Medical Consequences of Anabolic Steroids
John Brick in Handbook of the Medical Consequences of Alcohol and Drug Abuse, 2012
This is a balance of properties often referred to as the anabolic/androgenic ratio or AAR, a drug parameter established by the repeated administration of the steroid to rats, and then the measurement (by increase in weight) of the effects of the steroid on different tissue structures. The anabolic effect of a particular steroid molecule is measured by the increase in weight of the levator ani muscle in rats; the androgenic effect of the molecule is measured by increase in weight of rodent prostate tissue and, in some studies, seminal vesicles (Chaudry et al., 1976). Therefore, both the anabolic and androgenic properties of a drug are scaled by proxy measures, not by effects an athlete would easily recognize. Despite the limitations of the method, this is the assay used in steroid chemistry. Testosterone propionate as first developed by Schering in the 1930s, assigned an AAR of 1:1, is the basis of comparison for other anabolics. As masculinizing effects are often associated with androgens, as well as feminizing effects when androgens are broken down or “aromatized,” much effort in steroid chemistry has been devoted to maximizing the AAR of new drugs in order to obviate the untoward effects first noted by John Ziegler in the 1950s. Some drugs have been developed with much higher AARs than testosterone—10:1 in the case of nandrolone decanoate, and up to 30:1 for stanozolol. Still, the goal of developing an anabolic steroid with null androgenic effects remains elusive. Therefore, use of AAS always involves the introduction of exogenous androgens to the system, resulting in a cascade of endocrinological events downstream (Carvalho et al., 2000): serum testosterone levels increase short-term; due to limited levels of androgen-binding globulin, the proportion of free androgen increases; spikes in the levels of free androgens, mostly testosterone and androstenedione, stimulate the secretion of aromatases which break down the androgen molecules and clear them from the system, a process known as aromatization; the availability of aromatases causes circulating androgens to be converted to estradiol and other estrogens, leading to an increase of estrogens circulating in the system (Calzada, 2000); finally, the presence of estrogens in male subjects triggers its own cascade of endocrinological events. In males, this cascade caused by an excess of estrogens has a profoundly paradoxical and untoward effect, given the results most steroid users are seeking. This effect is physical feminization, including the development of breast tissue (gynecomastia), female-pattern fat deposition, and water retention. Gynecomastia is a frequently reported side effect of AAS use and is often a cause of psychological distress among those who experience it (Pope and Katz, 1994). It is in most cases transient, but when fatty gynecomastic deposits fail to resolve naturally, the sufferer may opt for costly surgical intervention, as removal of the fatty breast tissue is often the only way to eliminate cosmetic flaws of a type that can be profoundly embarrassing to men (Reyes et al., 1995). Aromatization—or the transmutation of masculinizing androgens into feminizing estrogens by the action of circulating enzymes known as aromatases—can have profound effects in males. In their study of male AAS-using powerlifters, Alen et al. (1987) found levels of serum estradiol (the estrogen into which testosterone aromatizes) similar to those found in ovulating females. Cessation of AAS use usually results in a return of blood estradiol to normal levels, and most AAS users experience a concomitant reversal of gynecomastia. However in others, the condition persists well after cessation of AAS use (Friedl and Yesalis, 1989; Pope and Katz, 1994) and can result, as already discussed, in serious and permanent cosmetic flaws that can only be reversed surgically. This persistence appears to occur not as a result of increased estrogen, but rather because of a short-term disruption of the estrogen/androgen balance due to a downregulation of endogenous testosterone production. Although the mechanisms underlying this process are not altogether clear, it appears that AAS use results temporarily in a decrease of endogenous testosterone release as a consequence of inhibitory feedback to the hypothalamic-pituitary-testicular axis (HPTA). The introduction of exogenous androgens in the form of AAS leads to a downregulation of the HPTA neuroendocrine pathway and a decreased release of endogenous testosterone (Alen and Rahkila, 1988; van Breda et al., 2003). This lack of endogenous testosterone results in such symptoms as short-term testicular shrinkage (Evans, 1997; Pope and Katz, 1994), a persistence of feminizing effects like gynecomastia due to an estrogen/testosterone imbalance (Gonzalez, McLachlan, and Keaney, 2001), and, in the absence of exogenous testosterone, loss of libido.
