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One of the most popular get-in-shape regimes of the moment is the aesthetic body building programme.
It's a classic body building programme which includes bulking up (picking up lean mass) and cutting (losing excess fat). The aim is to look 'ripped', like a typical cover model.
Traditionally you cut in summer to achieve a lean look, and bulk in winter. The process can take years to achieve, and then you have to work just as hard to maintain the look.
For half of the people in the exercise regime, the look comes relatively easy with hard work, but for the other half, no matter how hard they exercise, they simply can't achieve the desired physical shape.
Until a friend introduces them to someone at the gym who could get him 'what they needed': anabolic steroids.
Anabolic steroids are essentially synthetic versions of the male hormone testosterone, and work by increasing muscle tissue.
Anabolic means 'use of something that causes a building up of tissue'. The term anabolism refers more generally to an increase in lean tissue, in particular muscle tissue.
Drugabuse.org says that, during the 1930s, scientists discovered that anabolic steroids could facilitate the growth of skeletal muscle in laboratory animals, which led to abuse of the compounds first by bodybuilders and weightlifters and then by athletes in other sports.
Steroids are legally given to people for medical reasons if they have low levels of testosterone or oestrogen. It's also given to people who have had third degree burns due to the tissue regeneration properties.
It is illegal to use steroids without a valid prescription - steroids are Schedule III substances under the Controlled Substances Act.
How easy are steroids to get?
But in the fitness and sports world it is readily available, once you've found a seller.
One user (who requested to remain anonymous) told Health24 that there are always steroid pushers at the gyms, especially the larger ones.
They may approach you in the locker room and comment on your physique, thereby striking up a conversation.
Depending on your response, they may offer suggestions of how you can bulk up easier.
The rest is history, and soon you'll receive updates on your phone about what's available, and the cost.
It's also not unheard of for personal trainers to supply those they are training with illegal steroids.
But nobody's going to tell - there is a high level of loyalty among users and sellers, as both are indulging in something illegal, so the police or gym owners or managers seldom get tip-offs.
Users may also be able to buy them, under the counter, from sports nutrition retailers.
They are also readily available online, although for every real supplier there are about 10 who run online scams and the buyer will most probably end up with a container of chalk rather than any performance-enhancing drugs.
Not all steroids to the same thing
There are steroids for just about anything: to help you 'incinerate your fat'; to help you accentuate different parts of your body, depending on what's trending; to reduce water retention; to help build muscle, or to block oestrogen.
Iron magazine reports that a major side effect of using large doses of certain anabolic steroids, including testosterone, is the conversion of testosterone into oestrogen. Too much oestrogen is directly associated with gynecomastia, aka man boobs.
Some anabolic steroids are taken orally, others are injected into the muscle, and still others are provided in gels or creams that are applied to the skin. Doses taken by abusers can be 10 to 100 times higher than the doses used for medical conditions.
The World Anti-Doping Code is the document that harmonises regulations regarding anti-doping in sport across all sports and all countries of the world.
Read: Expert Q&A: Woman advised to take Oxandrolone by her trainer
Types of steriods
In the fitness industry, the most commonly used oral anabolic steroid is Dianabol, aka Dbols, which helps users build mass in a relatively short time. It costs around R400 for 60 capsules.
The most commonly used injectable is Test Prop (Testosterone Propionate) which, according to steroid.com, promotes nitrogen retention in the muscle, and the more nitrogen the muscles hold, the more protein the muscles store. It goes for around R380 for 10ml.
One extremely dangerous steroid that some used is called Tren (Trenbolone Enanthate), which is in reality intended for livestock and referred to as the 'greatest performance enhancing drug on earth'.
Directions for use would say 'use 1ml for 100kg of cattle'. It is often used for its alleged fat-burning properties as well as reputed powerful muscle building, strength increasing and "hardening" qualities.
Clomid is another popular drug that's used in post-cycle therapy, ie to 'put you back to normal'.
Read: Most body builders have body image concerns
How are steroids used?
Cycling: this is when multiple doses of steroids are taken over a specific period, then stopped, and started again.
Stacking: this is when users combine several different types of steroids at one time. Abusers will take two or more different anabolic steroids, they will mix oral and/or injectable types, and sometimes even including compounds that are designed for veterinary use (such as Tren).
The general (misguided) thinking, according to Drugabuse.gov, is that when different steroids interact they can increase muscle size more than when only one drug is taken at a time. There is no scientific proof that this is the case, however.
Read: Expert Q&A: Help, my son bought steroids!
What are the side effects of anabolic steroids?
You rarely see two people with the same side effects, and different steriods have different side effects. Most commonly you'll see mood swings and aggression, also known as “roid rage”.
Many of the short-term side-effects are cosmetic, and include: severe acne, excessive body and facial hair, shrinking of the testicles and reduced sperm count, abnormal breast development, as well as baldness.
Steroids act to increase blood pressure, which can lead to strokes.
They also reduce the production of cholesterol, leading to the furring of the blood vessels as well as coronary heart disease, increasing the possibility of a heart attack. These effects can occur within just a few weeks of taking steroids.
Male infertility is also linked to steroids. While steroids may make sportsmen “bulk up”, they suppress the release of the normal male hormone testosterone, which can suppress the production of sperm cells, leading to infertility in later life.
Loss of libido is also a common side effect.
In women side effects include a deeper voice, acne, emotional problems, hair loss, facial hair and menstrual irregularities.
Health24 Biokinetikist and fitness expert, Habib Noorbhai says that some urologists have reported that teenagers and young men (as young as 16 – 19 years of age) have been complaining of erectile dysfunction due to increased intake of various anabolic steroids.
But, it is the liver that is particularly vulnerable, which is why those using steriods should never consume alcohol at the same time.
Increased liver function caused by steroids could cause inflammation and in some cases, hepatitis.
Life-threatening liver cancer at high doses and prolonged exposure is also a reality. Studies found that these tumours did not shrink in all cases when the steroid was stopped.
The long term side-effects could be potentially life-threatening, and often these will only become apparent years after steroid use has ceased.
In fact, there are also studies that show that steroid use can be detrimental to your mental health and the effects will only become apparent many years later. These include depression, concentration problems and aggressive behaviour.
Habib warns that those who struggle to build muscle only consume steroids if it has been prescribed by a medical doctor.
He advises one reader who wants to gain muscle mass: "To increase muscle mass, you would need to eat 6 small meals per day coupled with high-intensity, explosive training for muscle power, strength and plyometrics as well as lifts."
"The business behind nutritional supplements is a focal concern and therefore, legislation and regulations coupled with education and awareness needs to be administered at all levels.
In the human movement sciences and within the fitness industry, there are no quick fixes". A great body takes dedication, time and perseverance.
Read: Teenagers and steroid abuse in SA
5 Ways to spot a steroid user: look for a distended gut/stomach, disproportionate upper body development, gynaecomastia (man boobs), acne, stretch marks and a sudden increase in muscle mass.
Watch: National Geographic Documentary on the effects of anabolic steroids
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