinflammatory properties of steroids have been attributed to their inhibitory effects on the action of phospholipase A2, an enzyme critical to the production of inflammatory compounds.22 Research has shown that steroids are active in affecting gene expression, translation, and enzyme activity.23 In short, they bring about their physiologic effects through a multitude of biochemical pathways. 23 One such pathway is through their induction of the production of proteins called lipocortins. Glucocorticoids stem the production of inflammatory mediators such as leukotrienes and prostaglandins and effectively halt the inflammatory cascade.22,24 As their wide-ranging side effects indicate, glucocorticoids can impact many systems throughout the body. Through negative feedback regulation of the hypothalamic-pituitary-adrenal (HPA) axis, exogenous glucocorticoids can directly induce hypopituitarism (Addison disease).2,25 Their actions on glucose metabolism can increase insulin resistance in tissues and increase fasting glucose levels.2,25 Glucocorticoids can act directly on osteoclasts to affect bone resorption and decrease calcium absorption in the gastrointestinal tract, resulting in osteopenia and osteoporosis.2,25

Because of the wide-ranging effects that glucocorticoids can have on a patient’s body and on the HPA axis in particular, a practitioner must be careful when discontinuing their administration. If steroids have been administered for less than 1 week, they can be stopped without tapering. For dosing lasting 1-3 weeks, tapering should be based upon clinical conditions and the illness for which the medication was prescribed.9 When the patient has taken glucocorticoids for more than 3 weeks, the practitioner’s goal is a quick tapering to physiologic doses and then a slow decrease in dosage while evaluating adrenal function.4 For patients who are taking equivalent doses of 30 mg of hydrocortisone daily or have established HPA axis dysfunction and are under stress (eg, major surgery, critical illness, trauma), an increased dosing of steroids (intravenous or intramuscular hydrocortisone) is recommended every 6 hours for 24 hours, followed by a tapering to the previous maintenance dose by 50% per day.25

Mineralocorticoids, endogenously represented by aldosterone and deoxycorticosterone, effect physiologic changes by altering electrolyte (sodium and potassium) levels, causing volume changes to occur. 2 Rather than being moderated by the HPA axis as glucocorticoid production is, mineralocorticoid production is mainly regulated by the renin-angiotensin-aldosterone system, although adrenocorticotropic hormone, a product of the HPA axis, does have minimal activity in stimulating aldosterone release.2

CONTROVERSY WITH STEROID PREPARATION

Recent developments involving both morbidity (751 total infections in 20 states as of October 2013) and mortality (64 deaths over the same time period) related to steroid compounds manufactured at the New England Compounding Center (NECC) show that the side effects of steroid injections range beyond those that can be explained by the physiologic and pharmacologic properties of glucocorticoids.26 The glucocorticoid preparations implicated in the nationwide fungal meningitis outbreak were manufactured at a compounding pharmacy, a facility that was neither licensed nor inspected by the United States Food and Drug Administration (FDA) for large-scale pharmaceutical manufacturing but was under regulation by the state pharmacy board in Massachusetts. 27 Traditionally, physicians turn to local compounding pharmacies to prepare mainstream pharmaceuticals that either are not offered in the concentration required for patient administration or are not compatible with a particular route of administration. Compounding pharmacies historically have been licensed to produce these medications for individual patients in quantities suitable to fill the prescription.27 Physicians also turn to compounding pharmacies to manufacture drugs for individual patient administration when FDA-approved drugs are not available through traditional distribution channels.27 Such pharmaceuticals may contain the same active ingredients as FDA-approved medications, but the potency and concentrations of the active ingredients vary greatly (from 68.5% to 265.4%).27 Although the FDA views compounded pharmaceuticals as unapproved new drugs because of their untested nature, the recent inspections of compounding pharmacies and the enforcement of laws regulating them have focused on the pharmacies effectively operating as drug manufacturing companies that distribute their compounded pharmaceuticals nationwide, rather than those that serve individual patients locally, such as NECC. 27

Multiple reports of fungal meningitis occurring after epidural steroid injection prompted an FDA inspection of the NECC pharmacy facilities and revealed a number of problems with manufacturing process and facilities, ranging from stagnant puddles of water in autoclaves to visible discoloration and fungal growth around the facilities.26,28 An examination of 321 recalled vials of methylprednisolone acetate revealed that 100 of these vials contained visible foreign matter.28 This finding shows that although physicians may not play a direct role in the manufacture of the compounds administered to patients, they can play a crucial role in the quality control process by simply looking at the compounds they give to their patients.

The laws governing compounding pharmacies and their regulation have recently been revised with the passage of the Drug Quality and Security Act signed on November 27, 2013. With this new law and revisions made to the Federal Food, Drug and Cosmetic Act (section 503A provided the exemptions for compounding pharmacies from compliance with current good manufacturing practices [CGMP], FDA approval prior to marketing, and labeling with adequate directions for use), compounding pharmacies can become “outsourcing facilities” and be placed under FDA regulation. 29 The new laws mandate compounding pharmacies to comply with CGMP requirements, to be inspected by the FDA on a risk-based schedule if they are an “outsourcing facility,” and to report adverse events to the FDA.29

CONCLUSION

Since their discovery, steroids have infiltrated nearly every branch of medicine and can be administered in nearly every route available. The effects of steroid use can vary widely, and the full spectrum of side effects can be present even in patients taking low doses. Practitioners must be aware that the drug can possibly exacerbate a preexisting condition or present a new medical condition. Knowledge of the clinical implications of prescribing these agents is critical.

Footnotes

The authors have no financial or proprietary interest in the subject matter of this article.

This article meets the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties Maintenance of Certification competencies for Patient Care and Medical Knowledge.

REFERENCES

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In Russia, they added new anabolic steroids to the list of prohibited potent and poisonous substances. As Izvestia was told in the government’s press service, the corresponding decree was signed by Prime Minister Dmitry Medvedev. Another document approved by him expands the list of drugs prohibited for distribution – it includes new synthetic drugs. Experts believe that it is necessary to fight the spread of hazardous substances, but it is much more important to work with their consumers.Otherwise, a dubious business will endlessly find ways to get around all the prohibitions.

Prime Minister Dmitry Medvedev signed a decree to supplement the list of potent and poisonous substances, the distribution of which entails punishment under Article 234 of the Criminal Code . The amendments to the list were prepared by the Russian Ministry of Internal Affairs in July 2018.

The list includes anabolic steroids enestebol, epitiostanol, propethandrol, mebolazine, roxybolone and other drugs, which are a modified version of hazardous substances already banned for circulation .Expanding the list allows you to establish state control over the distribution of these funds on the territory of Russia.

– In the course of monitoring the Internet, a number of resources have been identified that distribute anabolic steroids, which are modified versions of substances included in the list of potent ones, the press center of the Russian Ministry of Internal Affairs told Izvestia. – The turnover of identified anabolic steroids was previously limited in a number of foreign countries (Canada, Great Britain, Australia).

The government press service explained to Izvestia that the expansion of the list of drugs attached to Article 234 of the Criminal Code can hardly be called a tightening of control, because we are talking about hazardous substances. At the same time, the ban is not imposed on the steroids themselves, we are talking only about their free circulation . The drugs remain available for scientific and research purposes.

Masking molecules

The use of anabolic steroids leads to severe and often irreversible consequences for the body a.The expert of the League of the Health of the Nation, head of the department of the First Moscow State Medical University named after V.I. THEM. Sechenov of the Ministry of Health of the Russian Federation, Professor Evgeny Achkasov.

– Anabolics allow a pathological way to build up the muscle mass of a person, but his heart remains the same size and cannot cope with the load, the expert explained. – Famous bodybuilders died from this. In addition, anabolic steroids inhibit the synthesis of their own sex hormones, which leads to impotence.

