Latest in Cardio
Neither were there any restrictions against moderate drinking or eating sweets. Banquets held on fish days could be splendid, and were popular occasions for serving illusion food that imitated meat, cheese and eggs in various ingenious ways; fish could be moulded to look like venison and fake eggs could be made by stuffing empty egg shells with fish roe and almond milk and cooking them in coals.
While Byzantine church officials took a hard-line approach, and discouraged any culinary refinement for the clergy, their Western counterparts were far more lenient. During Lent, kings and schoolboys, commoners and nobility, all complained about being deprived of meat for the long, hard weeks of solemn contemplation of their sins.
At Lent, owners of livestock were even warned to keep an eye out for hungry dogs frustrated by a "hard siege by Lent and fish bones". The trend from the 13th century onward was toward a more legalistic interpretation of fasting. Nobles were careful not to eat meat on fast days, but still dined in style; fish replaced meat, often as imitation hams and bacon; almond milk replaced animal milk as an expensive non-dairy alternative; faux eggs made from almond milk were cooked in blown-out eggshells, flavoured and coloured with exclusive spices.
In some cases the lavishness of noble tables was outdone by Benedictine monasteries, which served as many as sixteen courses during certain feast days.
Exceptions from fasting were frequently made for very broadly defined groups. Since the sick were exempt from fasting, there often evolved the notion that fasting restrictions only applied to the main dining area, and many Benedictine friars would simply eat their fast day meals in what was called the misericord at those times rather than the refectory. Medieval society was highly stratified.
In a time when famine was commonplace and social hierarchies were often brutally enforced, food was an important marker of social status in a way that has no equivalent today in most developed countries. According to the ideological norm, society consisted of the three estates of the realm: The relationship between the classes was strictly hierarchical, with the nobility and clergy claiming worldly and spiritual overlordship over commoners.
Within the nobility and clergy there were also a number of ranks ranging from kings and popes to dukes , bishops and their subordinates, such as priests.
One was expected to remain in one's social class and to respect the authority of the ruling classes. Political power was displayed not just by rule, but also by displaying wealth.
Nobles dined on fresh game seasoned with exotic spices, and displayed refined table manners; rough laborers could make do with coarse barley bread, salt pork and beans and were not expected to display etiquette. Even dietary recommendations were different: The digestive system of a lord was held to be more discriminating than that of his rustic subordinates and demanded finer foods.
In the late Middle Ages, the increasing wealth of middle class merchants and traders meant that commoners began emulating the aristocracy, and threatened to break down some of the symbolic barriers between the nobility and the lower classes. The response came in two forms: Medical science of the Middle Ages had a considerable influence on what was considered healthy and nutritious among the upper classes. One's lifestyle—including diet, exercise, appropriate social behavior, and approved medical remedies—was the way to good health, and all types of food were assigned certain properties that affected a person's health.
All foodstuffs were also classified on scales ranging from hot to cold and moist to dry, according to the four bodily humours theory proposed by Galen that dominated Western medical science from late Antiquity until the 17th century. Medieval scholars considered human digestion to be a process similar to cooking.
The processing of food in the stomach was seen as a continuation of the preparation initiated by the cook. In order for the food to be properly "cooked" and for the nutrients to be properly absorbed, it was important that the stomach be filled in an appropriate manner. Easily digestible foods would be consumed first, followed by gradually heavier dishes. If this regimen were not respected it was believed that heavy foods would sink to the bottom of the stomach, thus blocking the digestion duct, so that food would digest very slowly and cause putrefaction of the body and draw bad humours into the stomach.
It was also of vital importance that food of differing properties not be mixed. Before a meal, the stomach would preferably be "opened" with an apéritif from Latin aperire , "to open" that was preferably of a hot and dry nature: As the stomach had been opened, it should then be "closed" at the end of the meal with the help of a digestive, most commonly a dragée , which during the Middle Ages consisted of lumps of spiced sugar, or hypocras , a wine flavoured with fragrant spices, along with aged cheese.
A meal would ideally begin with easily digestible fruit, such as apples. It would then be followed by vegetables such as lettuce , cabbage , purslane , herbs, moist fruits, light meats, such as chicken or goat kid , with potages and broths.
After that came the "heavy" meats, such as pork and beef , as well as vegetables and nuts, including pears and chestnuts, both considered difficult to digest.
It was popular, and recommended by medical expertise, to finish the meal with aged cheese and various digestives. The most ideal food was that which most closely matched the humour of human beings, i.
Food should preferably also be finely chopped, ground, pounded and strained to achieve a true mixture of all the ingredients.
White wine was believed to be cooler than red and the same distinction was applied to red and white vinegar. Milk was moderately warm and moist, but the milk of different animals was often believed to differ.
