What are steroids? A podcast for therapists

Episode 54

What are steroids?

What are the real risks to using steroids?

What does it have to do with mental health?

The pursuit of a perfect body is not just for women. There are unrealistic body expectations of men too. Steroids are more complex than we think and not the shortcut they’re assumed to be. As therapists, we don’t often hear about steroids and it’s actually really important that we know about them. Research tells us that steroid use is on the rise and its impacting the mental health of the ones using them.

Transcript

You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice. So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast. This is episode 54 last week. We covered a class of drugs that is somewhat obscure in 2021. Barbiturates. If you haven’t had a chance to go listen to it, head on over to betsybyler.com/podcast to check out the new episode. Barbiturates aren’t necessarily common drugs of abuse right now, but they’re used in some interesting ways in the current time.

Last week on the podcast. I also announced that I’m hosting a workshop. The workshop’s going to be October 16th and it’s online. If you aren’t able to attend on the 16th, it will be recorded so that you can watch later. One of the questions I get asked most is how to start the conversation about drugs and alcohol.

It sounds good in theory, and we ask people difficult things all the time. However, there’s something about using substances that can cause people to be defensive and providers, whether therapists, medical providers or others sometimes find it difficult to ask people out right if they’re using. It can seem like an accusation, even though it’s just a normal question.

I think part of that is that there’s a lot of shame around using substances, even though it’s relatively normal and pretty common as a coping skill. In the workshop. I’m going to tell you my process for how to start the conversation, what questions to ask, what you’re looking for in the answers and what that means about future intervention. To get more details, head over to betsybyler.com/workshop.

Today, we’re going to be covering a class of drugs that are considered drugs of abuse, but for different reasons. So we’re going to be covering steroids. To start talking about steroids. We need to distinguish between two types of steroids. The first is one that we’re not going to be talking about today because it’s not in the same category as a drug of abuse.

Corticosteroids are chemicals, often hormones that our body makes naturally. They help our organs, tissues, and cells to do their jobs. The corticosteroids are medications that quickly fight inflammation in our body. A common one is prednisone, which a number of us have probably heard about or taken ourselves. Prednisone works to slow or stop the immune system process that triggers inflammation. Corticosteroids get prescribed all the time for different reasons.

Any of us who’ve taken them or known someone who has knows that they’re not for long-term use. They’re typically a short course to handle something related to inflammation in the body. The other type of steroid are anabolic androgenic steroids. Those are the ones we’re going to be covering today. In a lot of the literature it’s abbreviated AAS for today, I’m going to be using the word steroids or anabolics and what I mean are anabolic androgenic steroids.

To start off, I want to talk about Hugh Jackman and Henry Cavill. Hugh Jackman as Wolverine and Henry Cavill in the Witcher. Both men are attractive by most standards and both men appear shirtless fairly often. This is of course by design. We know that sex sells.

It does seem that we have a bit of a double standard though. A few years ago. I remember watching the Olympics when Kathy Lee and Hoda were talking to a Polynesian dancer. The dancer was probably, I don’t know, 30 or 35 years younger than these women and was standing there totally silent shirtless in the garb that he was dancing in and they were rubbing on his chest with their hands and exclaiming over his muscles.

As I’m watching it, I was like “what the actual fuck? How is this okay? Why is no one saying anything?” He looked really uncomfortable. And I thought to myself. Hmm. I wonder if they asked his permission before they did that. I wonder if he minds this? He didn’t look like he was enjoying their attention. I could be wrong.

What I do know is that if that had been reversed and it had been two men touching a female that way people would have gone absolutely batshit. So we have this double standard that exists where men can be objectified in certain ways, but we’re upset when women are as well. I’m not suggesting that objectifying women is therefore the answer, I’m saying that we have to look at it both ways.

This brings us back to Hugh Jackman and Henry Cavill. Both of these men, along with countless other Hollywood actors and stunt people have talked about what they have to do in order to get ready for scenes in movies and shows. We’ve often seen mention of the fact that they go on massive diets and workout constantly.

That isn’t the only thing they do though. Right before filming, they do something else to cut weight. Henry Cavill appeared on the Graham Norton show, which if you’ve never seen is wonderful and funny. Cavill stated that four days prior to filming a shirtless scene, he allows himself to drink a liter and a half of water. The next day he drinks half a liter, but on day three, he goes completely without water and doesn’t drink water until shooting wraps up on the fourth day.