According to Evgeny Achkasov, it is necessary to prohibit these funds, but it is difficult to stop their distribution, because such drugs are very quickly modified.

– One molecule was removed, another was added – and now a new drug. And its action remains the same. Therefore, the prohibition of specific drugs does not lead to the desired consequences, – said the doctor.

The expert community does not question the dangers of using anabolic steroids for the human body. But not everyone is sure of the effectiveness of the measure taken.

– The distribution of anabolic steroids is local in nature. Yes, someone makes money on this, but these are small incomes – a penny business.It is not commensurate with the business of drug lords, ”said Alexei Kalinchev, endocrinologist, nutritionist and nutritionist, to Izvestia. – There is no bodybuilding without anabolic steroids. All “pitching” take certain drugs that fall under this article. Then you need to prohibit bodybuilding.

According to the expert, the distribution of anabolic steroids causes less harm to society than, for example, fast food.

– People consume this food en masse and also spoil their health, earning obesity and diabetes. And our society then pays for their treatment, – said Alexey Kalinchev.

He reported that muscle-building drugs are sold in every fitness club in the world. And the people who accept them are mostly marginalized individuals. They deliberately sacrifice their health, and bans will not affect this. However, they only harm themselves – their actions do not pose a threat to society.

Healthy lifestyle for the lazy

World champion in mixed martial arts, actor and director Oleg Taktarov compared the anabolic steroid trade with the drug trade and said that anabolics should be banned .

“It’s bad if people profit from the sale of something that is unhealthy,” he said. – Surely there are a lot of deceived people to whom these goods are crammed under the healthy lifestyle brand. They don’t have steroids written on them. It is rather written there that they increase muscle tone and supply them with vitamins. And this attracts buyers who want to achieve something not with work, but with a pill. There are plenty of such people.

But, according to the actor, those who understand the harm of anabolic steroids, but still take them, will not be stopped by the prohibitions.If they cannot find proven means, they will start taking drugs of “clandestine” production, that is, completely substandard.

“If a person needs a pill, he will find it,” noted Oleg Taktarov. – Remember the dry law. The consequences will be the same here. It’s not even about athletes who take drugs under the supervision of doctors, but about bodybuilding lovers and ordinary guys who just want to pump up.

In his opinion, work with the education of people is more important than prohibitions.They need to be motivated to achieve success by natural means.

Poison for harmony

2,4-dinitrophenol (2,4-DNP) was also included in the updated list of prohibited drugs. This poisonous substance is used in industry as an antiseptic for impregnating wood or fabrics. But it is often used as a means for losing weight . According to the Ministry of Internal Affairs, there have been several cases of fatal poisoning with this substance in the countries of the European Union.

Nutritionist, Doctor of Medicine, Head of the Weight Correction Clinic Alexei Kovalkov explained to Izvestia that officially approved drugs are sold in Russia that help to lose weight. But all of them do not cure the patient, but have a temporary effect – they partially block the absorption of fats or muffle hunger. And these drugs have a ton of side effects.

– Competent doctors do not use such means. Not to mention the frankly harmful substances. So no one will suffer from the fact that they ban the sale of poison that someone can drink in order to lose weight, the expert said.

Dmitry Medvedev also signed a decree (the document is at the disposal of Izvestia) on expanding the list of drugs and psychoactive substances prohibited for distribution. The list includes new synthetic drugs .

Commenting on these changes, the government’s press service emphasized that not a ban is imposed on narcotic substances, but a restriction – exclusively on the circulation of these substances. They can still be purchased with a prescription should the need arise.

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Anabolic steroids and testosterone | Dopinglinkki

As amended on 02.04.2020

Testosterone, the so-called male hormone, is the most important androgen in the body. In men, most of the testosterone is produced in the testes by Leydigin cells. Some testosterone is also produced in the adrenal cortex and peripherally by converting androstenedione. In women, testosterone levels are much lower than in men.However, it also has an important effect on the female body. In women, testosterone is produced in the ovaries and adrenal cortex [1, 2]. Hormonal regulation of testosterone is maintained and controlled by the hypothalamus-pituitary-gonad axis.

Androgens have androgenic, anabolic and psychological effects on the body. Androgenic effects include penile and prostate growth, hair growth in various areas, and baldness. Anabolic effects include enlargement of the larynx, thickening of the vocal cords, lipid changes, muscle growth, fat loss, enlargement of the sebaceous glands, and the formation of blood cells. The psychological effects of androgens include changes in libido, potency, sexual behavior, and aggression [3].

Anabolic steroids are synthetic derivatives of testosterone. In medicine, anabolic steroids have been used to try to achieve anabolic effects of testosterone without the virilizing side effects of androgens so that children and women can use them as well. However, the attempt failed. For this reason, the term “anabolic steroid” is misleading.It is more correct to use the term “anabolic androgenic steroid” [4].

Testosterone is a natural anabolic androgenic steroid in the body. Testosterone and other anabolic steroids share the same chemical structure. Attempts have been made to change the structure of synthetic anabolic steroids by increasing the anabolic effect and reducing the androgenic effect [5]. The ratio of anabolic to androgenic activity of testosterone is 1: 1, and each has a strong effect.In other anabolic steroids, this ratio varies with the predominance of the anabolic effect [2, 6]. In addition, the structure of anabolic steroids was changed so that the route of administration, absorption, duration of exposure and aromatization of the substance could be adjusted. Thus, anabolic steroids differ in their anabolic and androgenic ratio, route of administration (oral, intramuscular, cutaneous), absorption time, duration of action in the body and their aromatization to estrogen [7, 8].

The history of testosterone use can be traced back to 1935, when testosterone was successfully isolated from bovine testes. It was quickly discovered that oral testosterone is hepatotoxic and has a fast half-life. After testosterone was synthesized, injectable propionate appeared on the market, and later, in the 1950s, longer acting enanthate. In the 1950s and 1960s, the pharmaceutical industry became increasingly interested in new androgens, and by the end of the 1980s, a huge number of anabolic steroids, over a thousand, had been developed [9, 10].

Mechanism of action

Testosterone and all anabolic steroids act through androgen receptors. Androgen receptors are located on the x chromosome of cells and are ubiquitous in the body. In addition to muscles, androgen receptors affect the heart, immunity and nervous system [11].

Testosterone’s popularity as a doping agent is attributed to its strong effect on muscle strength and mass. Testosterone also affects lipolysis, which is the breakdown of fat cells.Both short term and long term use of anabolic steroids lead to increased cell growth due to increased protein synthesis. Testosterone-induced muscle cell growth is mediated by the activation of satellite cells and the growth of muscle cell nuclei [2].

The number of androgen receptors is limited, and usually normal testosterone levels are enough for them. Hence, muscle growth is not necessarily attributable to excess anabolic steroids. Another mechanism that explains muscle growth may be the effect of anabolic steroids on cortisol.Cortisol is a catabolic hormone and anabolic steroids can reduce its effect. The inhibitory effect of anabolic steroids on the myostatin gene is also thought to be a mechanism of muscle growth. Myostatin regulates muscle growth [8]. Testosterone also increases the secretion of growth hormone and insulin-like growth factor [12].

Application in medicine

According to the classification, these substances are classified as prescription drugs, the use of which is permitted only for the treatment of diseases confirmed by the drug control authorities.These diseases include, but are not limited to, testosterone deficiency syndrome (TDS), which develops due to dysfunction of the pituitary gland or testicles, various types of anemia, osteoporosis and chronic protein deficiency diseases, and delayed tissue healing. Testosterone is also used to treat the symptoms of the male equivalent of menopause. Prescription testosterone use has increased significantly over the past few decades, both in Finland and elsewhere [13, 14, 15].

Testosterone is used in injectable form as a mixture of various testosterone esters (for example, testosterone propionate, testosterone enanthate, testosterone phenylpropionate, testosterone isocaproate, testosterone decanoate, testosterone undecanoate) or orally, in the form of capsules containing testosterone undecano.Anabolic steroids are available in injectable and pill form.