Egg yolks were considered to be warm and moist while the whites were cold and moist. Skilled cooks were expected to conform to the regimen of humoral medicine. Even if this limited the combinations of food they could prepare, there was still ample room for artistic variation by the chef. The caloric content and structure of medieval diet varied over time, from region to region, and between classes. However, for most people, the diet tended to be high-carbohydrate, with most of the budget spent on, and the majority of calories provided by, cereals and alcohol such as beer.
Even though meat was highly valued by all, lower classes often could not afford it, nor were they allowed by the church to consume it every day. In one early 15th-century English aristocratic household for which detailed records are available that of the Earl of Warwick , gentle members of the household received a staggering 3. In the household of Henry Stafford in , gentle members received 2. In monasteries, the basic structure of the diet was laid down by the Rule of Saint Benedict in the 7th century and tightened by Pope Benedict XII in , but as mentioned above monks were adept at "working around" these rules.
This was circumvented in part by declaring that offal , and various processed foods such as bacon , were not meat. Secondly, Benedictine monasteries contained a room called the misericord , where the Rule of Saint Benedict did not apply, and where a large number of monks ate. Each monk would be regularly sent either to the misericord or to the refectory. When Pope Benedict XII ruled that at least half of all monks should be required to eat in the refectory on any given day, monks responded by excluding the sick and those invited to the abbot's table from the reckoning.
The overall caloric intake is subject to some debate. As a consequence of these excesses, obesity was common among upper classes. The regional specialties that are a feature of early modern and contemporary cuisine were not in evidence in the sparser documentation that survives.
Instead, medieval cuisine can be differentiated by the cereals and the oils that shaped dietary norms and crossed ethnic and, later, national boundaries. Geographical variation in eating was primarily the result of differences in climate, political administration, and local customs that varied across the continent.
Though sweeping generalizations should be avoided, more or less distinct areas where certain foodstuffs dominated can be discerned. In the British Isles , northern France , the Low Countries , the northern German-speaking areas, Scandinavia and the Baltic , the climate was generally too harsh for the cultivation of grapes and olives.
In the south, wine was the common drink for both rich and poor alike though the commoner usually had to settle for cheap second pressing wine while beer was the commoner's drink in the north and wine an expensive import. Citrus fruits though not the kinds most common today and pomegranates were common around the Mediterranean.
Dried figs and dates were available in the north, but were used rather sparingly in cooking. Olive oil was a ubiquitous ingredient in Mediterranean cultures, but remained an expensive import in the north where oils of poppy , walnut, hazel and filbert were the most affordable alternatives. Butter and lard , especially after the terrible mortality during the Black Death made them less scarce, were used in considerable quantities in the northern and northwestern regions, especially in the Low Countries.
Almost universal in middle and upper class cooking all over Europe was the almond , which was in the ubiquitous and highly versatile almond milk , which was used as a substitute in dishes that otherwise required eggs or milk, though the bitter variety of almonds came along much later. In Europe there were typically two meals a day: The two-meal system remained consistent throughout the late Middle Ages. Smaller intermediate meals were common, but became a matter of social status, as those who did not have to perform manual labor could go without them.
For practical reasons, breakfast was still eaten by working men, and was tolerated for young children, women, the elderly and the sick. Because the church preached against gluttony and other weaknesses of the flesh, men tended to be ashamed of the weak practicality of breakfast. Lavish dinner banquets and late-night reresopers from Occitan rèire-sopar , "late supper" with considerable amounts of alcoholic beverage were considered immoral. The latter were especially associated with gambling, crude language, drunkenness, and lewd behavior.
As with almost every part of life at the time, a medieval meal was generally a communal affair. The entire household, including servants, would ideally dine together. To sneak off to enjoy private company was considered a haughty and inefficient egotism in a world where people depended very much on each other. When possible, rich hosts retired with their consorts to private chambers where the meal could be enjoyed in greater exclusivity and privacy.
Being invited to a lord's chambers was a great privilege and could be used as a way to reward friends and allies and to awe subordinates. It allowed lords to distance themselves further from the household and to enjoy more luxurious treats while serving inferior food to the rest of the household that still dined in the great hall. At major occasions and banquets, however, the host and hostess generally dined in the great hall with the other diners.
However, it can be assumed there were no such extravagant luxuries as multiple courses , luxurious spices or hand-washing in scented water in everyday meals. Things were different for the wealthy. Before the meal and between courses, shallow basins and linen towels were offered to guests so they could wash their hands, as cleanliness was emphasized.
Social codes made it difficult for women to uphold the ideal of immaculate neatness and delicacy while enjoying a meal, so the wife of the host often dined in private with her entourage or ate very little at such feasts. She could then join dinner only after the potentially messy business of eating was done. Overall, fine dining was a predominantly male affair, and it was uncommon for anyone but the most honored of guests to bring his wife or her ladies-in-waiting.
The hierarchical nature of society was reinforced by etiquette where the lower ranked were expected to help the higher, the younger to assist the elder, and men to spare women the risk of sullying dress and reputation by having to handle food in an unwomanly fashion.