Let’s recap here, he’s shooting and working during whatever conditions there might be, whatever temperature, whatever is happening around him. And he hasn’t had anything to drink and certainly not anything to eat.

Henry Cavill is quoted as saying when you’re dehydrated for three days, you get to the point on the last day where you can smell water nearby. Not just Cavill and Jackman, but our superheroes in general are jacked. Their muscles are cut, they look amazing, and those are held up as the perfect male body type.

All of that can come at a pretty high cost. The actors have access to trainers and nutritionists and state-of-the-art facilities and their whole job is to get fit. But what about our average guys? I will say that there are women who use steroids. It is not the majority though. And so the majority of what we’re going to talk about today are going to be the use of steroids by men.

What are steroids: A history

As always, we’re going to start with the history. In 1886, a 24 year old Welsh cyclist, Arthur Linton, died during a race from Bordeaux to Paris, from what they reported as typhoid fever. However it is commonly believed that he had taken a performance enhancing stimulant called trimethyl.

In 1889, a French physician extracted testicular fluid from dogs and Guinea pigs and injected it into himself. He had announced the findings at a scientific meeting in Paris stating that he felt younger and had more energy.

Testosterone was first synthesized in 1935 in Germany and was medically used to treat depression. German scientists develop anabolic steroids as a way to treat hypogonadism, which is testosterone deficiency. The German scientist was later awarded the Nobel prize for his work.

There are some reports that Nazis tested anabolic steroids on prisoners between 1940 and 1945. It’s also reported that testosterone and analogs of testosterone are used to increase aggression and physical strength during the war. Interesting to me is that the use of steroids was used to deal with wasting disease in the aftermath of concentration camps.

In 1954, the former Soviet Union began to dominate the sport of powerlifting. The Soviet team doctor allegedly revealed his use of testosterone injections to the U S weightlifting, Dr. John Ziegler. Ziegler then began working on a compound that produced muscle-building benefits without androgenic risks and consequences. He was able to produce an anabolic steroid called dianabol, which is one of the first and oldest steroids, other than testosterone.

What are steroids: How they work

All anabolic steroids are schedule three drugs in the United States. There are some FDA approved uses. Anabolic steroids do get used for hypogonadism, low testosterone, delayed puberty in boys, testicular failure, Klinefelter syndrome, pituitary hypothalamic access dysfunction from tumors, injury, and radiation among other things. They’re used sometimes off-label to stimulate bone marrow for leukemia patients, to stimulate appetite and to deal with growth failure.

So a little bit about the mechanism of action here. Endogenous androgen is responsible for the growth and development of sex organs in men and maintaining secondary sex characteristics.

Endogenous anabolic steroids, such as testosterone and synthetic anabolic steroids mediate their effects by binding and activating androgen receptors. They also upregulate and increase the number of androgen receptors, which increases the ability to train more intensely and indirectly contributes to increased muscle size and strength.

They also have a stimulatory effect on the brain, through their diverse effects on various central nervous system neuro-transmitters. What followed up until 1990 was a series of different scandals in the Olympics and other major sports talking about the use of steroids. The United States had our own share of scandals and it continued long past when steroids became illegal. It’s still an issue today, as we all well know.

Steroids became illegal in the United States in 1990. What happened of course, is that these performance enhancing drugs went underground. There wasn’t the internet at the time and so this became about drug dealing. Steroids had to be gotten through different means and since they were illegal and trafficking was then a felony, this became harder and harder. Over the years, the drug trade for steroids hasn’t necessarily calmed down at all.

It’s actually gotten significantly easier to get steroids. Although in the steroid community, they’ll tell you that you can’t just trust anyone who says that they have a specific thing. Lots of the steroids that people are taking seem to be not what they were said to be. Which of course shouldn’t surprise us. We’ve been talking for months about the fact that there are such a thing as pressed pills when it comes to all sorts of different kinds of pharmaceuticals. Why not steroids? There’s been criticism of the 1990 Act that put these as a schedule three drug, because what it did was increase black market trade.

It was around the 1980s when the use of anabolic steroids started to spread to the general population instead of just elite athletes. Most steroid users were average men who wanted to look back. After steroids rights became illegal some of the other countries where they are legal became the main importers such as Mexico, and some of the European nations. The majority of people misusing steroids are male non-athlete weightlifters in their twenties and thirties. Research tells us that only about 22% of those started as teenagers.

