Anabolic Research Update
Why is my nose bleeding?
I started getting nosebleeds during my last cycle of testosterone and trenbolone. It happened several times while training during the same week and took awhile to stop each time. I don’t normally get nosebleeds, so I know it is the steroids. My friends tell me it is normal. It freaked me out, so I stopped taking steroids for awhile. I want to start again, but I’m nervous. I know people are talking. Can you help me understand what caused this and if I can avoid it in the future?
As you suspect, nosebleeds are a known possible side effect of steroid use. They occur at one time or another to a fair percentage of users. Physiologically, this problem is most directly caused by a combination of two factors. To begin with, when used at therapeutic and moderately supratherapeutic (above normally prescribed) dosages, anabolic steroids tend to decrease blood-clotting ability. If you want to know specifically what is happening, it appears the drugs increase plasmin, antithrombin III, and protein S levels, stimulate fibrinolysis (clot breakdown), and suppress clotting factors II, V, VII, and X.,[ii] If you look, you’ll see that the prescribing guidelines for anabolic/androgenic steroids in the U.S. warn of potential increases in prothrombin time, a measure of how long it takes for a blood clot to form.[iii] This ‘thinning’ of the blood also seems to make a full noticeable nosebleed more likely, and when it does occur, slower to stop.
Before we move on to the next factor, you need know that steroids don’t always reduce blood clotting. In fact, when used at high supratherapeutic dosages, these drugs can actually have the exact opposite effect on the blood. It seems that anabolic steroids can also elevate levels of thrombin[iv] and C-reactive protein,[v] as well as thromboxane A2 receptor density,[vi] which support clotting. At a certain dosage level, which is yet to be determined and likely varying between individuals, the pro-clotting changes in the blood appear to overtake the anti-clotting effects discussed earlier. These changes have been well-documented in some steroid abusing subjects,[vii] as are reports of (sometimes fatal) blood clots, embolisms, and strokes.[viii],[ix],[x],[xi],[xii] I don’t mean to confuse you, but I do think this is important to know. And in a small regard, the nosebleeds you reported may be a positive sign that your blood does not have an increased clotting tendency that would increase the risk of stroke.
The second big factor is probably very obvious: blood pressure. Although clinically consistently elevated blood pressure (hypertension) is not common in steroid users, it does occur with some frequency. I would first and foremost make sure I was not suffering from hypertension, as this is something that should never be ignored and can contribute to serious health issues. Often, elevated estrogen can be a key culprit in this side effect and slight changes in BP might be mitigated with a reduction in the estrogen level. Note, however, that hypertension is sometimes also reported with the use of non-aromatizing (purely anabolic/androgenic) compounds, so you can’t always rely on estrogen exclusively. Of course, during intense training, your blood pressure may become temporarily elevated as well. This likely explains why the nosebleeds were occurring during your training sessions. So increased blood pressure and reduced clotting could both be working hand in hand to support those nosebleeds.
I am not a physician and can’t advise you on what you need to do. With that said, as you probably know by reading my column, I believe you should always put safety first. The first thing I think any logical person would tell you is that you should go to the doctor for a full checkup. This is always a good idea when you cycle, and really a necessity if you are noticing strong side effects. If you don’t want to do this, you need to at least rule out hypertension. Blood pressure is an especially easy thing to check. I’d call some local large-chain pharmacies, as many of them will have a blood pressure machine on site for free use. I would say that, provided hypertension or any other pathological condition is not the cause, an occasional nosebleed is probably not serious. Certainly it can be very uncomfortable, frightening, troubling and even embarrassing to endure— and as you now know, it may indicate a more serious underlying issue, so you don’t want to just ignore it.