Shared drinking cups were common even at lavish banquets for all but those who sat at the high table , as was the standard etiquette of breaking bread and carving meat for one's fellow diners. Food was mostly served on plates or in stew pots, and diners would take their share from the dishes and place it on trenchers of stale bread, wood or pewter with the help of spoons or bare hands.
In lower-class households it was common to eat food straight off the table. Knives were used at the table, but most people were expected to bring their own, and only highly favored guests would be given a personal knife. A knife was usually shared with at least one other dinner guest, unless one was of very high rank or well-acquainted with the host.
Forks for eating were not in widespread usage in Europe until the early modern period , and early on were limited to Italy. Even there it was not until the 14th century that the fork became common among Italians of all social classes. The change in attitudes can be illustrated by the reactions to the table manners of the Byzantine princess Theodora Doukaina in the late 11th century.
She was the wife of Domenico Selvo , the Doge of Venice , and caused considerable dismay among upstanding Venetians. The foreign consort's insistence on having her food cut up by her eunuch servants and then eating the pieces with a golden fork shocked and upset the diners so much that there was a claim that Peter Damian , Cardinal Bishop of Ostia , later interpreted her refined foreign manners as pride and referred to her as " All types of cooking involved the direct use of fire.
Kitchen stoves did not appear until the 18th century, and cooks had to know how to cook directly over an open fire. Ovens were used, but they were expensive to construct and only existed in fairly large households and bakeries. It was common for a community to have shared ownership of an oven to ensure that the bread baking essential to everyone was made communal rather than private.
There were also portable ovens designed to be filled with food and then buried in hot coals, and even larger ones on wheels that were used to sell pies in the streets of medieval towns. But for most people, almost all cooking was done in simple stewpots, since this was the most efficient use of firewood and did not waste precious cooking juices, making potages and stews the most common dishes.
This was considered less of a problem in a time of back-breaking toil, famine, and a greater acceptance—even desirability—of plumpness; only the poor or sick, and devout ascetics , were thin. Fruit was readily combined with meat, fish and eggs. The recipe for Tart de brymlent , a fish pie from the recipe collection Forme of Cury , includes a mix of figs , raisins , apples and pears with fish salmon , codling or haddock and pitted damson plums under the top crust. This meant that food had to be "tempered" according to its nature by an appropriate combination of preparation and mixing certain ingredients, condiments and spices; fish was seen as being cold and moist, and best cooked in a way that heated and dried it, such as frying or oven baking, and seasoned with hot and dry spices; beef was dry and hot and should therefore be boiled ; pork was hot and moist and should therefore always be roasted.
In a recipe for quince pie, cabbage is said to work equally well, and in another turnips could be replaced by pears. The completely edible shortcrust pie did not appear in recipes until the 15th century. Before that the pastry was primarily used as a cooking container in a technique known as ' huff paste '.
Extant recipe collections show that gastronomy in the Late Middle Ages developed significantly. New techniques, like the shortcrust pie and the clarification of jelly with egg whites began to appear in recipes in the late 14th century and recipes began to include detailed instructions instead of being mere memory aids to an already skilled cook.
In most households, cooking was done on an open hearth in the middle of the main living area, to make efficient use of the heat. This was the most common arrangement, even in wealthy households, for most of the Middle Ages, where the kitchen was combined with the dining hall.
Towards the Late Middle Ages a separate kitchen area began to evolve. The first step was to move the fireplaces towards the walls of the main hall, and later to build a separate building or wing that contained a dedicated kitchen area, often separated from the main building by a covered arcade. This way, the smoke, odors and bustle of the kitchen could be kept out of sight of guests, and the fire risk lessened.
Many basic variations of cooking utensils available today, such as frying pans , pots , kettles , and waffle irons , already existed, although they were often too expensive for poorer households. Other tools more specific to cooking over an open fire were spits of various sizes, and material for skewering anything from delicate quails to whole oxen. Utensils were often held directly over the fire or placed into embers on tripods.
To assist the cook there were also assorted knives, stirring spoons, ladles and graters. In wealthy households one of the most common tools was the mortar and sieve cloth, since many medieval recipes called for food to be finely chopped, mashed, strained and seasoned either before or after cooking.
This was based on a belief among physicians that the finer the consistency of food, the more effectively the body would absorb the nourishment. It also gave skilled cooks the opportunity to elaborately shape the results.
Fine-textured food was also associated with wealth; for example, finely milled flour was expensive, while the bread of commoners was typically brown and coarse. A typical procedure was farcing from the Latin farcio , "to cram" , to skin and dress an animal, grind up the meat and mix it with spices and other ingredients and then return it into its own skin, or mold it into the shape of a completely different animal.
The kitchen staff of huge noble or royal courts occasionally numbered in the hundreds: While an average peasant household often made do with firewood collected from the surrounding woodlands, the major kitchens of households had to cope with the logistics of daily providing at least two meals for several hundred people.