What are steroids: Role in mental health

We can’t talk about steroids without talking about muscle dysmorphia. Muscle dysmorphia is a term that’s being used along with body dysmorphia and is related to OCD. Muscle dysmorphia is, as it sounds, being preoccupied by worries that one’s body is too small or not muscular enough, despite having a normal build or in many cases being extremely built. But when the person looks in the mirror, of course, that’s not what they see.

The part that relates to OCD is that sufferers typically engage in repetitive behaviors or mental reviewing in response to their perceived physical flaws or defects. Such as constantly checking the appearance of muscles and mirrors or other reflective surfaces or engaging in mental rituals, comparing how muscular they are to others.

While most of us probably don’t have body dysmorphia. We probably have some dysphoria about different parts of our body. We feel like certain things are too large or too small. There are people who refuse to look in mirrors. The way we perceive ourselves is often inaccurate.

As a totally small example imagine that someone goes on vacation somewhere and ends up getting really tan. As they get home people are saying, oh my goodness, you’re so tan. And the person’s like, no, it’s fading. They just can’t see what we see. In pictures they’d be able to, but at the time it’s just not something they’re able to notice. Because changes happen so slowly in our bodies, we often have trouble seeing them unless we’re shown photographic evidence.

This can be really difficult for someone who has body dysmorphia or muscle dysmorphia. They’re in the gym, working out all the time. When people are working out and lifting at this level, it is on their mind all day, every day. Pretty much everything they’re doing revolves around their body and what it looks like.

I’m not sure how you could do that without developing some kind of dysmorphia. Some of these people get to the place where they spend hours and hours working out despite injury. Or they’ll take increasingly sketchy amounts of steroids in order to keep increasing their gains. They’ll wear baggy clothing in order to cover up perceived imperfections. This takes on some really OCD type traits. It also makes it really difficult to treat when it comes to the addiction side of things. We’re going to talk about the addiction part a little bit later.

All steroids are either testosterone or they’re derivatives of testosterone. They all fall under the androgen umbrella rather than under the estrogen umbrella. The androgen receptors have been likened to a lock and the anabolic steroids as the key. When the key opens the lock, it triggers a genetic response in the muscle cells that basically tells the cell to synthesize more protein. This lets muscles recover more quickly and more efficiently. The ways that these anabolics impact the body are complex to say the least.

We need to differentiate between people who are dabbling with steroids and people who are really into the muscle and bodybuilding culture. Within that culture there’s going to be a range. In this range we’re going to have on one side, a “more responsible” use of steroids versus more reckless use of steroids. It depends on where you’re looking as to which type of person you’re going to find.

A really good place to look is actually on Reddit. So Reddit has a sub community that’s R/steroids. This is a pro steroid community where they talk about safe ways to use steroids and can ask questions. Finding non-judgemental information online about steroids is actually really difficult.

I had a hard time finding anything until I started looking at Reddit and other user sites about the use of steroids, because A they’re illegal and B they’re frowned upon, even though in the bodybuilding community they’re sort of everywhere. Certainly there are people who build “natural” and are really adamant against steroids. And so not everybody who’s bodybuilding or looking really cut or whatever is using steroids.

We’re looking at this today from a nonjudgmental perspective. I absolutely can understand the draw of steroids. It’s the same reason that somebody might take diet pills or some kind of stimulant to inhibit their appetite or have liposuction or whatever the case may be. So as we talk about steroids today, that’s where I’m coming from. While steroids aren’t necessarily going to be the first thing that walks through our door. I want us to have enough information to at least recognize it and have a decently intelligent conversation about it.

What are steroids: How they are used

Steroids are not something that you just take every day, just like you would an average medication. The process of using anabolic steroids is really complex to an extent that when I got really deeper into it, I understood about 50% of what I was reading. The guys who are using steroids at this level are fine tuning their workouts, their diet, but specifically the different kinds of drugs that they need to take in order to make this work. It almost seems like it’s an incredibly narrow pathway to get the right kind of gain without all of the bad side effects or minimal side effects in this case.

So we needed to talk about a couple of different words that the community uses and what they mean. There’s two ways, it seems, that people typically use steroids. Now we’re not talking about guys who are just throwing steroids at themselves here and there in sort of a haphazard way.

That’s not what’s happening here.

