Keeping up with the pace: the impact of steroids upon fertility and sexuality

The discovery of steroid hormones, and their striking variety and range of potent actions, has become a major focus in research into sexual health. In addition to estrogens and progesterones, the normal woman's body produces small amounts of testosterone in the ovaries. Testosterone is one of a number of naturally produced androgens (a steroid hormone producing male characteristics) which affect individual behavior, vitality and sexuality. As in males, artificially increasing steroid hormone levels by the administration of anabolic steroids will affect physical performance, reproductive physiology and behaviour. The effects of our own naturally produced steroids is determined by their precise nature and the balance of their relative concentrations.
Anabolic steroids are man-made synthetic derivatives of the naturally occurring steroid hormone testosterone. Testosterone has both anabolic and androgenic properties, terms derived from Greek. Anabolic means "to build," and androgen means "masculine" in characteristic. Whilst there are many types of steroids, each varying in their respective anabolic and androgenic potency, it's the anabolic property of steroids which athletes crave, and their androgenic property which attracts those who desire increased sexual desire and social attractiveness. Ordinarily most healthy males produce less than 10 milligrams of testosterone a day, a concentration higher than that naturally produced by women.
Social pressures to perform well athletically, to look physically attractive and to increase social energy and vitality leads to a temptation to get that chemical "edge". Self confidence and esteem may be sought by increasing lean muscle mass and improvements in body form which are often attributed to steroids. However the current widespread use of steroids, especially in colleges, has led to a number of relatively recent medical phenomena concerning reproductive health and behavior in these women. According to the NIH, anabolic steroid abuse is on the increase among adolescents, and most rapidly in young females. It has been estimated that hundreds of thousands of people aged 18 or older abuse anabolic steroids at least once a year. A NIDA survey of high school seniors suggested that as many as 0.5% of women admitted using steroids at some time in their lives. Thus it is reasonable to conclude that millions of American women either use or have used steroids at some point in their lives.

Natural and artificial steroids

Anabolic steroids are a family of synthetic (artificial) steroids made by the chemical modification of the male hormone testosterone. This may be done for many reasons, for example to increase the steroid's anabolic properties and to reduce its androgenic activity, or to make the steroid resistant to break down within the body and thereby prolong its activity. Whilst steroids have a bad name, they are in actual fact essential oils, vital to healthy physiology and sexuality, especially reproductive health. All steroids derive from the cholesterol molecule, an essential oil normally produced within the body, and a vital component of cell membranes. A series of highly specific enzymes found in the adrenal glands, located above the kidneys, and in the ovaries and testes, act to convert cholesterol in a series of steps into a large variety of natural steroid hormones which perform many actions within the body, such as regulating stress responses (for example cortisol produced in the adrenal), mineral and electrolyte balance (e.g. aldosterone produced by the adrenal), or sexual drive and fertility (the estrogens in the ovaries & androgens in the adrenal, testes & ovaries). The accompanying illustration shows the pathways of steroid synthesis in these tissues, with an inset panel showing the similarity in structure between testosterone and the commonly used anabolic steroid nandrolone.
Steroids are usually taken orally in the form of tablets or capsules, by intravenous injection or through the skin in ointments or gels. Oral administration runs the risk of increased liver damage as anabolic steroids must first pass through the liver for detoxification, whereas intravenous injection runs the gauntlet of infection. Commonly taken steroids include Anadrol [oxymetholone], Oxandrin [oxandrolone], Dianabol [methandrostenolone], Winstrol [stanozolol], Deca-Durabolin [nandrolone decanoate], Depo-Testosterone® [testosterone cypionate], Equipoise® [boldenone undecylenate] and testosterone itself in oral, injected or skin ointment forms.

