Do steroids affect sperm count?

Q: Do steroids affect sperm count?

Someday I want to have children with my boyfriend...but I’m concerned. He’s short, very muscular and he used to take steroids when he was younger (not anymore). Could his previous steroid use affect his sperm count and make him infertile? Also, his penis tilts to the side. Should I worry?

ANSWERED BY
DAVID SOBEL, MD, JD 

You’ve asked some good questions and you’re right: anabolic steroids can temporarily lower sperm counts and could potentially cause problems with fertility.

Trusting God When It Means Rejection

At his father’s funeral, American track and field star Carl Lewis placed his 100-meter gold medal from the 1984 Olympics in his father’s grave. “Don’t worry,” he told his surprised mother. “I’ll get another one.” 

	What is more, I consider everything a loss because of the surpassing worth of knowing Christ Jesus my Lord, for whose sake I have lost all things. I consider them garbage, that I may gain Christ. — Philippians 3:8

A year later, in the 100-meter final at the 1988 games, Lewis was competing against Canadian world record holder Ben Johnson. Halfway through the race, Johnson was still five feet in front. Lewis was convinced he could catch him. But at 80 meters, he was still five feet behind. “It’s over,” Lewis thought. As Johnson crossed the finish, he stared back at Lewis and thrust his right arm in the air, index finger extended.

Lewis was exasperated. He had noticed Johnson’s bulging muscles and yellow-tinged eyes, both indications of steroid use. “I didn’t have the medal, but I could still give to my father by acting with class and dignity,” Lewis said later. He shook Johnson’s hand and left the track.

COPD Blog: Inhaled Medications for COPD: Are the Steroids Dangerous?

Robert T. Schreiber, MD, an American Lung Association in New York expert

Many patients with COPD are prescribed inhaled medications to help treat symptoms of coughing, wheezing, and shortness of breath. However, some patients are reluctant to take them because they mistakenly think that all inhaled medications are steroids, and they’re afraid of the side effects. A patient might hear from family or friends that these medications have many adverse reactions — but they’re usually wrong.

Inhaled medications for COPD include short-acting and long-acting bronchodilators, and neither of them are corticosteroids. Patients with mild COPD and only intermittent symptoms are prescribed a short-acting bronchodilator, or short-acting beta agonist (SABA), to use when symptoms occur. Typically, these come in a metered dose inhaler and contain a quick onset medication (for example, albuterol). These medications are sympathomimetics (distant cousins of adrenalin), and work to open up the bronchial tubes quickly. A dose from a short-acting bronchodilator works rapidly and then leaves the body quickly, wearing off between four and six hours. The side effects are temporary, and may include nervousness, shakiness, increased heart rate or blood pressure, and insomnia. They do not have long-term consequences if used as directed.

Patients who have advanced COPD and persistent symptoms may be prescribed a long-acting bronchodilator as the next step in their treatment. Long-acting beta agonists (LABA) help to keep the bronchial tubes open for up to 12 hours. They are similar to SABAs in their action and side effects, and are also part of the sympathomimetics family. Salmeterol and formoterol are both LABA bronchodilators. Another type of long-acting bronchodilator is in the anticholinergic family. Tiotropium is the only long-acting inhaled anticholinergic currently available in the U.S. The most common side effects from this type of medication are dry mouth, constipation, and problems with urination, and they should be taken with caution by patients with glaucoma.

Recent medical research has shown that patients with moderate to severe COPD who took a combination of a LABA and an inhaled corticosteroid (ICS) had fewer exacerbations of their COPD in the course of one year. These combined medications (fluticasone plus salmeterol; budesonide plus formoterol) contain an extremely tiny dose of the corticosteroid, which is measured in micrograms. For comparison, oral doses of corticosteroids given to patients with COPD exacerbations typically contain 100 to 1000 times the amount found in the inhaled doses, and they’re measured in milligrams. In addition, most of the corticosteroid that is inhaled doesn’t travel beyond the lungs — very little gets into the blood stream and travels to the rest of the body.

While COPD medications are generally considered safe, there are some short- and long-term side effects that you should be aware of. When taken for many years, an ICS may increase the chance of osteoporosis, cataract formation, and skin bruising. It has also been suggested that the LABA-ICS combination may increase the chance of getting pneumonia. However, in medical practice, we typically don’t see the side effects from an ICS that people taking corticosteroid pills or shots may experience, such as face swelling, fluid retention, elevated blood sugar and blood pressure, and bone thinning.

