Steroid Side Effects: A New One to Worry About

Vital Whole Human
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I just snatched a name of a kid I went to high school with and haven’t seen in 35 years out of thin air. Surprised the hell out of everybody, including me.

This from a guy who called the woman across the street the wrong name for 2 years.

Without a mnemonic device I just assign people names based on absolutely nothing. Its just “Oh, he looks like a Mike.” And boom, now thats Mike. :man_shrugging:t2:

Fwiw, I’ve only done a couple of rounds of pro-steroids about 20ish years ago. But plenty of other substances prior to that.

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New massive study came out showcasing chronic use of corticosteroids is associated with reductions in brain matter within regions associated with executive functioning… this was only looking at corticosteroid use in the context of asthma… let alone VERY high dose bursts over many years for various chronic disease states.

Corticosteroid use is also contraindicated when trying to find patients to partake in clinical trials looking at modalities for treatment of alzheimers disease.

Both corticosteroids and anabolic steroids have been shown to exert neurotoxic effects within rodent models time and time again. Human studies began to pop up for AAS and cognitive decline I want to say 5-10 years ago.

Given the psychiatric side effects of high dose AAS use… are we suprised? The body likes homeostasis

How badly will you be affected? Who knows? Do you have a family history of dementia?

It’s similar to CTE and contact sport. Every hit you take is like a drop of water slowly filling up a bucket. How big is your bucket? Do you want to find out?

If so, a trenbologne sandwhich should be the quickest way to figure it out in the context of AAS induced neurodegeneration.

I’d still be participating in contact sports right now if I had the ability to do so. Everyone’s limit to how much risk they’re willing to take is different.

Scary thing about cognitive decline associated with dementia style neurodegeneration is how subtle or even absent the symtpoms tend to be… until you hit say 60+…

Look at all of the boxers who were verbally fluent during their prime, yet shattered images of their former selves by the time they hit 60-70… I sTiLl tHiNk iT’S wOrTh It.

Muhammed Ali was diagnosed with Parkinsons disease in his 40s. He was a world champion, imagine those who wind up in similar condition without having attained any sort of world title.

Like with boxing you need to minimise risk. For AAS this means limit duration of exposure, dose and be wise about the drugs you choose to put into your body.

For boxing, majority of damage occurs during hard sparring. You want to limit the degree to which you are exposed to concussive or sub-concussive blows. No amount of getting hit in the head (or supra dosages of AAS) is good for you.

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“Sorry doctor! I saw this study! I don’t want my inhaler anymore”

“Would you rather die”

“…”

I’m not well versed on treatment modalities for asthma. I know you can take beta 2 agonists like albuterol.

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You’ll be fine… slight cognitive reduction within a very smart person still = a very smart person.

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Alarm bells should be ringing for the youngins who are already on this hamster wheel and haven’t thought about long-term consequences. IMO, folks like Meadows who minimized the risks have probably contributed to thousands, if not tens or hundreds of thousands, of years in lost life expectancy.

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I checked that box too. Fighting dermatamyositis for a few years I took up to 80mg/day of medrol, and seldom less than 12mg/day

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Haha yes, that seems to be in vogue these days.

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You took more than “trt” for a while didn’t you?

I’m joking, I’d suggest taking a closer look at the data prevalent on anabolic steroid use and cognitive deterioration.

Overt, clinically evident deterioration isn’t necessarily the same as significant deterioration bad enough to impede your day to day life.

I’d think serious complications would be seen in your 60’s-70’s-80’s esp in the data that seemed to suggest AAS increased beta amyloid turnover. Dementia style neurodegeneration only serious fucks you up after it’s been going on for a long time

And hey… even if you get to that point, you won’t know because you won’t know what happened yesterday, let alone what happened years ago when you took some diazepam (using humour, not sure if this helps… you are fine)

Furthermore, the mean duration of “on” time is quite substantial within most of these studies. Mean dosages are also quite high.

Lower dose use is also associated with a subclinical degree of cogntitive deficit while “on” but in the context of recreational use “lower dose” has come to mean like 400mg testosterone equivalent per week… which isn’t a low dose to begin with

Your 100mg (or whatever you take per week) is restoring normal physiology and/or going slightly over that at most.

You are aware dementia is more common in women then men? I don’t think having a normal androgen concentration is going to kill your brain.

A big one is alcohol… stay away from alcohol. There seems to be no amount of intake that is safe.

Understandable as it is quite literally a very fun toxin.

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On the other hand. If you’re worried about something like parkinsons… may I suggest cigarettes?