Doping

According to the Penal Code, both testosterone and anabolic steroids are doping substances. They are the most popular doping substances.

For example, the following substances (trade names in brackets) are illegally sold on the Internet and elsewhere on the black market:

  • nandrolone (Deca-Durabolin, Retabolin, Laurobolin)
  • methandienone (Dianabol, Danabol, Anabol, Metabolin)
  • stanozolol (Stromba, Winstrol, Winstrol Depot)
  • trenbolol (Parabolan, Finajet)
  • oxymetholone (Anapolon, Anadrol, Androlic)
  • oxandrolone (Anavar)
  • boldenone (Equipose)
  • fluoxymesterone (Halotestin)
  • Methenolol (Primobolan, Primobolan Depot)
  • testosterone with derivatives (Sustanon, Panteston)

The most important reason for using testosterone and anabolic steroids is to improve athletic performance.The quick results and the slowdown in the development of muscle growth, of course, can certainly motivate the application. Weightlifters are motivated to improve athletic performance. Other motivations for use include improving exercise performance, burning fat, slowing the changes caused by aging, increasing self-confidence and improving mood [8, 16, 17, 18, 19, 20].

Anabolic steroids are often used in courses. The course of application can last from several weeks to several years, but on average, several months.There are often breaks of several months between periods of use. In the initial phase of use, the dose of steroids is increased gradually. In the final phase, steroid use is gradually phased out over 1–2 weeks. The purpose of the breaks is to reduce side effects and restore hormonal function in the body. Another method of application is the so-called. “Blast and cruise”. It implies that taking high doses (blast) alternates with low doses (cruise). During the “Blast and cruise” course, steroids are taken continuously, without interruption.Abuse is characterized by the use of excessive doses of anabolic steroids and the simultaneous use of different types of steroids (stacking) [8, 16, 17, 20, 21]. Oral anabolic steroids are used daily due to their fast half-life. Intramuscular anabolic steroids are often used weekly [22].

The medical use of anabolic steroids is aimed at achieving physiological concentrations in the body, but doping is often aimed at achieving concentrations approximately 40-100 times higher (supraphysiological concentrations) [8].

Side effects 90,095

Androgen receptors are ubiquitous in the body, and therefore anabolic steroids affect the functioning of various internal organs. Because of this, there are a number of possible side effects. Some are light and transient, and some are life-threatening. The risk of side effects increases with long-term use of high doses.

The study of the side effects of anabolic androgenic steroids and the acquisition of scientific evidence are hampered by a number of factors.In some countries, the use of anabolic steroids is prohibited, in which case the person is unlikely to report their use. Due to the fact that the substance is purchased on the black market, the user may not know in what doses and what exactly he is using. For ethical reasons, the side effects of high doses have not been studied in humans. In addition, substances intended for animals are used for other purposes, and there is no data on the effects of these substances on humans. Thus, research data is mostly speculative, often based on case studies and studies using medical doses [8].

According to a Finnish population study, the risk of premature death among anabolic steroid and testosterone abusers is 4.6 times higher than in the control group [23]. In a similar Danish study, mortality among anabolic steroid users was three times higher in seven years than in controls. Consumers were also much more likely to seek medical attention [24].

Side Effects: Hormonal Disorders 90 095

With the introduction of testosterone and anabolic steroids in quantities that exceed the body’s needs, hormonal disorders and reproductive disorders develop.

In men, the body’s own production of hormones decreases. Shrinking of hormone-producing glands and organs, such as testicles, is noted. After courses of hormone administration, infertility and a decrease in sexual function may develop [25, 26].

These changes are often reversible but may persist for many years. Sometimes the body does not recover at all.

Men may develop gynecomastia, that is, enlargement of the mammary glands, and chest pain. This is because testosterone and some anabolic steroids aromatize to estrogen [27, 28, 29].
In women, testosterone and anabolic steroid use causes excess body hair growth, coarsening of the voice, decreased breast size, baldness, clitoral enlargement, skin disorders, and menstrual irregularities. Some of these symptoms persist even after discontinuation of these substances [25].

In adolescents, as a result of the use of testosterone and anabolic steroids, growth can stop, which can lead to the development of short stature [25].During adolescence, use of anabolic steroids may be more harmful than use started in adulthood [30].

Side effects: serious illness 90 095

Testosterone and anabolic steroids, used in excessive doses, can lead to significant deviations in body fat to levels that are hazardous to health. They also affect blood clotting factors and hemoglobin. Thus, long-term use of these hormones can lead to an increased risk of heart and vascular disease, myocardial infarction and stroke.Steroids impair cardiac contractility and lead to degeneration of the heart muscle, which can lead to cardiac arrhythmias and sudden death [31, 32, 33, 34].

Anabolic steroid and testosterone abuse increases the risk of diabetes. Use increases insulin resistance and the risk of diabetes, and may induce a pre-diabetic state [35]. The use of the same syringes by different people increases the risk of blood-borne diseases, which include hepatitis and HIV [36].

Abuse of testosterone and anabolic steroids also increases the risk of cancer and liver damage [16, 37]. Anabolic steroids taken by mouth in pill form are more dangerous to the liver than steroids used in injectable form. Liver disease can range from reversible mild cellular disorders to jaundice and malignant liver tumors with poor prognosis despite treatment.

Side Effects: Mental Disorders

Testosterone and anabolic steroid preparations also affect the central nervous system.The regions in the brain that they influence are closely associated with centers that regulate mood, sex drive, and aggressiveness [38].

Against the background of steroid use, 20-30% of people using excessive doses of testosterone and anabolic steroids have clear mood disorders that may meet the criteria for the classification of mental illnesses, which include depression, agitation, psychotic reactions with hallucinations and decreased cognitive function [8 , 25, 31].It is also estimated that about a third of anabolic steroid users are addicted to anabolic steroids [39, 40].

Approximately 30% of people who use excessive doses of testosterone and anabolic steroids are aggressive, hostile and irritable. Several case reports have shown that hormones can impair urge control [31].

Mood disorders and behavioral changes are likely the sum of many factors.The large number of anabolic steroids is one of the explanatory factors. The personality and psychosocial environment of the user also influences the behavior resulting from the use of anabolic steroids. Convincing evidence of the so-called. there are no attacks of rabies. In addition to anabolic steroids, aggressive and violent behavior is often associated with other intoxicants and exposure to risky behavior in general. However, anabolic steroids can act as a trigger [29, 41, 42, 43, 44].

Timo Seppälä
Director of Medical Affairs
Finnish Anti-Doping Committee FINADA (now the Finnish Center for Ethical Sports SUEK ry)

Updated by
Dopinglinkki

90,000 What are the uses of anabolic steroids?

Anabolic steroids were first developed to promote proper skeletal and muscle growth in patients with degenerative diseases. Modern medical science notes various uses of anabolic steroids, one of which is to help prevent muscle and bone petrification.Anabolic steroids are also associated with the pituitary gland producing proper hormone levels, and has been noted to be a powerful aid for people who also transition from woman to man.

Medical uses of anabolic steroids have been noted to help relieve some of the symptoms associated with severe muscle damage. There are a number of diseases that directly or indirectly affect muscles, such as fibromyalgia or dystrophy. People who experience degenerative muscle disease usually receive oral steroids to stimulate healthy muscle growth as it will be difficult for the body to create proper hormone levels without the use of anabolic steroids.The steroid works by increasing the levels of testosterone in the body, which is usually transferred to the muscles that heal over time.

Instead of affecting the muscles, some diseases will directly petrify the formation of bones in the skeletal system. It has been noted that individuals who suffer from diseases such as fibrodysplasia, progressive ossificans, are relieved of chronic symptoms when steroids are prescribed by medical personnel. Anabolic steroid use has been linked to helping a person regulate pain associated with bone petrification.When combined with rehabilitation, anabolic steroids are not only able to increase muscle growth, but they can also repair bones affected by degenerative bone diseases.

