Anabolic steroids: a review of their effects on the muscles, of their possible mechanisms of action and of their use in athletics

Anabolic steroids are synthetic molecules developed in the hope of obtaining a complete separation of the androgenic and myotrophic (anabolic) actions of testosterone. Such a goal has never been fully achieved. However, some synthetic steroids present a partial dissociation between these two activities. Since a single hormonal receptor apparently mediates the androgenic as well as the anabolic actions of testosterone, differences in patterns of androgen metabolization in the muscles and the sex accessory organs have been proposed as a possible cause of this phenomenon. Undoubtedly, androgens are able to exert a trophic effect on skeletal and cardiac muscle fibres in subjects with low circulating levels of testosterone such as prepubertal or hypogonadal males and females; however, the widespread use of anabolic steroids in male athletes to increase their physical performances poses the question of whether these compounds are active in the presence of normal circulating levels of testosterone. Most experimental animal studies indicate that anabolic steroids are ineffective in this situation. Since the results of the experiments performed in humans are largely contradictory, it is still not clear whether anabolic steroids are able to improve athletic performances. These and other relevant issues are reviewed.