Effects of steroids upon fertility

Before we start to consider what actions steroids have, we first have to familiarise ourselves with which steroids are produced by the ovaries. As in the adrenal gland, there are three distinct cellular compartments present in the human ovary. The Follicular compartment is the structure that enlarges each month to form a small cyst or growth which releases mainly estrogen. When the follicle bursts to release the egg, the cyst then collapses to form a small cavity known as the Corpus Luteum which starts to produce the hormone progesterone. It is the cycling of these two compartments slows down with age and eventually stops at menopause. The third compartment which is greatly overlooked is the Stroma, which is the source of the ovarian androgen production until death. The principal ovarian androgen released is testosterone, suggesting that it is the balance of estrogens and testosterone that determines femininity, rather than the absence of testosterone itself. Thus natural testosterone production is not the sole preserve of the male.
Luteinising Hormone (LH) released from the pituitary acts on Thecal cells in the Corpus Luteum to increase the production of progesterones, whilst Follicle Stimulating Hormone (FSH) acts on the Granulosa cells of the Follicular compartment to increase the production of estrogens. An increase in circulating androgens such as testosterone or anabolic steroids which mimic the actions of testosterone blocks the production and release of LH and FSH, resulting in a decline in levels of LH, FSH, estrogens and progesterone in the blood stream. At an extreme this may result in the inhibition of follicle formation and ovulation, and may cause irregularities in the menstrual cycle such as amenorrhea. Younger women are particularly vulnerable to the effects of the high anabolic steroid dosages common in sport and body fitness culture.
Other side effects of anabolic steroid use in females include increased sexual desire, enlargement of the clitoris, facial hair growth and loss of breast tissue (often compensated for by breast implantation). Anabolic steroid use by pregnant women may lead to growth retardation of the female foetus or even foetal death. The lowering of the frequency of the voice, decrease in breast size and clitoral enlargement associated with steroid use are generally irreversible.

Psychological effects of anabolic steroids

Increased testosterone levels in the blood are associated with stereotypically "masculine" behavior, such as aggression and increased sexual desire. Whilst controlled aggression may be advantageous for athletic training, it may also lead to increased social or domestic violence. Anabolic steroids may also cause euphoria, confusion, sleeping disorders, extreme anxiety, paranoia and hallucinations. As with all addictive drugs, withdrawal symptoms occur with an abrupt end to steroid use. These withdrawal symptoms may include aggressive or violent behavior, suicidal depression, mood swings, and even psychosis. Some have suggested that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.

Increasing androgen levels by methods other than the use of anabolic steroids

Some individuals use human choriogonadotropins (hCG) to enhance natural testosterone production, whilst other natural sources of testosterone include the wild herb smilax officianalis. Administration of DHEA (dehydroepiandrosterone), an androgen produced by the adrenal gland which is a common precursor of all sex steroids, including testosterone, is used to treat women with sexual dysfunction arising from adrenal androgen insufficiency. DHEA has been shown to increase the levels of circulating androgen steroids, and to improve sexual function and diminish personal sexual distress without significant side effects. The relationships and interconversion of the naturally occuring androgens and estrogens is illustrated below.

Other recent strategies for increasing lean muscle mass without steroid use includes taking insulin shots, or injecting human growth hormone and other insulin-like growth factors. These are usually synthetically produced and are very expensive (except for insulin). Taking insulin as a growth hormone is a risky business, as it can easily induce hypoglycaemic coma at high concentration.

Medical Uses of Steroid Hormones

Although many steroid hormones are naturally produced by the ovaries and the adrenal gland, the levels of these hormones decrease as part of the aging process. Indeed fertility starts to decline in women as early as 27. Thus steroid hormones are often used as part of HRT therapies. Three of these are available as clinical treatments including Depo-Estradiol Cypionate, which is used to relieve hot flashes, to enhance mood, increase the perception of well-being, and to stop vaginal dryness. Depo-Testosterone Cypionate is similarly used to endow a sense of well-being, to restore enthusiasm and to counteract emotional changes associated with the menopause such as depression, irritability, insomnia and panic attacks. Testosterone Propionate is faster acting and more quickly cleared from the system than Depo-Testosterone Cypionate, but has a similar range of actions including anabolic effects, including increasing the body's response to exercise, restoring libido, memory and concentration, and increasing energy & vitality. Other medicinally used steroids include the estrogen and progesterone precursors DHEA and Pregnenolone, and the estrogens themselves - Estriol, Estradiol and Progesterone.

Thus steroid oils are essential to human health, fertility and happiness. They decline with age and serve as key social signals declaring our reproductive vitality and fitness. However they are normally present only at tiny concentrations, typically less than a millionth of the concentration of normal blood glucose. Small changes in their levels can have major effects upon the balance of steroid actions, and those who use them should tread wearily.
Rhodri J Walters Ph.D., NYAS.
Cellscience Ltd.