Corticosteroids vs Anabolic Steroids

Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.

If you have had an injury, you may receive a corticosteroid injection, and you may wonder whether this will have an impact on muscle growth and recovery.

This article answers what the difference is between corticosteroids and anabolic steroids.

We shall cover the following points:

• Hormones
• Anabolic steroids
• Anabolic steroid abuse
• Side effects
• Addictive potential of anabolic steroids
• Corticosteroids
• Uses
• Side effects
• Potential for abuse
• Conclusion 

Hormones

These hormones travel to different organs and regulate physiological functions of the body.

Steroid hormones are special family hormones produced in the body that have a vast number of uses from enhancing growth to anti-inflammatory effects.

Cortisol or cortisone is the main stress hormone produced by the adrenal glands and as the name suggests it is needed at times the body is under stress.

Testosterone or various androgens are sexual hormones i.e., they help in the development of male-specific growth and secondary sexual characteristics.

Despite the production of these hormones in the body people might need to administer synthetic versions of these hormones.

Corticosteroids are the replacement for cortisol and anabolic steroids function as testosterone in the body.

At times the use of these synthetic hormones might be useful such as for their anti-inflammatory effects and at other times they might be abused e.g., their growing effects.

While these two hormones fall in the same family of being steroid hormones, they have very different outcomes in the body.

In this article, we will look upon how corticosteroids differ from anabolic steroids along with their uses and abuses for various needs.

Anabolic Steroids

Let us start with the anabolic steroids due to the heightened fitness craze around the globe.

Simply put anabolic steroids help grow male-specific characteristics e.g., beard, and more interestingly makes your muscles very large (hypertrophy) and improve athletic performance. [2]

So why not just use it and get fit?

Breaking it down, ‘anabolic’ steroids or ‘anabolic-androgenic’ steroids are manufactured (synthetic) versions of the male sex hormone testosterone or structured very similarly to testosterone. [3]

The word ‘anabolic’ simply refers to muscle building and ‘androgenic’ refers to inducing male sexual characteristics.

Common anabolic steroids include fluoxymesterone and nandrolone.

Uses

Many people in the world often experience problems maintaining a normal amount of testosterone in their bodies.

It could be due to some birth defect, disease process, or aging. In these specific cases, doctors may prescribe the use of anabolic steroids for their beneficial effects. [4]

Some of the common uses of anabolic steroids include:

• Male Hypogonadism – having lower than normal testosterone levels in your body, specifically, less than 300 ng/dL.
• Delayed puberty – puberty depends on normal levels of hormones, especially, testosterone in the body, and hence anabolic steroids can be useful in people with low testosterone who might experience delayed puberty.
• AIDS patients
• Chronic muscle-wasting conditions

Anabolic steroid abuse

The main concern of most people regarding anabolic steroids is their abuse potential. It is roughly used by almost 5 to 10% of the athletic population, especially by bodybuilders. [5]

Most people who misuse these steroids are between 20 – 30 years of age with males being the dominant abusers.

Anabolic steroids are usually taken orally, injecting them into muscles, and/or applied on the skin as gels or creams.

Some people might abuse 10 to 100 times higher than normal prescribed doses to achieve desired effects.

There are various patterns used by anabolic steroid users for administering these drugs. They include:

• Cycling – refers to administering multiple doses for a small period of time and then stopping for some time. An example would be 6 months on and 6 months off. This cycle is continued.
• Stacking – refers to combining (piling) two or more types of steroids and mixing oral and/or injectable types of steroids.
• Pyramiding – refers to slowly (linear fashion) increasing the dose and/or frequency of steroid use until the peak is reached. The dose and/or frequency is then reduced gradually tapering off to zero.
• Plateauing – this is a way to avoid developing tolerance over one type of steroid. In this method, various steroids are used in an alternating, overlapping, or substituting manner. (tolerance refers to the increase in dose administration to achieve the same or desired effect after a period of using the drug)

It should be noted that none of the patterns described are scientifically approved to be beneficial or harmless.

Side Effects

The misuse of anabolic steroids comes with numerous side effects. [6]

These side effects can be short-term (acute), long-term (chronic), age, or gender-specific. Unfortunately, some of these effects can be permanent.

Male-specific effects

Most of the effects in males are related to the reduced function of the testicles.

When the body detects an external source of testosterone available it minimizes its production (through the testes) as the body recognizes it doesn't need to produce any.

As a result, men experience:

• Decreased sperm count
• Shrinking of testicles
• Infertility – due to reduced sperm count
• Enlargement of breasts or gynecomastia – this occurs due to hormonal imbalance created by the use of anabolic hormones. Taking high doses of anabolic steroids disrupts the body’s check and balance system leading to a relative excess of female-like hormones causing breast enlargement

Female-specific effects

Females experience side effects opposite to that of men.