Male adolescents who are negatively affected by an imbalanced pituitary gland are given anabolic steroids to help normalize and regulate proper hormone levels. The pituitary gland secretes a number of hormones that promote growth spurts, which will require the use of anabolic steroids if not secreting the proper amounts.The doctor will prescribe a dose of anabolic steroids to help the developing boy for a period of six months to a year. The medical use of anabolic steroids has also been used in severe cases of the pituitary gland.

It has also been noted that the use of anabolic steroids is extremely beneficial for female-to-male transsexuals. If given in large quantities, women will begin to develop masculine characteristics. Anabolic steroids will stimulate testosterone levels, which will manifest as muscle growth, hair growth, deepening of the voice, and aggressive and dominant personality types.

Although steroids can be useful for a variety of medical reasons, there are also cases of illegal use. Athletes and bodybuilders are known to use steroids to build muscle quickly, regardless of the potential health risks that may pose. Most of these steroids are illicitly obtained from sources outside of a notarized prescription. Rigorous tests are usually performed in professional sports to ensure that athletes do not have an unfair advantage when using steroids.This could lead to legal action against them.

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90,000 everything you need to know about “therapeutic exceptions” – RBC

WADA has the right to review the issued approvals. TUEs can also be issued retroactively: if an athlete needs emergency assistance due to a sharp deterioration in health, doctors can use a drug prohibited by the anti-doping code, after which the athlete will be required to issue a permit for it.

Sports analysis: how doping was taken and fought

Read on RBK Pro

Who exactly gets the TUE?

Lists of athletes who have received TUEs are not officially published – this is a medical secret, not subject to disclosure, WADA only provides information on the number of therapeutic exceptions issued (see.(See infographic for this article). Information is also available about drugs that have been approved for athletes with therapeutic exceptions.

Since September 2016, the Fancy Bears hacker group began to upload documents stolen from the WADA server, which contain the names of athletes who received TUEs at different times. Among them are world sports superstars Williams sisters, Rafael Nadal (tennis), Ryan Lochte, Mireya Belmonte Garcia (swimming), Fabian Cancellara (cycling), Simone Biles (artistic gymnastics) and others.WADA officials’ letters published in October 2016 by Fancy Bears mention the names of more than 200 top US athletes (of which about half are in cycling). In February 2017, the doctor of the Norwegian ski team Petter Olberg, in an interview with the Norwegian newspaper VG Sporten, mentioned that “50-70% of the team members are diagnosed with asthma and are taking drugs from the prohibited list”. Fancy Bears have posted a WADA correspondence that mentions the names of Norwegian TUE skiers.

The question of the need to publish information about which athletes received the TUE has been raised repeatedly.Belarusian biathlete Daria Domracheva believes that the disclosure of this information is a violation of the human right to protect information about private life, but it will not help in the fight against doping. Russian skier Nikita Kryukov in an interview with the Sovetsky Sport newspaper said that he asked IOC President Thomas Bach when the therapeutic exceptions would be canceled, but he replied that it would be difficult to do so. In his open letter in December 2017, Kryukov equated TUE with doping. “If you are sick, then get treatment! If you took a drug that is prohibited, then wait a month, six months, a year until it is withdrawn, so that it does not leave a trace on the chart, and then – come back.You don’t run competitions in a cast or take off a cast after a week if the doctor told you to walk for six months, “he wrote in an official address on his website.

Do Russian athletes often receive TUEs?

In 2017, the Russian Anti-Doping Agency (RUSADA) issued 22 TUEs, and in 2016, in the year of the Summer Olympics in Rio de Janeiro, 15. National agencies of other leading sports countries used this opportunity much more actively. Athletes from the USA, France and Italy have received the largest number of therapeutic exceptions (see.infographic).

In 2016, 2,175 TUEs were issued worldwide, WADA told RBC. More than a quarter of them (28%) are in only two countries – the United States and France. The agency associates a significant increase in the number of permits issued in 2015–2016 with the tightening of the requirements for entering such information into the ADAMS database since 2016 (it contains information about all movements of athletes and the results of their doping tests, as well as the TUE issued to them).

“Athletes do not receive more therapeutic exemptions from year to year, but we are learning about more exemptions issued worldwide due to better compliance,” WADA spokeswoman Maggie Durand told RBC.

Why Russian athletes rarely receive TUE

Russian athletes are less likely to apply for a TUE than their colleagues.According to sports doctors, this is due to the weakness of the administrators who serve the clubs and teams, and the poor awareness of the athletes themselves about this possibility. The former head of RUSADA Ramil Khabriev, in an interview with the Sport-Express newspaper, suggested that the reason for the small number of applications from Russian athletes could be difficulties in preparing documents. In her book “The Magic of Victories”, Olympic champion in artistic gymnastics Svetlana Khorkina writes that she only learned about the existence of the practice of therapeutic exceptions from materials published by the hacker group Fancy Bears in 2016.

RUSADA Director General Yuri Ganus, in response to a request from RBC, noted that the reason for the significant differences between the number of TUEs issued in Russia and in other countries may be the approaches used in different healthcare systems. For example, athletes with diagnosed asthma (the most common disease, for the treatment of which representatives of ski disciplines receive TUE) in Russia, are most often eliminated even at the stage of children’s sections, noted sports doctor, professor Nikolai Durmanov.

There is evidence that Russian athletes, even when sick, often did without drugs included in the prohibited list.For example, at the 2010 World Championships, swimmer Ksenia Popova began an asthma attack during a 25 km swim, and after the finish she lost consciousness. Popova did not use potent drugs and did not issue a permit for them. The diagnosis of asthma was also confirmed for biathlete Alexei Volkov, who won gold in the relay 4 × 7.5 km at the Sochi Olympics. At the age of two, he was diagnosed accordingly, and Volkov was granted permission to take medications only two years after the start of his international sports career.Volkov noted that before receiving the TUE, he did without drug therapy, since exacerbations of the disease occurred in him in late spring, when the ski season was already ending .

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What medications are most frequently requested by athletes?

American athletes most often issue a TUE for the use of drugs of the group of central nervous system stimulants (138 approvals were issued by USADA and sports federations in 2016), Russians and Italians, as a rule, ask for permission to use glucocorticosteroids – (39 requests to RUSADA and 238 requests to NADO Italia in 2016, the agencies of these countries do not disclose information on the number of licenses issued by type of drug).In France, athletes have requested the most TUEs for diseases of the endocrine and cardiovascular systems (a total of 118 approvals for the two reasons indicated). French athletes received 42 permits in 2016 for the use of various glucocorticosteroids.

“This is a group of drugs that are used as widely as antibiotics: for rheumatism, rheumatoid arthritis, bronchial asthma, autoimmune diseases, thyroid diseases.Glucocorticosteroids are also used for all diseases of the connective tissues, ”sports doctor Ilya Melekhin told RBC. In his opinion, if steroids are allowed as a therapeutic exception, they do not greatly affect athletic performance. Doctor Yuri Vasilkov points out that in addition to respiratory diseases, steroids are used for minor injuries, bruises and sprains. “When they were not prohibited, we were fluent in this technique, injected drugs where necessary, and the recovery period was literally halved.Glucocorticosteroids are widely used in contact sports, in particular in football. When we were banned, we began to use medicinal ointments and physical rehabilitation. A little time [of recovery] is shifting, but why should we get caught, ”the former chief physician of the Russian national football team explained to RBC.

Attention deficit hyperactivity disorder (ADHD) is a diagnosis often indicated by foreign athletes for obtaining TUE.To treat it, athletes ask for permission to take stimulants, in particular methylphenidate (commonly known under the brand name “Ritalin”).

