Steroids are a class of similar compounds that exert a wide range of functions. Some of them occur naturally in the human body and include Vitamin D, Cholesterol, the sex hormones (Testosterone, Estrogen and Progesterone) and the group of compounds secreted by the adrenal glands called as Corticosteroids. Corticosteroids have several important functions like maintaining blood pressure, blood glucose levels, salt and water balance and other critical processes. Steroids are prescribed to counter the inflammatory processes involved in diseases like allergies, asthma, rheumatoid arthritis, lupus and inflammatory bowel disease.

In common parlance when we mention steroid abuse by athletes it almost always means abuse of a class of steroids called as "Anabolic Steroids". Anabolic steroids are a group of steroids that aid in muscle building. Medical practioners prescribe this class of steroids for patients with chronic muscle wasting diseases like cancers, HIV-AIDS and long-standing malnutrition. However athletes use these steroids to improve muscle mass, stamina, endurance and performance. Not only their use and abuse poses potentially lethal side effects but they also infringe on the Olympic code of honor and ethics of sportsmen and sportswomen.

Misuse of anabolic steroids can have far-reaching implications on the human body and include:

1. Liver tumors.
2. Increased LDL Cholesterol levels.
3. Decreased HDL Cholesterol levels.
4. Kidney tumors.
5. High blood pressure.
6. Salt and Fluid retention.
7. Severe acne.
8. Aggression, mood swings and psychiatric complications.

In addition they can have gender-specific side effects. Typically in men the following side effects are observed:

1. Low sperm counts.
2. Shrinking of the testes.
3. Development of breasts.
4. Baldness.
5. Infertility.
6. Prostate cancer.

And in women:

1. Male-pattern baldness.
2. Deepened voice.
3. Growth of facial hair.
4. Menstrual abnormalities.

Normally in adolescents there is a physiological growth spurt at or around puberty triggered by endogenous steroids. Anabolic steroid abuse in this age-group leads to premature maturation of the skeletal system and thus stunted growth.

The endogenous steroid production is regulated by a tight axis called as the Hypothalamic-Pituitary-Adrenal axis (the HPA axis.) If steroids are administered from outside, whether medically or otherwise, this axis is suppressed leading to a temporary reduction in the adrenal glands activity. To prevent overt complications doctors tend to taper patients' or wean them gradually from external steroids so that the adrenal glands can recover to resume normal duties. When one suddenly stops taking steroids, owing to the physiological dependence on them, they experience severe withdrawal symptoms.

WITHDRAWAL SYMPTOMS:

Steroid withdrawal symptoms can mimic many medical illnesses and include weakness, fatigue, low blood pressure, low blood glucose, nausea, vomiting, diarrhoea (and fluid-electrolyte imbalances), menstrual changes, fever, joint pains, muscle aches, and mental changes.

Thus tapering of the doses when one is on steroids is mandatory. If this is not ensured there can be potentially lethal effects.

Steroid abuse among athletes:

There are three types of abuse amongst athletes:

Cycling: In this the athletes take multiple doses of steroids over a specific period of time, stop for a period, and start again.

Stacking: In this form of abuse two or more different anabolic steroids, often a mixture of oral and/or injectable types, and sometimes even compounds that are designed for veterinary use are used.

Pyramiding: Users slowly escalate steroid abuse (increasing the number of steroids or the dose and frequency of one or more steroids used at one time), reaching a peak amount at mid-cycle and gradually tapering the dose toward the end of the cycle.

Some of the common anabolic steroids that are abused include: Stanozolol (remember Ben Johnson ?), Oxandrolone, Oxymethalone are oral agents. Nandrolone, Boldenone and Testosterone are available as injectables.

In summary steroid abuse amongst athletes is of growing concern not only to their own health but also it eliminates the spirit of sportsmanship amd marginalizes the honest and hardworking athletes. Stringent testing of athletes, compulsive testing and life-bans on the culprits can help make sports clean morally.