This is intuitive as they experience a surge of testosterone in their body causing them to develop male-like features.

The effects can include:

• Hirsutism – refers to a condition when women have excessive growth of coarse, dark hair in a male-like pattern.
• Roughening of skin
• Reduced breast size
• Virilization – refers to the enlargement of the clitoris
• Deepen the voice

Side effects in both men and women

Some side effects experienced by both men and women include:

• Cardiovascular diseases – include hypertension, heart attack, and/or stroke. These effects are due to the decreased relative quantities of estrogen (female hormone) which have heart-protective effects.
• Hypercholesterolemia – increased levels of LDL (bad cholesterol) and decreased levels of HDL (good cholesterol)
• Liver problems – liver metabolizes most of the drugs that you eat. Oral steroid formulations can cause liver dysfunction and even liver cancer.
• Acne and oily skin
• Male-pattern baldness
• Infectious diseases like HIV/AIDS and hepatitis C in people who inject anabolic steroids
• Skin infections (at the injection site)

Side effects in Teens

Teens usually experience the same side effects as adults. [7]

However, they can experience:

• Stunted growth – high levels of steroid hormones signal the bones to stop growing earlier than the normal age. A person might experience poor overall growth
• Stunted height – this occurs if teens use anabolic steroids before their growth spurt. It occurs due to the early fusing of long bones of the body diminishing any room for linear growth.

Addictive potential of anabolic steroids

People using anabolic steroids do not get the usual feeling of being ‘high’ however, they can develop an addiction to certain effects of anabolic steroids.

The primary reason for the abuse of these hormones is the surge in muscle growth and the feeling of increasing strength. This can lead to around a third of all users becoming dependent. [8]

These feelings of having increased strength, looking bulkier, and staying leaner. Withdrawing from anabolic steroids could lead to:

• Depression – this is one of the most serious withdrawal symptoms of anabolic steroids. Not feeling the same way as it used to be during the use of steroids can lead to severe depression.
• Fatigue
• Restlessness
• Loss of appetite
• Insomnia or other sleep problems
• Decreased libido (reduced sexual drive)
• Steroid cravings

How to treat anabolic steroid addiction?

If you want to stop taking anabolic steroids consult your doctor or endocrinologist.

Most people find cognitive behavioral therapy and the use of certain medications effective for leaving the habit of anabolic steroid abuse.

You might be prescribed antidepressants or other symptomatic medications for certain withdrawal symptoms.

Corticosteroids

Corticosteroids are synthetic or man-made formulations of the hormone cortisol. [9]

Corticosteroids have a wide range of uses in clinical practice and they are most commonly used as anti-inflammatory drugs i.e., combat swelling (inflammation) in various parts of the body.

Corticosteroids are available in different forms depending on the desired effects. Some of the common formulations available include:

• Oral tablets
• Injections including intramuscular, intravenous, or intraarticular (directly into joint)
• Inhalers or nasal sprays
• Topical steroids including lotions, creams, and gels

Some examples of corticosteroids include prednisone, dexamethasone, fluticasone, etc.

Uses

Clinically, corticosteroids are used to suppress the body’s various reactions to decrease damage. [10]

Occasionally the body produces a severe and excessive reaction in certain conditions.

For instance, asthmatic patients have cells (eosinophils) that secrete various bronchoconstrictive (narrowing of airways) chemicals in excess leading to difficulty in respiration.

The use of corticosteroids can help reduce this inflammatory response and avoid bronchoconstriction.

The indications of corticosteroids usually involve their anti-inflammatory and immunosuppressive (suppressing the immune system) effects.

Various conditions that can be treated with corticosteroids include:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Allergies e.g., allergic rhinitis (runny nose and sneezing) and hay fever
• Urticaria – developing hives due to an allergic response
• Dermatitis
• Atopic eczema
• Psoriasis – a common autoimmune condition affecting the skin and joints.
• Severe joint pain
• Rheumatoid arthritis (RA) – is an autoimmune disease affecting joints.
• Inflammation of joints
• Gout – increased uric acid in the body leading to uric acid deposition in the joints
• Systemic lupus erythematosus (SLE) – a multiorgan autoimmune disease.
• Inflammatory bowel disease (IBD) – IBD includes both ulcerative colitis and Crohn’s disease.
• Giant cell (temporal) arteritis
• Multiple sclerosis (MS)
• Various blood cancers e.g., leukemias
• Used for prevention of transplant rejection – immunosuppressive properties help prevent the body’s defense systems from attacking the transplanted organ.

The uses of side effects are not limited to these mentioned above and this list is not exhaustive.

Side Effects

When there are so many positives why not use them more often? Despite having so many uses the only thing that limits the extensive use of corticosteroids is their side effects profile. [11]

The list here is also exhaustive. Just like how they can have beneficial effects on multiple organs they have negative effects on these organ systems as well.