In 2016, 138 permits for the use of various stimulants were issued in the United States (which and how many permits were requested, the American anti-doping agency does not disclose). It was methylphenidate that was taken by American gymnast Simone Biles, who won four gold and one bronze medals at the 2016 Olympics – information about the therapeutic exception issued to her was in documents leaked by the hacker group Fancy Bears.After the publication of the data, Biles stated that she was taking the drug with the permission of the anti-doping agency, since she was diagnosed with ADHD as a child.

In Russia, methylphenidate and its derivatives have been withdrawn from drug circulation and are considered a drug. The diagnosis of ADHD raises doubts among doctors; it cannot be checked by instruments. According to a researcher at the Center for Preventive Psychiatry Alexander Fedorovich, the diagnosis of attention deficit hyperactivity disorder is not used in adult psychiatric practice in Russia.“This is a child’s diagnosis, at least in Russia. If such syndromes are observed in an adult, we put “organic damage to the central nervous system” or something else, ”he told RBC. However, the criteria for the diagnosis of impaired activity and attention are present in both the International Classification of Diseases and the American Statistical Classification of Mental Disorders (DSM-V).

RUSADA received only two requests for stimulants and antidepressants in 2016, whether they were satisfied is unknown.

Sochi-2018: which of the Russian athletes achieved acquittal in court

Are there any “occupational diseases” of athletes?

The most common disease of professional athletes is asthma, which is typical for representatives of cyclic sports.Research by the American Olympic Committee has shown that it is very common among cyclists (45% of elite athletes in the study) and skiers (60% of all skiers in the study).

Professor Ken Fitch, a member of the WADA Medical Research Committee, found that athletes with asthma more often won medals at the Olympics in 2000-2010 than athletes who have not been diagnosed with this disease: the percentage of asthmatics among all participants in the Olympics traditionally ranges from 4-7% and the percentage of winners diagnosed with asthma reached 15.6% of all gold medalists at the 2002 Salt Lake City Olympics.

Is it possible to forge a certificate of illness to obtain a TUE?

Former doctor of the Russian national football team and Spartak Moscow, Yuri Vasilkov, in an interview with RBC, expressed the opinion that it is impossible to obtain a fictitious certificate to obtain a TUE. “There [in WADA] everything is checked, such jokes do not work there,” he said.National Anti-Doping Agencies and International Sports Federations may request WADA to review the decision on therapeutic exemptions issued to athletes of a competing team. In this case, the WADA specialist will have to confirm that all the criteria for an exception have been met.

A 2013 study among Danish athletes (645 people were interviewed in 40 sports, of which 19% had ever received a TUE), showed that 51% of them believed that their competitors could have received therapeutic exceptions not for treatment of diseases, and to improve the result.4% of the respondents called this “normal practice”. Moreover, athletes who have already received a TUE, more often than their counterparts without such experience, stated that unscrupulous competitors can bypass the control system for issuing therapeutic exceptions.

Does the TUE approved dosage help improve athletic performance?

The standard that physicians should follow when deciding whether to grant a therapeutic exception emphasizes that drug intake should not significantly affect results.However, in practice, it is not always possible to determine the degree of influence, experts say.

Sports doctor-traumatologist, Ph.D. Artem Katulin believes that medical indications for the use of substances prohibited by WADA put athletes in a “more advantageous position.” In his opinion, there is a clear line when the prescribed medication only heals and when it begins to have a significant impact on athletic performance, and this line is determined for each individual.

Of the drugs for which athletes are most likely to request a TUE, stimulants (given to athletes with ADHD or narcolepsy) may have the most obvious effect on performance.Corticosteroids, when used systematically, can also have a stimulating effect, points out Professor Ken Fitch of the University of Western Australia. Professor of the Center for Sports Medicine and Functional Research at the University Hospital in Clermont-Ferrand, Martin Duclos, also stated the stimulating effect of glucocorticosteroids on the body of athletes.

The dosage of the drugs prohibited by WADA is determined by the doctor who prescribes the treatment. There are no clear dosage limits in the TUE rules, other than the principle that the prescribed dose is “unlikely to lead to improved athletic performance.”

90,000 Nerd Revolution: Fireproof Forests and Bananas on Steroids

  • Sophia Smith Geiler
  • BBC Future

Photo by iStock

famine whole countries – the potential of plants is far from being explored.

We eat them, we put them in a vase and look at them with approval – but are we using all their useful qualities to the fullest?

For example, here are four ways in which a “plant revolution” can take place in our world.

1. Creation of hybrid superplants

When we eat vegetables, they are usually grown by farmers. However, these plants have relatives in the wild that are about as much to farm vegetables as wolves do to dogs, the Crop Wild Relatives (CWR) project highlights.

And these wild relatives, growing far from farm fields and gardens, have learned to resist pests, diseases, soil salinity and climate change on their own.

That is why breeders are working to cross agricultural plants with wild plants and get a hybrid that, on the one hand, will be tenacious, and on the other, will retain all the advantages that already “tamed” plants have, for example, high productivity.

Photo author, LM Salazar / Crop Trust

Photo caption,

By crossing wild vegetables with cultivated varieties, you can create a superhybrid that is not afraid of parasites or diseases

The goal of the CWR project is to prepare agriculture for the changing climate of the planet, collecting, protecting and studying those hardened wild relatives.

Plans are truly global: the countries with the most wild cousins ​​are Brazil, China and India, while the largest concentration can be found in Greece, Azerbaijan and Portugal.

All the advantages of this program should be felt, first of all, by developing countries – those where the population is growing at a particularly fast pace.

And nevertheless, despite the fact that wild analogs of the crops we are used to are widespread throughout the world, they also have powerful enemies.

These enemies include human activities: war, non-agricultural land use, global warming, environmental pollution and agricultural intensification.

The Millennium Seed Bank at Kew Botanical Gardens, together with partners from around the world, are breeding and preserving wild varieties for years to come.

2. Using plants as a medicine

It would seem that this is nothing new – people have been using medicinal plants since time immemorial.But perhaps we need to look more energetically for new ways to use them.

Today, man knows more than 28 thousand medicinal plants, but less than 16% of them are listed in official medical reference books.

The plant-based medicine industry is growing rapidly. Back in 2012, according to the WHO, its total cost reached an astonishing $ 83 billion.

The popularity of herbal preparations is great. In Germany, for example, about 90% of the population uses them – in particular, obtained from garlic and foxglove.

However, there is a serious problem faced by the authorities that control this industry: sometimes hazardous to health or simply counterfeit products appear on the market.

The names of plants and herbs are often confused, and patients end up being offered a contraindicated (and potentially deadly) medication.

One of the countries where they are trying to fight this is China. In December 2016, Chinese authorities announced plans to integrate more traditional Chinese medicine drugs into the country’s healthcare system by 2020.

Detailed illustrated plant reference guides will be produced to prevent confusion.

If we want to unleash the full salutary potential of medicinal plants, the researchers strongly recommend: use plants from renewable sources, cultivate them, urgently introduce new procedures for reliable source tracing and more effective quality control!

3. Bananas on steroids

In general, not only bananas.Let’s say enseta, a genus of plants in the Banana family, has been cultivated for thousands of years in Ethiopia. The Ethiopians have more than 200 names for it. And they use it in different ways.

One of the main food products in Africa (they use primarily flour, which is obtained from the trunk and rhizome, edible fruits, like a real banana, it does not have – Translator’s note ), enset is used both in medicine and in construction huts, animals are fed, ropes and clothing are made from it – not to mention that this plant provides an ideal microclimate for coffee plantations.

Enseta withstands drought, heavy rains, floods. This so-called false or Abyssinian banana is just some kind of treasure.

Photo author, PAul Wilkin

Photo caption,

Enset has been grown for thousands of years in Ethiopia

Scientists are trying to figure out whether the Enset can grow somewhere else – in particular, in those African (and not only African) countries where the population is constantly hunger threatens.