So, most inhaled medications prescribed for COPD do not contain steroids. But even combined medications that have an ICS contain only small amounts and are usually safe for most people. Of course, everyone is different, and you may react differently than someone else to a medication. Therefore, you should always discuss the potential benefits and risks of a new treatment with your doctor before you start to take it.

Dr. Schreiber is board certified in internal medicine and pulmonary diseases by the American Board of Internal Medicine. He is a member of Nassau Chest Physicians, P.C., who are actively involved with the American Lung Association in New York. Schreiber is director of the SICU at St. Francis Hospital, medical director of the Oyster Bay Cove Village Police Department, and a member of the Nassau County Medical Reserve Corps. He is on the professional staffs of St. Francis Hospital, North Shore University Hospital (Manhasset and Plainview), and St. Joseph Hospital.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/inhaled-medications-for-blog.aspx

COPD Treatment Tips to Keep You on Track

Managing COPD means staying on track with a good treatment plan. Get tips for managing symptoms, exacerbations, and other COPD issues.

By Chris Iliades, MD

Medically reviewed by Lindsey Marcellin, MD, MPH

You can live well with chronic obstructive pulmonary disorder (COPD) if you get the right COPD treatment plan and stick to it. The goals of a good COPD treatment plan are to manage and avoid COPD symptoms, slow the progression of the disease, manage COPD exacerbations and emergencies, and improve your general health and well-being.

It's important to learn as much as you can about your condition and work closely with your treatment team. That means taking all your medications on time and keeping all of your treatment appointments.

Medications that your doctors prescribe — bronchodilators, steroids, and antibiotics — help keep your COPD symptoms under control, but there is also a lot you can do on your own to stay on the right track.

COPD Treatment Action Plan

The American Lung Association recommends that people with COPD work with their doctor to develop an action plan based on their specific COPD symptoms. Every plan is different, and your plan may change over time. But an action plan should outline specific steps depending on your symptoms. Here is an example:

• Green zone. You are in this zone when your symptoms are under control. Take all your daily medications, keep all your scheduled doctor appointments, and follow your exercise and diet regimens.
• Yellow zone. COPD symptoms like feeling breathless, increased cough, increased phlegm, decreased appetite, and trouble sleeping could be symptoms of a COPD exacerbation. Your action plan should outline how to take your rescue medications, when to use oxygen, and how to use breathing exercises such as pursed-lip breathing. It should also discuss when to call your doctor.
• Red zone. If you have COPD symptoms like severe shortness of breath, chills and fever, confusion, chest pain, or coughing up blood, your action plan goes into emergency mode. Have your emergency contacts ready, call 911 if you need to, increase your oxygen, and get help right away.

COPD Tips to Stay on Track

In addition to following your treatment plan, you can help keep your COPD under control by avoiding potential complications, watching out for anxiety and depression, and making sure you have a good support system. Here’s how:

• Preventing COPD flares. Quitting smoking and avoiding secondhand smoke are two of the most important things you can do to help control COPD symptoms. Air pollutants, allergens like dust and mold, and chemical fumes can also cause a COPD exacerbation. Keep your windows closed and stay indoors as much as possible when pollen and pollution levels are high. Also, make sure to get flu and pneumonia vaccines to help avoid the complication of infection.
• Avoiding depression. Having COPD can make it hard to sleep, enjoy food, and do many of the activities you once enjoyed. Feeling down occasionally is normal, but clinical depression — when feelings of sadness and other symptoms last for more than two weeks — is dangerous. Depression may keep you from sticking to your treatment plan. Learn the symptoms of depression and ask for help if you need it. Treatment for depression may be an important part of managing your COPD.
• Understanding COPD anxiety. Your brain has a region that sets off an alarm signal when oxygen levels are low. For people with COPD, this region can become overly sensitive and send off alarm signals that feel like an anxiety attack. If you are worrying about your breathing all the time, especially if you are afraid to leave the house because of it, you may need help managing anxiety. Treatments such as breathing exercises, counseling, and medication can help keep anxiety under control.
• COPD support. Managing COPD can be tough, but you don't have to do it alone. Talk to your friends and family about your physical and emotional needs. Many find that joining a COPD support group offers an opportunity to share with others who understand. A support group can be a source of experience, strength, and hope, and can help you keep your COPD treatment on track.

