Nowadays, the term steroids often brings up the association of doping, triggered by the much-discussed abuse of artificial steroids in competitive sports in the media. In contrast, it is often unknown that these substances also occur completely naturally in the body, with the best-known steroid being cholesterol.
What are steroids?
Without the use of artificial steroids, especially cortisone preparations, many diseases could not be effectively treated or cured today. Natural steroids are found in animals, plants, and fungi in addition to the human organism. They fulfill many different biochemical functions such as vitamins, sex hormones such as estrogens in women and androgens in men, bile acids or toxins. In humans and animals, the body produces important proteins and steroid hormones from the steroid cholesterol. Another endogenous steroid is cortisol, which belongs to the group of glucocorticoids. In addition to the natural ones, there are the artificially produced steroids. These include the anabolic steroids or anabolic steroids, which serve to build muscle and are similar to the male sex hormone testosterone. These steroids have become known as illicit doping agents. Other artificial steroids are used in the form of synthetic hormones for medical purposes, such as hydrocortisone or progesterone.
Pharmacological action
Without the use of artificial steroids, especially the glucocorticoids (i.e., cortisone preparations), many diseases could not be effectively treated or cured today. Each synthetically produced steroid exerts a different effect on the body and organs, which, thanks to the much higher dose, is much stronger than that of the corresponding natural steroid. Cortisone preparations are used, for example, to reduce inflammation. They reduce the swelling of mucous membranes in allergic rhinitis or asthma and have an antispasmodic effect. They are also used in cases of impending premature birth to promote the maturation of the baby’s lungs. Applied to the skin, these steroids also develop an anti-inflammatory effect in cases of eczema or allergic reactions. “Smart” steroids attempt to treat only the surface of the skin without affecting deeper layers.
Medical application and use
Synthetically produced glucocorticoids are used for medical purposes in a variety of immune disorders and in acute emergencies. They can be used to treat diseases such as asthma, epilepsy], skin diseases such as atopic dermatitis or eczema, multiple sclerosis, Crohn’s disease, rheumatic diseases, or some types of cancer such as leukemias and multiple myeloma. Steroids are also used when the body itself does not produce enough vital glucocorticoids. Steroids are also important after organ transplants. These preparations are administered both as injections, in the form of tablets and inhalation, and for topical application in the form of ointment. In order to avoid excessive and thus dangerous dosages, the correct dose must be determined on an individual basis. The decisive factors are the severity of the disease, the patient’s response to the steroid, and the planned duration of treatment. While a high-dose short-term therapy with steroids in tablet form can also be terminated abruptly, in the case of long-term treatment the therapy must be terminated very gradually “creeping out” and under constant medical supervision in order to avoid severe side effects. The aim is to disturb the body’s own glucocorticoid production as little as possible. Here, “alternating” therapy has proven particularly successful, in which the steroid is taken in double doses only every 2nd day.
Risks and side effects
Steroids in the form of glucocorticoids can have a variety of side effects. Depending on the strength and site of application, long-term use over weeks or months of cortisone applied to the skin can cause skin breakdown (atrophy)and delayed wound healing. Long-term “systemic” (i.e., non-local) use may pose further risks. This can lead to an increase in blood sugar and water retention in the tissue, which in turn leads to weight gain. The immune system can be weakened and stomach ulcers can develop.There is also a risk of developing diabetes mellitus or osteoporosis or, if already present, of these conditions being exacerbated by steroids. The preparations can further increase the risk of thrombosis. Therefore, it is imperative that steroids be used as long-term therapy only under strict medical supervision.
