The most serious complication of anabolic steroid use is the development of hepatic tumors, either adenoma or hepatocellular carcinoma. The hepatic tumors arise in patients on long term androgenic steroids, usually during therapy of aplastic anemia or hypogonadism, but occasionally in athletes or body builders using anabolic steroids illicitly. Tumors are typically found after 5 to 15 years of use, but onset within 2 years of starting therapy with testerosterone esters has been described. Many of the case reports have occurred in patients with other risk factors for cancer, such as Fanconi?s syndrome, iron overload or chronic hepatitis C (from blood transfusions). However, hepatic adenomas and hepatocellular carcinoma have also been described in patients taking androgenic steroids who have no other evidence of liver disease and normal histology in the nontumor parts of the liver. The pathology of the tumors is usually hepatic adenoma or ?well differentiated? hepatocellular carcinoma or hepatic adenoma with areas of malignant transformation. Rare instances of cholangiocarcinoma and angiosarcoma have also been described in patients on long term androgenic steroids. Clinical presentation is generally with right upper quadrant discomfort and a hepatic mass found clinically or on imaging studies. Routine liver tests are often normal unless there is extensive spread or rupture or an accompanying liver disease. Alphafetoprotein levels are usually normal. There is often (but not always) spontaneous regression in the tumor when the anabolic steroids are stopped. Hepatocellular carcinoma arising during anabolic steroid therapy is believed to have a better prognosis than that related to cirrhosis or chronic hepatitis B and C; however, deaths from hepatic rupture or tumor spread and metastasis have been reported in patients with anabolic steroid related hepatocellular carcinoma without cirrhosis.
Other reasons for steroid abuse
Many buy steroids on the black market without a doctor’s prescription. One reason people give for taking steroids is to increase their muscle size and / or reduce body fat. This group includes people who have muscle dysmorphia, a behavioral syndrome in which people have distorted images of their bodies. Sometimes, people who have experienced physical or sexual abuse take steroids to boost muscle size. Adolescents abuse steroids as a part of a pattern of high-risk behaviors. Despite these commonly cited reasons, researchers agree that most steroid abusers do not have psychological problems when they start abusing the drugs.
A substance can be legal but may be banned in certain circumstances. For instance, an insurance company may test an insurance applicant for nicotine to verify the person's assertion that he or she is not currently using tobacco. In the case of prescription medications, the high addictive potential for certain medications makes drug testing important. In the case of some athletes, many of the prohibited substances are legal but have the potential to affect the athlete's performance. Athletes must exercise caution in their choices of medications as they are ultimately responsible for any substances detected in their bodies.