Guidelines on how to prepare for a two-day banquet can be found in the cookbook Du fait de cuisine "On cookery" written in in part to compete with the court of Burgundy  by Maistre Chiquart, master chef of Amadeus VIII, Duke of Savoy.
Food preservation methods were basically the same as had been used since antiquity, and did not change much until the invention of canning in the early 19th century. The most common and simplest method was to expose foodstuffs to heat or wind to remove moisture , thereby prolonging the durability if not the flavor of almost any type of food from cereals to meats; the drying of food worked by drastically reducing the activity of various water-dependent microorganisms that cause decay.
In warm climates this was mostly achieved by leaving food out in the sun, and in the cooler northern climates by exposure to strong winds especially common for the preparation of stockfish , or in warm ovens, cellars, attics, and at times even in living quarters. Subjecting food to a number of chemical processes such as smoking , salting , brining , conserving or fermenting also made it keep longer.
Most of these methods had the advantage of shorter preparation times and of introducing new flavors. Smoking or salting meat of livestock butchered in autumn was a common household strategy to avoid having to feed more animals than necessary during the lean winter months.
Vegetables, eggs or fish were also often pickled in tightly packed jars, containing brine and acidic liquids lemon juice , verjuice or vinegar. Another method was to seal the food by cooking it in sugar or honey or fat, in which it was then stored. Microbial modification was also encouraged, however, by a number of methods; grains, fruit and grapes were turned into alcoholic drinks thus killing any pathogens, and milk was fermented and curdled into a multitude of cheeses or buttermilk.
The majority of the European population before industrialization lived in rural communities or isolated farms and households.
The norm was self-sufficiency with only a small percentage of production being exported or sold in markets. Large towns were exceptions and required their surrounding hinterlands to support them with food and fuel. The dense urban population could support a wide variety of food establishments that catered to various social groups. Many of the poor city dwellers had to live in cramped conditions without access to a kitchen or even a hearth, and many did not own the equipment for basic cooking.
Food from vendors was in such cases the only option. Cookshops could either sell ready-made hot food, an early form of fast food , or offer cooking services while the customers supplied some or all of the ingredients.
Travellers, such as pilgrims en route to a holy site, made use of professional cooks to avoid having to carry their provisions with them. For the more affluent, there were many types of specialist that could supply various foods and condiments: Well-off citizens who had the means to cook at home could on special occasions hire professionals when their own kitchen or staff could not handle the burden of throwing a major banquet.
Urban cookshops that catered to workers or the destitute were regarded as unsavory and disreputable places by the well-to-do and professional cooks tended to have a bad reputation. Geoffrey Chaucer 's Hodge of Ware, the London cook from the Canterbury Tales , is described as a sleazy purveyor of unpalatable food. French cardinal Jacques de Vitry 's sermons from the early 13th century describe sellers of cooked meat as an outright health hazard.
The stereotypical cook in art and literature was male, hot-tempered, prone to drunkenness, and often depicted guarding his stewpot from being pilfered by both humans and animals. In the early 15th century, the English monk John Lydgate articulated the beliefs of many of his contemporaries by proclaiming that "Hoot ffir [fire] and smoke makith many an angry cook. The period between c. More intense agriculture on an ever-increasing acreage resulted in a shift from animal products, like meat and dairy, to various grains and vegetables as the staple of the majority population.
A bread-based diet became gradually more common during the 15th century and replaced warm intermediate meals that were porridge- or gruel-based. Leavened bread was more common in wheat-growing regions in the south, while unleavened flatbread of barley, rye or oats remained more common in northern and highland regions, and unleavened flatbread was also common as provisions for troops.
The most common grains were rye , barley , buckwheat , millet and oats. Rice remained a fairly expensive import for most of the Middle Ages and was grown in northern Italy only towards the end of the period.
Wheat was common all over Europe and was considered to be the most nutritious of all grains, but was more prestigious and thus more expensive. The finely sifted white flour that modern Europeans are most familiar with was reserved for the bread of the upper classes.
As one descended the social ladder, bread became coarser, darker, and its bran content increased. In times of grain shortages or outright famine, grains could be supplemented with cheaper and less desirable substitutes like chestnuts , dried legumes , acorns , ferns , and a wide variety of more or less nutritious vegetable matter. One of the most common constituents of a medieval meal, either as part of a banquet or as a small snack, were sops , pieces of bread with which a liquid like wine , soup , broth , or sauce could be soaked up and eaten.
Another common sight at the medieval dinner table was the frumenty , a thick wheat porridge often boiled in a meat broth and seasoned with spices. Porridges were also made of every type of grain and could be served as desserts or dishes for the sick, if boiled in milk or almond milk and sweetened with sugar.
Pies filled with meats, eggs, vegetables, or fruit were common throughout Europe, as were turnovers , fritters , doughnuts , and many similar pastries. By the Late Middle Ages biscuits cookies in the U. Grain, either as bread crumbs or flour, was also the most common thickener of soups and stews, alone or in combination with almond milk.
