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Le conseguenze psicofisiche e sessuali del doping

La TOS a base di testosterone consente di gestire i sintomi dovuti alla carenza di testosterone. Tuttavia, la somministrazione di questi farmaci dovrebbe avvenire solo a seguito di una diagnosi certa che prevede esami di laboratorio per vedere se i livelli di testosterone sono inferiori alla norma e una valutazione clinica dei sintomi. Infatti, le linee guida raccomandano di prescrivere la TOS solo agli uomini con diagnosi certa e sintomatologia manifesta.

• Nella valutazione del paziente che deve intraprendere terapia steroidea con una durata prevista di almeno 3 mesi, è necessario stimare il rischio di frattura.
• L’uso a lungo termine di steroidi può portare all’insorgenza di una cataratta o di un glaucoma, oltre ad accrescere il rischio di infezioni oculari.
• In questi casi, sarà il pediatra che segue il bambino a decidere se aggiungere alla terapia un protettore gastrico, che, comunque, non va dato di routine.
• Tale articolo mette in luce l’ampia variabilità nell’aderenza alle linee guida (ACR 2010 ed altre) e nella prescrizione dei farmaci per l’osteoporosi nonché nel monitoraggio e nella valutazione laboratoristico-radiologica del problema (20).
• Per quanto riguarda il tumore della vescica, i risultati di una revisione della letteratura pubblicata sulla rivista Nutrition and Cancer, nel 2022, suggeriscono che non ci sia associazione tra consumo di carne bianca e aumento del rischio di tumore della vescica.

Proprio per questo si associa il termine steroidi alla palestra, in realtà il loro utilizzo è presente in ogni disciplina. Da questionari sottoposti a circa 4000 soggetti [6] che hanno fatto uso di AS è emerso che gli effetti indesiderati da loro più frequentemente riportati sono quelli indicati nella Tabella 2. Nei giovani, gli steroidi possono interferire con la crescita e il comportamento e portare a uno sviluppo anomalo delle caratteristiche maschili.

Trattamento

Il medico, però, dopo aver visitato Emanuele, spiega loro che il bambino ha una semplice influenza e che somministrare cortisone in questo caso può essere non solo inutile ma anche dannoso. Possono essere presenti problemi associati alla somministrazione a lungo termine del prednisolone, e si riferiscono alla soppressione della normale funzionalità surrenale, alla malattia di Cushing iatrogena e alla crisi metabolica dovuta ad una brusca sospensione del farmaco. L’emivita plasmatica non è significativa da un punto di vista terapeutico nella valutazione dei corticosteroidi sistemici, ma il prednisolone e prednisone sono corticosteroidi intermedi con una emivita biologica di ore.

• Uno studio prospettico con un approccio sistematico è necessario al fine di ottenere dati più affidabili sui rischi per la salute a breve e lungo termine legati all’utilizzo di tali sostanze.
• Pertanto, l’uso non terapeutico oltre ad esser illegale, è fortemente sconsigliato.
• In studi preclinici è stato dimostrato che la somministrazione di androgeni per lungo tempo ad alte dosi, in combinazione con cancerogeni, provoca l’insorgenza di tumori alla prostata [9], mentre in associazione a estrogeni può causare il carcinoma della mammella [10].
• Fisiologicamente, i livelli di testosterone negli uomini diminuiscono a partire dai anni.
• 376 che disciplina in Italia la tutela sanitaria delle attività sportive e della lotta contro il doping.

Non è comune che i malati di mieloma assumano gli steroidi per un lungo periodo, ma nel caso in cui succeda è facile prendere peso, soprattutto al viso, ai fianchi e alle spalle. In questo caso possono comparire anche altri effetti collaterali, tra cui ritenzione idrica, innalzamento della pressione e un rischio leggermente accresciuto di contrarre infezioni. D’altronde, come dichiarato da Bush,7 luminare della medicina respiratoria pediatrica, da una parte nessun adulto è mai deceduto per 1 cm di altezza in meno, mentre rifiutare una terapia con steroidi può avere effetti anche fatali. E d’altra parte non è da sottovalutare che un’asma non controllata può anch’essa avere come conseguenza una riduzione della crescita rispetto alle attese, indipendentemente dalla terapia con steroidi inalatori. I farmaci in grado di incidere sui meccanismi alla base della malattia, e quindi di modificarne il decorso, sono trattamenti che agiscono con modalità diverse a vari livelli del sistema immunitario.

