There was some controversy surrounding "Up the Down Steroid" and the 2005 film The Ringer , as both feature the same plot: someone pretending to be disabled in order to compete in the Special Olympics.  The Ringer was written and filmed months before this episode was aired, although, The Ringer was not released to the public until after this episode aired. According to the episode's DVD audio commentary, series co-creators Trey Parker and Matt Stone did not think that they ripped off The Ringer , since the idea to them did not seem hard to come up with, and they did not even think it was big enough for a twenty-minute episode let alone a two-hour film.  In the opening scene, the boys are playing the same "Investigative Reports with Bill Kurtis " funtime game as they did in the season two episode " Cartman Joins NAMBLA ". 
Steroid abuse can also affect the heart (cardiovascular system) and cholesterol (lipid profile). Generally, in studies where steroids are abused, HDL-cholesterol (the good stuff) declines, and LDL-cholesterol tends to go up. Yeah, the good cholesterol goes down and the bad cholesterol goes up. In a related area, the heart often has to work harder because of this, and there also seems to be a steroid-related mild hypertrophy of the left ventricle which is accompanied by a decreased diastolic relaxation. This is very unclear, as regards steroid use, with regards to potential for reversibility and what portion is due to steroid use and what portion is due to training, which also increases ventricle size. Also in a related vein (ha ha) are increases in diastolic blood pressure. All of this increases risk for cardiovascular disease.