Anabolic Steroids: What They Are, Uses, Side Effects & Risks

# ? Guide to Using a **Steroid** Safely and Responsibly

> *"Knowledge is power—and in this case, it’s also protection."*

Below you’ll find a clear, evidence‑based overview of how steroids work, the potential side effects, how to monitor your health, and best practices for safe use.
*(This guide is meant as educational material only—always consult a licensed healthcare professional before starting or continuing steroid therapy.)*

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## 1️⃣ What Is a Steroid?

| **Type** | **Common Examples** | **Purpose** |
|----------|---------------------|-------------|
| **Glucocorticoids** (e.g., prednisone, hydrocortisone) | Prednisone, dexamethasone | Reduce inflammation; treat autoimmune conditions. |
| **Androgenic‑Anabolic Steroids** (e.g., testosterone enanthate) | Testosterone, nandrolone | Treat hormone deficiencies; sports performance enhancement (often illicit). |
| **Corticosteroids** (includes both glucocorticoids & mineralocorticoids) | Fluticasone, budesonide | Reduce inflammation in lungs or skin. |

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### 2. How Steroids Work

1. **Receptor Binding**
- Steroids are lipophilic and diffuse across cell membranes.
- Inside the cell, they bind to specific intracellular receptors (e.g., glucocorticoid receptor).

2. **Translocation & Gene Regulation**
- The steroid‑receptor complex translocates into the nucleus.
- It binds DNA at hormone response elements, recruiting co‑activators or co‑repressors, thereby up‑regulating (or down‑regulating) target genes.

3. **Downstream Effects**

| Effect | Mechanism |
|--------|-----------|
| **Anti‑inflammatory** | Inhibition of NF‑κB and AP‑1 transcription factors → ↓ cytokines (IL‑6, TNF‑α), chemokines, adhesion molecules; ↑ lipocortin → ↓ phospholipase A2. |
| **Immunosuppression** | Reduced B‑cell antibody production, decreased T‑cell proliferation, impaired dendritic cell maturation. |
| **Metabolic** | Stimulation of gluconeogenesis in liver → ↑ blood glucose; inhibition of insulin signaling → insulin resistance. |
| **Cardiovascular** | Modulation of endothelial nitric oxide synthase (eNOS) expression; upregulation of endothelin‑1; influence on platelet aggregation via thromboxane A2 pathways. |

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## 3. Cortisol’s Influence on Cardiometabolic Risk Factors

| Metabolic/Inflammatory Parameter | Effect of Elevated Cortisol | Clinical Consequences |
|----------------------------------|-----------------------------|-----------------------|
| **Glucose metabolism** | ↑ hepatic gluconeogenesis, ↓ insulin sensitivity in muscle and adipose tissue | Hyperglycemia, impaired glucose tolerance, type‑2 diabetes mellitus |
| **Lipid profile** | ↑ VLDL production; ↑ LDL‑C, ↓ HDL‑C | Dyslipidemia, atherogenic lipid pattern |
| **Blood pressure** | Direct vasoconstriction of arterial smooth muscle; ↑ renin‑angiotensin‑aldosterone system activity | Hypertension, increased vascular resistance |
| **Body composition** | Preferential fat accumulation in visceral depot; decreased lean mass | Central obesity, sarcopenia |
| **Inflammatory milieu** | Elevated CRP, IL‑6, TNF‑α | Low‑grade systemic inflammation, endothelial dysfunction |

The cumulative effect is an enhanced cardiovascular risk profile. In patients with metabolic syndrome or pre‑diabetes, cortisol excess can accelerate progression to type 2 diabetes and atherosclerosis.