Le conseguenze psicofisiche e sessuali del doping

Il colesterolo svolge il ruolo di un intermedio chiave nella sintesi di altri steroidi coinvolti in una varietà di processi biochimici e fisiologici. Partecipa alla costruzione dello “scheletro cellulare”, membrane cellulari, fornisce la loro permeabilità selettiva, fa parte del midollo osseo, dello sperma e della bile, protegge le articolazioni dall’aterosclerosi, partecipa alla sintesi di lipidi e acidi grassi [4]. Talvolta si può registrare anche un aumento del livello degli zuccheri nel sangue.

Negli uomini, ci sono poche controversie sul ruolo critico del testosterone nella libido maschile e nella funzione sessuale. Molte prove e studi hanno dimostrato i benefici sessuali dell’uso esogeno di testosterone per gli uomini. Ad esempio, in una coorte di uomini ipogonadici trattati cronicamente con gel di testosterone, i punteggi che quantificano il desiderio sessuale, il godimento, la qualità dell’erezione e l’attività http://smac-bd.com/2023/09/21/nuove-linee-guida-per-il-dosaggio-e-il-corso-di/ sessuale sono stati tutti notevolmente e in modo sostenibile migliorati rispetto al basale. In particolare, FL442 ha mantenuto la capacità di prevenire la proliferazione cellulare anche nelle linee cellulari con mutazioni AR che conferivano resistenza a enzalutamide. Nella pratica sportiva, l’utilizzo di steroidi anabolizzanti accresce lo sviluppo muscolare, potenziando la forza fisica e la resistenza allo sforzo.

• Sono utili in ogni situazione in cui si verifichi un’infiammazione, come l’artrite reumatoide e le altre malattie del tessuto connettivo, la sclerosi multipla e in casi di urgenza come l’edema cerebrale dovuto a un tumore, gli attacchi d’asma e le reazioni allergiche gravi.
• Uno degli effetti negativi meno consacrati è l’impatto negativo sulla psiche umana.
• Il doping è un reato penale, punito fino a tre anni di reclusione (che possono diventare di più se insorgono danni effettivi per la salute), se ad essere indotto ad assumere sostanze vietate per doping è un minorenne o se, a distribuire le sostanze, è un dipendente del CONI.
• Il processo intricato e specifico dei tessuti determina la risposta trascrizionale e quindi cellulare.

È interessante notare che non molto tempo fa si pensava che dosi elevate di androgeni o il loro uso prolungato potessero causare il diabete mellito. Con la mano leggera di Leninger, il testosterone è considerato un ormone controinsular, perché quando viene iniettato nel corpo dall’esterno, la secrezione di insulina dalle cellule β delle isole pancreas di Langerhans diminuisce. La sintesi di insulina è ridotta dall’organismo, in quanto il testosterone migliora la permeabilità della membrana del glucosio e aumenta la sintesi di glicogeno nel fegato. Cioè, il testosterone assume semplicemente alcune delle funzioni dell’insulina [2]. Gli effetti collaterali variano in funzione della dose e della durata della terapia. Possono includere bruciori di stomaco (assumere la compressa a stomaco pieno oppure con un bicchiere di latte può prevenirli, oppure si possono prendere dei farmaci specifici), irritabilità, aumento dell’appetito, difficoltà ad addormentarsi.

