by Mike Arnold
“Bodybuilding isn’t about health” is a statement uttered frequently by today’s BB’ing enthusiasts. Yet, as a byproduct of the physical culture movement, its practice was rooted in a philosophy which placed health above all else. Throughout the first few decades of the sport, this core value remained central, with physical development being considered just one aspect of the greater whole, but as the years passed by a gradual transition took place, in which the original principles that defined the movement gave way to the appearance centered incarnation that dominates today.
This shift in priorities was met with no small amount of resistance, as bodybuilding purists continued to push their ideals on the masses, but as the 1960’s drew to a close it became apparent that the tide was changing.
As steroids began to infiltrate physique competition on a global scale, old-school ideologies took a back seat to the new competitive model, which proclaimed “let the best physique win”. For the first time in history, BB’rs could be judged solely on the quality of their physique without racial, educational, or moral bias. While this lent a degree of fairness to the judging process and advanced BB’ing as a whole, it also served as the catalyst for the health problems that were to follow.
Now that success was determined solely by appearance, anything which offered an advantage in this area was viewed with considerable interest. With steroids possessing profound physique altering capabilities, they, along with training and diet, became priority #1. As the years went by and doses grew, so did the number of reported adverse health events, prompting researcher’s to examine the relationship between steroid use and health. By the 1980’s, a link to liver, kidney, endocrine, and cardiovascular function had been clearly established, although our understanding was still limited. However, by the 1990’s and especially into the 2000’s the evidence was irrefutable—the verdict being that steroids were capable of directly contributing to a variety of health ailments affecting multiple bodily systems.
This departure from the original guiding principles of the sport, while understandable given the circumstances, bears sole responsibility for the health problems we see today, whether they be drug, diet, or training related. But, instead of being met with the concern these issues demand, many choose to remain in a state of denial, as if ignoring the underlying problem undermines its existence. Apathy has become the prevailing attitude at best, and at worst, some have forsaken common sense altogether and taken on a “get big or dye trying” mentality.
While competitive BB’ing has progressed to the point where it is unlikely we will ever be able to completely separate the good from the ugly, with all the knowledge we have at our disposal, we no longer need to accept a roll the dice approach to drug use, nor does one necessarily need to compromise their future success in this sport in order to maintain a fair degree of health. We have come quite a long way in our understanding of both BB’ing pharmacology and how to minimize the damage associated with its application. Anyone who fails to take advantage of this knowledge acts foolishly, putting their health at risk. The take home message here is that while we cannot prevent all harm, we can certainly help mitigate it by taking the proper steps, giving us the best chance of living a long life absent of serious drug-induced health problems.
Perhaps the most serious of all steroid-related side effects are their ability to negatively affect the cardiovascular system, which they can do not only by increasing blood pressure, altering the lipid profile, and elevating hematocrit, by through the direct remodeling of heart tissue, resulting in both cardiomegaly (enlarged heart) and compromised function. Although there is little we can do limit the later, outside of avoiding the mega-doses advocated today, there is much we can do to help keep the other health markers in range, drastically reducing the possibility of experiencing an adverse cardiovascular event(s).
Without getting into great detail, I will highlight some of the most important steps a BB’r can take to maintain health in this area. Let’s begin with cholesterol, or lipids. All AAS have the potential to adversely affect lipids, but one category of AAS is much more injurious than the rest. These are the methylated steroids; those that are typically administered orally. While there are a few oral steroids which are not methylated, the vast majority of them are. This is done out of necessity, as the methyl attachment is what allows the steroid to survive its first pass through the liver, safely delivering the steroid into the bloodstream where it can then be used for muscle growth. Without this methyl attachment, most steroids would be rendered inactive, preventing the individual from receiving their benefits. Injectable steroids bypass the digestive system completely, being delivered directly into the bloodstream via intramuscular injection, so a methyl attachment is not required.
It is this methyl attachment which is largely responsible for the negative fluctuations in cholesterol levels seen in most oral steroid users. When we hear about BB’rs coming back from the doctor’s office with an HDL (good cholesterol) reading in the single digits, you can be almost certain that methylated steroids were involved. They are the “cholesterol killers” and pose the single greater risk to our cardiovascular health of all steroids. In an ideal world, methylated drugs would be avoided unless preparing for a competition, or if they are used throughout the year, it becomes critical to not only properly cycle these AAS (one must consider their liver function as well, as methyls are potentially stressful to the liver), but to utilize cholesterol support products, which can help minimize the negative effects of methyls on lipids.
Of course, diet also plays a key role in maintaining cardiovascular health, so if one is serious about protecting themselves, in makes no sense to take the above recommendations and then work against that end goal by following a diet loaded with trans-fats, high fructose corn syrup and other processed sugars, refined grains, and fats from animals fed unnatural diets. In terms of cholesterol supplementation, there are a variety of effective cholesterol modulating supplements on the market. There more of them you can include in your program, the better. In my personal experience, I have witnessed numerous BB’rs maintain a fairly normal cholesterol profile even with the semi-regular use of methyls (with appropriate off-time) by adhering to the supplement and dietary guidelines mentioned here. I should also mention that these recommendations are directed primarily to long-term steroid users (or those who plan to be), not those who will only run a hand-full of cycles and then be done with it.
