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The third and final class of orally activated steroids are the ring A modified drugs. The modifications made to the A-ring will stabilize and preserve the 17-beta hydroxyl group of the steroid and limit the oxidation to the 17-keto form, which will deactivate the steroid. In the body, testosterone and other androgens exist as both active and inactive forms, usually in the same amounts to establish equilibrium. Scientists have used this knowledge to modify the A-ring of the steroid that will cause a shift in the equilibrium towards the methylation at the 1 alpha positions and an unsaturation in the 1( 2) position, thus increasing the bioavailability of the drug. Primobolan, Proviron, and 1-testosterone are all A-ring modified steroids. However, drugs that are A-ring modified have been known to cause the user to experience heavy androgenic side effects. The side effects are quite dramatic, especially given the mild nature of the drug itself. This is cause for great concern among athletes considering an A-ring modified oral steroid.

One of these three techniques are used in every oral steroid available, and in many prohormones as well. The most effective method is the 17-alpha alkyl modification, which unfortunately makes it the most damaging as well. Prolonged use commonly leads to permanent liver damage.

The lipophilically modified drugs are too weak to be effective, especially given their variable absorption rate. The A-ring modified steroids are much less effective than the 17-alpha alkylated drugs but exhibit harsh androgenic side effects which make the drug not worth the risk.

The side effects of steroid use and abuse are well documented. However, there is great public misconception regarding the actual nature of these effects. Often times the side effects of steroid use are over-stated or exaggerated by misinformed anti-steroid advocates. This chapter is meant to dispel the myths and rumors about the side effects of anabolic steroid use and provide the reader with actual scientific data regarding the effects of certain drugs.

The following side effects have been reported resulting from steroid use and abuse: liver disease, liver tumors, liver failure, gynecomastia (male breast development), deep voice/ excessive hair growth in females, enlarged clitoris (in females), shrunken testicles (in men), athlerosclerosis and heart disease, psychological addiction (leading to depression), HIV/ AIDS (from sharing needles), reduced sperm count, impotence, infertility, male pattern baldness, painful urination, enlarged prostate and prostate cancer (in men), disruption in menses (in women), frequent and continuous headaches, yellow staining of the eyes and skin (through jaundice), bad breath, personality changes, anxiety and panic attacks, mania, irritability, aggressive behavior, insomnia, fatigue, puffy face and body, face and body acne, sore tongue, stomach pains, vomiting (sometimes with blood), diarrhea, nausea, skin rashes, increased risk for injury (in some cases), muscle cramps, ankle swelling, stroke, high blood pressure, increased LDL, decreased HDL, bloating, kidney stones, kidney failure, frequent and painful erections (in men), increased estrogen production, blood poisoning (from injecting), high risk of infection (from injecting), decreased bone density, bone and joint pain, brain tumors, cancer, and death. It is important to note that some of these side effects are rarer than others and have been largely exaggerated in the mainstream media. It is not likely that the average steroid user will experience most of these side effects, and there prevalence amongst steroid users is highly variable.

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