We were unable to find clinical trials in our usual sources specifically for side effects of Dianabol and Sustenol. Neither drug is licensed in BNF.
We found a chapter on Anabolic Side Effects in the Encyclopedia of Sports Medicine and Science (1).
They highlight "One of the problems with athletes, in particular strength athletes and bodybuilders, is the use of oral and parenteral AS at the same time ("stacking"), and in dosages which may be several (up to 40 times) the recommended therapeutical dosage. The frequency and severity of side effects is quite variable. It depends on several factors such as type of drug, dosage, duration of use and the individual sensitivity and response."
They categorise side effects of anabolic steroid (AS) use into the following sections.
Orally administered AS have more damaging effects on the liver than parentally administered AS. "In clinical trials, treatment with anabolic steroids resulted in a decreased hepatic excretory function. In addition, intra hepatic cholestasis, reflected by itch and jaundice, and hepatic peliosis were observed. Hepatic peliosis is a hemorrhagic cystic degeneration of the liver, which may lead to fibrosis and portal hypertension. Rupture of a cyst may lead to fatal bleeding.
Benign (adenoma's) and malign tumors (hepatocellular carcinoma) have been reported. There are rather strong indications that tumors of the liver are caused when the anabolic steroids contain a 17-alpha-alkyl group. Usually, the tumors are benign adenoma's, that reverse after stopping with steroid administration. However, there are some indications that administration of anabolic steroids in athletes may lead to hepatic carcinoma. Often these abnormalities remain asymptomatic, since peliosis hepatis and liver tumors do not always result in abnormalities in the blood variables that are generally used to measure liver function."
- The Male reproductive system
"Prolonged use of anabolic steroids in relatively high doses will lead to hypogonadotrophic hypogonadism, with decreased serum concentrations of LH, FSH, and testosterone.
There are strong indications that the duration, dosage, and chemical structure of the anabolic steroids are important for the serum concentrations of gonadotropins. A moderate decrease of gonadotropin secretion causes atrophy of the testes, as well as a decrease of sperm cell production.
A well-known side effect of AS in males is breast formation (gynecomastia). In general, gynecomastia is irreversible.
AS may affect sexual desire. Although few investigations on this issue have been published, it appears that during AS use sexual desire is increased, although the frequency of erectile dysfunction is increased. This may seem contradictory, but sexual appetite is androgen dependent, while erectile function is not. Since sexual desire and aggressiveness are increased during AS use, the risk of getting involved in sexual assault may be increased."
"during anabolic steroid use total cholesterol tends to increase, while HDL-cholesterol demonstrates a marked decline, well below the normal range. Serum LDL-cholesterol shows a variable response: a slight increase or no change. The response of total cholesterol seems to be influenced by the type of training that is done by the athlete. When a great deal of the exercise consists of aerobic exercise, the increasing effect of AS is counterbalanced by an exercise-induced increasing effect, which may result in a net decline in total cholesterol.
The effect of anabolic steroids on triglycerides is not well known.
No unanimity exists about the influence of anabolic steroids on arterial blood pressure. The response is most probably dose dependent. There is some data suggesting that high doses increase diastolic blood pressure, whereas low doses fail to have a significant effect on diastolic blood pressure.
There is evidence that the use of anabolic steroids does elicit structural changes in the heart and that the ischemic tolerance is decreased after steroid use. Echocardiographic studies in bodybuilders, using anabolic steroids, reported a mild hypertrophy of the left ventricle, with a decreased diastolic relaxation, resulting in a decreased diastolic filling. Some investigators have associated cardiomyopathy, myocardial infarction, and cerebro-vascular accidents with abuse of anabolic steroids. However, a possible causal relationship could not been proved, because longitudinal studies that are necessary to prove such a relationship, have not been conducted yet. There is convincing evidence that oral administration of anabolic steroids has stronger adverse effects on the mentioned variables than parenteral administration."
"Increased testosterone levels in the blood are associated with masculine behavior, aggressiveness and increased sexual desire. Increased aggressiveness may be beneficial for athletic training, but may also lead to overt violence outside the gym or the track. There are reports of violent, criminal behavior in individuals taking AS. Other side effects of AS are euphoria, confusion, sleeping disorders, pathological anxiety, paranoia, and hallucinations.
Anabolic steroid users may become dependent on the drug, with symptoms of withdrawal after cessation of drug use. The withdrawal symptoms consist of aggressive and violent behavior, mental depression with suicidal behavior, mood changes, and in some cases acute psychosis.
"In both males and females acne are frequently reported, as well as hypertrophy of sebaceous glands, increased tallow excretion, hair loss, and alopecia. There is some evidence that anabolic steroid abuse may affect the immune system, leading to a decreased effectiveness of the defence system. Steroid use decreases the glucose tolerance, while there is an increase in insulin resistance. These changes mimic Type II diabetes. These changes seem to be reversible after abstention from the drugs.
There are some case reports suggesting a causal relationship between anabolic steroid use and the occurrence of Wilms tumor, and prostatic carcinoma. In the literature also sleep apnea has been reported, which has been associated with AS-induced increased in hematocrit, leading to blood stasis and thrombosis.
AS use may affect thyroid function. Administration of AS has been found to decrease thyroid stimulation hormone (TSH), and the products of the thyroid gland. In addition, thyroid binding globulin (TBG). These changes reversed within weeks after discontinuation of AS use.
A serious consequence of AS use may be the multiple drug abuse. On the one hand athletes use different kinds of drugs in an attempt to counterbalance the side effects: hCG, thyroid hormones, anti-estrogens, anti-depressants. On the other hand people try to support the anabolic effects of AS by using additional anabolic hormones as for instance: different types of AS at the same time, growth hormone, insulin, erythropoietine, and clenbuterol. Because most of this takes place outside the official medical circuit, it is likely that these practices may lead to serious conditions."
A previous ATTRACT question has looked at the effect of steroid use, specifically on sperm count (2).
Health Education Programmes
We did not find a lot of information about the effects of educational programmes in preventing AS use.
A randomised prospective trial in US adolescent male athletes used a team based educational intervention, designed to reduce adolescent athletes intention to take anabolic androgenic steroids(AAS). (ATLAS program) (3-5)
"We studied 31 high school football teams that comprised 3207 athletes in 3 successive annual cohorts (1994-1996). The intervention included interactive classroom and exercise training sessions given by peer educators and facilitated by coaches and strength trainers. Program content included discussion of sports nutrition, exercise alternatives to AS and sport supplements, and the effects of substance abuse in sports, drug refusal role-playing, and the creation of health promotion messages. Questionnaires assessing AS, the use of sport supplements and alcohol and other illicit drugs, and potential risk and protective factors were administered before and after the intervention (before and after the football season) and up to 1 year after the program. At season's end, intentions to use (P<.05) and actual AS use (P<.04) were significantly lower among students who participated in the study. Although AS reduction did not achieve significance at 1 year (P<.08), intentions to use AS remained lower (P = .02). Illicit drug use (marijuana, amphetamines, and narcotics) was reduced at 1 year, whether alcohol was included (P = .04) or excluded (P = .02) from the index. Other long-term effects included fewer students reporting drinking and driving (P = .004), less sport supplement use (P = .009), and improved nutrition behaviors (P<.02)."
One study examining the relationships between athletes knowledge of long-term effects of AS and their attitudes towards the drug. They do not give details about the subjects involved and methods used, but suggest that AS educational programs for athletes have limited value. (6)
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