Your COPD treatment plan is a lifelong process. Sticking with the plan is the best way to keep living well with COPD, and staying in close touch with your health care team will allow you to adjust your COPD treatment plan over time.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/copd-treatment-tips.aspx

How to Prevent a COPD Flare-Up

Find out how to prevent a COPD exacerbation and what to do if you experience one.

By Madeline Vann, MPH

Medically reviewed by Cynthia Haines, MD

In most cases, patients who have chronic obstructive pulmonary disease (COPD) can keep symptoms such as cough, shortness of breath, or sputum under control. But there are times when COPD patients can experience exacerbations, a worsening of symptoms that is also called a flare-up.

"An exacerbation is when a chronic disease gets worse for some reason. With COPD, this is usually because of infection,” explains Richard Castriotta, MD, professor at the University of Texas Medical School at Houston.

COPD exacerbations result in about 1.5 million emergency room visits every year in the United States. The risk of an exacerbation varies according to the severity of your COPD. People with severe COPD have about 3.43 exacerbations a year compared with 2.68 on average for people with moderate COPD.

COPD Exacerbations: Signs and Causes

The COPD symptoms that you will recognize as an exacerbation are:

• Worsening cough
• Worsening feeling of being short of breath (dyspnea)
• Changes in sputum, such as changing color (clear to yellow, green, brown, or red) or quantity (either more or less than usual)

Many COPD flare-ups occur without any known cause. However, the most commonly understood causes of COPD exacerbations are respiratory infections such as colds or the flu.

If you have increased COPD symptoms such as a fever, chills, and "purulent" sputum (yellow in color), you should call your doctor immediately. You may need a prescription for antibiotics to help fight the infection.

COPD Exacerbations: How to Handle an Occurrence

How you handle a COPD flare-up will depend on how well you have your symptoms under control under normal circumstances and how severe the exacerbation is. If your symptoms are usually under control and your exacerbation is not severe, you should talk to your doctor about how to treat an increase in symptoms at home. You may be able to use your bronchodilator or steroids to address some symptoms under a doctor's supervision.

If you have followed your doctor's instructions and your efforts to control symptoms at home have not worked, do not take more medication. Instead, call your doctor's office or go to the ER.

If you're having trouble breathing, you should go to the ER immediately. At the hospital you may receive ventilator treatments or medication to help you breathe. In some instances, you may be hospitalized until you get better.

COPD Exacerbations: Prevention Strategies

There are several ways that you can prevent exacerbations or reduce their severity:

• Stop smoking. The more years you smoke, the worse your exacerbations are likely to be. Chronic and heavy smokers are at increased risk for severe exacerbations.
• Take antibiotics as prescribed. If your doctor gives you antibiotics to treat an infection that might lead to an flare-up, make sure you take all the medication as your doctor instructs, even if you feel better before you have finished every dose.
• Get your flu shot. Get a flu vaccine every year when flu season begins and make sure that you are up-to-date with your pneumococcal vaccine.
• Find a primary care doctor you can stick with. Data from a study of 388 COPD patients showed that those who did not have a regular doctor were more likely to need to go to the ER. The researchers estimate that 10 percent of visits could be prevented if more people with COPD had regular doctors. You also can reduce the risk of having to go back to the ER with a relapse if you have a doctor you can visit about a week after you go to the hospital with an exacerbation.

If you understand which COPD symptoms to watch out for, you will be able to respond to COPD exacerbations quickly and learn how to prevent them in the future.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/prevent-copd-flare.aspx

Bangladesh's "teenage" brothels hold dark steroid secret

By Andrew Biraj | Reuters

TANGAIL, Bangladesh (Reuters) - Their faces painted heavy with make-up, teenage girls in short, tight blouses and long petticoats loiter in squalid alleys, laughing and gesturing to potential clients who roam Tangail town's infamous red light area in the early evening.

There is no shortage of men looking for "company" in Kandapara slum, a labyrinth of tiny lanes - lined cheek-by-jowl with corrugated iron shacks - a few hours drive northeast of Bangladesh's capital, Dhaka.

But with rates as low as 50 taka (60 U.S. cents), the need to attract as many customers as possible is desperate - prompting a rising, yet dangerous, trend of steroid abuse among adolescent sex workers to "enhance" their appearance.