One square meter of enseta plantation feeds more people than almost any crop.Enseta actually provides three different types of food: baking dough, soups and porridge, and boiled root (similar to potatoes).

But first, scientists will have to figure out where to get the seeds for planting. The fact is that nowadays Ethiopian peasants simply cut off pieces of plants and plant them. Nobody knows how they are pollinated.

But sooner or later, researchers will find out the secret of these super bananas.

4. Plants-firefighters

The ability of plants and trees to burn (or not burn) is very important – just think about the devastating forest fires and their consequences for the economy, society and the environment.

This may be the case, in part, because there is very little plant diversity in the affected areas.

But, in principle, for some ecosystems, forest fires are a normal and even important process. Many tree species have learned to survive in the midst of fire and turn it to their advantage.

Photo author, LM Salazar / Crop Trust

Photo caption,

Researchers are constantly looking for new ways to breed super plants that will help fight hunger, drought, fires, etc.

Trees and plants that are better able to withstand fires, as a rule, have a thick bark (or thick seed coat), the ability to quickly recover and … cones, which just need fire.

These trees, for example, the so-called fire pine, are a kind of Phoenix of the plant world, they are reborn from the flame.

When the fire burns off the bud’s protective resin layer, it throws seeds into the air, ensuring that the tree grows elsewhere.

The fire pine tree itself may burn completely, but young pines will soon appear on the ashes.

Researchers at Kew Botanical Gardens are cataloging both more and less combustible plants and are working to plan landscapes that are more fire resistant.

Such landscapes can act as natural fire fences and reduce the amount of valuable natural resources that are consumed by forest fires.

To read the original of this article in English, visit BBC Future .

Study of the steroid blood profile by tandem mass spectrometry

Steroid hormones are formed from cholesterol in the process of numerous transformations, each stage is carried out under the action of a certain enzyme. Synthesis is carried out mainly in the adrenal cortex. In the process of synthesis, steroids are differentiated into 3 types: mineralocorticoids, glucocorticoids and sex hormones.

The study of the steroid blood profile allows for a simultaneous assessment of the level of metabolites (intermediate products) of all steroid hormones.

What is the steroid profile study for?

As part of a comprehensive examination of diseases of the hypothalamic-pituitary-adrenal system and adrenogenital syndrome in order to identify or exclude disorders at the level of the adrenal glands.

Who is the study shown to?

Patients with the following problems are usually examined:

  • Menstrual irregularities
  • Infertility
  • Polycystic ovary syndrome
  • The appearance of signs of hyperandrogenism in women: hair growth on the face, white line of the abdomen, coarsening of the voice, muscle growth
  • Clinical signs of adrenal insufficiency: increased weakness, rapid fatigue, weight loss, nausea, vomiting, decreased blood pressure up to loss of consciousness

What exactly is determined in the analysis process?

The level of intermediate metabolites of steroid hormones in the process of multistage transformations.The analysis is performed by tandem mass spectrometry.

Profile Composition:

  • 17-hydroxyprogesterone,
  • 21-deoxycortisol,
  • 11-deoxycortisol,
  • cortisone,
  • cortisol – reflect the successive steps in the synthesis of glucocorticoids.
  • Corticosterone and deoxycorticosterone – intermediate metabolites of aldosterone, characterize the synthesis of mineralocorticoids
  • Progesterone,
  • androstenedione,
  • dehydroepiandrosterone,
  • testosterone – characterize the synthesis of sex hormones.
  • 17-OH-pregnenolone – the precursor of all steroid hormones

What do the steroid profile test results mean?

The attending physician is responsible for the interpretation of the results. Analysis of the level of metabolites allows the doctor to determine at which intermediate stage in the synthesis of steroid hormones the violation occurred and / or which enzyme has ceased to function.

How to properly prepare for the study?

Venous blood is donated in the morning on an empty stomach, after 8-12 hours of hunger, drink water as usual.It is recommended to cancel medications containing estrogens and androgens in 48 hours, to exclude heavy physical activity and stress in a day.

From strychnine to meldonium – Money – Kommersant

The doping scandals that hit Russian sport upset the fans and made them disillusioned with the activities of the World Anti-Doping Agency (WADA). Many recall the glorious times of Soviet sports, when there was no rumor about any doping.”Money” investigated the issue with the help of those who laid the foundation for the doping power of the USSR.

Doping

Never before has Russian sport been so close to failure. First, the revelatory films of the German TV channel ARD, and then the WADA report called into question the achievements of our athletes, as well as the participation of the Russian track and field team in the 2016 Olympics in Rio de Janeiro, as well as in other international competitions. The membership of the All-Russian Athletics Federation in the IAAF has been suspended.On November 10, 2015, the work of the RUSADA laboratory in Moscow was suspended; now, doping samples will be checked in the British UKAD. The head of the anti-doping laboratory, Grigory Rodchenkov, accused of destroying 1,417 doping samples, as well as his deputy Timofey Sobolevsky, moved to another job – in the United States. The management of RUSADA has resigned.

And it soon became clear that not only the use of doping causes harm to health, but also the fight against it. On February 3, the former chairman of the executive board of RUSADA Vyacheslav Sinev suddenly died, and ten days later, after returning from a ski run, the executive director of RUSADA Nikita Kamaev died just as suddenly.The names of both were associated with a doping scandal.

The last blow was the story of meldonium: a drug that was successfully and openly used both in medicine and in sports, from January 1, 2016, it was included in the list of banned WADA. According to the resource “R-sport”, by April this substance was found in the samples of hundreds of athletes.

All this unpleasant news raises reasonable questions from sports fans.Why did the West suddenly begin to expose our athletes? It is clear that they are all lying, but there is nowhere without doping in modern sports. Why don’t they expose their own? Let them admit that the whole sports world is doping! And in general, how to determine what is doping and what is not doping? Finally, why were there no doping scandals in Soviet sports, and a dime a dozen in Russian? Apparently, someone does not like our sports achievements, so they slander our athletes, coaches and officials (according to our own athletes, coaches and officials).

A number of questions are easy to answer at once. For example, what is doping and what is not doping. In addition to meldonium, there are many substances that at one time were not included in the list of prohibited in sports until their specific properties were discovered. So, in the late 1970s, in any pharmacy you could buy a remedy for the common cold called “Ephedrine”. But it turned out that ephedrine has a psychostimulating effect, increases vitality, reduces fatigue and is also a fat burner.Further more: ephedrine turned out to be a convenient raw material for the artisanal production of drugs containing methamphetamine and ephedrone. Therefore, in the end, it was banned from free sale. It is characteristic that the naphthyzine that remained on sale after a while also showed itself not only as a remedy for the common cold – today it is known that it is addictive.

Back in the 1960s, the International Olympic Committee had nothing against anabolic steroids or psychotropic stimulants. It was only in 1973 that the IOC commission classified the doping class and banned the use of several groups of drugs: psychostimulants amphetamine and its derivatives, sympathomimetic amines, CNS stimulants, narcotic drugs (morphine, caffeine, etc.)) and anabolic steroids. Subsequently, this list was actively replenished.

In addition, there is a list of substances prohibited in certain sports. For example, in bullet shooting and among archers, alcohol is classified as doping: it is believed that a small dose of alcohol relieves tremors in the hands and lowers the heart rate. For the same reason, shooters are prohibited from various sedatives, beta-blockers. Similar drugs are prohibited in a number of other sports, in particular in ski jumping, as well as in chess (doping control at international chess tournaments was introduced in 2001).

But what can I say if drugs such as morphine and cocaine have long been used in medicine (morphine is still used) as a pain reliever and were considered relatively harmless. And marijuana, like other cannabinoids thousands of years ago, is still used to relieve pain and spasms, treat tumors and even psychosis. All of these drugs, in certain doses, can be used as doping in sports and are therefore prohibited.