The importance of bread as a daily staple meant that bakers played a crucial role in any medieval community. Bread consumption was high in most of Western Europe by the 14th century. Estimates of bread consumption from different regions are fairly similar: Among the first town guilds to be organized were the bakers', and laws and regulations were passed to keep bread prices stable.
The English Assize of Bread and Ale of listed extensive tables where the size, weight, and price of a loaf of bread were regulated in relation to grain prices. The baker's profit margin stipulated in the tables was later increased through successful lobbying from the London Baker's Company by adding the cost of everything from firewood and salt to the baker's wife, house, and dog.
Since bread was such a central part of the medieval diet, swindling by those who were trusted with supplying the precious commodity to the community was considered a serious offense. Bakers who were caught tampering with weights or adulterating dough with less expensive ingredients could receive severe penalties. This gave rise to the " baker's dozen ": While grains were the primary constituent of most meals, vegetables such as cabbage , chard , onions , garlic and carrots were common foodstuffs.
Many of these were eaten daily by peasants and workers and were less prestigious than meat. The cookbooks, which appeared in the late Middle Ages and were intended mostly for those who could afford such luxuries, contained only a small number of recipes using vegetables as the main ingredient. The lack of recipes for many basic vegetable dishes, such as potages , has been interpreted not to mean that they were absent from the meals of the nobility, but rather that they were considered so basic that they did not require recording.
Various legumes , like chickpeas , fava beans and field peas were also common and important sources of protein , especially among the lower classes. With the exception of peas, legumes were often viewed with some suspicion by the dietitians advising the upper class, partly because of their tendency to cause flatulence but also because they were associated with the coarse food of peasants.
The importance of vegetables to the common people is illustrated by accounts from 16th-century Germany stating that many peasants ate sauerkraut from three to four times a day. Fruit was popular and could be served fresh, dried, or preserved, and was a common ingredient in many cooked dishes. The fruits of choice in the south were lemons , citrons , bitter oranges the sweet type was not introduced until several hundred years later , pomegranates , quinces , and, of course, grapes.
Farther north, apples , pears , plums , and strawberries were more common. Figs and dates were eaten all over Europe, but remained rather expensive imports in the north. Common and often basic ingredients in many modern European cuisines like potatoes , kidney beans , cacao , vanilla , tomatoes , chili peppers and maize were not available to Europeans until after , after European contact with the Americas, and even then it often took considerable time, sometimes several centuries, for the new foodstuffs to be accepted by society at large.
Milk was an important source of animal protein for those who could not afford meat. It would mostly come from cows, but milk from goats and sheep was also common. Plain fresh milk was not consumed by adults except the poor or sick, and was usually reserved for the very young or elderly. Poor adults would sometimes drink buttermilk or whey or milk that was soured or watered down. On occasion it was used in upper-class kitchens in stews, but it was difficult to keep fresh in bulk and almond milk was generally used in its stead.
Cheese was far more important as a foodstuff, especially for common people, and it has been suggested that it was, during many periods, the chief supplier of animal protein among the lower classes. There were also whey cheeses , like ricotta , made from by-products of the production of harder cheeses. Cheese was used in cooking for pies and soups, the latter being common fare in German-speaking areas.
Butter , another important dairy product, was in popular use in the regions of Northern Europe that specialized in cattle production in the latter half of the Middle Ages, the Low Countries and Southern Scandinavia. While most other regions used oil or lard as cooking fats, butter was the dominant cooking medium in these areas.
Its production also allowed for a lucrative butter export from the 12th century onward. While all forms of wild game were popular among those who could obtain it, most meat came from domestic animals. Domestic working animals that were no longer able to work were slaughtered but not particularly appetizing and therefore were less valued as meat. Beef was not as common as today because raising cattle was labor-intensive, requiring pastures and feed, and oxen and cows were much more valuable as draught animals and for producing milk.
Mutton and lamb were fairly common, especially in areas with a sizeable wool industry, as was veal. Domestic pigs often ran freely even in towns and could be fed on just about any organic waste, and suckling pig was a sought-after delicacy. Just about every part of the pig was eaten, including ears, snout, tail, tongue , and womb. Intestines, bladder and stomach could be used as casings for sausage or even illusion food such as giant eggs.
Among the meats that today are rare or even considered inappropriate for human consumption are the hedgehog and porcupine , occasionally mentioned in late medieval recipe collections. In England, they were deliberately introduced by the 13th century and their colonies were carefully protected. They were of particular value for monasteries, because newborn rabbits were allegedly declared fish or, at least, not-meat by the church and therefore they could be eaten during Lent.
A wide range of birds were eaten, including swans , peafowl , quail , partridge , storks , cranes , larks , linnets and other songbirds that could be trapped in nets, and just about any other wild bird that could be hunted. Swans and peafowl were domesticated to some extent, but were only eaten by the social elite, and more praised for their fine appearance as stunning entertainment dishes, entremets , than for their meat. As today, geese and ducks had been domesticated but were not as popular as the chicken , the fowl equivalent of the pig.
