Health Tips

Know your medication: Steroids

Have you ever heard of steroids? Chances are you have; perhaps from news regarding how a sports player uses steroids to boost his or her own performance (this is known as doping), or maybe you’re taking steroids for a medical condition. If you keep abreast of the development of Covid-19 treatment since last year, you may also know that doctors use steroids to treat severe Covid-19 cases. 

To the general public, steroids sound like a blanket term for a class of drugs that is powerful, addictive but may have significant side effects. While these knowledge are not wrong, there are more steroids medication than you would expect.

There are ‘two worlds’ in steroids

Not all steroids are the same. In general, steroids can be classified into two groups: corticosteroids and anabolic steroids. 

Corticosteroids

A rule of thumb: whenever a steroid is mentioned in the context of medical treatment, it usually means corticosteroids. Corticosteroids are a group of steroids that are very good at lowering the inflammation level in the body. It is commonly prescribed for various diseases, such as rheumatoid arthritis, asthma and inflammatory bowel disease (IBD). Dexamethasone, an example of corticosteroids, is what some doctors used to treat severe Covid-19 patients. Other examples of corticosteroids are prednisone, prednisolone and methylprednisolone.

Here’s a fun fact: do you know that our body makes steroids naturally? These natural steroids are important for many physiologic processes in our body, including stress response, immunity, nutrients metabolism, regulation of inflammation and levels of salts and electrolytes. Corticosteroids are essentially man-made steroids that are used as medical treatments.

As useful as corticosteroids are, they come with many side effects; those side effects can take place in many organs. Side effects range from those that are not necessarily serious but are displeasing to patients (eg, Cushingoid appearance) to those that are life-threatening (eg, serious infections). Here are the side effects caused by corticosteroids:

• Skin and appearance: 

  • Skin thinning

  • Purpura (Purple or red discolored spots on skin; occurs when small blood vessels in the skin burst, causing blood to pool under the skin)

Steroid purpura. Image credit to © DermNet New Zealand via Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand)

• Weight gain

• Cushingoid appearance, also known as ‘moon face’ (facial puffiness)

Patient’s facial appearance 3 months after therapy with inhaled fluticasone propionate and antidepressants. Ozlem Celik, Mutlu Niyazoglu, Hikmet Soylu and Pinar Kadioglu, CC BY 2.5, via Wikimedia Commons

• Acne

• Hirsutism (Excessive growth of dark and coarse facial hairs in women)

• Redness on face

• Striae (stretch marks)

• Eyes:

  • Cataract 

  • Increased intraocular pressure, which can lead to glaucoma

• Cardiovascular and heart related:

  • Water retention and high blood pressure

  • Higher risk of heart attack, stroke and heart failure

  • Possibly higher level of cholesterol

• Gastrointestinal related:

  • Gastric pain/ulcer, which the risk can be further increased if steroid is taken with nonsteroidal anti-inflammatory painkiller

• Bone and muscles:

  • Osteoporosis, which is reduced bone strength and higher risk of bone fracture.

• Metabolic effects:

  • Higher blood sugar level, which can complicate the treatment of diabetes if steroids is taken concurrently for other accompanying medical conditions.

  • Hypothalamic-pituitary-adrenal (HPA) axis suppression. This is a condition that happens when steroid treatment is stopped abruptly. The body’s own steroid hormones productions stopped all of a sudden, thus affecting one’s well-being. Symptoms include fatigue, weight loss, salt craving and stomach complaints.

• Others:

  • Lower immunity, which leads to higher risk of infection (But..but it is used in treating severe Covid-19 though? Well, it is complicated; but in simpler terms: in severe Covid-19, the patient’s own immunity goes haywire and enters into full-fledged inflammation. Steroids are used to reduce the extreme inflammation caused by the virus infection, not to eliminate the infection itself.)

  • Growth problems in children and adolescents

That is why you should never take steroids without the advice from a healthcare professional. If a doctor prescribes you steroids, you should also strictly follow the doctor’s or pharmacist’s instructions on how to take them. The reason that they are aware of the side effects of steroids medication but still prescribe you with steroids is because your medical condition may call for it, and the benefits of starting a steroid therapy outweighs the potential side effects you may experience. Talk to your healthcare professional on how to handle or prevent these side effects, and do not stop taking your steroid therapy without your healthcare professional’s advice.

Although corticosteroids do have many side effects, drug makers managed to make them into different dosage forms. What this means is that an asthma patient who requires steroid therapy, no longer needs to take a steroid pill and instead only needs to take inhaler steroids (known as inhaled corticosteroids). Such pharmaceutical innovation is amazing because by inhaling steroids, it stays largely in the lung and only an insignificant amount may enter the bloodstream. As a result, the overall body is exposed to less steroids, which results in fewer side effects.

