Opinion – Bruno Gualano: Hormonal modulation is Russian roulette

In 1939, Adolf Butenandt and Leopold Ruzicka were awarded the Nobel Prize in Chemistry for their description of the synthesis of testosterone. The discovery would benefit men with a deficiency in the production of this hormone – the so-called hypogonadism, which results in a loss of strength, libido, fertility, etc. But it wasn’t the therapeutic effects that gave testosterone and its analogues the current poster.

In the 1950s, anabolic steroids invaded the sport. In East Germany, a vast doping program — revealed by secret documents obtained after the fall of Communist rule — helped produce 150 gold medals in three decades.

More impressive than the sporting results are the reports of drugged athletes, who suffered from serious sequelae. “Bodies are destroyed, souls, too,” denounced former runner Ines Geipel, who presided over an organization to support victims, mostly women.

Surveys indicate that the use of anabolic steroids went beyond elite sport. Today, recreational practitioners of physical activity — those who train for aesthetics, pleasure or health — are the biggest adepts of these drugs.

Worldwide, an estimated 18% of people who exercise use anabolic steroids. In Brazil, the proportion of users can reach 33% among bodybuilders, in numbers underestimated by self-report.

Given the indications of a true epidemic of anabolic steroids, it is surprising that a growing number of health professionals endorse the use of these drugs for non-therapeutic purposes.

Many of these professionals are based on the premise that, with adequate dose regimens and monitoring, it is possible to safely achieve aesthetic results. The practice has generally been touted as hormone modulation — an ethically and legally convenient euphemism for anyone who fears being framed as a “bomb” prescriber.

It so happens that this hormonal modulation has no logical basis. In low amounts, anabolic steroids do not bring relevant benefits. For real gains to be made, supraphysiological doses are needed, capable of keeping testosterone levels above the normal range.

The point is that, precisely in this condition, the risks of adverse events are greater: atherosclerosis, cardiomyopathy, arrhythmias, hypogonadism, hypertension, renal failure, prostate cancer, mood and body image disorders, dependence, virilization (accentuation of masculine traits, such as excess facial and body hair, baldness, acne, deep voice, clitoral hypertrophy), subfertility, hepatitis, menstrual irregularities, etc. (I stop here due to space limitations).

There is nothing to indicate that patient follow-up with routine exams and prescription of “preventive drugs” can protect against such complex adverse events, especially since many of these can take years to manifest.

How to find the fine adjustment of dose capable of producing benefits without causing harm? Science is far from the answer (if it even exists), but the prescriber of steroids — every now and then the user himself — thinks he is capable of such a feat, in the best “la Garantia soy yo!” style.

Personal experience detached from science is not enough to guarantee risks to life. The cosmetic prescription of anabolic steroids is unreasonable, especially in light of the universal bioethical aphorism that subsidizes human care: “primum non nocere” (first do not harm).

Anabolic steroids are a shortcut in the search for the ideal body, but no one can say if or when the bill will arrive, nor its price. Anyone who prescribes hormonal modulation for aesthetic reasons (which includes the “beauty chip”, perhaps called that because of the beautiful damage it can cause) shrugs off the risks that the patient runs. As far as I know, playing Russian roulette is not part of the health professional’s list of behaviors.