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 such as testosterone also increase the risk of cardiovascular disease or coronary artery disease. Most of these side-effects are dose-dependent, the most common being elevated blood pressure, especially in those with pre-existing hypertension. Adrenal androgens function as weak steroids (though some are precursors), and the subset includes dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), androstenedione (A4), and androstenediol (A5). The main subset of androgens, known as adrenal androgens, is composed of 19-carbon steroids synthesized in the zona reticularis, the innermost layer of the adrenal cortex. For males, providers typically order testosterone blood tests to check for low testosterone levels. 4,5α-Dihydrogenated derivatives of testosterone such as DHT cannot be aromatized, whereas 19-nortestosterone derivatives like nandrolone can be but to a greatly reduced extent. As an example, the 17α-alkylated AAS methyltestosterone and metandienone are converted by aromatase into methylestradiol. In addition, some 19-nortestosterone derivatives, including trestolone (7α-methyl-19-nortestosterone (MENT)), 11β-methyl-19-nortestosterone (11β-MNT), and dimethandrolone (7α,11β-dimethyl-19-nortestosterone), cannot be 5α-reduced. Most of the testosterone is converted into dihydrotestosterone (DHT), which is the more active form, and then utilized by the target tissues. This differentiates the narrower male pelvis from the wider female pelvis. Testosterone has a pronounced effect on the muscle mass and increases muscle bulk. There are several other forms of androgens and androgen-related chemicals. As an adult, your body converts about 10% of your testosterone into DHT each day. Another androgen is dihydrotestosterone (DHT).
