Steroids in modern medicine represent two sides of the same coin. 

News of athletes from the baseball diamond to the skating rink using performance enhancing, testosterone building “anabolic steroids” has only grown more common since testosterone was first synthesized nearly eight decades ago. 

At the same time, inflammation-reducing corticosteroids are prescribed by doctors of several kinds every day. 

The term “steroid” actually comes from the name for a specific organic biological compound that can input traits into cell membranes and change how cells interact – characteristics that these very different kinds of steroids have in common. 

“You have anabolic which is building and catabolic which is tearing down,” Dr. Benjamin Boothby, an orthopedic surgeon at MercyHealth, said.

Corticosteroids fall under the category of catabolic as they reduce inflammation, while substances like cholesterol, the most common steroid in the body, exhibit anabolic characteristics.  

Dr. Ryan Szepiela, a ProMedica affiliated muscle and joint doctor who is also the team doctor for the Toledo Mud Hens, also drew clear distinctions between the two main types of steroids.  

He said most anabolic steroids are not approved by the Food and Drug Administration and are illegal, although there are some creams available that can be prescribed by a physician for those that do not produce regular amounts of testosterone. These creams work by simulating testosterone in the body.  

“Our bodies make both kinds of steroids,” Dr. Szepiela said, cautioning that those looking to boost their testosterone should not look to self diagnose with cure-all substances advertised on television, but should instead consult a physician. “Corticosteroids work very similar to a hormone your body produces in the adrenal glands called cortisol.” 

Prednisone, triamcinolone and kenalog are common examples of corticosteroids. Most of the time these medications are available only via prescription, but in cases where a corticosteroid is required in a low dose for something like a poison ivy rash, there are creams that are available over the counter. 

“When you injure something your body’s natural response is to swell, become red and become inflamed,” Dr. Szepiela said. “Part of that is inflammatory processes and part of that is bringing in natural healing factors as part of your body’s way of rescuing the situation, that causes pain as well.”    

As a sports medicine doctor, Dr. Szepiela said that he prescribes corticosteroids fairly often, usually for things like muscle and joint injuries. 

Corticosteroids are commonly only prescribed for a short period of time, typically not longer than three weeks, according to the American Academy for Family Physicians. 

Dr. Szepiela said there can be serious side effects if the medications are used longer than that or too often over time, including thinning of the bones due to osteoporosis. 

“You need a healthy balance of the steroid in your body to start with,” he said. “If you are over prescribing that is going to shut down your body’s natural processes as well. If you look at that, it can also cause issues such as weight gain, and actually do the opposite of what you want it to do in multiple injections, which is break down the joint. Some is OK, but a lot has to be regulated.” 

For certain conditions like osteoarthritis, that might require an injection of medication at a joint, the number of injections at which problems might start occurring is known in advance.

For example, Dr. Boothby said he will only inject a knee with steroids four times each year.  

He said that he prescribes “dose packs” in such a way that the taking of tablets gradually tapers off. He said the adrenal system near the kidneys, which produces steroid hormones in the body, would be most affected by overuse, which might lead to muscle atrophy or skin pigment changes. 

Describing corticosteroids as the gold standard for treatment of pain and inflammation in medicine currently, Dr. Szepiela said that could change in the future, as medicine might come to embrace what is more natural for the body.  

“We are doing a lot of research into using the body’s own natural healing processes, moving forward,” he said. “If you have heard of platelet rich plasma or concentrated platelets, those are healing factors or growth factors that you can do a blood draw from your own body and reiinject it, so there may be a future in that treatment. 

“When you have a fever, a fever is your body’s natural response to an infection,” Dr. Szepiela said. “Your body is trying to fight off that infection, by taking medicine to reduce the fever, are you reducing your body’s ability to fight that infection? Steroids are the same way. You are reducing the pain, but are you reducing the body’s natural healing response? That question has gone back and forth and we are always looking for something new in medicine.”  

Dr. Boothby noted that, however, there are always going to be situations and conditions where a steroid would be needed.

He described a situation related to osteoarthritis in which cartilage might be damaged.  

“Your body will try to repair the cartilage but it cannot, because we cannot regrow cartilage,” he said. “Your body will send all these inflammatory markers to the joints to try and heal and with that comes white blood cells and inflammation. Even though it is a natural response that your body does, it is not necessarily a good response. The body is trying to repair but it is not able to so it is just causing more pain.

“Especially if you are immuno-compromised, there are many things outside the scope of even my practice of medicine, that require steroids,” Dr. Boothby said.  

First Published January 15, 2023, 5:00 a.m.