It should be noted that most of the side effects of corticosteroids usually occur due to long-term (chronic use) or in cases of overdose.

Some of the common side effects of corticosteroids include:

• Increased appetite
• Weight gain and obesity – weight gain often shows as a characteristic increase in fat around the waist
• Increased risk of infection – this is due to the immunosuppressive functions of corticosteroids
• Oral or vaginal candidiasis (thrush) – due to decreased immunity
• Depression and mood changes
• Psychosis
• Steroid-induced diabetes – corticosteroids tend to decrease the effect of insulin and long-term use induces insulin sensitivity in the body
• Hypertension – it is especially common in people of African descent
• Osteoporosis – weakening of the bone due to decreased bone density. It is more common in post-menopausal women.
• Cushing syndrome – is a constellation of symptoms due to excess corticosteroids in the body. symptoms include typical moon facies, truncal obesity, muscle wasting and thinning of limbs, and weakened immunity.
• Withdrawal symptoms – as with the use of anabolic steroids, corticosteroids also cause withdrawal symptoms after long-term use. The body senses external administration of corticosteroids and reduces the production of endogenous (body’s own) cortisol. Abruptly discontinuing corticosteroids, therefore, can lead to serious side effects. The doses are usually tapered off in a safe way.
• Disease relapse – also known as steroid withdrawal syndrome refers to a condition in which the disease’s symptoms reappear after the discontinuation of corticosteroids.

Abuse potential

Contrastingly, corticosteroids are not abused as frequently as anabolic steroids.

Most of their negative effects are due to their long-term use in medical conditions and not for aesthetic purposes.

How to Naturally Fix your Testosterone Levels 

Naturally, you can induce your testosterone production in several ways. Some common examples are:

• Exercising regularly, especially weight training
• Eating a balanced diet containing protein, omega-3 fatty acids, fibers
• Enjoy adequate sleep
• Reduce a stressful lifestyle
• Spend more time doing what you like
• Have a good sexual life
• Use a natural supplement with clincially proven ingredients

Summary

Steroids are crucial hormones required for the normal development and sustainability of the body.

Testosterone is required for muscle growth, bone growth, and the development of male sexual characteristics.

Cortisol, on the other hand, is needed in stressful situations to keep the body resilient.

Both, anabolic steroids and corticosteroids, have beneficial effects as well as adverse effects.

If used properly and according to the indicated scientific guidelines they can be used for the treatment of various conditions e.g., hypogonadism (anabolic steroids) and asthma (corticosteroids).

The excessive use or abuse of these steroid hormones however can lead to deleterious effects which can also lead to death.

Therefore, it is important for people to stick to the natural way of staying healthy. Having a good routine, eating healthy, and exercising regularly should be incorporated.

In case there is a need to use any type of steroid consult your physician prior to the use of these drugs.

References:

[1] NHS Choices (2019). Anabolic steroid misuse. [online] NHS. Available at: https://www.nhs.uk/conditions/anabolic-steroid-misuse/.

[2] Medline Plus (2019). Hormones. [online] Medlineplus.gov. Available at: https://medlineplus.gov/hormones.html. 

[3] The Editors of Encyclopedia Britannica (2018). anabolic steroid | Definition, Effects, & Examples. In: Encyclopædia Britannica. [online] Available at: https://www.britannica.com/science/anabolic-steroid.

[‌4] ADF - Alcohol & Drug Foundation. (2016). ADF - Drug Facts - Steroids. [online] Available at: https://adf.org.au/drug-facts/steroids/.

[5] Ny.gov. (2006). Anabolic Steroids and Sports: Winning at any Cost. [online] Available at: https://www.health.ny.gov/publications/1210/.

[6] Abuse, N.I. on D. (2018). What are the side effects of anabolic steroid misuse? [online] National Institute on Drug Abuse. Available at: https://nida.nih.gov/research-topics/anabolic-steroids

[7] Office of the Commissioner (2019). Teens and Steroids: A Dangerous Combo. [online] U.S. Food and Drug Administration. Available at: https://www.fda.gov/consumers/consumer-updates/teens-and-steroids-dangerous-combo.‌

[8] Abuse, N.I. on D. (n.d.). Are anabolic steroids addictive? [online] National Institute on Drug Abuse. Available at: https://nida.nih.gov/research-topics/anabolic-steroids

[9] NHS inform (2019). Corticosteroids. [online] Nhsinform.scot. Available at: https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/corticosteroids.‌

[10] NationalInstituteforHealthandCareExcellence (2019). BNF is only available in the UK | NICE. [online] NICE. Available at: https://bnf.nice.org.uk/treatment-summaries/corticosteroids-general-use/

[11] Muhammad Yasir and Sidharth Sonthalia (2019). Corticosteroid Adverse Effects. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK531462/.