Blood pressure is the next biggie on the list. The first step in controlling BP starts with monitoring. Whether you to go to local pharmacy or have a blood pressure reading device of your own, the ability to check your BP regularly is of crucial importance, as even small changes in drug use, diet, or even stress levels can cause rapid and meaningful changes in one’s blood pressure. While the failure to manage lipids results in accumulative damage over time, extreme elevations in blood pressure is potentially dangerous from an acute standpoint, while also resulting in accumulative damage. As with lipids, there are a variety of OTC supplements, as well as prescription drugs which one can employ in order to significantly lower blood pressure.
Two other relevant and interrelated factors are steroid type and estrogen levels. Quite frankly, some steroids are worse offenders than others when it comes to their effects on blood pressure. In most cases, but certainly not all, those drugs which cause the most water retention are likely to result in the largest elevations in blood pressure, while drugs which lack this characteristic, such as Primobolan, are usually much more mild in this regard. Personal response will also play a role in how we respond to the various AAS, so while we can and should use the experiences of others to help us make informed decisions, personal experience should still be our primary teacher.
Excess estrogen can also be problematic, as it is associated with an increased level of water retention and therefore, a rise in blood pressure. However, this side effect is rather easy to control, as AI’s (anti-estrogens) allow us to control the rate of aromatization and keep estrogen levels within a normal range. One of the worst things a BB’r can do, if he wants to avoid a heart attack, is take a boat-load of steroids without any regard for their water-retaining and/or estrogen increasing properties. You can spot these guys a mile away with their big, bloated, red faces, who look like they would pop if you poked them with a needle. There is no longer any excuse for this kind of haphazard approach to steroid use.
Perhaps the most frequently ignored cardiovascular risk factor is elevated hematocrit. Hematocrit is the percentage of red blood cells in the blood. As hematocrit rises, the blood gets thicker, increasing the possibility of forming a blood clot leading to stroke. The problem is that all AAS increase red blood cell production and they do so quite substantially. Decades ago, prior to the arrival of EPO, AAS were the preferred treatment method for those with anemia (deficient red blood cell production), so one should not underestimate the ability of AAS to increase RBC count. As with the other health markers, the goal is to keep hematocrit in a normal range.
There are a few ways we can go about this, all of which you can include in your program for little to no cost, and one of them might even earn you a few dollars. The first and most effective is giving blood, but keep in mind that your blood will be refused if you tell them you have a history of steroid use. This is because steroid users are considered to share many of the same risk factors as I.V. drug abusers—the connection being needle-sharing. As absurd as this sounds, it is reality and until such time that ignorance departs from this establishment, things will continue to remain this way. However, there is an alternative—self blood-letting. While I am not going to recommend this due to the fact that you could pass out mid-way through and bleed out, it is really no different than donating blood at a clinic. Obviously, having someone around you while you do this is a good idea. I am assuming that anyone who goes this route will have thoroughly educated themselves regarding the amount of blood which can be safely drawn at one time and how frequently the procedure can be repeated.
Aspirin, while not a cure, can also be effective, as anything which thins the blood reduces the likelihood of experiencing a stroke. Many steroid users opt to use baby aspirin at low doses on a daily basis; particularly when using higher dosages and/or steroids known to having a potent effect on RBC production (ex. Anadrol, EQ), which brings me to my next point—steroid selection. Some drugs appear to be worse in this regard than others, but like with many steroid-related issues, personal response can make a big difference in how one responds to these drugs. Some people seem to be more prone to experiencing sharp increases in hematocrit, while others are only moderately affected, but don’t fool yourself, steroids will increase hematocrit in everyone and depending on your natural hematocrit level, it may not take much to bring you into the danger zone.
The final factor to take into consideration is your hydration level. Dehydrations results in a direct increase in hematocrit by reducing the amount of plasma in the blood (i.e. the liquid component of blood). Therefore, staying hydrated is of paramount importance, as a single day of dehydration could be all it takes to initiate the formation of a blood clot. With all the other risk factors already working against us, why add another one to the list when it is so easily avoided? Stay well hydrated at all times and not only will it reduce your chances of having a stroke, but it will provide numerous other health benefits, as well.
While many younger steroid users, due to their current good health, tend to downplay the risks involved, there is not a single BB’r, who, after having experienced a serious adverse cardiovascular event, did not regret his decision to forgo comprehensive monitoring and preventative care. What many don’t realize is that much of the damage which takes place with AAS is accumulative. We don’t just wake up one day and all of a sudden have problems. They build up slowly, over time, starting when we are young and continue to worsen the longer these drugs are used until the day comes when the BB’r has an unexpected heart attack or stroke, or the doctor tells him that he will need triple bypass surgery at age 43.
And don’t think that if you make it through your steroid using days intact that you are off the hook. It doesn’t work that way. Since the damage is accumulative and long-lasting, once the damage has been done, the individual will continue remain at risk for developing serious cardiovascular health problems, even years after AAS have been discontinued. As steroid users we need to take responsibility for our health, as no one is going to do it for us. Just about every suggestion here, even the supplementation, can be implemented for either free or at a relatively low cost. In combination with these suggestions, bloodwork and blood pressure monitoring are an absolute must, as this is the only way to accurately track lipids, blood pressure, and hematocrit. Keep these health markers in range, and you greatly increase your chances of living a long, healthy life.