But at the Fourth Council of the Lateran , Pope Innocent III explicitly prohibited the eating of barnacle geese during Lent, arguing that they lived and fed like ducks and so were of the same nature as other birds. Meats were more expensive than plant foods. Testosterone administered by mouth is rapidly absorbed, but it is largely converted to inactive metabolites, and only about one-sixth is available in active form.
This modification reduces the liver's ability to break down these compounds before they reach the systemic circulation. Testosterone can be administered parenterally , but it has more irregular prolonged absorption time and greater activity in muscle in enanthate , undecanoate , or cypionate ester form.
These derivatives are hydrolyzed to release free testosterone at the site of injection; absorption rate and thus injection schedule varies among different esters, but medical injections are normally done anywhere between semi-weekly to once every 12 weeks. A more frequent schedule may be desirable in order to maintain a more constant level of hormone in the system. In addition, because estered testosterone is dissolved in oil, intravenous injection has the potential to cause a dangerous embolism clot in the bloodstream.
Transdermal patches adhesive patches placed on the skin may also be used to deliver a steady dose through the skin and into the bloodstream. There is also the risk that an intimate partner or child may come in contact with the application site and inadvertently dose himself or herself; children and women are highly sensitive to testosterone and can suffer unintended masculinization and health effects, even from small doses.
Injection is the most common method used by individuals administering AAS for non-medical purposes. The traditional routes of administration do not have differential effects on the efficacy of the drug. Studies indicate that the anabolic properties of AAS are relatively similar despite the differences in pharmacokinetic principles such as first-pass metabolism. However, the orally available forms of AAS may cause liver damage in high doses. Known possible side effects of AAS include: Depending on the length of drug abuse, there is a chance that the immune system can be damaged.
Most of these side-effects are dose-dependent, the most common being elevated blood pressure , especially in those with pre-existing hypertension. AAS have been shown to alter fasting blood sugar and glucose tolerance tests. A number of severe side effects can occur if adolescents use AAS. For example, AAS may prematurely stop the lengthening of bones premature epiphyseal fusion through increased levels of estrogen metabolites , resulting in stunted growth. Other effects include, but are not limited to, accelerated bone maturation , increased frequency and duration of erections, and premature sexual development.
AAS use in adolescence is also correlated with poorer attitudes related to health. Probably carcinogenic to humans. Other side-effects can include alterations in the structure of the heart , such as enlargement and thickening of the left ventricle , which impairs its contraction and relaxation , and therefore reducing ejected blood volume.
AAS use can cause harmful changes in cholesterol levels: AAS use in adolescents quickens bone maturation and may reduce adult height in high doses. There are also sex-specific side effects of AAS. Development of breast tissue in males, a condition called gynecomastia which is usually caused by high levels of circulating estradiol , may arise because of increased conversion of testosterone to estradiol by the enzyme aromatase.
This side-effect is temporary; the size of the testicles usually returns to normal within a few weeks of discontinuing AAS use as normal production of sperm resumes. Female-specific side effects include increases in body hair , permanent deepening of the voice, enlarged clitoris , and temporary decreases in menstrual cycles.
Alteration of fertility and ovarian cysts can also occur in females. Kidney tests revealed that nine of the ten steroid users developed a condition called focal segmental glomerulosclerosis , a type of scarring within the kidneys. The kidney damage in the bodybuilders has similarities to that seen in morbidly obese patients, but appears to be even more severe.
High doses of oral AAS compounds can cause liver damage. A review in CNS Drugs determined that "significant psychiatric symptoms including aggression and violence, mania , and less frequently psychosis and suicide have been associated with steroid abuse. Long-term steroid abusers may develop symptoms of dependence and withdrawal on discontinuation of AAS".
Recreational AAS use appears to be associated with a range of potentially prolonged psychiatric effects, including dependence syndromes, mood disorders , and progression to other forms of substance abuse, but the prevalence and severity of these various effects remains poorly understood. Large-scale long-term studies of psychiatric effects on AAS users are not currently available.
DSM-IV lists General diagnostic criteria for a personality disorder guideline that "The pattern must not be better accounted for as a manifestation of another mental disorder, or to the direct physiological effects of a substance e. As a result, AAS users may get misdiagnosed by a psychiatrist not told about their habit. Affective disorders have long been recognised as a complication of AAS use. From the mids onward, the media reported "roid rage" as a side effect of AAS.
A review determined that some, but not all, randomized controlled studies have found that AAS use correlates with hypomania and increased aggressiveness, but pointed out that attempts to determine whether AAS use triggers violent behavior have failed, primarily because of high rates of non-participation. Compared with individuals that did not use steroids, young adult males that used AAS reported greater involvement in violent behaviors even after controlling for the effects of key demographic variables, previous violent behavior, and polydrug use.