I’ve been better, looking at more surgery now. I knew this would be a consequence of training the way I did given my constraints. Was hoping it would be at an older age

Have at least two big ones coming up.

I regret none of it. If I could do it all over again I wouldn’t change a thing.

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Being a lifelong adrenaline junky and having to take this 2x/d is like a cruel ironic twist.

When I was only taking 12.5 2x/d sometimes I’d skip it or hold off for a while then do speed reps just to get that adrenaline/dopamine burst.

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Some people take up to four HUNDRED milligrams of metoprolol per day. At those dosages I you’d feel like a zombie though.

If you like the “rush” from exercise… can you run? Distance running is a good one for an endorphin rush

However it’s a high impact activity that if taken to the degree distance runners practice at tends to destroy peoples hips and knees.

I know a few old former competitive ultra marathon runners. They’re seriously worse off than the guys I know who did weights for decades.

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No, not really. My LVEF is down to about 40% at last measurement through stress/echo.

And yeah, 400 mg. would turn me into a potato.

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There’s a medication used off label for ADHD called guanfacine… another one called clonidine. They work on alpha adrenergic receptors instead of beta adrenergic receptors

Unlike stimulants used for adhd these meds actually work by blunting the sympathic nervous system. Similar to beta blockers, but not as cardioprotective

They were developed as anti hypertensives, but don’t work as well as beta blockers for that purpose. Anyhow what people noticed is that is REALLY calmed people down, aside from a few other properties like the regions in the brain they bind to and antagonise alpha 2 adrenergic receptors

Some very savy people thought of the idea to trial and patent these meds for ADHD (i’m sure they got very rich)

I take them for my terrible ADHD as I prefer them to stimulants that I very seldom use… every time the dose was increased by ONE MILLIGRAM I’d wind up sleeping 12+ straight hours a day for a good week.

It works great if you can get past the first month or two of initiation and dose titration. Many can’t due to work/life, but in high school outside of homework and whatnot you can get away with needing to sleep a lot. Kids going through growth spurts do it all the time

I’m sorry to hear about the LVEF, is that the measurement you’ve had ever since the heart attack?

Is it symptomatically low? I’m not a cardiologist but I know 40% is right on the cutoff between mildly and moderately reduced cardiac function. Mildly reduced is 41-50%

I don’t have heart failure but I have IST. So my heart feels like it’s going to explode if I don’t take beta blockers or ivabradine. Ivabradine us crazy expensive though.

What’s interesting for IST is, beta blockers for a majority of this cohort actually increases energy and exercise tolerance (myself included).

POTS (don’t have this) is even worse because these people faint whenever they stand up without medication and they have can at times have IST in conjunction with that (dysautonomia is a spectrum).

I’d feel better and have more energy on 50-100mg metoprolol per day as opposed to not being on it. Isn’t that interesting?

Many people with IST are found to have antibodies attacking cardiac beta adrenergic receptors so the condition may be autoimmune. Whether a condition increases morality rates long term is unknown. Untreated I think it would as tachycardia induced cardiomyopathy is a real condition.

As to you using steroids in your 20’s, I wouldn’t worry about it. Not a doctor, but from what i’ve noted the body can tolerate a lot of abuse (for most), esp when young.

You are well spoken and highly intelligent. If it had any impact on your IQ I’d think said impact would be very minimal.

But dementia is awful if you have it, my grandma who lives with us is now moderate stage alzheimers. I hate her as a person and always have (view harboured by a lot of my family as she is likely on the spectrum and harbours many narcissistic atrributes).

The denial is the worst. She’s still driving, but only very short trips even though she can’t remember what happened one hour ago and will never give that up even though her executive functioning/processing skills are pretty much gone at this point.

I imagine she will get in a crash relatively soon if her geriatrician doesn’t revoke her right to drive. She wouldn’t listen anyway, a stubborn narcissist will never listen.

It’s like that south park episode

Because her driving skills are shocking. I think even she’s realised now as I don’t see her drive more than 2-3x per week now.

I imagine the way I react to any titration of guanfacine is how most people on beta blockers feel… that… must… suck…

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No, it was initially at about 65% after the STEMI, reduced but within normal range. But after another more protracted eschemic event and a couple rounds of covid it is significantly reduced. The last measurement (40%) was taken was in April.

Eh, I dunno. Ive always been very very high strung and agressive. It has definitely taken me down about a dozen notches, which is actually a great benefit.

I only mention it out of technicality. I consider it pretty insignificant.

It didn’t I’ve had it measured a couple times and it has consistently been within the same range.