"There is a huge difference between my appearance now and the malnourished look of my childhood," says Hashi, 17, who was lured into the sex trade by a trafficker when she was 10 and sold to Kandapara's brothel, where she began taking steroids.

"I am healthier than before and fit to serve a lot of customers in a day. Sometimes up to 15," she says, placing a large black bindi, or dot used by Hindu women, between her perfectly shaped eyebrows.

She sits in her tiny room with a bed, a cooking stove and posters of Bollywood stars taped across the wall.

Hashi is one of around 900 sex workers - some as young as 12 - living a painful life of exploitation in Kandapara, not only bonded by debt and fear of stigma, but compelled to take the steroid, Oradexon, which brings more income but leaves dangerous side effects.

COW FATTENING DRUG

Also known as Dexamethasone, Oradexon treats inflammation and allergies in humans and is used by farmers to fatten livestock.

Charities say the over-the-counter drug is taken by 90 percent of sex workers in Kandapara and the other 14 legalized brothels across this impoverished South Asian nation.

The girls are first forced to take it by their madams, or "sardarnis", who run the brothels.

It increases their appetite, making them gain weight rapidly and giving the appearance that these poorly nourished teens are in fact healthy and older - attracting clients who prefer girls with "curves".

It also helps sardarnis keep the police away. The legal age for sex work in Bangladesh is 18.

The girls then continue to consume it, saying that it keeps them "strong and healthy", which in turn will help them get more clients in a day so they can earn enough to survive.

"My sardarni forced me to take a tablet. She beat me up and stopped giving food. She threatened me and reminded me about my loans," says Hashi, who has a four-year-old son staying with relatives, whom she has not seen for two years.

"In this brothel, customers always look for healthy girls. I take Oradexon. I need customers so I can pay my bills and loans. If I don't get any customers one day, I cannot eat in the next day. I wish to save some money for my son."

The story is the same with most of Kandapara's teenage sex workers, or "chukris".

Sold for as little as 20,000 taka ($245) by their poor, rural families to traffickers, they are then traded on to brothel sardarnis, who are former prostitutes themselves and keep the teenagers in bonded sex work.

The girls speak of being with up to 15 men in one day, but say their earnings are pocketed by their sardarnis, who tell them they have to work to pay off the money paid for them.

Many girls have been in Kandapara's brothel for years, yet due to their illiteracy, they have no idea whether their debts have been cleared and what their rights are.

Others, who have been left by their sardarnis because they are too old or not-profitable, are in principle free to leave but choose not to, fearful of the social exclusion they will face in the conservative, Muslim society outside of Kandapara.

BATTLE WITH BROTHELS

Oradexon, they say, keeps them going, even though there are known risks associated with its long-term use.

The steroid can cause diabetes, high blood pressure, skin rashes and headaches and is highly addictive, according to social activists.

It also weakens the immune system and leaves patients more susceptible to illnesses. There have been reports of young sex workers dying from over-use of the drug.

The small white pill is easily available in Kandapara's slums. It is sold without prescription for 15 taka (18 U.S. cents) for a strip of 10 at the tea and cigarette stalls blaring Bangladeshi pop music that populate a maze of open-sewer lanes.

"Steroids are life-saving as well as life-destroying drugs which are used by sex workers in poor countries," said Shipra Gowshami, a lawyer and human rights activist who works with sex workers in brothels in the central Bangladeshi town of Faridpur.

"A lack of awareness, easy availability and malpractices of quacks are some of the prime causes of why these drugs are being abused," Gowshami said.

In 2010, ActionAid Bangladesh began a campaign to promote awareness of the drug among sex workers. But they say they are facing a long fight in persuading not only the brothels to stop using it but also authorities to regulate it.

"There have been attempts to raise awareness on the negative impact of the use of such medicine but brothel owners, madams and pimps are a long way from withdrawing such practices," said Farah Kabir, country director for ActionAid Bangladesh.

"We have an uphill battle, yet it can be won. There needs to be greater regulation in the sale of such drugs. Government and the state must play an active role."

(Writing by Nita Bhalla; Editing by John Chalmers and Paul Tait)

http://news.yahoo.com/bangladeshs-teenage-brothels-hold-dark-steroid-secret-024639562.html