So the first way is through a cycle. The cycle is that they will spend 12 to 20 weeks depending on the steroids. And then they do what’s called a PCT, which is a post cycle therapy or treatment where they spend another 12 or so weeks helping their body recover from steroids.

This is kind of a newer phenomenon in terms of the last 20 ish years. Whereas in the seventies and eighties, there weren’t these options available to help deal with the side effects of the use of steroids. We have the cycle route where you’re on steroids and then off and helping your body recover from the hormone intake.

Or we have what’s called blast and cruise. So a blast is where you’re taking them at a high level, just like you would in a cycle. But instead of going off of them, you use testosterone as a bridge between cycles. And so that’s what’s called cruising. So the blast and the cruise method, you don’t really go off of them.

I’ve seen arguments for both. I saw some places where guys who were promoting the blast and cruise method had some criticism of the guys using the cycle method, because it was seen as less intense or committed in some way. It seems that running a cycle and then a post cycle treatment time is what the guys do, who have a lot of concerns about long-term health.

The majority of discussion I saw everyone was talking about doing post cycle therapy as being standard. I think it sort of depends. And the blast and cruise method does seem to be a more recent development.

There are three things that bodybuilders focus on and that’s bulking, cutting and strength. First is the bulking phase where they’re working on building more muscle. This is usually a lot of calories, putting on weight and then working out extremely intensely in order to pack it on as muscle. This is where the steroids come in. The whole point of them is to help put that weight on as muscle. So you gain 10, 15 pounds a muscle during a cycle.

And then the cutting part is when they’re doing that either before a competition, which they call a comp or they’re cutting to get off of fat and water weight. Then that’s a super restrictive diet and specific kinds of exercise. Typically they’re preparing for some kind of competition. Sometimes they’re called tested competitions or untested competitions. The testing is sort of interesting as a lot of guys talk about the fact that even in tested competitions, the drug tests are take-home. And they do polygraphs, which I had no idea about, but some guys are saying that the polygraphs are done by rookies and that it’s easy to get past.

Somebody wants to go on a cycle and there’s a lot of information on how to prep for that in terms of what kind of drugs they are going to need. And it’s not just one thing. These guys are taking a lot of different drugs in order to put this sort of cocktail together. Every cycle, they say, should have a backbone of testosterone. They’re taking testosterone in addition to the anabolic steroid, which is a testosterone derivative of some chemical form.

What are steroids: Different types

There are two forms of steroids. One is oral medication, so taken by mouth and one is injectable, which they call pinning. To pin someone like pinning them with a needle. They’re either doing injectable or they’re doing a mix of oral and inject. Typically, I see the recommendation to not do oral only because a lot of the oral steroids are super liver toxic and so they’ll do this combination.

The testosterone is the thing that has to be injected. This is why they don’t recommend oral cycles. Without testosterone and just the oral steroid, you’re going to have low sex drive, fatigue, depression, erectile dysfunction, muscle loss, and weakness. A number of those things are directly contrary to what they’re trying to do when they’re bulking.

The cycle that I’m describing is based off of the Wiki page on Reddit/steroids and the guys there maintain the page pretty well. This is their recommendation. And there are plenty of ways that people do this differently. But this is just to give you an example of how this works. They prepare for a cycle by making sure they have all of their gear as they call it.

Their gear is short for the steroids that they’re taking. You’re either on gear or off. So in a cycle, assuming that you were an average functioning male with two normally functioning testes, they’re at a decent body fat percentage, ideally 15% or less, they’ve done their pre-cycle blood work and don’t have any high estrogen levels. Then they would begin injecting.

Injections are done in a muscle and they alternate different places. Typically in the glutes, but also in other places to avoid building scar tissue. The forums are very clear about not reusing needles and having proper technique when it comes to injections. During this 12 to 16 week cycle, they’re being injected probably every three to three and a half days and taking an oral steroid as well if that’s what they’ve chosen and continuing to eat and work out and devoting a ton of time bulking up.

There are a lot of different steroids. There are some more common ones that people talk about. So for bulking, the steroids that are most common are dianabol, trenbolone, DECA and anadrol. Anadrol is a cheap bulking oral steroid that has some serious downsides. While it does give you a lot of bulk, it’s an oral steroid, which means that it has a lot of liver toxicity. This has to do with how it’s broken down and carried in the body. The drug was created to help with weight gain after surgery or infection, and to occasionally treat osteoporosis or hormonal conditions.