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40.5 lol

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I’d ask if it was a steroid haha. Now, I know that drugs that end in olol are beta blockers.

Is there a different type of drug that could achieve the same results without the beta blocker side effects (sluggishness)? Maybe an ace inhibitor or ARB drug? Maybe those aren’t strong enough? I’ve heard ARB + Beta blocker can have a 1+1=3 effect. You may be able to use a lot less total if combining.

I don’t know enough to give advice, and I know you are smart enough to not take this as advise. I’d like to know if there is a reason you are on the beta blocker specifically if there is one? I do suppose if you are prone to anxiety and it has noticeable effects on the heart, that a beta blocker would be advantageous there.

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Those alpha 2 adrenergic receptor agonists can help too.

Substantially decreases my required beta blocker dose.

But very sedating initially.

Also cost like a zillion dollars

Look at pharmacokinetics of guanfacine, how it blunts sympathetic outflow.

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I can’t relate to that. But i’ve had covid twice.

First time took me a month to recover from and I still feel short of breath after second round (three weeks ago)

It’s equitable to the flu for me, which isn’t great. Delta felt worse than omicron.

Look at the standard deviations. Some had a T/E ratio of 0.01

Can likely pass a simple doping test using TNE and ceasing use like a day or two out from the event.

Large scale social situations will also do it. I always need to take more if i’m going to be around crowds.

I’ve had the fast heart rate (according to medical documentation) from around the age of 13 onwards. It gets better with age for many, I can’t say this has been the case for me

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400mgs of metoprolol per day!!!

In combination with some desoxyn (google) and you’ll be ready to take on the world!

/s

I’ve found for IST it honestly is “the more the better” before a very distinct cutoff point when my RHR will dip too low and I’ll be quite tired. But if beta blockers make you tired that’s a no go.

What about ivabradine (for fast HR, won’t alter how forcefully your heart contracts and isn’t used for afib)

Some calcium channel blockers like
Diltiazem can slow HR while acting as an anti arrhythmiac.

I’m not a doctor, I don’t even know what particular subtype of dysautonomia you have. Is it POTS (regular vs hyperadrenergic. The latter = pots + ist), IST, familial dysautonomia…

But these are things to discuss with your doc. I used to take a pain medication that gave me auditory and visual hallucinations when dosages were titrated to any dose above minimum dose that can be prescribed for SR tablets of this nature.

Eventually after having dealt with this for quite a while I asked my doc “is there any alternative. I have university and these particular side effects are very annoying”.

So I was kept on the lowest possible dose and given IR oXyCoDoNe to take as needed.

I don’t like oxycodone because it makes me tired and it makes my brain feel fuzzy. But when I’m waking up at like 3am (if sleeping at all) that actually works out.

It is that particuar medication. Every time post OP when the dose goes above around 150mg/day it happens. The medication in question here is tapentadol

Like anabolic steroids, corticosteroids, benzodiazepines and potent anticholinergic I’d be willing to argue opiates/opiods aren’t great for cognitive function.

Beta blockers seem to be fine though :laughing:

Discount for the fatigue

Going to knock off a few IQ points over the next few months lol. Next two surgeries are bad enough to warrant PCA, and I’m in painkillers daily at this point…

I’ve made my voice known that I don’t want that nasty PCA machine ever again unless they put something that isn’t fentanyl in it… I don’t think I have a choice in the matter

It’s the most nauseating experience. Morphine is supposed to be worse according to literature, but nothing has ever made me feel so sick so quickly aside from that fentanyl PCA.

Surgery wound up going from arthroscopic to open incision when it was decided to perform biceps tenotomy… I have popeye biceps on that arm now… but I regret nothing aside from having never presented to an ER after one of my many shoulder dislocations.

If I can get it back in it’s fine… or at least I thought so (not really but didn’t want prolonged rest)… until I woke up and wasn’t able to use that arm anymore.. oops…

The next two are probably going to be worse as I imagine shaving off bone is unpleasant

I hear tren is great for postoperative recovery (joking). Though I wouldn’t be suprised if TRT or sometbing like oxandrolone expedites healing

I’ve seen animal models that seem to suggest this notion. With TRT think about it… you’re in bed for days/weeks/months depending on how bad the surgery is. You might be using painkillers that cause secondary hypogonadism (all opiate painkillers aside from tapentadol). On TRT no compensated hypogonadism!!! More muscle preservation!!!

I imagine AAS to a degree would shorten rehabilitation time as you’d have less muscle mass/strength that’d you’d need to gain back postoperatively

At the expense of giving yourself dementia… one shot of test is all it takes :disappointed: to wind up with alzheimers

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