Metabolic side effects have included osteolytic-induced hypercalcemia in immobilized patients or those with metastatic breast disease. Anabolic steroids affect electrolyte balance, nitrogen retention, and urinary calcium excretion. Edema, with and without congestive heart failure, has occurred during anabolic steroid therapy. Decreased glucose tolerance requiring adjustments in hyperglycemic control has been noted in diabetic patients. The androgenic activity of anabolic steroids may decrease levels of thyroxin-binding globulin and result in decreased total T4 serum levels and increased resin uptake of T3 and T4. Free thyroid hormone levels remain unchanged and there is no clinical evidence of thyroid dysfunction. Significant increases in low density lipoproteins (LDL) and decreases in high density lipoproteins (HDL) have occurred. [ Ref ]
Side effects of anabolic steroids with relevance in forensic medicine are mainly due to life-threatening health risks with potential fatal outcome and cases of uncertain limitations of criminal liability after steroid administration. Both problems are typically associated with long-term abuse and excessive overdose of anabolic steroids. Side effects may be due to direct genomic or nongenomic activities (myotrophic, hepatotoxic), can result from down-regulation of endogenous biosynthesis (antiandrogenic) or be indirect consequence of steroid biotransformation (estrogenic).Logically, there are no systematic clinical studies available and the number of causally determined fatalities is fairly limited. The following compilation reviews typical abundant observations in cases where nonnatural deaths (mostly liver failure and sudden cardiac death) were concurrent with steroid abuse. Moreover, frequent associations between structural characteristics and typical side effects are summarized.
PCT involves the use of drugs whom through different mechanisms help restore hormonal balance after a steroid cycle. The two drugs usedfor this are Clomid and tamoxifen . These drugs are antiestrogens and are used to block the negative feedback inhibition of estrogen, which occurs primarily at the This may foster the heightened release of GnRH, and subsequently LH and testosterone. While estrogen levels are not especially high in men, it is still a very strong inhibitor of testosterone Since it is also formed from the aromatization of testosterone in peripheral tissues, its role in the regulation of androgen biosynthesis is regarded as a fairly direct one. The purpose of using anti-estrogens is to both trigger correction in LH levels more quickly, and to augment total LH. They may also be necessary to combat gynecomastia in some individuals, which can occur even with low estrogen levels (it is partly a function of the androgen to estrogen balance in the breast).