Decades ago, the use of performancing-enhancing drugs, or PEDs, had been reserved for use by only the most elite of athletes, including bodybuilders and competitive sports players. In this day in age, however, PEDs have become ubiquitous amongst not only competitive athletes, but also regular gym-goers. As they play such a drastic role in the betterment of athletic performance, the benefits of PEDS are not without a trade-off: they have innumerable dangerous health consequences that must be understood. 

But what are PEDs in the first place? The most common form of PEDs comes in the form of anabolic-androgenic steroids, or AAS, which are derivatives of the male sex hormone testosterone. In a performancing-enhancing context, AAS such as pure testosterone are used to increase systemic androgenic activity in the body, manifesting in the hyper-development of male sexual characteristics such as hair growth, acne development, low voice, muscularity, and libido. By taking AAS, athletes are also able to reap the competitive benefit of erythropoiesis, or the production of red blood cells, increasing athleticism and endurance. In addition to overall increase in testosterone, many forms of testosterone derivatives other than pure testosterone, have anabolic, tissue-selective properties, directly leading to an increase in muscle mass. By taking AAS, athletes are able to give themselves a competitive edge in beating their counterparts. 

However, the effects of AAS on the body also have overwhelming negatives. It is widely known that taking AAS in the form of exogenous testosterone can shut down endogenous androgenic activity, leading to symptoms such as shrunken testicles, breast tissue development, and low energy. In addition, a new study conducted by Oslo University Hospital suggests that AAS can also lead to premature aging of the brain. 

Due to their chemical structure, after being injected using a needle into the blood, AAS enter the brain very easily. As steroids, AAS are hydrophobic, non-polar molecules, meaning they are able to passively diffuse through the phospholipid bilayer of cells through passive transport, depending upon concentration. At Oslo University Hospital, Dr. Bjørnebekk and his colleagues lead a study to investigate the effects of AAS on brain aging by scanning the brains of patients with past AAS use and those without it using MRIs. In the study, Dr. Bjørnebekk tested the brain age gap, or the difference between a patient’s chronological age and their predicted brain age, with a high brain age gap marking a higher risk for cognitive disease. Across the board, the AAS group showed significantly higher brain aging, or higher brain age gap, than standard participants, illustrating the underlying risks involved with AAS use. 

While the detrimental effects of exogenous AAS abuse are widespread across the body, unfortunately, technology to aid in the success of PED-using athletes has been flourishing in recent years. As exogenous AAS use often leads to crashed endogenous testosterone production in men, PCT, or Post-Cycle Therapy, drugs have been created to help men regain normal endogenous testosterone production after exogenous steroid abuse. Since AAS users usually experience low testosterone and high estrogen levels, estrogen blockers, such as Clomid or Nolvadex, are used in PCT to regain natural hormonal balance. While this may address the acute hormonal consequences of AAS use, technology, as of now, has not yet been created to ameliorate the long-term effects of AAS use on the brain. Manifested in the higher incidence of brain age gap in AAS users in the study, the neurodegenerative effects of AAS cause neurons to gradually lose function and die, which is often permanent. In conclusion, while PEDs in the form of AAS do exhibit strong competitive benefits for athletes, their long-term negative consequences and role in the acceleration of neurodegeneration make using AAS an unwise choice. 

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