On the Sophistication of Herbal Medicines
Aruna Bakhru in Nutrition and Integrative Medicine, 2018
We generally start with one teaspoon three times daily, increase to six times daily, and so on, increasing as the situation demands. Other herbs, in other situations, may necessitate a much wider range of dosing. Specifically, and counterintuitively, plant tinctures may produce sufficient healing effects when given in tablespoon doses or in drop doses. That is, for some people one tablespoon of the herbal tincture may be necessary to produce effects, for others three to four drops will do so. This is often hard to digest for people trained in a pharmaceutical mindset. Nevertheless, while rarely recognized, pharmaceuticals also possess that kind of range of action. Nothing has revealed this more than studies of pharmaceutical pollution in the world's waters. Louis Guillette, a reproductive endocrinologist and professor of zoology at the University of Florida, is an expert in the study of endocrine-disrupting chemicals in the environment. He has often focused on pharmaceutical estrogens and estrogen mimics in water supplies and streams. Resultant male reproductive problems have been documented in panthers, birds, fish, alligators, frogs, bats, turtles, dogs, and humans. This includes, in some instances, complete feminization of males. His research has consistently found that androgen levels, ratios, and free testosterone levels are all significantly altered by these environmental pollutants. Guillette (2000) has commented that the levels of chemical pollutants necessary to produce these effects are incredibly tiny. As he says: “We did not [test] one part per trillion for the contaminant, as we assumed that was too low. Well, we were wrong. It ends up that everything from a hundred parts per trillion to ten parts per million are ecologically relevant. … at these levels there is sex reversal … [The research] shows that the highest dose does not always give the greatest response. That has been a very disturbing issue for many people trying to do risk assessment in toxicology.”Because all life forms are nonlinear, self-organized systems, they are exceptionally susceptible to even tiny inputs, which explains, to a certain extent, why some homeopathic preparations work as they do. The grossest homeopathic preparations begin at six parts per trillion. Despite regular attacks on homeopathic medicines by mainstream medicalists, we have seen some homeopathic preparations produce significant alterations in disease conditions. Such tiny inputs, whether of homeopathics or herbal medicines, can cause physiology to shift, sometimes significantly. Unfortunately for a reductive orientation, the inescapable truth is that medicinal plant dosages run along a rather broad spectrum. While suggested dosages for most plant medicines exist, I have found in practice that each person who is ill presents with unique disturbance of their body ecology. The cytokine cascade, even in people with the same disease (e.g., Lyme), can be subtly, or sometimes significantly different.
Klinefelter's Syndrome (47XXY or 46XY/47XXY)
K. Gupta, P. Carmichael, A. Zumla in 100 Short Cases for the MRCP, 2020
Klinefelter's syndrome is the most common cause of male hypogonadism, affecting 1:500 males. The diagnosis is made with a buccal smear for karyotype analysis. Plasma gonadotropin levels are increased. The incidence increases with advancing maternal and paternal age. With increasing numbers of X chromosomes, the incidence of mental retardation increases. There is an increased risk of breast cancer, i.e. twenty times that of normal males, though still only a fifth of that found in women. The mosaic form (46XY/47)Q(Y) tends to be less severe in all respects, often with normal testes and, occasionally, fertility. Many of these patients are also obese and have an increased incidence of disorders such as diabetes, bronchiectasis and varicose veins.
Psychometric and Faciometric Support for Observable Facial Feminization in Gay Men
Published in Journal of Homosexuality, 2019
Julia M. Robertson, Barbara E Kingsley, Gina C. Ford
Though male homosexuality appears to be evolutionarily paradoxical, phenotypic feminization has been offered as a route for three current models positing a genetic basis for male homosexuality. We tested whether facial feminization is observable in gay men in two studies. In Study 1, using two composite images of gay and of heterosexual men, naive participants (N = 308) rated the “gay” face more highly on stereotypically feminine traits and actual femininity and the “heterosexual” face more highly on stereotypically masculine traits and actual masculinity. In Study 2, faciometrics of 428 Internet images of gay (N = 219) and heterosexual men were analyzed along six sexually dimorphic ratios. The faciometrics of gay men were more feminine, both in gestalt terms and for five of the six individual traits. The studies offer objective support for a more feminized facial phenotype in gay males that is difficult to explain through cultural or behavioral cues.
Facial Feminization Surgery: The Ethics of Gatekeeping in Transgender Health
Published in The American Journal of Bioethics, 2018
The lack of access to gender-affirming surgery represents a significant unmet health care need within the transgender community, frequently resulting in depression and self-destructive behavior. While some transgender people may have access to gender reassignment surgery (GRS), an overwhelming majority cannot afford facial feminization surgery (FFS). The former may be covered as a “medical necessity,” but FFS is considered “cosmetic” and excluded from insurance coverage. This demarcation between “necessity” and “cosmetic” in transgender health care based on specific body parts is in direct opposition to the scientific community’s understanding of gender dysphoria and professional guidelines for transgender health. GRS affects one’s ability to function in an intimate relationship, while FFS has the same impact on social interactions an, therefore may have a far greater implication for one’s quality of life. FFS is a cost-effective intervention that needs to be covered by insurance policies. The benefits of such coverage far exceed the insignificant costs.
Gendered gambling domains and changes in Sweden
Published in International Gambling Studies, 2011
Jessika Svensson, Ulla Romild, Mikael Nordenmark, Anna Månsdotter
The study examines two Swedish replication prevalence studies (n = 10,000 and n = 15,000) with the aim of exploring evidence for a feminization of gambling in Sweden between 1997/1998 and 2008/2009. Gambling domains were classified based on the games' basic orientation towards strategy and chance, as well as on each game's setting in either a public place or a home environment. The criterion for a domain was that the respondent had gambled at least twice a month in any mode of gambling within the domain. Logistic regression analysis showed no signs of a feminization. Instead, the gender order in gambling seems to be reinforced. Preferences for the different types of domains were still highly gendered, despite the fact that men in 2008/2009 tended to gamble more on games of chance, especially in public places. The implications of the findings in relation to gender equality and constraints on women's leisure activities are further discussed.