And one more change: according to the new IOC regulations, pregnant athletes do not have the right to compete in disciplines that require physical effort. And not only because of the danger of stress for the fetus. During pregnancy, hormonal changes occur, in particular, the growth of chorionic gonadotropic hormone, which stimulates the production of testosterone, which leads to an increase in strength and endurance. It is known that athletes sometimes use this, performing in the first trimester of pregnancy (when the risks to the fetus are not so high).In 2012, Swiss triathlete Nicole Spirig won the London Olympics while pregnant. In addition, hormonal benefits persist for some time after childbirth, which allows athletes to achieve high results: examples of this are runners Paula Radcliffe and Kara Gucher, skier Christina Shmigun-Vyakhi and others.

In general, the talk about what to call doping reminds the legend of a German hammer thrower who allegedly showed high results at home tournaments and weak at international ones.And all because at international competitions he was allegedly forbidden to swear in German during the throw.

To simplify, let’s give the most comprehensive definition of doping: these are all drugs that are currently included in the WADA stop-list.

Broad muscle masses

The history of doping is as old as sport itself. There is information that garlic was used as a stimulant at the Olympiads in Ancient Greece.In modern history, doping began with strychnine – rat poison in small doses is a strong muscle stimulant (it was also used in a mixture with heroin, cocaine and caffeine). At the III Olympic Games in St. Louis, marathon runner Tom Hicks made his way to the victorious finish thanks to assistants – and a double dose of strychnine, which he washed down with alcohol. He barely survived, but did not violate the anti-doping rules – they did not exist then.

Cyclists were and remain one of the earliest and most active users of doping.Since the beginning of the 20th century, several dozen cases of doping in road racing have been recorded. In 1955, French racer Jean Maleyak, participating in the Tour de France at the Mont Ventoux stage, fell off his bike and was in a coma for 15 minutes. It was later established that Maleyak had taken drugs before the race.

At the 1960 Rome Olympics, Dane Knud Jensen took 15 amphetamine tablets with coffee before the race in front of the public. On the track, he fainted; during the fall, the athlete died from a head injury.It was after the Roman Olympics that regular doping tests began.

In July 1967, at the same stage of Mont Ventoux, where Jean Maleyak almost died, a misfortune happened to the Englishman Tom Simpson. From the start of the race, he began to drink brandy, then behaved strangely on the road, fell twice and did not get up a second time. Doctors recorded cardiac arrest – and two empty amphetamine packs. Following the incident, the UCI has stepped up doping controls.

Around the same time (late 1960s – early 1970s), medical research on the use of doping in the Soviet Union began.Officials and scientists began to receive information about the success of the United States in studying the effect of anabolic steroids (studies have been conducted since 1960 in an atmosphere of strict secrecy). Since it was not possible to obtain data directly from the geopolitical and ideological adversary, all that remained was to track scraps of data from Western medical journals, but access to them was severely limited.

Prior to that, in the USSR, athletes and coaches were engaged in amateur performances – for example, since the 1940s, they were raising functional with the help of such means as pervitin.These pills were sold freely in pharmacies until 1970, and were considered a medicine. In fact, it is methamphetamine (a drug) that acts on the central nervous system, increasing physical and mental activity, as well as pressure, eliminating fatigue, but eventually destroying the body. One of the popular names is “screw”.

Then, preparations based on ginseng appeared, and in the Baltic states they created some protein preparations that seemed to have a beneficial effect on the body. But the advent of anabolic steroids has ushered in a new era in sports.

And so, in 1972 in the USSR, a manual appeared under the name “Anabolic steroids and sports performance”, created under the leadership of senior researcher, candidate of medical sciences S.K. Sarsania with the participation of employees of the research laboratory at the State Central Order of Lenin Institute of Physical Culture (GTsOLIFK). The work was immediately classified, distributed under the DSP label among the coaches of the national teams of the country and was never republished.However, after 40 years, excerpts from it appeared in the magazine for bodybuilders “Iron World”, as well as on a number of sites.

The authors point to various factors contributing to the growth of performance and accelerating recovery processes in athletes of international class. Among these factors, in addition to massage and electrical stimulation, are named “anabolizers – substances of various chemical nature, enhancing the biosynthetic processes occurring in the body and, above all, protein synthesis.”

The following are examples of the effective use of anabolic steroids in the West: “G.Connolly, who used Dianabol, became a medalist at the 1960 Olympic Games and a world record holder in hammer throw, depriving this title of a Soviet athlete. In 1964, according to the American press, all Americans – winners of the Tokyo Olympic Games in shot put, used anabolic steroids. Soon, anabolic steroids began to be used in Europe, and at the 1968 Olympics, the shot put podium was already half European. Now anabolic steroids are used by such world-famous athletes as discobol R.Bruch (Sweden), who was the first in the world to send a disc beyond the 70 m mark, shot putters N. Steinhower, D. Woods, D. Long, R. Matson, P.O.Brian (all USA), A. Rowe (England), H. Birlenbach (FRG) “.

Further, there are references to the studies of the French in 1960, as well as to a number of American works of different years: “Steinbach’s studies are interesting: firstly, it is obvious that in a young body already very small doses of dianabol (three times a week, 3 mg) provide clear impact… Johnson and O’Shea published the results of their studies in 1969, after which it became obvious that there was a significant increase in weight and muscle strength in individuals exercising with dianabol … The findings of Johnson and O’Shea were confirmed by the research of Ward (USA), who concluded that taking 10 mg of Dianabol daily for five weeks in combination with strength training increased strength, lean mass and maximized oxygen consumption. For example, the result in the bench press increased by 16 kg, in the squat with a barbell – by 23 kg, and in the bench press – by 16 kg (in percentage terms, the increase was 12.7%, 10.7% and 9.0%, respectively). “

And finally, for the first time, the results of Soviet studies in the field of anabolic steroids use are described: “Our experience in the use of anabolic steroids allows us to assert that in weightlifting, the intake of anabolic steroids by highly qualified athletes at the pre-competition stage lasting two or three weeks can increase athletic performance by 15 kg in total triathlon independently from the weight category of the athlete … Younger athletes quickly recover after enormous loads, they, as a rule, still have a significant adaptive reserve, which largely depends on the state of the hormonal sphere.Moreover, there is a clear connection between the level of physical fitness and sexual potency in its various manifestations (Khureton). This largely explains the better tolerance of high loads by young athletes. “

It should be noted that even then Soviet scientists paid special attention to the possible side effects of anabolic steroids. “The role of sex hormones in the tolerance of the training load becomes even more obvious due to the fact that at high loads, unfavorable shifts in the genital area are possible… The use of anabolic steroids by adult athletes sometimes gives such a significant increase in results because they make up for the lack of the necessary amount of sex hormones in athletes necessary to adapt to significant muscle loads … The use of anabolic steroids by young athletes has not so much a replenishing, but a depressing effect on sexual glands “. And the conclusion follows:” In connection with the significant influence of anabolic steroids on the body of women and young athletes, the use of anabolic steroids by athletes of both sexes under the age of 18 is strictly prohibited. “

Sergei Sarsania, the author of the classified training manual, a leading researcher at the Russian State University of Physical Culture, told Dengam about how scientific developments were brought to life.

“The bar just jumped on the chest”

– Sergei Konstantinovich, it happens that athletes are given some kind of pills at a training camp, and when asked: “Is this doping?” – doctors answer: no, just vitamins to restore the body…

“Yes, there was such a practice,” Sarsania replies. “In 1979, I worked with hockey“ Dynamo ”. And he suggested to Yurzinov (coach of the Moscow “Dynamo” – “Money”) to give the team a course of anabolic steroids. A choice: either to tell them about it directly, or to feed them “in the dark”. He thought about it and offered to say that these are vitamins.

But Sergei Sarsania spent most of his research in the national weightlifting team.

