These were closer to what is considered “normal” in the world of corticosteroids, and as he continued the treatment, decreasing his dosage every two weeks, the side-effects began to taper off. Now, at 20 mg, the various mental states have disappeared and his hands have become steady once again.
Corticosteroids are the most commonly prescribed steroid, and that has slowly led to an eagerness and tendency for doctors to fork over prescription forms without hesitation. “They’re overprescribed because doctors just don’t have other tools they can use,” Kokayi says. “So there’s more reliance on steroids to get the job done.”
The choice Levin had to make isn’t an easy one, and it’s one prescribed-steroids users are often forced to make. “It’s a calculated acceptance on the part of the patient and their physician to understand what the consequences are, and someone very often has to decide between the ravages of their disease or the ravages of the steroids that are helping them,” says Dr. Bernstein.
These are the effects of steroids when they are prescribed. When a doctor endorses what they believe is the best course of action. When tests are done in advance, doses are controlled and effects are closely monitored.
This is not the category stereotypical steroids users fall into.
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“There are ways to notice when guys are on steroids,” says Rhys. “[In] gym locker rooms, people go inside the stalls [and use], I’ve seen that a couple times.”
The list of physical signs of steroids use is long and always changing, but there is a group of usual suspects. It includes acne on the back, shoulders, underneath the chin; purplish and pinkish skin (“A lot of guys that are on roids tan, because the skin becomes very discolored,” says Rhys); a permanently bloated stomach despite the presence of abdominal muscles; shrunken testicles and enlarged breasts.
Under the skin, the risks are greater: reduced sperm count, liver disease and a heart attack or stroke are all things to be worried about, says Dr. Kokayi.
But the side-effect most easily observed and commonly known isn’t just topical—it is seen, heard and felt. It is roid rage.
“Psychologically [steroids] are a disaster. They are mood altering; they make people really crazy,” says Richard M. O’Brien, a psychology professor at Hofstra University. “Roid rage is very, very, very real.”
To try and understand what sends a steroids user from zero to 60 in a single “Hey, you lookin’ at me?” take a look at what is going on inside. The dosage prescribed by a doctor is intended to shock the body but not overwhelm it. The quantity being injected by LI’s gym goers is only being monitored by one person—the user.
“Illegal doses of anabolic steroids are 10 to 100 times higher than what a physician would prescribe,” says Dr. Rashmi Gulati, medical director at Patients Medical.
Our bodies follow a circadian rhythm, which dictates the quantity of hormones naturally secreted throughout the day. There are times when they are secreted more—the morning—and times when they are secreted less—the evening—says Dr. Bernstein. Instead of riding the highs and lows, injecting anabolic keeps the body in sixth gear with the accelerator floored.