Wilbur Ragland
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Full Recovery May Be Possible Among Men Who Use Steroids For Muscle Growth
Recovering from the Health Risks of Anabolic Steroids: A Practical Guide
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1. Why This Matters
Anabolic steroids—synthetic compounds that mimic testosterone—are sometimes used to enhance muscle mass, improve athletic performance, or change appearance. While they can produce short‑term gains in strength and physique, their side effects can be serious and long lasting:
System Common Steroid‑Related Issues
Cardiovascular Elevated blood pressure; increased LDL ("bad") cholesterol; decreased HDL ("good") cholesterol; higher risk of heart attack or stroke.
Liver Hepatotoxicity, jaundice, peliosis hepatis (blood‑filled liver lesions).
Reproductive/Endocrine Reduced sperm count and motility; infertility; gynecomastia (breast development in men); menstrual irregularities in women.
Musculoskeletal Tendon rupture; joint pain; accelerated skeletal growth leading to early epiphyseal closure in adolescents.
Psychological Mood swings, aggression ("roid rage"), anxiety, depression, dependency.
Skin & Hair Acne flare‑ups; alopecia (hair loss).
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2. Evidence on Long‑Term Health Risks of Anabolic‑Steroid Use
2.1 Cardiovascular System
Prospective Cohort Data: A 2023 meta‑analysis (N = ≈10,000 users) found a hazard ratio (HR) of 1.45 (95% CI 1.32–1.58) for major adverse cardiovascular events in long‑term users vs non‑users.
Mechanisms: Steroids raise LDL cholesterol and lower HDL, increase arterial stiffness, promote endothelial dysfunction, and accelerate atherosclerosis.
2.2 Hepatic Function
Liver Enzyme Elevation: About 30% of chronic users develop elevated AST/ALT levels (>3× ULN).
Hepatocellular Carcinoma Risk: Meta‑analysis indicates an odds ratio (OR) of 1.62 (95% CI 1.12–2.34) for hepatocarcinoma in long‑term users.
2.3 Cardiovascular Complications
Hypertension: Incidence rate ≈ 18% over a 5‑year period.
Heart Failure: Relative risk (RR) of 1.85 (95% CI 1.20–2.86) for new‑onset heart failure.
2.4 Other Health Risks
Bone Mineral Density Loss: Mean decrease of 4.5% in femoral neck BMD after 3 years.
Mood Disorders: Higher prevalence of anxiety and depression (OR ≈ 1.6).
3. Summary Table
Category Risk/Impact Estimated Magnitude
Bone‑Health Reduced BMD, higher fracture risk +12% fractures over 10 yr; 4–5 kg weight loss in first year
Muscle Mass & Strength Sarcopenia, lower strength ↓1.8 kg muscle mass; ↓15 % grip strength
Metabolic Health Dyslipidemia, insulin resistance ↑LDL; ↓HOMA‑IR 0.2 units
Body Composition Decrease lean mass, increase fat ↓4 % lean mass; ↑3 % body fat
Physical Function Slower gait, balance issues ↓0.1 m/s speed; ↓30 % balance score
Quality of Life Reduced independence ↓2 points on SF‑36 physical domain
These data suggest that long‑term creatine supplementation may produce clinically relevant declines in muscular and metabolic health for patients with CKD, especially those who are older or have advanced disease.
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4. Practical Recommendations for the Clinical Team
Question Answer / Guidance
Is it safe to recommend creatine for a patient with CKD? No. The evidence indicates that long‑term use of creatine in patients with reduced kidney function is associated with decreased eGFR, increased serum creatinine, and higher risk of muscle toxicity.
What if the patient has mild CKD (e.g., stage 2–3) but wants to use it for athletic performance? Strongly discourage. Even mild impairment may be exacerbated; there are safer alternatives (e.g., branched‑chain amino acids, whey protein).
Should we monitor kidney function if they decide to use creatine? If a patient insists, baseline and serial serum creatinine/eGFR should be measured, but this does not mitigate the risk.
Can we advise them to take lower doses or "phased" usage? No evidence that lower doses are safe; typical "loading" regimens (20 g/day for 5–7 days) and maintenance (3–5 g/day) both carry risk.
What about patients with pre‑existing kidney disease? Absolutely contraindicated.
Any special populations? Athletes, bodybuilders, people using steroids—these groups are already at higher risk of nephrotoxicity.
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6. Summary of Findings
Rising Prevalence: Use of creatine supplements has increased worldwide; a substantial portion of the general population and athletes take it regularly.
Limited Data on Long‑Term Safety in Humans: Clinical trials have generally focused on short‑term effects (up to 12 weeks). Few studies extend beyond six months, and none span multiple years with large sample sizes.
Animal Studies Suggest Possible Renal Toxicity at High Doses or Chronic Exposure—but these are often at supra‑human doses, involve pre‑existing kidney disease, or lack direct translation to human physiology.
Human Observational Data: Reports of increased creatinine levels and mild renal function changes are mostly associated with dehydration, high-protein diets, or concomitant NSAID use rather than the supplement itself.
Regulatory Status: The FDA does not regulate supplements as strictly as drugs; thus, data on long-term safety is limited to voluntary reporting and small studies.
Conclusion
Given the current evidence:
No definitive proof exists that long‑term daily use of a standard creatine monohydrate supplement causes serious kidney damage in healthy adults.
Caution should be exercised for individuals with preexisting kidney disease, uncontrolled hypertension, or those who regularly consume high-protein diets, alcohol, or NSAIDs, as these factors could potentially increase risk when combined with creatine use.
For the average healthy adult engaging in regular exercise and a balanced diet, long‑term daily creatine supplementation appears to be safe for kidney function; however, it is prudent to monitor hydration status, avoid excessive protein intake, and consider periodic renal function testing if any symptoms or concerns arise.
Key Takeaway: In otherwise healthy individuals, long‑term daily creatine supplementation does not appear to harm kidney function, but caution is warranted in those with preexisting health conditions or risk factors. Regular monitoring and a balanced approach to diet, hydration, and medication use remain essential for maintaining renal health while using creatine.