The drug response was highly variable. The mechanism of these variable reactions could not be explained by demographic, psychological, laboratory, or physiological measures. A study of two pairs of identical twins, in which one twin used AAS and the other did not, found that in both cases the steroid-using twin exhibited high levels of aggressiveness, hostility, anxiety, and paranoid ideation not found in the "control" twin.
The relationship between AAS use and depression is inconclusive. There have been anecdotal reports of depression and suicide in teenage steroid users,  but little systematic evidence. A review found that AAS may both relieve and cause depression, and that cessation or diminished use of AAS may also result in depression, but called for additional studies due to disparate data.
Androgens such as testosterone , androstenedione and dihydrotestosterone are required for the development of organs in the male reproductive system , including the seminal vesicles , epididymis , vas deferens , penis and prostate. The pharmacodynamics of AAS are unlike peptide hormones. However, as fat-soluble hormones, AAS are membrane-permeable and influence the nucleus of cells by direct action. The pharmacodynamic action of AAS begin when the exogenous hormone penetrates the membrane of the target cell and binds to an androgen receptor AR located in the cytoplasm of that cell.
From there, the compound hormone-receptor diffuses into the nucleus, where it either alters the expression of genes  or activates processes that send signals to other parts of the cell. The effect of AAS on muscle mass is caused in at least two ways: It has been hypothesized that this reduction in muscle breakdown may occur through AAS inhibiting the action of other steroid hormones called glucocorticoids that promote the breakdown of muscles.
As their name suggests, AAS have two different, but overlapping, types of effects: Some examples of the anabolic effects of these hormones are increased protein synthesis from amino acids , increased appetite, increased bone remodeling and growth, and stimulation of bone marrow , which increases the production of red blood cells.
Through a number of mechanisms AAS stimulate the formation of muscle cells and hence cause an increase in the size of skeletal muscles , leading to increased strength. The androgenic effects of AAS are numerous. Depending on the length of use, the side effects of the steroid can be irreversible.
Processes affected include pubertal growth, sebaceous gland oil production, and sexuality especially in fetal development. Some examples of virilizing effects are growth of the clitoris in females and the penis in male children the adult penis size does not change due to steroids [ medical citation needed ] , increased vocal cord size, increased libido , suppression of natural sex hormones , and impaired production of sperm.
Men may develop an enlargement of breast tissue, known as gynecomastia, testicular atrophy, and a reduced sperm count. Compounds with a high ratio of androgenic to an anabolic effects are the drug of choice in androgen-replacement therapy e. This disassociation is less marked in humans, where all AAS have significant androgenic effects. A commonly used protocol for determining the androgenic: The VP weight is an indicator of the androgenic effect, while the LA weight is an indicator of the anabolic effect.
Two or more batches of rats are castrated and given no treatment and respectively some AAS of interest. Animal studies also found that fat mass was reduced, but most studies in humans failed to elucidate significant fat mass decrements.
The effects on lean body mass have been shown to be dose-dependent. Both muscle hypertrophy and the formation of new muscle fibers have been observed. The hydration of lean mass remains unaffected by AAS use, although small increments of blood volume cannot be ruled out. The upper region of the body thorax, neck, shoulders, and upper arm seems to be more susceptible for AAS than other body regions because of predominance of ARs in the upper body.
After drug withdrawal, the effects fade away slowly, but may persist for more than 6—12 weeks after cessation of AAS use. Overall, the exercise where the most significant improvements were observed is the bench press. The measurement of the dissociation between anabolic and androgenic effects among AAS is based largely on a simple although arguably unsophisticated and outdated model involving rat tissue bioassays.
The intracellular metabolism theory explains how and why remarkable dissociation between anabolic and androgenic effects can occur despite the fact that these effects are mediated through the same signaling receptor, and of course why dissociation is invariably incomplete.
An animal study found that two different kinds of androgen response elements could differentially respond to testosterone and DHT upon activation of the AR. Changes in endogenous testosterone levels may also contribute to differences in myotrophic—androgenic ratio between testosterone and synthetic AAS.
Testosterone can be metabolized by aromatase into estradiol , and many other AAS can be metabolized into their corresponding estrogenic metabolites as well. The major effect of estrogenicity is gynecomastia woman-like breasts. AAS are androstane or estrane steroids. As well as others such as 1-dehydrogenation e.
The most commonly employed human physiological specimen for detecting AAS usage is urine, although both blood and hair have been investigated for this purpose. The AAS, whether of endogenous or exogenous origin, are subject to extensive hepatic biotransformation by a variety of enzymatic pathways.
The primary urinary metabolites may be detectable for up to 30 days after the last use, depending on the specific agent, dose and route of administration. A number of the drugs have common metabolic pathways, and their excretion profiles may overlap those of the endogenous steroids, making interpretation of testing results a very significant challenge to the analytical chemist.
Methods for detection of the substances or their excretion products in urine specimens usually involve gas chromatography—mass spectrometry or liquid chromatography-mass spectrometry.
