Certo. Ecco la traduzione in inglese, mantenendo il più possibile struttura, significato e registro del testo originale.
Scrittura
Anabolic steroids are defined as substances capable of reproducing the effects of testosterone, the hormone responsible for aesthetic and behavioral characteristics typical of the male sex.
Steroid abuse is characterized by the use of doses higher than therapeutic doses for non-medical purposes, with negative consequences for health. This phenomenon is fairly widespread in the United States among adolescents, and to a lesser extent in our areas. The connection with the sporting environment is typical, but it is not the only one. A steroid user may also be connected to “the gym” secondarily, because of the training necessary to make the steroids work, without having any real interest in competitive sports.
There are essentially three categories of steroid users and potential abusers:
a) those who want to enhance athletic performance
b) those who want to shape their body in order to be aesthetically attractive or suitable for artistic professions
c) those who want to enhance aggressive performance for occupational purposes or social success. This category also includes cases in which aggressive behaviors, which are actually antisocial, become positive characteristics within the person’s own group (e.g. gangs or youth/student environments).
During use, the most frequent psychological effects include excitatory (manic) and psychotic symptoms, whereas when use is discontinued, depressive syndromes of varying intensity may develop, with an associated risk of suicide.
The effects are often biphasic, meaning that the effect during use is followed by the opposite effect when use is stopped. Thus, for example, energy levels increase during use but decrease after discontinuation, and the same applies to sexual desire.
Sometimes the effects on the aesthetic and sexual spheres are paradoxical. For example, men may develop breasts. These effects are partly caused by the exhaustion of spontaneous testosterone production when the body becomes accustomed to receiving massive doses from outside. When the steroid is discontinued, the person has a “blocked” testosterone production system. Furthermore, some steroids produce partly “mixed” effects, either masculinizing or feminizing depending on the organ on which they act.
Some of the side effects during use include:
– increased blood pressure and water retention, with swelling of the tissues
– increased muscle mass
– breast development (gynecomastia) in men or breast reduction in women
– liver disease
– enlargement of the prostate
– reduction in testicular volume
– enlargement of the clitoris
– skin eruptions
– baldness and loss of body hair; hirsutism in women
– changes in the tone of the voice (a deeper voice)
Toxic effects may be aggravated by the simultaneous use of other anabolic drugs or by so-called “building-block” substances, that is, substances used as constituents of muscle tissue and intended to form new tissue under the stimulation of steroids, such as certain amino-acid mixtures.
Growth hormone (GH), for example, is used as an anabolic agent. Its effects are particularly negative because it can induce an increase in the size of the heart without a corresponding increase in its vascularization. At the same time, while the area that needs to be supplied with blood increases as muscle mass increases, and the pumping force required increases because of the higher blood pressure, the heart’s functional capacity is reduced. Growth of the ends of the bones and joints, which gives a more “massive” appearance together with increased muscle mass, can make joint movement difficult.
Steroid dependence should be considered a medium- to long-term toxic effect of steroids, resulting from an action on the brain and, unlike other toxic effects, not spontaneously reversible.
The recurrent use of steroids despite their toxic effects must be distinguished into:
– pursuit of the desirable effects of steroids while accepting the risks to life and health, including psychological risks. These cases constitute a mental disorder comparable to anorexia nervosa, in which control of physical appearance is pursued by forcing the body toward increased muscle mass. The person’s interest is centered on perceiving their physical form as satisfactory, often despite objectively limited results and actual acquired deformities caused by the disproportionate development of certain muscle groups, as well as functional limitations resulting from the anatomical imbalance between muscle and the osteoarticular system. The diagnostic framework of “body dysmorphic disorder” can be used to describe this condition, as can that of anorexia nervosa. Steroids become problematic substances in the same way that appetite suppressants, diuretics, and laxatives are for people with anorexia.
– pursuit of the state of excitement induced by steroids. This situation constitutes steroid dependence. Anabolic steroids are substances of abuse that become so through an initial phase of instrumental use. Classic drugs, in fact, are generally used to produce euphoria and pleasure, and they induce dependence through this type of relationship. In some cases, such as morphine dependence, the initial reason for use was to control pain, but the substance’s action on the brain produces a bond that subsequently continues independently and constitutes dependence. Other substances are initially used for a pleasurable purpose without being identified in themselves as “the goal,” but because of their action on the brain they likewise induce dependence.
As with other addictions, the doses used and the duration of use are crucial factors in dependence, which on average requires one year of regular use to develop. Medical use, which involves limited doses and may simply compensate for deficiency states, is not associated with a significant risk of abuse. The gratification associated with overstimulation would be a crucial factor in making the relationship with steroids relatively “autonomous” from the original reason for their use. Doubts about whether steroid dependence is actually equivalent to other forms of dependence arise from the delay with which steroids produce their effects, whereas other drugs owe much of their ability to bind users to them to the rapidity of their effects.
In any case, steroid abuse tends to become polysubstance abuse, in which the initial period while waiting for the steroid effect to appear may be covered by more traditional substances such as alcohol or cocaine. It is not uncommon for the unpleasant component of steroid-induced excitement, or withdrawal-related depression, to be managed through the use of the same substances. In general, the pattern resembles stimulant abuse: it begins with a predominantly stimulating effect and eventually develops into a pattern of depressant abuse when the stimulation has become unpleasant and anxiety and depressive symptoms have become predominant.
The most difficult aspect to understand in steroid dependence is the distinction between the psychology of initial use, aimed at developing muscle mass and sexual performance, and what happens later, namely dependence, which becomes an independent problem.
In intervention programs for steroid dependence, increased knowledge of the negative effects does not alter the risk of relapse. What is surprising is not so much this result, but rather the fact that anyone ever thought that people with drug dependence could change their behavior simply because of fear of the negative consequences of drug use.