– For the first time, Vorobyov introduced me to anabolic steroids at a training camp in Dubna before the 1968 Olympics in Mexico City (Arkady Vorobyov, multiple world and Olympic champion, honored coach of the USSR, head coach of the USSR national weightlifting team.- “Money”). Once he called to him and gave me Nerobol tablets from the Hungarian company “Gedeon Richter”. They had to be given to athletes two pieces twice a day, each 5 mg. They were not banned then. Soon two employees from the Institute of Endocrinology came to the camp, where the anabolic steroids Nerobol and Retabolil were being tested. They were analogous to American Dianabol, with the same active ingredient – methandienone. The results of clinical trials were controlled by a specially created committee headed by the Deputy Minister of Health of the USSR Avetik Burnazyan.The institute staff explained to me the pharmacological action of these drugs, and I realized that this was a gold mine. But then no one knew either the correct dosage or side effects – all this was for me to investigate.

Before the 1968 Olympics, Sarsania together with the national team went to the acclimatization camp. According to the time zone, acclimatization took place in Cuba, in height – in Mexico City (the capital of Mexico is located at an altitude of almost 2.5 thousand meters above sea level). There, weightlifters from the USSR set several world records.

There, at the Olympics, Sarsania met the American weightlifter, champion Tommy Kono, who told him about a useful source of information – Strength & Health magazine. In Moscow, this magazine could only be found in the VNIIFK library. In the magazine Sarsania came across an article by two namesake authors: The Johnsons wrote about the negative effects of anabolic steroids on the liver.

– I translated it and published it in the magazine “Sport Abroad”, adding a number of my own questions, for example: are anabolic steroids useful for a young body? The article caused a furor among specialists, it was reprinted by specialized publications of the entire socialist camp (where their own research in sports medicine was actively developing). And for her they gave a hard hat to our international curator – the deputy chairman of the USSR Sports Committee V. I. Koval: it turned out that everything connected with this topic is subject to strict censorship.

According to Sergei Sarsania, he conducted his research on athletes involved in various sports, giving them drugs in small doses: for example, Nerobol was in tablets of 20 mg per day, retabolil – injections of 50 mg every ten days. After that, the strength indicators, blood, oxygen consumption were measured. Even at therapeutic doses, the effect was amazing – the bar “just jumped on the chest”. Sarsania recalls the shock he experienced when he saw David Rigert jump on a gymnastic goat with a 90-kilogram barbell.

However, on the ground, athletes who heard about the miraculous effect of pills were often engaged in amateur performances.

– Once the coaching staff of the national team of the country conducted a survey of athletes, – Sarsania recalls. – And one weightlifter of the all-Union level from Volgograd wrote that he was taking 25 tablets daily – 125 mg each! Then I learned that he died of cirrhosis of the liver five years after the end of his sports career. But if in weightlifting I somehow managed to establish control, then in other forms, especially in athletics, there was no system: they ate as God willing.

Another unexpected effect of anabolic steroids was psychological properties. Increased testosterone production led to increased aggression. In a competitive environment, this was a positive factor: the athletes lost their fear of the barbell, they did not “burn” at the tournament, they were confident in themselves. But outbursts of aggression appeared regularly: according to Sarsania, Vasily Alekseev lost his temper at the training camp in Bulgaria and crushed the entire hall with a barbell bar. On the other hand, all aggression subsided as soon as the medication was stopped.

– We flew like this at the Munich Olympics in 1972. The control estimates passed: clean and jerk 12-14 days before the start, snatch in seven to ten days, bench press in five days. And then it turns out that for the first time at the Olympics there will be doping control. And the then head coach Alexei Medvedev, three days before the tournament, gave the command to end with steroids. As a result, the athletes lost confidence, and we earned four “steering wheels”: Shariy, Pavlov, Kanygin and Rigert received zero marks.It is all the more offensive that there was no doping control in the end. But the athletes “scored” on this control and performed well.

The real doping control was at the next Olympics, in Montreal. Then the Bulgarian weightlifters fell under the distribution. Ours miraculously escaped disqualification, Sarsania recalls: “Vasya Alekseeva in Montreal was washed all night with citric acid to hide the traces of steroid use.”

The “cover” for doping was not only medical, but also administrative.Before the 1978 World Ice Hockey Championship, Sarsania was asked to test the USSR national team. At a closed meeting on the eve of the tournament, he reported on the situation: the team is “killed”. The national team coach V. V. Tikhonov asks: “What are we going to do?” Sarsania suggested a course of anabolic steroids, but … what about doping control? The head of the football and hockey department V. I. Koloskov answers: “Sych is responsible for doping (the deputy chairman of the USSR Sports Committee, who oversaw winter sports. -” Money “), I take it upon myself.” And Valentin Lukich himself once invited Koloskov to the post.As a result, the samples from our hockey players turned out to be the purest, and won the first place.

Officials worked well before the 1980 Moscow Olympics.

– My friend Vanya Abadzhiev (the famous coach of the Bulgarian national weightlifting team – “Money”) was very worried about doping control. I reassured him: there will be no control, this is the Olympics of socialist countries, no one will allow them to lose face. And so it happened. The deputy chairman of the USSR Sports Committee, Viktor Igumenov, personally took the President of the IOC Medical Commission, Prince de Merode, to Lake Baikal, went fishing and rested… In general, we decided the question. And all the samples were poured into Yauza and they forgot about the doping control.

Reset records

All this suggests that the use of doping, as well as manipulations to hide its traces, including the “sleight of hand” of sports officials, is not a trend in recent years, but a practice that has taken root since Soviet times. Why problems have come to light in recent years is also no secret.

Sergei Sarsania believes that the reason for everything is “a mess, lack of professionalism and lack of systematic work.”Honored coach of the USSR Abel Kazachenkov, who prepared the Russian national judo team for three Olympiads, calls doping punctures sloppiness. “Do you remember the doping scandals in the USSR? No. There was centralization, the state controlled, there was scientific support. Previously, athletes underwent medical examination only in the first and second dispensaries, now everyone is looking for a doctor for himself. And they also” chemically “themselves or rely on a coach.” …

Olympic biathlon champion Anfisa Reztsova in her interviews approaches the problem extremely pragmatically: “If you are not caught, you are not a thief.”“In modern sports, there is nowhere without doping, I’m telling you for sure,” Reztsova is sure. Therefore, one must not get caught: they say, in Russia, many troubles come from amateur performances, as well as from greed, the desire to snatch a “pill” over the program. And he cites the example of Norwegian skiers who “never come across”.

Anatoly Yakimov, a candidate of pedagogical sciences, who worked for 45 years at the Moscow Regional Institute of Physical Culture, disagrees with the Olympic champion.He believes that there are inexhaustible reserves for building up sports results based on improving training methods, as well as technical innovations. And it reminds us of how in the 1970s the transition to plastic skis took our coaches by surprise. Reminds of innovative skates – “slap skates”, about “high-speed” overalls “Long John” for swimming, which our coaches traditionally look at with distrust. He also cites the example of Kenyan and Ethiopian runners who, without any doping, win at medium, long and marathon distances, because they live and train in mountain conditions, that is, in natural hypoxia, and, having descended to the plain, show phenomenal results.”But it takes a long time to improve the preparation method, and doping gives an instant result, and it doesn’t matter what happens to the athlete next,” Yakimov sums up.

Others remind about natural and legal products, long-term use of which gives an effect no worse than doping: black and red caviar, pomegranate, aloe, hematogen. As well as herbal preparations with adaptogenic properties: Rhodiola rosea, roots of leuzea, Eleutherococcus, Schisandra, propolis and pollen and others.

What will happen to sports in the future? More and more often, calls are heard to “reset” all world records and start counting achievements from scratch. Moreover, a similar step has already been taken in weightlifting, albeit in a truncated form: in 1992, the IWF “shifted” the weight categories.