Male sex hormones are also called anabolic steroids because they stimulate anabolism, the building-up phase of metabolism. Under their influence, protein synthesis increases in bone, muscle, and skin, leading to increased bone density, muscle mass, and skin tone. These hormones are also androgens — that is, they stimulate the development of male sex characteristics: facial and body hair, male distribution of fat and muscle, deep voice, and so forth. (Female hormones — estrogens and progesterone — are actually derivatives of androgens, so that in both sexes both types of hormones are present and in delicate balance. Estrogens produce female characteristics but, except for maintaining bone density in women, do not have the general anabolic actions of androgens.)
For some time now male athletes and bodybuilders have taken anabolic steroids to increase muscle bulk and enhance performance. In fact, the practice has become astonishingly common. Most physicians deplore this use of steroid hormones, but until recently some wrote prescriptions for them to all comers. In 1991, the Drug Enforcement Agency made anabolic steroids controlled substances, ending legal prescription of them. A black market now supplies both oral and injectable forms of these drugs, but they are of questionable purity. In our experience, people deter mined to use these drugs cannot be dissuaded by warnings about their harmful effects. The promise of rapid development of big muscles and a powerful body image is totally seductive, especially for teen-agers and young men. Competitive bodybuilders say they cannot take the chance of not using steroids, since everyone else is using them.
Anabolic steroids may be hazardous to both physical and mental health. They weaken resistance by unbalancing the body's hormonal system and predispose those who take them to weakness rather than strength in later life. They commonly increase aggression, possibly encouraging violent behavior ('"roid rage;/). They may also undermine sexual potency and desire. Women athletes who take steroids may become masculinized; for example, they may develop deep voices and facial hair.
Proponents of steroids say that adverse effects are rare, and that medical science has failed to document any serious consequences of use. They say that instead of condemning nonmedical use of anabolic steroids, researchers should be trying to invent new compounds that are anabolic without being significantly androgenic.
The oldest and most effective drugs for coughs are the opiates. They directly depress the center in the brain that controls the cough reflex. It is not always a good idea to stop people from coughing; sometimes they need to expel material from the respiratory tract. If an unproductive cough continues, however, it should be stopped.
The most common opiate prescribed for coughs is codeine, a relatively less powerful one that is reasonably active by mouth. Because of the danger of dependence, doctors do not like to prescribe opiates casually. Pharmacologists have tried to vary the molecules of opiates to come up with new compounds that will suppress coughs but not cause euphoria or dependence. Some of their inventions are available by prescription, such as hydroco-done, a semisynthetic derivative of codeine. Although these narcotic cough suppressants carry warnings about dependence, patients and doctors may not appreciate the reality of the risk until it is too late. Also, these drugs, like other narcotics, are depressants and can interfere with thinking and motor coordination. If they are the only thing that works for a bad cough, they should be taken intermittently or for only a few days in a row so as to avoid habitual use.
I've had asthma all my life and am allergic to just about everything ... As a child I took a lot of codeine for coughs. For the past ten years I've been on Hycodan, which I understand contains a narcotic [hydrocodonel. Originally, I took one tablet four times a day; now I take two four times a day. If I try to cut down the dose I start coughing and get really congested. Also, I get upset and can't sleep.
If I think about it, I guess I know I'm addicted, but I don't like to face that. I've never had anything to do with drugs ... — fifty-two-year-old woman, university guidance eounselor
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