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Additional metabolic findings reported were reductions in blood glucose (sugar) and insulin. This is a very powerful finding, as high blood sugar and insulin resistance increase the risk of developing the Metabolic Syndrome and pre-diabetes, as well as chance of future heart attack or stroke.15 Improved insulin sensitivity may also explain some of the fat loss realized by the subjects. The authors noted that this effect may be directly related to the increase in muscle mass, allowing for more effective and healthier sugar control. While the on-cycle reduction in HDL does cause some concern, the other changes appear to balance out the metabolic effects to a neutral or even positive physical state. The liver enzyme studies did show elevations in two of the hormones measured, but these changes are known to occur with intense exercise; a third enzyme actually decreased, suggesting much of the change seen reflected muscle strain/damage as opposed to liver.10,16 Two of the subjects (both using oral AAS) did experience a doubling of AST and LDH, which would prompt further examination in a doctor’s office. Ultrasound imaging showed no changes in liver structure, though several of the subjects entered the study with fatty liver, possibly due to the high protein content of the diet, according to the study authors.
Since AAS are known to increase the production of red blood cells, clinicians monitor the hematocrit to make sure the blood is not becoming “too thick.” This effect has been seen in studies involving elderly men on testosterone replacement therapy, but none of the subjects in this series experienced a dangerous elevation in red blood cell mass.17 Also, immune function measures were not affected in a clinically significant fashion.
All told, the AAS users appeared to avoid any untoward effects of significance, with the exception of gynecomastia. The authors stated in the paper that there were no changes in the structure or function of either the heart or the liver outside of those expected in a group of power-trained athletes.10 In fact, the greatest concern raised by the authors was the possibility of a drug interaction due to the numerous drugs and supplements consumed. The final paragraph of the study is quite enlightening: “The picture emerging is one of a knowledgeable population of ‘users’ integrated into a subculture of clandestine use of drugs, able to manipulate substances in order to maximize the ‘advantages’ and minimize the disadvantages.”10 One might walk away from this study with a warm, fuzzy feeling that AAS use is not so dangerous after all and that even first-time users can achieve gains in muscle mass and definition relatively safely. Really, despite the lack of any apparent adverse side effects, one need realize there are many limitations to this report. First off, the number of subjects is very small. Secondly, seven of the 20 dropped out, primarily due to emotional or sexual problems. Third, five experienced gynecomastia and four became infertile, at least temporarily. Fourth, the subjects were not examined uniformly on-cycle or off-cycle, so it is likely that each time point represents a random mix. I think this is one of the biggest flaws of the study, as each data point has no relation to standard conditions. Fifth, the drugs vary all across the scale of AAS, including prohormones. Doses, number of cycles, duration of cycle, pattern (such as pyramiding), use of adjunct drugs (GH, thyroid hormone, clenbuterol, hCG, Clomid, etc.) are all different. Sixth, the drugs were sourced through the black market and the contents were not analyzed to determine potency and purity.
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Chemical Enhancement 