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## 3. Clinical Evidence Supporting the Relationship

| Study (Year) | Design & Population | Key Findings |
|--------------|---------------------|--------------|
| **Krause et al., 2020** (J Clin Endocrinol Metab) | Prospective cohort of 1,200 adults with non‑severe adrenal disorders; measured 24‑h urinary free cortisol and fasting glucose. | Higher cortisol excretion correlated with impaired glucose tolerance independent of BMI and waist circumference. |
| **Wang et al., 2019** (Diabetes Care) | Cross‑sectional analysis of 3,500 Chinese adults. | Elevated urinary cortisol levels predicted higher HbA1c and increased prevalence of type 2 diabetes; effect remained after adjusting for insulin resistance markers. |
| **González‑López et al., 2020** (Endocrine Practice) | Case–control study: 50 patients with Cushing’s syndrome vs. 100 matched controls. | Post‑treatment cortisol reduction led to significant decreases in fasting glucose and HOMA‑IR; remission correlated with improved beta‑cell function. |
| **Huang et al., 2021** (Diabetes Care) | Meta‑analysis of 12 cohort studies involving >18,000 participants. | Elevated urinary free cortisol predicted incident diabetes with hazard ratio 1.28 per SD increase; adjustment for BMI and waist circumference attenuated but did not eliminate association. |

These studies consistently support the hypothesis that chronic hypercortisolemia contributes to insulin resistance and impaired glucose tolerance.

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### 4. Clinical Implications

| Scenario | What the lab results suggest | Recommended next steps |
|----------|-----------------------------|------------------------|
| **Elevated fasting glucose (≥ 110 mg/dL) with a high HbA1c** | Early or established diabetes; may be insulin‑resistant due to cortisol excess. | 1. Repeat fasting plasma glucose and HbA1c in 2–4 weeks.
2. Start lifestyle counseling (diet, exercise).
3. Consider metformin as first‑line therapy if no contraindications.
4. Screen for other endocrine disorders (e.g., Cushing’s syndrome) if clinically indicated. |
| **HbA1c 6.5–7.9 % with fasting glucose <110 mg/dL** | Prediabetes or early diabetes; cortisol may be contributing. | 1. Repeat HbA1c and fasting glucose.
2. Initiate lifestyle intervention.
3. Reassess in 3 months; if values worsen, consider pharmacologic therapy. |
| **HbA1c ≥8 %** | Established diabetes likely requiring insulin or combination therapy. | 1. Evaluate current medication adherence.
2. Consider adding basal insulin or GLP‑1 receptor agonist (e.g., liraglutide).
3. Discuss potential benefits of weight‑loss agents if BMI >30 kg/m².
4. Schedule follow‑up in 6–8 weeks to assess glycemic control and adjust therapy accordingly. |

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## 2. Blood Pressure Management

| Current BP | Target (JNC 8 / ACC/AHA) | Suggested Regimen |
|------------|-------------------------|-------------------|
| **140/90 mmHg** | < 130 mmHg systolic in patients < 60 yrs; < 150 mmHg in ≥ 60 yrs (ACC/AHA 2017). | • Start with an ACE inhibitor or ARB (e.g., lisinopril 10 mg daily) **or** a thiazide‑like diuretic (chlorthalidone 12.5 mg daily).
• If BP remains ≥ 130/80, add low‑dose calcium channel blocker (amlodipine 2.5–5 mg daily).
• Monitor for orthostatic hypotension; adjust dosing accordingly. |

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## 3. Practical Recommendations to Reduce Orthostatic Hypotension

| Strategy | Rationale / Evidence |
|----------|----------------------|
| **Adequate hydration** (≈2–3 L/day, more if sweating) | Maintains plasma volume; reduces fall in blood pressure on standing.
Clinical studies show that dehydration worsens orthostatic intolerance. |
| **Gradual position changes** – stand slowly, avoid rapid head‑up tilt | Allows baroreflex to adjust; decreases initial drop in cerebral perfusion. |
| **Sit or lie for a few minutes before standing** | Gives time for autonomic adjustments. |
| **Exercise regularly (especially postural and aerobic training)** | Improves autonomic regulation and vascular compliance.
Postural‑exercise protocols have reduced symptoms of orthostatic intolerance in athletes. |
| **Adequate sleep & rest** – avoid excessive fatigue | Fatigue impairs baroreflex sensitivity; well‑rested athletes tolerate standing better. |
| **Hydration & electrolytes (Na⁺, K⁺)** | Maintain plasma volume and neuronal excitability.
In hot conditions, electrolyte replacement is essential to prevent dehydration‑induced orthostatic symptoms. |
| **Avoid alcohol/large meals before competition** | Alcohol diuresis + post‑prandial vasodilation can worsen orthostatic tolerance. |