Side-effects for Anadrol are puffiness and water retention, gynecomastia, which is developing male breast tissue (they use the slang term gyno for gynecomastia for this side effect), acne, rapid weight gain, stomach pain, high cholesterol, and a risk for stroke. In terms of use for steroids. The cycle is about eight weeks on this one.

DECA is an injectable steroid that originated back in the seventies. DECA is a bulking drug used to build body mass quickly. DECA appears to be the less exciting form as it takes a little while to see gains, however it’s popular because when it does kick in, it has good results.

The side-effects with this are similar developing male breast tissue, water retention, also risk for enlarged prostate, loss of appetite, depression, low sperm count as well as liver failure, stroke and heart failure. It has to be taken with a base of testosterone or the guy’s going to have even more issues with the downsides like erectile dysfunction and low libido. The cycle on this one is about 12 weeks.

Dianabol is a third popular bulking steroid and results in the most weight gain in terms of muscle and water. Weight gain in this sense is a good thing. It’s one of the oldest and most popular performance enhancers, increasing testosterone levels and promoting muscle growth. It was created to help with muscle wasting and anemia. It’s a very cheap medication and it’s also very toxic to the liver.

The side effects are as expected water retention, male breast tissue, acne, hair loss, liver damage, infertility, depression, sleeplessness, testicular shrinkage, and potentially serious heart issues. The cycle on this one’s pretty short, four to six weeks.

No conversation about bulking steroids would be complete without trenbolone. What they call Tren. This is by far the most effective steroid that exists. Every forum I saw talked about it. It is a steroid on steroids. You can expect, though, with that amount of power comes a lot of downsides.

Tren has a number of significant side effects. Some happen immediately and some over time. The reason these guys like it is that you lose big amounts of body fat and gain big amounts of muscle mass. The experts say that it’s also massively toxic and debilitating to sex. There’s what’s called a tren cough, which is a severe cough that usually comes on immediately after injecting. And the cough doesn’t sound like a big deal, but apparently it’s really overwhelming and you feel like you can’t breathe.

There’s the sexual side effects, high blood pressure, night sweats, development of breast tissue, acne, hair loss, insomnia, anxiety, rapid heart rate, aggression, decreased cardiovascular endurance and kidney and liver issues. This one is a 10 week maximum cycle.

What are steroids: Cycles and Post Cycle

During the bulking phase they’re also going to be monitoring their side effects specifically for breast tissue. When the breast tissue starts forming, they’ll use what’s called aromatase inhibitors. This was originally created to be used in breast cancer to break down estrogen.

Estrogen is a big problem when it comes to steroid use. One of the byproducts of testosterone is estradiol, which is a form of estrogen and estrogen is what helps female secondary sex characteristics develop. When they start seeing side effects like gyno, they will use these aromatase inhibitors, but a lot of them will say not to use them preemptively.

So you can see why they need a post cycle recovery time. These steroids are incredibly intense and they have huge side effects. I think the difference here is that there’s no way of taking steroids without side effects. They will cause them as opposed to a lot of medications where the side effects are minimal if they show up at all. We’ll talk about side effects in just a little bit.

So after someone does their cycle, which could be 12 to 16 weeks, upwards of 20, I saw, then they have the PCT or the post cycle treatment. What happens when a man is taking testosterone by injection is that the body stops producing testosterone on its own. There’s always going to be testicular shrinkage during this time because the testes have been told that they don’t need to produce testosterone anymore.

Coming off steroids is going to cause a hormonal crash or a post cycle crash, which can leave the man feeling terrible. Low testosterone has to do with depression, fatigue, muscle loss, and a number of other effects. How long the PCT lasts depends on what they took and how long they took it for as well as how their body responded. There are some specific medications that they use to help encourage testosterone production to resume.

When someone’s post cycle there’s a lot of complaints of depression, mood alterations in general, fatigue, lethargy and insomnia. Men are cautioned that at the end of a four to eight week post cycle time, they’re not going to be back to normal.

The other stage about cutting is where they’re using different drugs in order to help cut down water weight, and body fat. These cutting medications can be used during a cycle, but the person’s going to put on less muscle mass because it is used for cutting down the body fat. And that works against the bulking nature of the other compounds.

There’s one drug that gets used sometimes by some of these guys that you might not expect and that’s insulin. The insulin helps feed muscles during an intense exercise session to prevent muscle breakdown and help performance. Insulin was banned by the international Olympic committee, but it’s impossible to detect since our bodies do create it.

