On the topic of steroids, what are the real long-term and short-term issues when someone is on them?

Dr. Amy Nett: Steroids, basically you’re giving yourself cortisol. What happens when you have long-term overactivation of your stress response, you have high levels of cortisol. What happens when you have these high levels of cortisol floating around? Well, osteopenia or osteoporosis. Your tissues are not going to be thriving. You’re going to be sort of potentially suppressing — just think about anything that happens when you have high cortisol around. Remember, cortisol is one of these things that we want to keep within that U-shaped curve or kind of the Goldilocks effect. Too much or too little cortisol influences anything from our soft tissues like our muscles and our bones. It can influence our brain. We’re also upsetting our HPA axis because if you’re taking cortisol, you’re potentially going to be suppressing your own HPA axis. Remember that when our patients come off cortisol, it can take awhile for them to start producing their own cortisol again. Of course, as we mentioned, you’re also increasing risk of gastritis, stomach ulcers, or bleeding. You can almost think of using steroids or hydrocortisone, that sort of thing, it’s almost like having that chronic fight-or-flight response on all the time because you’re keeping high levels of cortisol on all the time. I tried to minimize the use of steroids whenever possible.