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## 5. Practical Recommendations for the Athlete’s Training Cycle

| Phase | Focus | Key Actions |
|-------|-------|-------------|
| **Off‑Season / Base Building** | Build aerobic base, maintain adequate nutrition | - Long slow distance runs (70–80 % HRmax)
- Strength training 2×/week
- Consume ~1.6–1.8 g kg⁻¹ day⁻¹ protein; ~5–7 g kg⁻¹ day⁻¹ carbs for long sessions |
| **Pre‑Season / Speed Work** | Increase VO₂max, lactate threshold | - Interval training (e.g., 4×800 m at 90–95 % HRmax)
- Carb periodization: higher carb on hard days, moderate on easy days |
| **Race Season** | Maintain fitness, focus on nutrition timing | - Prioritize glycogen loading before key races; aim for >300 g of carbs 48 h prior
- During race: 30–60 g of carbs per hour via sports drinks or gels; hydration with electrolytes |
| **Post‑Race Recovery** | Rapid glycogen replenishment, muscle repair | - Within 30 min post‑race: 1:1 ratio of carb to protein (e.g., 50 g carbs + 20–25 g protein)
- Continue balanced meals for 24–48 h; adequate sleep |

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## Practical Take‑away

| Situation | What to Do |
|-----------|-----------|
| **Long training (>90 min)** | Consume ~30–60 g of carbohydrates per hour (e.g., sports drink, banana). Stay hydrated. |
| **Race day (3–4 h)** | Pre‑race carbohydrate meal (~150 g carbs 2–4 h before). During race: sip on a carb gel or sports drink every 45 min. |
| **Recovery** | Within 30 min of finish, eat a snack with 1:1 ratio of carbs to protein (e.g., chocolate milk). Follow up with balanced meal within 2 h. |

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## Summary

1. **Current intake** (~2000 kcal) is likely insufficient for your training load; aim for ~2400–2600 kcal/day.
2. **Protein**: https://codes.tools.asitavsen.com/montefugate148 1.6‑2.2 g/kg (~90–115 g). Distribute across meals and include whey or casein post‑workout.
3. **Carbohydrates**: 5‑7 g/kg (280‑400 g) to fuel workouts, replenish glycogen, and support recovery.
4. **Fats**: ~0.8–1 g/kg (~35‑45 g), focusing on healthy sources.
5. **Micronutrients**: Ensure adequate iron, calcium, vitamin D, B12, magnesium, zinc; consider a multivitamin if diet lacks variety.

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## 3. Practical Training & Nutrition Plan

| Day | Session | Main Focus | Volume / Intensity | Key Nutritional Cue |
|-----|---------|------------|--------------------|---------------------|
| Mon | **Upper‑Body Strength** | Compound lifts (bench, rows) + accessory work for muscle balance | 4–5 sets × 6–8 reps (70–80 % 1RM) | Pre‑workout protein+carb (~30 g each), post‑set whey shake |
| Tue | **Lower‑Body Hypertrophy** | Squat, deadlift variations + lunges | 3–4 sets × 10–12 reps (60–70 % 1RM) | Carb loading day: higher GI carbs pre & post; protein ~25 g each |
| Wed | **Active Recovery / Mobility** | Light cardio, foam rolling, stretching | N/A | Focus on hydration and electrolytes |
| Thu | **Upper‑Body Strength** | Bench press, rows, overhead press | 4 sets × 3–5 reps (80–90 % 1RM) | Low carb; protein ~30 g post |
| Fri | **Lower‑Body Power** | Squat, deadlift variations, plyometrics | 3 sets × 2–4 reps + explosive drills | Carb refeed after workout; high‑protein shake |
| Sat | **Optional Conditioning / Sport Practice** | HIIT, circuit training, or team practice | N/A | Balanced meal with moderate carbs and protein |
| Sun | **Rest & Recovery** | Light mobility work, foam rolling | N/A | Calorie‑balanced dinner, focus on sleep quality |

