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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Medical Myths Medical Myths
 

Are All Steroids Bad?


October 10, 2013

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center

 


It's hard to escape the news stories about professional athletes gone bad by using performance-enhancing drugs, blood doping and steroids. So, it's understandable if you think steroids are bad.

But in fact, steroids are flowing through your blood and moving in and out of a variety of tissues and organs as you read this. And it's likely they are helping to keep you healthy. Actually, steroids are essential to life. Many life-saving medications contain steroids.

How can this be? The answer lies in the fact that there are many types of steroids. Their effects in the body differ. And so do their side effects.

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The Many Faces of Steroids

The body normally makes many steroids. Due to their similar chemical structures, all steroids are actually lipids (fats).

Here are the major categories of steroids and examples of each:

  • Cholesterol – This is a building block of all steroid hormones. Cholesterol may build up in arteries, causing heart attacks and strokes.
  • Cortisol – This hormone is made by the adrenal glands, two small organs that sit on top of the kidneys. Cortisol is involved in many vital body functions, including energy regulation and immune function.
  • Mineralocorticoids – These are hormones produced by the adrenal glands that regulate the body's balance of fluids and electrolytes (such as sodium and potassium).
  • Sex steroids – These include testosterone, estradiol and progesterone. Sex steroids are made mainly by the testes in men and the ovaries in women. Their actions include sexual development, sex drive, ovulation and menstruation.

In addition to the body's naturally occurring steroids, medications and supplements may contain steroids. Examples include:

  • Prednisone – This is an oral steroid that mimics the actions of cortisol. As a powerful anti-inflammatory agent, its effects can be life saving. However, its benefits must be balanced against the serious side effects it can cause. (See below.)
  • Inhaled steroids – A common example is fluticasone. It's found in nasal sprays and inhalers such as FloNase and FloVent, and other drugs).
  • Steroid enemas – Hydrocortisone enemas are commonly used for inflammation in the rectal area. This can occur in people with ulcerative colitis or Crohn's disease.
  • Topical steroids – Hydrocortisone cream in low concentration is available without a prescription. More potent versions need a prescription. They are most commonly used for skin inflammation found with eczema and many other skin disorders.
  • Androgens – These are "male" sex hormones, though women have androgens as well (though in lower amounts than men). The most common and legitimate use of testosterone is for men with problems related to low testosterone. However, many men also take androgens without a prescription (some of which are illegal) to increase strength and muscle mass.

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The Bright Side of Steroids

Steroid treatment can help dramatically improve some of the most common and debilitating diseases, such as:

  • Asthma – Steroids reduce inflammation in the airways and ease breathing.
  • Inflammatory bowel disease – Disorders such as ulcerative colitis and Crohn's disease are associated with inflammation of the digestive tract. Steroids can quiet this down.
  • Rheumatoid arthritis and gout – A low dose of steroids can quickly reduce the serious and destructive joint inflammation associated with these conditions.
  • Severe allergic reactions – A brief course of steroids can treat the itchy rash from contact with poison ivy or inflammation and swelling in the airways that may develop with severe medication reactions.

Doctors prescribe steroids for many other conditions as well.

  • When the body makes too little cortisol (a condition called adrenal insufficiency or Addison's Disease), steroid "replacement" therapy can be life saving.
  • Certain infections improve faster when steroids are given along with antibiotics compared with antibiotics alone. One example is a common pneumonia associated with HIV infection.

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The Dark Side of Steroids

Why do steroids have such a bad reputation when they help so many conditions? It's because of the long list of their potential side effects, including:

  • Cataracts
  • Weight gain
  • Leg swelling and facial fullness
  • Increased blood sugar (and risk of diabetes)
  • Suppression of the immune system and increased risk of infections
  • Muscle weakness
  • Osteoporosis
  • Insomnia
  • Confusion, hallucinations or mood changes

The types of steroids taken by body builders and other athletes to enhance performance may have other side effects, such as:

  • Nausea
  • Liver damage
  • Shrinking of the testes
  • Kidney failure
  • Stroke
  • Blood clots in the legs or lungs

This is why they are banned by most athletic organizations.

Some side effects of steroids can be avoided or treated.  For example, calcium, vitamin D and bone-building medications (such as alendronate) can counter bone loss and osteoporosis that may complicate treatment.  However, the best way to avoid complications is to minimize the duration and dose or, better yet, to avoid steroid use altogether.

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The Bottom Line

Anyone who is thinking about taking steroids, whether for medical or other purposes, should have a healthy respect for their potential to cause trouble. But, it is a myth to say steroids are all bad. Just ask the person with arthritis who couldn't move or function without steroids, or the person with asthma who is spared emergency room visits and hospitalizations due to the powerful anti-inflammatory actions of steroids.

As with any medicine, each person has to weigh the risks and benefits of taking steroids. Taking steroids only to build muscle mass or improve athletic performance, has no health benefits. So, while there are legitimate benefits associated with steroid use, it's easy to see why this class of medications has a bad reputation.

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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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