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Heart disease in an otherwise healthy young athlete who is abusing anabolic steroids likely results from increased levels of low-density lipoprotein (LDL) and decreased levels of high-density lipoprotein (HDL).

Several studies suggest that anabolic steroid abuse in athletes increases LDL levels by > 20% and decreases HDL levels by 20% to 70%. These lipoprotein abnormalities have been shown to increase the risk for coronary artery disease three- to six-fold. Anabolic steroid abuse may cause cardiac ischemia by exaggerating oxygen demand at peak exercise, potentially precipitated by accelerated atherosclerosis from lipoprotein abnormalities over years of abuse.

Silver reviewed the adverse effects of anabolic steroids in a JAAOS article and reported that anabolic steroid use can lead to hypertension, changes in lipid profile, elevated liver enzymes, increased risk of tendon and muscle injury, testicular or uterine atrophy, depression, psychosis, and immunosuppression.

Achar et al. reviewed a total of 49 studies describing 1,467 athletes to investigate the cardiovascular effects of the anabolic steroid abuse. They found that anabolic steroid abuse was associated with elevated levels of LDL, low levels of HDL, elevated systolic and diastolic blood pressure, and left ventricular hypertrophy. They also noted that there were some small case studies describing fatal ventricular arrhythmias secondary to anabolic steroid abuse.

Incorrect Answers:
Answer 1: High density lipoprotein levels are decreased, not increased, in those abusing anabolic steroids. This decrease in HDL levels contributea to the development of heart disease in these otherwise healthy individuals.
Answer 2: Systolic and diastolic blood pressure are elevated, not decreased, after prolonged anabolic steroid use. This does not lead to heart disease in those who abuse anabolic steroids.
Answer 4: Alteration of myocardial conduction patterns (., ventricular arrhythmia) is not a cause of heart disease in anabolic steroid abusers. It is, however, a cause of sudden death in these individuals.
Answer 5: Anabolic steroids do not cause 'direct' endothelial damage to the coronary arteries.

Transdermal patches (adhesive patches placed on the skin) may also be used to deliver a steady dose through the skin and into the bloodstream. Testosterone-containing creams and gels that are applied daily to the skin are also available, but absorption is inefficient (roughly 10%, varying between individuals) and these treatments tend to be more expensive. Individuals who are especially physically active and/or bathe often may not be good candidates, since the medication can be washed off and may take up to six hours to be fully absorbed. There is also the risk that an intimate partner or child may come in contact with the application site and inadvertently dose himself or herself; children and women are highly sensitive to testosterone and can suffer unintended masculinization and health effects, even from small doses. Injection is the most common method used by individuals administering AAS for non-medical purposes. [45]

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