The use of gonadal steroids pre-dates their identification and isolation. Medical use of testicle extract began in the late 19th century while its effects on strength were still being studied. In the s, it was already known that the testes contain a more powerful androgen than androstenone , and three groups of scientists, funded by competing pharmaceutical companies in the Netherlands, Germany, and Switzerland, raced to isolate it.
The chemical synthesis of testosterone was achieved in August that year, when Butenandt and G. Wettstein, announced a patent application in a paper "On the Artificial Preparation of the Testicular Hormone Testosterone Androstenoneol.
Clinical trials on humans, involving either oral doses of methyltestosterone or injections of testosterone propionate , began as early as Kennedy was administered steroids both before and during his presidency. The development of muscle-building properties of testosterone was pursued in the s, in the Soviet Union and in Eastern Bloc countries such as East Germany, where steroid programs were used to enhance the performance of Olympic and other amateur weight lifters.
In response to the success of Russian weightlifters, the U. The new steroid was approved for use in the U.
It was most commonly administered to burn victims and the elderly. The drug's off-label users were mostly bodybuilders and weight lifters. Although Ziegler prescribed only small doses to athletes, he soon discovered that those having abused Dianabol suffered from enlarged prostates and atrophied testes.
Three major ideas governed modifications of testosterone into a multitude of AAS: Androgens were discovered in the s and were characterized as having effects described as androgenic i. Although anabolic steroid was originally intended to specifically describe testosterone-derived steroids with a marked dissociation of anabolic and androgenic effect, it is applied today indiscriminately to all steroids with AR agonism-based anabolic effects regardless of their androgenic potency, including even non-synthetic steroids like testosterone itself.
The legal status of AAS varies from country to country: Unlawful distribution or possession with intent to distribute AAS as a first offense is punished by up to ten years in prison. Those guilty of buying or selling AAS in Canada can be imprisoned for up to 18 months. In Canada, researchers have concluded that steroid use among student athletes is extremely widespread. A study conducted in by the Canadian Centre for Drug-Free Sport found that nearly 83, Canadians between the ages of 11 and 18 use steroids.
AAS are readily available without a prescription in some countries such as Mexico and Thailand. The history of the U. The same act also introduced more stringent controls with higher criminal penalties for offenses involving the illegal distribution of AAS and human growth hormone. By the early s, after AAS were scheduled in the U. In the Controlled Substances Act, AAS are defined to be any drug or hormonal substance chemically and pharmacologically related to testosterone other than estrogens , progestins , and corticosteroids that promote muscle growth.
The act was amended by the Anabolic Steroid Control Act of , which added prohormones to the list of controlled substances , with effect from January 20, In the United Kingdom, AAS are classified as class C drugs for their illegal abuse potential, which puts them in the same class as benzodiazepines.
Part 1 drugs are subject to full import and export controls with possession being an offence without an appropriate prescription.
There is no restriction on the possession when it is part of a medicinal product. Part 2 drugs require a Home Office licence for importation and export unless the substance is in the form of a medicinal product and is for self-administration by a person.
Many other countries have similar legislation prohibiting AAS in sports including Denmark,  France,  the Netherlands  and Sweden.
United States federal law enforcement officials have expressed concern about AAS use by police officers. It's not that we set out to target cops, but when we're in the middle of an active investigation into steroids, there have been quite a few cases that have led back to police officers," says Lawrence Payne, a spokesman for the United States Drug Enforcement Administration.
Following the murder-suicide of Chris Benoit in , the Oversight and Government Reform Committee investigated steroid usage in the wrestling industry.
The documents stated that 75 wrestlers—roughly 40 percent—had tested positive for drug use since , most commonly for steroids. AAS are frequently produced in pharmaceutical laboratories, but, in nations where stricter laws are present, they are also produced in small home-made underground laboratories, usually from raw substances imported from abroad.
As with most significant smuggling operations, organized crime is involved. In the late s, the worldwide trade in illicit AAS increased significantly, and authorities announced record captures on three continents. In , Finnish authorities announced a record seizure of A year later, the DEA seized In the first three months of , Australian customs reported a record seizures of AAS shipments.
Illegal AAS are sometimes sold at gyms and competitions, and through the mail, but may also be obtained through pharmacists, veterinarians, and physicians. AAS, alone and in combination with progestogens , have been studied as potential male hormonal contraceptives.
From Wikipedia, the free encyclopedia. This article is about androgens as medications. For androgens as natural hormones, see Androgen. Ergogenic use of anabolic steroids. Use of performance-enhancing drugs in sport. Illegal trade in anabolic steroids. Pharmacy and Pharmacology portal.
British Journal of Pharmacology. Houglum J, Harrelson GL, eds. Principles of Pharmacology for Athletic Trainers 2nd ed. Int J Sports Med. Mini Rev Med Chem. Anabolic-androgenic steroid therapy in the treatment of chronic diseases".
Clinics in Endocrinology and Metabolism.