Of course, not every steroid therapy calls for inhaled corticosteroids. In some cases, taking steroids pills (which have more side effects) is the only option. Other steroids form include injections, nasal sprays (used in the treatment of allergies), and topical steroid creams (used in the treatment of eczema and psoriasis). The less exposed the other body organs are to steroids, the lesser the side effects.

Anabolic steroids misuse

Now let’s talk about another group of steroids called anabolic steroids, commonly known as androgens.

Similar to corticosteroids, androgens occur naturally in human’s body too; testosterone is one of them. However, unlike corticosteroids, androgens have limited medical use. It is used in he treatment of hormonal problems in men or as hormone replacement therapy for transgender individuals. However, androgens are more famous for its performance-enhancing ability and its abuse in sports. 

Because anabolic steroids mimic the naturally occurring hormones in the body, recreational athletes (eg, weightlifters and bodybuilders) who use them to improve overall strength and personal appearance. Occasionally, high-profile athletes were also reported to misuse androgens to enhance their performance. This is known as anabolic steroids misuse.

All androgens have some side effects when taken in high doses; other side effects depend upon the structure of the androgen or the steroids to which it is converted. 

• Physiological

  • Acne

  • Male pattern baldness

  • Liver Damage

  • Premature closure of the growth centers of long bones (in adolescents) which may result in stunted growth

  • Stunted growth and disruption of puberty in children

• Psychological

  • Increased aggressiveness and sexual appetite, sometimes resulting in abnormal sexual and criminal behavior, often referred to as “Roid Rage”

  • Withdrawal from anabolic steroid use can be associated with depression, and in some cases, suicide.

• Males only:

  • Breast tissue development

  • Shrinking of the testicles

  • Impotence

  • Reduction in sperm production

• Females only:

  • Deepening of the voice

  • Cessation of breast development

  • Growth of hair on the face, stomach and upper back

  • Enlarged clitoris

  • Abnormal menstrual cycles

Deaths were reported with anabolic steroids misuse. This is no joke, guys. 

Steroids can be found in unimaginable places

Are you a big fan of traditional herbal products and supplements, and often buy them from random sellers who are not healthcare professionals? Be careful. Just when you thought the herbal products are unbelievably effective, you might be putting your own health in danger.

Many herbal and traditional products which are not registered with the National Pharmaceutical Regulatory Agency (NPRA) can be adulterated with steroids to boost the effects it claimed to provide. We should be careful with those medicine or food with extravagant medical claims as they may contain steroid components. This is commonly seen in medicines that used to miraculously stop knee pain after consumption of the product. Some examples of products tested positive with steroids are;

• Tunglin

• Majun Dua Istimewa

• Gamat Ikan Haruan Plus

• Majun Taufiq Dua Istimewa

• Delima Raja Urat

• Madu Adunan Herba

Traditional medicines that are contaminated with steroids can be easily obtained in retail shops. This is why you should never buy healthcare products from non-healthcare professional individuals. And always check if the product is registered with NPRA, as evident by the presence of the Meditag hologram sticker. 

Image credit: http://www.myhealth.gov.my/en/current-meditagtm-hologram-security-sticker/

Read more on how to spot choose traditional medicine wisely in this article.

A word from DOC2US

If you have any questions related to steroids, you can consult our professional doctors and healthcare professionals on DOC2US. DOC2US is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere.  For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

Download DOC2US app on Apple App Store, Google Play Store and Huawei App Gallery; or use our web chat at https://web.doc2us.com/

Till then, stay at home and take care!

Note: DOC2US is not for medical emergencies. In the event of severe medical conditions, please call 999.

Disclaimer: As a service to our users and general public, DOC2US provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1.  

   Use of androgens and other hormones by athletes - UpToDate. Accessed February 17, 2021. https://www.uptodate.com/contents/use-of-androgens-and-other-hormones-by-athletes?search=Use%20of%20androgens%20and%20other%20hormones%20by%20athletes&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

2. Major side effects of systemic glucocorticoids - UpToDate. Accessed February 17, 2021. https://www.uptodate.com/contents/major-side-effects-of-systemic-glucocorticoids?search=Major%20side%20effects%20of%20systemic%20glucocorticoids&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

3. Norliza. Steroid. PORTAL MyHEALTH. Published July 21, 2014. Accessed February 17, 2021. http://www.myhealth.gov.my/en/steroid/

4. Steroids. nhs.uk. Published October 18, 2017. Accessed February 17, 2021. https://www.nhs.uk/conditions/steroids/

5. Anabolic steroid misuse. nhs.uk. Published October 17, 2017. Accessed February 17, 2021. https://www.nhs.uk/conditions/anabolic-steroid-misuse/

    

Written by

Ms Joyce Toh