Anabolic Steroids, Growth Hormone, and Hypertrophy of the Heart

The debate on the effect of anabolic substances on the structure of the heart reached another phase, since Finnish scientists studied twenty local bodybuilders who had just finished their cycles. Steroids don’t damage the heart, the researchers found. But the combination of steroids and growth hormone does.

Context

Since the eighties scientists have been discussing whether steroids enlarge the heart, when several sports investigators learned steroid use was associated with enlargement of the left ventricular mass – the part of the heart that pumps oxygenated blood through the body. An overdeveloped left ventricle causes arrhythmia and, in severe cases, death.

In 2001 Australian physicians found the hypertrophy in clean strength athletes and postulated that this condition was caused by weight training, not steroid use. They also found that the hypertrophy didn’t impair their subjects’ health.

The new Finnish study, published in the International Journal of Sports Medicine in the summer of 2003, doesn’t contradict the Australian study. Nevertheless, it provides insight into the relationship between anabolic substances and heart hypertrophy.

Study

The Finnish ran an advertorial in a bodybuilding magazine on their project. Twenty bodybuilders, who had planned to do a cycle and bought their medication on the black market, responded. Before their cycle started the bodybuilders had their medication checked and analysed by the pharmacological department of the university. Not unnecessary, because up to fifty percent of the European black steroids may be counterfeited, according to the latest estimates.

Sixteen bodybuilders used steroids only. The weekly doses varied from a few hundred milligrams to more than thousand milligrams. Four athletes stacked their steroids with growth hormone. All four used moderate dosages of two, three or four IU’s during four to six weeks. The growth hormone was injected once daily, mostly in the evening. In this group steroid doses were 1,3 times higher than in the steroids only group.

When their cycles ended, the bodybuilders had their hearts examined. The table below summarizes some results. The control group consisted of fifteen young males with active life styles who didn’t engage in weight training.

Results

Steroids and the combination of steroids and growth hormone change the structure of the heart, the table suggests. But that doesn’t have any consequences for the cardiovascular health of at least the steroid users. Their diastolic blood pressure – reported to rise phenomenally in some steroid related medical horror-stories – was fine, and more interestingly, their E/A ratio improved. Cardiologists use the E/A ratio to measure the hearts efficiency. According to the table, in the steroids only group deterioration of the heart muscle didn’t occur.

But growth hormone, well, that is another story. The table speaks for itself. The higher steroid doses that the GH-users took can only explain a small part of the serious ventricular hypertrophy, the Finnish stress. They suspect that the lowering effect of androgens on the IGF-1-binding protein 3 concentrations causes the ventricular growth.

Discussion So far not so good. But there is more. The Finnish discovered something very interesting about the nature of the relationship between anabolic aids and hypertrophy of the heart: it’s direct. For example, the Finnish asked their subjects for how many years they had been using steroids. The answers varied from one to twelve years.

Statistically the relationship between lifetime steroid use and the E/A ratio was weak. On the other hand, the mean steroid dose of the present cycle was a strong predictor of variables like E/A ratio, ventricular weight of relative wall thickness. This means that cycles don’t have a cumulative effect on heart hypertrophy.

The Finnish discovered that even the pronounced impact of cycles with added growth hormone wears off. That became evident when they investigated an athlete three times: when he just finished a five weeks cycle of steroids and growth hormone, after a wash out period of 237 days, and just after he completed a steroids only cycle.

The results are in the figure below.

Of course a study with twenty users is not conclusive. But the study suggests that

1. just like the Australians proved before, steroids are not as disastrous for the heart morphology as some agencies want you to believe;
2. the combination with growth hormone does however add considerable cardiovascular risks to steroid cycles; and
3. the deleterious effects wear off during wash out periods.

Especially athletes in their late thirties and older should take their wash out periods seriously. The age of the subjects in the Finnish study ranged from 25 to 43. In this population age was the strongest predictor of the E/A ratio. The older they were, the lower their ratio ratio. (The Pearson’s correlation coefficient was –0.70. The coefficient of mean steroid dose and E/A ratio was –0.42.)

Sources

Karila TAM, Karjalainen JE, Mantysaari MJ, Viitasalo MT, Seppala TA. Anabolic Androgenic Steroids Produce Sose-Dependent Increase in Left Ventricular Mass in Power Athletes, and this Effect is Potentiated by Concomitant Use of Growth Hormone. Int J Sports Med 2003; 24: 337-343.

Sader MA, Griffiths KA, McCredie RJ, Handelsman DJ, Celermajer DS. Androgenic anabolic steroids and arterial structure and function in male bodybuilders. J Am Coll Cardiol. 2001 Jan;37(1):224-30.

About the author

Willem Koert

(Anti-)Doping Expert at Dopingautoriteit Netherlands

Willem Koert holds a Master of Science in Sociology. In the 1990s, he published an ethnographic study on bodybuilding subculture. He has also investigated the black market for steroids for the Dutch health department. He currently works as a science writer for academic and national newspapers and professional magazines for the Dutch and European food industry. His prime interest however lies in bodybuilding. Therefore he publishes Ergogenics, a newsletter on bodybuilding related science.