Corticosteroids are a synthetic man-made drug which closely resembles cortisol, a hormone naturally produced from the adrenal glands. Cortisol is essential for health and wellbeing. During stress, the body produces extra cortisol to prevent it from becoming sick. When cortisol is released into the bloodstream, it proceeds to act on different parts of the body and helps with: the body’s response to stress or danger, reducing inflammation, controlling blood pressure, influencing memory formation, controlling salt and water balance, and increasing the body’s metabolism of glucose.
Common corticosteroid medications include prednisone, prednisolone, cortisone, hydrocortisone, and methylprednisolone.
While steroids are commonly associated with bodybuilders and people who aim to illegally increase lean muscle mass, there are many legitimate medical uses for steroids. Corticosteroids are a common group of steroids which are used to treat arthritis, asthma, autoimmune diseases (such as Lupus, Crohn’s disease, and multiple sclerosis), myositis (inflammation of the muscle), skin conditions, eye diseases, Addison’s disease, and some types of cancer. They can also be used to prevent or reduce nausea caused by chemotherapy, and decrease some types of allergic reactions.
Corticosteroids can be taken orally as a pill, injected directly into inflamed areas such as joints, taken through an inhaler (for the treatment of asthma), given as an intravenous or intramuscular injection, as eyedrops or ear drops, or applied topically as creams or ointments. Local steroid treatments (applied directly to where the problem exists) are preferred to systemic treatments (used throughout the body) due to their reduced risk of side effects.
Anabolic steroids, on the other hand, are synthetic drugs that imitate the masculinizing effects of the male sex hormones, particularly testosterone.
Testosterone is commonly known as the ‘male sex hormone’ even though it occurs naturally in females as well, although in much smaller amounts. This hormone is known to have both anabolic and androgenic effects, which aid with promoting bone density, muscle growth, and the rapid recovery from injury (anabolic effects), as well as developing and maintaining all of the male characteristics, such as hair growth, voice deepness, and muscle mass (androgenic). The anabolic group of steroids is the type mainly associated with performance enhancement and abuse in competitive athletics and weightlifting.
Anabolic steroids are used legitimately in medicine to treat low testosterone levels, delayed puberty in boys, and certain types of bone and blood disorders.
Steroids work by decreasing inflammation and reducing the activity of the immune system. Inflammation is caused when the body’s white blood cells and chemicals act to protect the body against infection and foreign substances such as bacteria and viruses. With certain medical conditions such as autoimmune diseases, the immune system doesn’t work properly and causes it to mistakenly attack its own body tissues, causing inflammation. Symptoms of inflammation include redness, warmth, swelling, and pain.
Steroids work to reduce the production of the chemicals that cause the inflammation, keeping tissue damage as low as possible. Steroids can also affect the activity of the immune system by changing the way the white blood cells work. Corticosteroids also prevent cells in the body from multiplying by shutting down the production of DNA.
If only required for a short amount of time, the initial doses of corticosteroids will be high and continue for a few days to a week or so, and then will be stopped abruptly at the end of the course. If high doses are taken for more than three weeks, the dose will need to be lowered and tailed off gradually.
For patients requiring treatment for a longer period of time, the dose starts off high to control symptoms, and then is gradually reduced to a lower daily dose that keeps symptoms away. The length of steroid treatment varies depending on the patient and the disease, with some treatment being gradually stopped as condition improves, while other treatments are lifelong, as the symptoms return if the steroids are stopped.
Short courses of steroids usually cause minimal to no side effects, while long-term use over around 2 – 3 months, or recurring short courses are more likely to cause side effects. Patients should not just stop the medication if they have been taking it for longer than 3 weeks as they may develop serious withdrawal effects if the body has become used to the steroids. A change in any dose should be supervised by a doctor, and any reductions should be done slowly over a number of weeks. Steroid dose reductions must be done gradually due to fact that the body produces steroid chemicals naturally, which are required to be healthy, and when an individual takes synthetic steroids for a few weeks or more, the body may reduce or stop making its own steroid chemicals. When a course of steroids is suddenly stopped, the body may be left with no steroids which can cause various and often severe withdrawal symptoms which last until the body resumes making natural steroids over a few weeks. The symptoms of steroid withdrawal include
Side effects of steroid medication use include
Alternatively, the side effects of anabolic steroid use include
Steroids should be used with caution in people who have a damaged liver or liver problems, a history of mental health problems, open wounds which are healing, a history of stomach or duodenal ulcers, osteoporosis, cataracts, heart conditions such as recent heart attacks, heart failure, or hypertension, diabetes, epilepsy, or are pregnant or breastfeeding.
It is advised that an individual should not take any anti-inflammatory painkillers such as ibuprofen while taking steroids as the two in combination can increase the risk of a stomach or duodenal ulcer developing.
Many other medications interact with steroids, possibly affecting how they work. This could result in one or the other medication being rendered ineffective or having more side effects than normal. Examples of medications that interact with steroids include warfarin, Non-steroidal anti-inflammatory drugs (NSAID’s), live vaccines (vaccines which contain the germ they are protecting against), epilepsy medicines (particularly carbamazepine, phenytoin, and phenobarbital), diabetes medication, certain inhalers (especially those containing salbutamol which can cause complications with steroids), Digoxin (used for heart failure and arrhythmias), diuretics, and treatments for HIV and AIDS.
It is also advised that an individual taking a course of steroids for more than 3 weeks should consider getting a medical bracelet to alert medical staff that they are taking steroids if they become unconscious for a prolonged period of time.
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