The problem is that insulin can be fairly deadly. When these guys are using it they’ll talk about lightheadedness and a number of them have talked about making sure when they use it that they’re not alone. Because the risk of going into a diabetic coma is real.

So let me put this together. It took me quite a while to sort through all the information and get a gist of what’s happening. And I’m certain that I’m missing some chunks of information and caveats, because this is a really complex process. It is not something that a guy just hands you a bottle of pills in the gym, and you’re good to go.

Cycles are really complex, done what they consider properly. There’s blood work. You’re working with a doctor, the drugs aren’t coming from the doctor, but you’re doing blood tests often to check on liver function, cholesterol. They recommend checking blood pressure sometimes two to four times a day to make sure that it’s under control.

There’s plans for what to lift on what day, what to focus on, what the diet should be when you’re bulking up, what the diet should be when you’re cutting, how to do injections, what kind of gear to use, different combinations of steroids and the side effect profiles for each one.

What are steroids: Risks and Side effects

Basically the big deal here is that there are significant risks and these guys know that. They are not confused about there being risk. The side effects are inevitable and they work to try to control them and keep them down. Certainly ones like trenbolone have the worst side effects and are the most severe, but it’s also the most powerful steroid and so guys put up with it. Not all of them, but it is something that they’ve usually tried.

For the guys who are blasting and cruising, they are just staying in a constant state of testosterone production that is higher than normal. They know that that means that they’re likely going to be on testosterone for the rest of their lives. There is a moment in which the testes will not go back to normal.

I’m going to read the list and then we’ll go over a couple of them. Acne, erectile dysfunction, estrogen imbalance, gonad atrophy, gynecomastia (that’s the breast tissue), hair loss, hypothalamic pituitary gonadal axis shutdown, hypertrophic cardiomyopathy, hypogonadism hypothyroidism, joint pain, lactation, liver stress, pain in the back, shin calf, et cetera, lipid changes in the HDL or in the LDL, spermatogenesis changes and what they call “test flu” because it’s flu like symptoms related to the influx of testosterone over and above what the body is normally produce.

One of the first ones that people will talk about is acne. This seems to be a guarantee and something that they take great care to deal with when they’re going into competition, how their skin looks is really important. It wouldn’t be good for them to have all these muscles and have them completely on display and popped out and have acne.

Losing your hair is something that the guys just expect is going to have. Now not everybody loses their hair, but it certainly accelerates the process for those who have that in their system. In general, there are drugs that they use in order to deal with it, but apparently they’re really expensive and a lot of guys just give up and call it a day and plan on being bald.

Changes in estrogen level appear to be at the heart of a lot of the side effect issues. There’s high estrogen side effects. That’s where the acne comes in. Water retention, aggression, depression, insomnia, erectile dysfunction, and development of breast tissue.

On the low estrogen side, they talk about dehydration, loss of libido, still erectile dysfunction, loss of penile sensitivity, night sweats, fatigue, lethargy, itchy skin, obsessive thoughts among other things. Their estrogen levels are going to be impacted and so they are going to be dealing with these things. It just depends on whether it’s on the high or on the low side.

The development of breast tissue is one of the main and most common side effects that they talk about and that they have to deal with. Most of it is about prevention because afterwards it is really just surgery that can take care of it. If one of the guys had this condition before they went on steroids, it’s unlikely that it would resolve on its own. The surgeries for it are fairly successful, but doing exercises aren’t necessarily going to take it away.

Issues with the liver and with the lipid panels are commonly discussed as well. As we talked about earlier, a number of the oral steroids are very liver toxic, which leads a lot of guys to want to use the injectables and limit the oral steroids.

The issue with cholesterol is a side effect as well. According to the literature, the use of anabolic steroids can significantly reduce or wipe out the good cholesterol that we need in our bodies while also raising the bad cholesterol by as much as 50%. This is not related to diet, but instead how the steroids work in the body.

When it comes to our cardiovascular system, there are a number of risks. High blood pressure is something that they have to pay attention to all the time. The danger here is called cardiac hypertrophy, which is the abnormal enlargement or thickening of the heart muscle. Which can cause alterations in the heart structure, including left ventricular hypertrophy. The thickening of the left ventricle can impair the diastolic properties with the mass increase. This thickening of the left ventricle is what leads to sudden cardiac death.