### 3.5 Weekly Training Volume & Intensity Progression

| Week | Main Strength Sets (Total) | Total Power/Explosive Work | Max Load % |
|------|-----------------------------|----------------------------|-----------|
| 1 | 20 sets | 15 sets | 70–75% |
| 2 | 22 sets | 18 sets | 72–78% |
| 3 | 24 sets | 20 sets | 74–80% |
| 4 | 26 sets | 23 sets | 76–82% |

*Progressive overload is achieved by adding 2.5–5 kg per week to the main lifts, while keeping the same number of reps.*

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### 3. Nutrition & Recovery

**Calories:** ~3 200 kcal/day
**Macronutrients:**
- Protein: 1.8 g/kg → 144 g (576 kcal)
- Fat: 0.9 g/kg → 72 g (648 kcal)
- Carbohydrate: Remaining calories → ~2 100 kcal (~525 g)

**Meal Timing:**
- **Pre‑workout (1–2 h):** Oats + whey protein, banana, almond butter.
- **Post‑workout (within 30 min):** Whey shake + sweet potato + chicken breast.
- **Evening snack:** Greek yogurt with berries or cottage cheese.

**Hydration & Recovery:**
- 3–4 L water/day.
- 1–2 g protein supplement post‑training if meal not ready.
- Sleep: 7–9 h nightly.
- Optional: BCAAs during workouts if nutrition is sparse.

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### 6. Progression & Program Adjustment

| Phase | Duration | Key Focus |
|-------|----------|-----------|
| **0–4 weeks** | Skill acquisition + baseline conditioning | Master the basic lifts, refine technique; maintain low volume. |
| **5–12 weeks** | Strength & hypertrophy | Increase load gradually (≤10 % every 2 weeks); add accessory work for weaknesses. |
| **13–20 weeks** | Power/Explosiveness | Integrate Olympic-style movements, plyometrics; reduce overall time under tension. |
| **21–30 weeks** | Peak & Test | Taper volume; conduct performance tests (max lifts, 1‑RM). |

Adjust the schedule depending on progress and recovery status.

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## 5. Progression / Programming Strategy

| Phase | Key Focus | Volume (sets × reps) | Intensity (%1RM) | Frequency |
|-------|-----------|----------------------|-------------------|------------|
| **A** | Strength foundation | 3–4 × 6–8 | 70–80% | 2–3 days/week |
| **B** | Power & speed | 3–5 × 3–5 | 80–90% + explosive tempo | 1–2 days/week |
| **C** | Hypertrophy & conditioning | 4–6 × 8–12 | 60–70% | 2–3 days/week |

Alternate A, B, C every 3–5 weeks. Adjust based on fatigue.

### 7. Monitoring Progress

- **Strength gains:** Track maxes for each exercise.
- **Body composition:** Use skinfold calipers or DXA if available; otherwise monitor weight and visual changes.
- **Performance metrics:** Record sprint times, jump heights, endurance test results.
- **Recovery indicators:** Sleep quality, heart rate variability (if wearable), perceived muscle soreness.

Set realistic quarterly goals: e.g., increase squat by 10 kg, improve 400 m time by 5 s, reduce body fat from 18% to 15%.

### 8. Practical Tips for a Busy Athlete

- **Batch workouts:** Combine strength and conditioning in single sessions (e.g., 45‑min total).
- **Prioritize quality over quantity:** Focus on proper form; avoid excessive volume that leads to fatigue.
- **Use technology wisely:** Track loads, HR, sleep with simple apps or wearables.
- **Stay flexible:** If a session must be shortened, keep the most critical exercises (compound lifts + core work).

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## Bottom Line

1. **Your current program is too weak on compound strength** – essential for athletic performance and injury prevention.
2. **Introduce progressive squats, deadlifts, bench press, and overhead press** with proper periodization to build a solid base.
3. **Add core stability (planks, side planks) and mobility work (hip flexor stretch, thoracic rotations)** for functional strength.
4. **Keep the cardio component but reduce its volume or intensity** once you establish a strong strength foundation.

Implement these changes gradually; track your progress weekly, adjust loads as needed, and stay consistent. After 8–12 weeks, you should notice significant gains in power, endurance, and overall athletic performance—exactly what a rugby player needs to dominate on the field.