Da un punto di vista prettamente sessuologico, tali sostanze solo inizialmente incrementano la libido sessuale che poi tende a ridursi in modo drastico. Tra questi, ci sono anche derivati esogeni con strutture chimiche simili al testosterone come il M1T (metil – 1 – testosterone), il Nandrolone e il Danazolo che presentano effetti collaterali come la maggiore capacità di insorgenza di ictus e infarto. In aggiunta alle precedenti, vengono poi anche utilizzate Eritropoietina (EPO), Darbepoietina, GH (Ormone della Crescita), HCG (Gonadotropina Corionica Umana), IGF-1 (Fattore di Crescita insulino-simile) e insulina.

Anabolizzanti steroidei: colesterolo, transaminasi, numero di spermatozoi

L’uso a lungo termine di corticosteroidi, soprattutto alle dosi più alte e specialmente per via endovenosa od orale, causa invariabilmente molti effetti collaterali, che colpiscono quasi tutti gli organi del corpo. I corticosteroidi per inalazione e quelli che vengono applicati direttamente sulla cute causano decisamente meno effetti collaterali rispetto a quelli somministrati per bocca, in vena o tramite iniezione. L’influenza degli ormoni androgeni sullo sviluppo del cancro è anche sostenuta da diversi modelli animali. In studi preclinici è stato dimostrato che la somministrazione di androgeni per lungo tempo ad alte dosi, in combinazione con cancerogeni, provoca l’insorgenza di tumori alla prostata [9], mentre in associazione a estrogeni può causare il carcinoma della mammella [10]. In altri studi su animali si è osservato che la somministrazioni di dosi usate dai body builders riduce la vita media e induce lo sviluppo di sarcomi, tumori al fegato e rene, oltre a produrre danni cardiaci. Inizialmente il precursore del testosterone DHEA era stato indicato come possibile antitumorale per i suoi effetti anticancerogeni nei ratti [11].

Da che età e come si usa il cortisone

È stata osservata una soppressione dose dipendente attesa dei livelli di testosterone e livelli di globulina leganti gli ormoni sessuali, con una depressione dei livelli di testosterone libero osservata solo nel gruppo 1,0 mg. La massa corporea magra è aumentata in modo dose-dipendente, ma non vi è stato alcun cambiamento significativo nella massa grassa. Anche i livelli di HDL sono diminuiti in modo dose-dipendente, ma sia i livelli lipidici che ormonali sono tornati al basale dopo l’interruzione del trattamento. Per quanto riguarda gli atleti che hanno fatto uso di AS, sono stati riportati casi di tumori alla prostata, rene, testicolo, linfomi (vedi Tabella 3). Nel caso dei tumori epatici il rischio aumenta se l’uso di AS si accompagna ad abuso di alcol, dieta povera di verdure, uso di contraccettivi, fumo, stato di portatori di virus come Epstein Barr e citomegalovirus. Gli AS contenenti un gruppo alchilico come il danazolo, il metiltestosterone, nandrolone, ossimetolone and lo stanozolo sono quelli più sospettati di causare tumori.

Terapie a lungo termine

Alcuni recenti studi clinici hanno dimostrato che potrebbe essere utile iniziare la terapia con gli interferoni beta già dopo il primo attacco riferibile a sclerosi multipla qualora, all’esame di risonanza magnetica, siano rilevabili caratteristiche compatibili con la malattia. In questa condizione, denominata sindrome clinicamente isolata (o CIS), gli interferoni beta possono infatti ritardare in modo significativo la comparsa di un secondo attacco. Per quanto riguarda l´impiego di farmaci al di fuori delle indicazioni per le quali sono stati sintetizzati, è opportuno ricordare che la loro somministrazione a persone non malate è sempre pericolosa in quanto priva di finalità terapeutica, scopo fondamentale di un medicamento. Usando dosi troppo elevate di steroidi, oltre che a tirarvi addosso più effetti collaterali, non farete che aumentare il rischio di diventare “insensibili” al farmaco stesso. I corticosteroidi sono i più potenti farmaci disponibili per ridurre le infiammazioni nell’organismo.

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