‘Good’ vs. ‘bad’ steroids: They can be life-saving and can have adverse effects

Q: What’s the difference between steroids prescribed by doctors and the ones used by body builders?

A: Yes, the term can be confusing. But in fact, steroids are flowing through your blood and moving in and out of a variety of tissues and organs as you read this. And it’s likely they are helping to keep you healthy. Actually, steroids are essential to life. Many life-saving medications contain steroids.

How can this be? The answer lies in the fact that there are many types of steroids. Their effects in the body differ. And so do their side effects.

The body normally makes many steroids. Cholesterol is a building block of all steroid hormones. Cortisol, also known as a corticosteroid, is involved in many vital body functions, including energy regulation and immune function. Sex steroids include testosterone, estradiol and progesterone, which are important for sexual development, sex drive, ovulation and menstruation.

In addition to the body’s naturally occurring steroids, many medications contain steroids, most often corticosteroids prescribed to dampen inflammation. For example, prednisone is an oral steroid that mimics the actions of cortisol. Corticosteroids are the key ingredient in nasal sprays for allergies and inhalers for asthma. Topical corticosteroids treat a variety of skin diseases.

As a powerful anti-inflammatory agent, steroid effects can be life-saving. However, its benefits must be balanced against the serious side effects it can cause. The long list includes weight gain, higher blood sugar levels and increased risk of diabetes, suppression of the immune system, loss of bone density, insomnia, and mental health issues.

The types of steroids taken by body builders and other athletes to enhance athletic performance typically are anabolic steroids, like synthetic testosterone. They also have significant side effects, including emotional instability, anger, liver damage, stroke and blood clots in the legs or lungs. In addition to potentially offering unfair competitive advantages, that’s another important reason why they are banned by most athletic organizations.

Anyone who is thinking about taking steroids, whether for medical or other purposes, should have a healthy respect for their potential to cause trouble. But, it is a myth to say steroids are all bad. Just ask the person with arthritis who couldn’t move or function without corticosteroids, or the person with asthma who is spared emergency room visits and hospitalizations due to the powerful anti-inflammatory actions of steroids.

(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)