Vorona Elena, Nieschlag Eberhard
Division of Endocrinology, Diabetology and Nutritional Medicine, Department of Gastroenterology and Hepatology, University Clinics of Münster, Münster, Germany.
Center of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany -
Minerva Endocrinol. 2018 Dec;43(4):476-488. doi: 10.23736/S0391-1977.18.02810-9. Epub 2018 Feb 19.
Despite the fact that sports organizations and legislators have introduced various mechanisms to discourage athletes from using performance and appearance enhancing substances a high percentage of athletes admits to their unabated application. In competitive athletics, bodybuilding and in recreational sports anabolic androgenic steroids (AAS) continue to be the substances most abused. This review summarizes the side effects of AAS abuse on organs and system functions in both sexes. High doses of AAS cause a significant increase of erythrocytes and hemoglobin concentration, which may lead to thromboembolism, intracardiac thrombosis and stroke. Long-term AAS abusers have a higher incidence of arrhythmias, atherosclerosis, concentric left-ventricular myocardial hypertrophy with impaired diastolic function and also sudden cardiac death. Changes of liver function and structure, up to hepatocellular carcinoma, have been described, mainly in cases of chronic misuse of 17α-alkylated AAS. Sleeplessness, increased irritability, depressive mood status are often observed in AAS abuse. In former AAS abusers depression, anxiety and melancholy may persist for many years. Due to negative feedback in the regulation of the hypothalamic-pituitary-gonadal axis AAS can cause reversible suppression of spermatogenesis up to azoospermia. In women the changes most often caused by AAS abuse are hirsutism, irreversible deepening of voice, dysmenorrhea, secondary amenorrhea with anovulation and infertility. AAS abuse notwithstanding, under clinical conditions testosterone remains the most important hormone for substitution therapy of male hypogonadism.
尽管体育组织和立法者已经引入了各种机制来劝阻运动员使用提高成绩和改善外观的物质，但仍有很大比例的运动员承认他们仍在持续使用这些物质。在竞技体育、健美运动和休闲体育中，合成代谢雄激素类固醇（AAS）仍然是滥用最多的物质。这篇综述总结了滥用AAS对男女器官和系统功能的副作用。高剂量的AAS会导致红细胞和血红蛋白浓度显著增加，这可能会导致血栓栓塞、心内血栓形成和中风。长期滥用AAS的人心律失常、动脉粥样硬化、同心性左心室心肌肥厚伴舒张功能受损以及心源性猝死的发生率更高。已经描述了肝功能和结构的变化，直至肝细胞癌，主要发生在长期滥用17α-烷基化AAS的情况下。滥用AAS时经常会观察到失眠、易怒增加、抑郁情绪状态。在以前滥用AAS的人中，抑郁、焦虑和忧郁可能会持续多年。由于下丘脑-垂体-性腺轴调节中的负反馈，AAS可导致精子发生可逆性抑制直至无精子症。在女性中，滥用AAS最常引起的变化是多毛症、声音不可逆变深、痛经、无排卵继发性闭经和不孕。尽管存在AAS滥用的情况，但在临床情况下，睾酮仍然是男性性腺功能减退替代治疗中最重要的激素。
