Scientists developed anabolic steroids not for bodybuilders seeking bigger muscles, but to create a safer, more targeted form of testosterone. Testosterone, the primary male sex hormone, is also produced in smaller amounts in women. This hormone produces both anabolic and androgenic effects. Anabolic effects build and maintain muscle and bone mass—the desirable outcomes. Androgenic effects, however, cause most of testosterone's problematic side effects. These include male pattern baldness and acne in both sexes. In women, high testosterone doses cause virilization—the development of male characteristics like facial hair growth, genital enlargement, and voice deepening. Since the muscle-building effects are highly desirable while the androgenic effects are not, scientists sought to isolate the benefits and eliminate the drawbacks. The result: modern anabolic steroids that maximize muscle growth while reducing—though not eliminating—unwanted side effects.
The golden age of anabolic steroids commenced in the early 1950s when thousands of anabolic steroid drug candidates were synthesized in pharmaceutical company laboratories. Still, only a scant few ever made it to the commercial drug market. Most of the newly developed AS never left the lab because animal and isolated-cell testing showed they tended to cause severe side effects. In the case of oral anabolic steroid drugs, most of the side effects involve the liver. The medicines with the least tendency toward producing side effects were eventually approved for sale.
Despite their name, no anabolic steroid is purely anabolic. Scientists attempted to isolate the muscle-building effects while eliminating the masculinizing ones, but they never fully succeeded. Some drugs, like oxandrolone (marketed as Anavar), lean more heavily toward building muscle than producing androgenic effects, but all retain some masculinizing characteristics. This limitation hasn't prevented medical use. Doctors prescribe these steroids for testosterone replacement therapy and to treat conditions that cause severe muscle loss—burn victims, cancer patients, and people with AIDS all benefit from the drugs' ability to preserve muscle mass during illness. Yet the medical applications are dwarfed by a different use entirely: athletes and bodybuilders seeking larger muscles represent the vast majority of steroid users, despite having no medical need for the drugs.
Anabolic steroids come in two forms: oral and injectable. Injectable versions are generally considered safer because they bypass the liver entirely. Oral steroids, by contrast, must survive their first pass through the liver—and that's where problems can begin. To resist premature breakdown, oral steroids are chemically modified in ways that allow them to accumulate in liver tissue, particularly at high doses. This accumulation can trigger liver inflammation (hepatitis) and, in extreme cases, damage cells enough to cause liver disease or cancer. An even rarer complication is peliosis hepatis, a condition where blood-filled cysts form in the liver.
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