The last side effect we come to is roid rage. Roid rage is a term that I’ve heard most of my life and just assumed was a thing. We talk about testosterone being related to aggression and so it made sense to me, but the research doesn’t necessarily support that. What’s interesting is that yes, there are mood changes. There are drastic hormone drops that cause irritability and some. But it’s not coming from the steroids themselves.

What the research seems to be showing is that roid rage exists when there is underlying pathology. Most of the people taking steroids do not have this. Certainly with your hormones being completely out of whack and sweating and having pain and feeling sick and constantly stressing your body you’re going to be irritable. That makes sense.

But it’s not that these guys are somehow specifically out of control. And one of the essays I read this man suggested that being bigger is triggering some part of the caveman brain that this person is dangerous. And so anytime somebody shows any kind of irritation or anger, and they’re a big guy it’s going to be looked at as this person’s about to go into a roid rage.

The last point I’ll make about roid rage is that it was also found that some of the compounds that people were taking had lots of different chemicals that weren’t actually what they were supposed to be. We’ve got to think about synthetics and synthetics, which was “legal marijuana” and “legal meth” that were full of different chemicals and had really negative side effects for a lot of different reasons.

Each batch was going to have slightly different chemicals or drastically different chemicals. There’s no regulation on this stuff. And so roid rage can also come from a combination of drugs that wasn’t supposed to be there to begin with.

Reports on death related to anabolic steroids tend to be about a few things. One is sudden cardiac death or cardiac related issues that caused the death. Two there’s a risk of suicide due to the rapid fluctuation in mood and depression and the other mental health impacts that using steroids. And the third liver failure and the fourth has to do with some link to cancers, although that’s really debated hotly. there’s liver cancer and prostate cancer, kidney, those sorts of things. But in a lot of places, the guys will say that those links are pretty tenuous.

What are steroids: The community

For the most part, I found the steroid using communities online to be relatively middle of the road. Nobody I saw was just saying that steroids are awesome, that there’s no risk that you just take them and fuck everybody else. I saw really careful descriptions, attention to detail that was beyond anything I expected. And that is an entire subculture. Of course, I shouldn’t be surprised by this because this is what people do.

And the internet has allowed us as humans to come together in an increasingly niche way. You can find people that like a certain thing that you like down to a very minute detail, it’s going to be the same way online with people who are using steroids.

One of the things I noticed that was really interesting is the common consensus that young men should not take steroids. What constitutes young, kind of varied. But the ages I saw were like 23 to 25 with 25 being at the higher end, The men in the forums were encouraging these young men to not take steroids for a number of reasons, partly because they’re not finished developing and that their testosterone levels are at the highest level they’ll ever have. During that time, they encourage the young men to use that to their advantage. And they said it’s basically free steroids.

One of the other common threads is that most discussions I saw recommended that people either get to their genetic potential or close to it before using steroids. Now by genetic potential, they’re talking about having used all of the resources at your disposal, meaning that your workout needs to be on point, your diet needs to be strict and you need to have gotten your body fat down to a pretty low level.

They recommend that you’re under 15%, but that your body fat ideally be closer to 10% body fat before you move on to using steroids. This is a really different conception than what I think the public thinks that steroids can do for you. I think people think of steroids as being sort of a shortcut.

That’s not what these guys are saying. In fact, they’re saying the opposite and they have some pretty harsh words for somebody who’s using them and hasn’t done the work of exercise and diet. I saw some places where people were suggesting that diet was like 75% of what happens in bodybuilding and at 25% would be everything else.

That’s a pretty surprising number. Everything I saw in the steroid using community was different than I expected. I’m not really sure what I thought I was going to find, but the careful consideration, and even the encouragement to rethink your choice before starting steroids, that was kind of surprising.

One of the big points that I saw was that if you can’t build muscle without steroids, then you’re not going to build it with them. I found this to be really interesting. I think about steroids and stereotypically. It’s a really thin guy who wants to be jacked, take steroids. And now he is this super cut beefy guy.

That’s not what the forums are saying. The forums repeatedly say that if you can’t build muscle on your own, you’re not going to build it with steroids, that there is a genetic component to whether or not you can build a lot of muscle.

What are steroids: Addiction

Steroids are considered a drug of abuse. However, they differ in a lot of ways. I didn’t find a lot of places where people were saying steroids ruined my life. I lost everything I had. I sold out my relationships. I also didn’t see people necessarily downplaying risk. In fact, if anything, the information was actually pretty scary as I read it. And that these guys are well aware of it for the most part was also really interesting.

