How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabol
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How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabolic and cardiovascular health Deaglan McCullough 1 & Richard Webb 2 Claire E. Stewart 1 & Ian G. Davies 1
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Kevin J. Enright 1
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Katie E. Lane 1
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Jim McVeigh 3
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Accepted: 16 November 2020 # The Author(s) 2020
Abstract It is estimated 6.4% of males and 1.6% of females globally use anabolic-androgenic steroids (AAS), mostly for appearance and performance enhancing reasons. In combination with resistance exercise, AAS use increases muscle protein synthesis resulting in skeletal muscle hypertrophy and increased performance. Primarily through binding to the androgen receptor, AAS exert their hypertrophic effects via genomic, non-genomic and anti-catabolic mechanisms. However, chronic AAS use also has a detrimental effect on metabolism ultimately increasing the risk of cardiovascular disease (CVD). Much research has focused on AAS effects on blood lipids and lipoproteins, with abnormal concentrations of these associated with insulin resistance, hypertension and increased visceral adipose tissue (VAT). This clustering of interconnected abnormalities is often referred as metabolic syndrome (MetS). Therefore, the aim of this review is to explore the impact of AAS use on mechanisms of muscle hypertrophy and markers of MetS. AAS use markedly decreases high-density lipoprotein cholesterol (HDL-C) and increases low-density lipoprotein cholesterol (LDL-C). Chronic AAS use also appears to cause higher fasting insulin levels and impaired glucose tolerance and possibly higher levels of VAT; however, research is currently lacking on the effects of AAS use on glucose metabolism. While cessation of AAS use can restore normal lipid levels, it may lead to withdrawal symptoms such as depression and hypogonadism that can increase CVD risk. Research is currently lacking on effective treatments for withdrawal symptoms and further long-term research is warranted on the effects of AAS use on metabolic health in males and females. Keywords Anabolic-androgenic steroids . Metabolic syndrome . High-density lipoprotein cholesterol . Low-density lipoprotein cholesterol . Insulin resistance . Cardiovascular disease
1 Introduction The fine margins of winning and losing in athletic competitions has always encouraged innovative techniques to help athletes gain a competitive advantage with little regard to the potential negative consequences. Although research into sex
* Deaglan McCullough [email protected] * Ian G. Davies [email protected] 1
Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
2
Faculty of Science, Liverpool Hope University, Liverpool, UK
3
Substance Use and Associated Behaviours Group, Manchester Metropolitan University, Manchester, UK
hormones existed in the early 19th century, it was only in the 1930s when the anabolic effects of testosterone were demonstrated [1]. Shortly thereafter, the hormone started to be used by competitive athletes
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