If you've heard about steroids from only the mass media, you may think they're bad news. Sensational stories about athletes bulking up on anabolic steroids — and experiencing side effects such as aggressive behavior and infertility — abound. Others detail the serious side effects — such as bone thinning and high blood pressure — that can occur with use of prescription corticosteroid medications. All of this may make you wonder why they're so commonly prescribed.

But the medications that make up this class of drugs — including corticosteroids such as cortisone, hydrocortisone and prednisone — have great potential in the treatment of a variety of conditions, from rashes to lupus and asthma. Working with your doctor, you can take steps to reduce the medications' side effects so that the benefits of treatment outweigh the risks.

Steroids are hormones naturally produced by the adrenal glands, located on top of your kidneys, and by the ovaries in women and testes in men.

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Adrenal glands Your adrenal glands, tiny organs each about half the size of your thumb, ... << ENLARGE

Naturally produced steroids help control:

• Stress of illness and injury
• Development of sexual characteristics
• Immune function
• Inflammation
• Metabolism
• Salt and water balance

Steroid medications are chemically similar to natural steroids and duplicate their actions. Examples include:

• Corticosteroids. These drugs mimic the effects of the hormones cortisone and hydrocortisone, which are naturally produced by your adrenal glands. When prescribed in doses that exceed your body's usual levels, corticosteroids suppress inflammation, which can reduce the symptoms of inflammatory conditions such as arthritis and asthma. This is the most commonly prescribed category of steroids for treating medical conditions.

  Researchers don't fully understand how corticosteroids suppress inflammation. One theory is that they deactivate a protein associated with inflammation. Another is that they alter the function of cell membranes.

• Birth control pills and hormone therapy medications. Although not commonly thought of as steroids, these drugs are chemically similar to the female sex hormones estrogen and progesterone, which are produced mainly by the ovaries. Doctors prescribe birth control pills for contraception and to relieve menstrual cramps and premenstrual syndrome. Hormone therapy is prescribed to relieve menopausal symptoms such as hot flashes and vaginal dryness.
• Anabolic steroids. These drugs are chemically related to the male sex hormone testosterone, which is produced mostly by the testes. They're less commonly prescribed than are other steroid medications, though doctors may prescribe them to treat certain sexual and growth disorders. Some athletes buy them illegally to increase muscle mass and strength.

Cortisone was the first steroid drug available. In 1935, researchers at Mayo Clinic, Rochester, Minn., isolated the hormone cortisone from adrenal glands. In 1948, doctors first used the new drug to treat a 28-year-old woman with severe rheumatoid arthritis. Cortisone remarkably relieved inflamed, swollen joints after just a few days of use. People who normally couldn't climb out of bed or into a bathtub could do so after using the drug.

Today, dozens of corticosteroid medications are available. The drugs are front-line treatments for rheumatoid arthritis, lupus, asthma, allergies and many other conditions. They also treat life-threatening conditions such as Addison's disease, in which the adrenal glands don't produce enough steroids, and help prevent organ rejection in transplant recipients.

You can take corticosteroids:

• Orally. Pills, capsules or syrups help treat the inflammation and pain associated with certain chronic conditions such as arthritis and lupus.
• By inhaler and intranasal spray. These forms help control inflammation associated with allergy and asthma.
• Topically. Creams, ointments and roll-ons can help heal many skin conditions.
• By injection. This form is used to treat such signs and symptoms as the pain and inflammation of tendinitis, severe musculoskeletal pain or serious rashes from poison ivy.

After dramatically improving arthritis symptoms in the 1940s, cortisone was hailed as a miracle drug. But problems soon emerged. People taking cortisone in doses high enough to relieve inflammation experienced harmful side effects after taking them for months.

Oral corticosteroids
Since oral corticosteroids affect your entire body instead of a particular area, this form is the most likely to cause significant side effects. Within days or weeks of starting oral therapy, you have an increased risk of:

• Elevated pressure in the eyes (glaucoma)
• Fluid retention, causing swelling in your lower legs
• Increased blood pressure
• Mood swings
• Weight gain, with fat deposits in your abdomen, face and the back of your neck

When taken longer term, you may experience:

• Cataracts
• High blood sugar, which can trigger or worsen diabetes
• Increased risk of infections
• Loss of calcium from bones, which can lead to osteoporosis and fractures
• Menstrual irregularities
• Muscle weakness and pain
• Suppressed adrenal gland hormone production
• Thin skin, easy bruising and slower wound healing

Inhaled corticosteroids
When using inhaled corticosteroids, some of the drug may deposit in your mouth and throat instead of making it to your lungs. This can cause coughing, hoarseness, dry mouth and sore throat. Gargling and rinsing your mouth with water and spitting it out after each use may reduce such effects. Although some researchers have speculated that these drugs slow growth rates in children who use them for asthma, studies show that they don't affect final adult height.

Topical and injected corticosteroids
Topical corticosteroids can lead to thin skin, red lesions and acne. Injected steroids can lead to a number of side effects such as nerve damage and decreased resistance to infection, so doctors usually try to perform no more than three such injections in a six- to 12-month period.

Even though all of these side effects are possible with the use of corticosteroids, it's unusual for one person to experience all of them.

Despite their side effects, corticosteroid drugs remain an important medical treatment. To get the most benefit with the least amount of risk:

• Ask about low-dose medications and intermittent dosing. Newer forms of corticosteroids come in varying strengths and lengths of action. Ask your doctor about using low-dose, short-term medications or taking oral corticosteroids every other day instead of daily.
• Ask about switching to nonoral forms of corticosteroids. Inhaled corticosteroids for asthma, for example, reach lung surfaces directly, reducing the rest of your body's exposure to them and leading to fewer side effects.
• Make healthy choices during therapy. When you're on corticosteroid medications for a prolonged period, talk to your doctor about ways to minimize side effects. You may need to restrict calories or increase physical activity to prevent weight gain. Exercise can help reduce muscle weakness and osteoporosis risks. And taking calcium and vitamin D supplements and prescription bisphosphonates, such as alendronate (Fosamax) or risedronate (Actonel), can minimize bone thinning.
• Take care when discontinuing therapy. If you take oral corticosteroids for prolonged periods, your adrenal glands produce less of their natural steroid hormones. To give your adrenals time to recover this function, your doctor may advise you to reduce your dosage gradually over a period of weeks or even months. If the dosage is reduced too quickly, you may experience fatigue, body aches, lightheadedness and difficulty recovering from minor illnesses.

  The greatest risk to your health during corticosteroid withdrawal is the inability of your adrenal glands to respond to the acute physical stress of serious illness, injury, surgery or general anesthesia. This can lead to shock and even death. Because additional corticosteroids can be given to you in preparation for surgery, it's important that you tell all your doctors if you have taken corticosteroids during the preceding year.

Remember that corticosteroids are neither as awful nor as miraculous as they've been portrayed. Although they may cause a range of side effects, they can also relieve the inflammation, pain and discomfort of many different diseases and conditions. If you work with your doctor to make choices that minimize side effects, you may achieve significant benefits with a reduced risk of such problems.