They did talk about having thought they would only do one cycle and then they’d be done. And they chuckled about that because apparently no one does just one cycle. Remember that they’re doing this for the gains. They want to have these gains and see their bodies change and it becomes somewhat of an obsession.

We talked at the beginning about muscle dysmorphia, and I think it turns into that in a lot of cases, your body does become dependent on these drugs. It’s not for the same reason though. We’re not talking about a dopamine rush. We’re talking about the fact that steroids replace the body’s ability to create testosterone, which is the main chemical in men that controls a lot of these functions. It affects not just their sex lives, but their very body composition.

That brings us to the last part of our discussion addiction, tolerance, and withdrawal. Addiction is continuing to use despite the consequences. And that definitely exists in this community. I’m not saying that everyone who uses steroids is addicted. I have no way of knowing that and I don’t even assume that that’s true. I do know that the obsessiveness that this leads to can be really all encompassing and there’s a ton of money being spent on it, a ton of time and they’re forcing their body to do something unnatural.

The guys will talk about the fact that you won’t necessarily lose all the gains you made when you stop using steroids, but anything that pushes you past your own genetic potential will be lost. So whatever you could build without steroids, even if you built it with steroids will likely stay. But after that point, when you’re pushing yourself above and beyond, That stuff’s going to go away. And so they’re constantly fighting against the clock and trying to manage these ever increasing side effects. It is an incredible gamble for them and they believe it’s worth it. I am certain that along the way, there is addiction.

The guys also talk about that. No one was saying that they’re not addictive. In fact, a number of guys were saying that they used steroids and working out to get off of their other drug of abuse. It doesn’t appear that people are using steroids and abusing other drugs. I mean, they are in some cases I bet, but these guys are absolutely trying to make their body into a machine that functions to build muscle strength and to look good for competitions and in general.

What are steroids: Not just for men

There are women who take steroids. Certainly the percentage of women taking steroids versus the percentage of men is extremely small. Steroids are always paired with testosterone. For a woman, an influx of testosterone is going to cause issues related to male secondary sex characteristics. There’s male pattern, baldness, voice lowering, facial hair growth, decrease in breast tissue and clitoral enlargement.

There are small communities of women who are taking steroids on the internet. But typically what I saw is that they’re in the male forums because there just isn’t the information. There are some compounds that are easier on a woman’s body than other compounds. So there tend to be a few that women lean towards versus the wide array that men lean towards.

I think about the cycle that a lot of these guys are in, where they thought they would do one cycle. They thought they would get to a certain place and be happy. And the line where they’ll be happy if they just get this or that keeps moving, I can see easily how this would happen.

The pressure that these men feel to look a certain way, leads to more obsessive behavior and more intensity, just like any other substance that you can have an addiction to. Once you’ve already experienced some side effects, you kind of get used to it and then you keep going and going because the risk doesn’t seem as high.

Steroid use is not super common. According to the research it is on the rise. What I want us to do is to be listening for language about pre-workout supplements, performance enhancers, bulking up, cutting those kinds of things. I want us to listen for that language and if we have a client that’s really involved in going to the gym, I want us to have a frank conversation about it. And I want us to talk about whether or not steroids have ever been a part of things. We’re not accusing them. We’re asking them about a really important part of their lives.

Sometimes asking questions like this can be really difficult and people get really defensive. And that’s why I decided to hold a workshop in October about this very thing. The workshop on October 16th is about how to have a conversation about substance use with your clients. I’m going to share with you my process of how to start it, what questions to ask and how to interpret their answers with a focus on making the conversation feel good to you and to them. I use this conversation as a relationship builder.

If you haven’t had a chance go over to betsybyler.com/workshop for more details and for the signup. I really hope that you’re able to join me. If you feel like you already know how to have these conversations, please share this information with your colleagues who may not know or feel comfortable doing this.

I hope the information on steroids has been helpful and interesting. There are always links in the show notes to research and other articles that I use in creating the episode. You can find the information on this episode at betsybyler.com/podcast.

It’s hard to believe that the next episode is in October already, and it’s the first week of the month. So that means I’m doing an interview. This time I’m going to be interviewing a school-based therapist from the east coast. I’m excited to bring you her recovery story. I hope you’ll join me for that podcast. And until then have a great week.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.