Steroids in Sports

Most young athletes can demonstrate to the fact that the competitive urge to win — and win at all costs — is furious. Besides the glory of bragging rights and the fulfillment of personal gain, over and over again young athletes struggle in the pursuit of greater dreams — a award for their country, a college scholarship or a position in a professional team. (Robert H. Coombs, Louis Jolyon West, 1991)

For an increasing number of athletes, winning at all costs includes taking performance-enhancing drugs. Some may appear to achieve physical gains from such drugs, but at what cost? The truth is, the long-term effects of these drugs haven’t been rigorously studied. And short-term benefits are enjoyed by many drawbacks.

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Take the time to learn about the benefits, dangers and many unknowns concerning alleged performance-enhancing drugs. (Robert H. Coombs, Louis Jolyon West, 1991)

“Anabolic steroids” is the well-known name for man-made substances linked to the male sex hormones (e.g., testosterone). They prop up the augmentation of skeletal muscle (anabolic effects) and the development of male sexual characters in both males and females. The term “anabolic steroids” will be used in this report because of its acquaintance, although the appropriate term for this composite is “anabolic-androgenic steroids.” (Robert H. Coombs, Louis Jolyon West, 1991)

Anabolic steroids were primed in the late 1930s mainly to treat hypogonadism, an ailment in which the testes do not create sufficient testosterone for typical growth, maturity, and sexual performance. The primary medical uses of these compounds are to treat overdue puberty, various types of impotence, and wasting of the body caused by certain diseases. (Nick A. Evans, 2004).

During the 1930s, scientists discovered that anabolic steroids could facilitate the growth of skeletal muscle in laboratory animals, which led to abuse of the compounds first by bodybuilders and weightlifters and then by athletes in other sports. Steroid abuse has become so prevalent in athletics that it can have an effect on the outcome of sports competitions. (Nick A. Evans, 2004).

In the United States, supplements such as tetrahydrogestrinone (THG) and androstenedione (street name “Andro”) formerly could be bought lawfully without a prescription through various commercial resources, including health food stores. Steroidal supplements can be converted into testosterone or an analogous compound in the body. Not as much of is known about the side effects of steroidal supplements, but if large quantities of these compounds substantially increase testosterone levels in the body, then they also are likely to produce the same side effects as anabolic steroids themselves. The purchase of these supplements, with the notable exception of dehydroepiandrosterone (DHEA), became illegal after the passage in 2004 of amendments to the Controlled Substances Act. (Nick A. Evans, 2004).

Steroid abuse affects individuals of various ages. However, it is difficult to guesstimate the true incidence of steroid abuse in the United States because many data sources that measure drug abuse do not comprise steroids. Scientific evidence indicates that anabolic steroid abuse among athletes may range between 1-6%. (Barrie Houlihan, 1997).

One of the main reasons people give for abusing steroids is to develop their athletic performance. Among athletes, steroid abuse has been estimated to be less that 6 percent according to surveys, but anecdotal information suggests more widespread abuse. Although testing procedures are now in place to discourage steroid abuse among professional and Olympic athletes, new designer drugs constantly become available that can escape detection and place athletes willing to deceive one step ahead of testing efforts. (Matthew J. Mitten, 2005)

Another justification people give for using steroids is to increase their muscle size or to decrease their body fat. This group includes people suffering from the behavioral syndrome called muscle dysmorphia, which causes them to have an indistinct image of their bodies. Men with muscle dysmorphia think that they look small and weak, even if they are large and muscular. Likewise, women with this condition think that they look fat and flabby, even though they are actually lean and muscular. (Kent F. Burnett, Mark E. Kleiman, 1994)

Some anabolic steroids are taken by mouth, others are injected, and still others are supplied in gels or creams that are applied to the skin. Doses taken by abusers can be 10 to 100 times more than the doses given for medical conditions. (Kent F. Burnett, Mark E. Kleiman, 1994)

Although numerous clinical studies have been conducted, there is limited evidence supporting the efficacy of anabolic steroids in enhancing athletic performance in sports. Unfortunately, the anabolic steroids’ literature is littered with design problems. The most significant methodological problem is the disparity in dosing strategies between clinical trials and real-world use. (Kent F. Burnett, Mark E. Kleiman, 1994)

When used by athletes, the anabolic steroids are typically “stacked.” That is, the drugs are administered in cycles of gradually increasing doses and additional anabolic steroid agents are added along the way. Stacking cycles typically last between 7 and 14 weeks and often involve 2-3 oral agents along with 1 or 2 long-acting injectable AASs. By contrast, clinical investigators are justifiably restricted from duplicating these regimens in experimental situations for ethical reasons. As a result, studies are typically limited to the use of 1 agent, either oral or injection. Athletes tend to use oral agents in doses similar to those in clinical trials, but often use injectable agents in doses 3-8 times greater than those in clinical studies. Further exacerbating this problem is the issue of effect size. For example, a 1% improvement would be difficult to demonstrate statistically in a clinical trial setting, but in world-class athletics it could be the difference between a gold medal and last place. (Kent F. Burnett, Mark E. Kleiman, 1994)

These findings lead us, as consumers of the biomedical literature, to the conclusion that past studies of anabolic steroids may be of limited value in determining the efficacy and toxicity of these agents under current athletic use. In spite of a lack of comprehensive scientific evidence, however, there is little doubt that anabolic steroids can produce a significant ergogenic effect. As with many other substances of abuse,  steroid users often possess a more sophisticated pharmacologic understanding than the general population, and counseling patients regarding the effects of these agents is often problematic. (Will H. Courtenay, 2000)

Steroids are often abused in patterns called “cycling,” which involve taking many doses of steroids over a definite period of time, holding for a period, and resuming again. Users also recurrently combine more than a few dissimilar types of steroids in a method known as “stacking.” Steroid abusers typically “stack” the drugs, denoting that they take two or more dissimilar anabolic steroids, mixing oral and/or injectable types, and occasionally even including compounds that are designed for veterinary use. Abusers think that the dissimilar steroids act together to produce an effect on muscle size that is greater than the effects of each drug separately, a theory that has not been tested scientifically yet. (Will H. Courtenay, 2000)

Another manner of steroid abuse is referred to as “pyramiding.” This is a process in which users slowly escalate steroid abuse (increasing the number of steroids or the dose and frequency of one or more steroids used at one time), getting a peak amount at mid-cycle and steadily tapering the dose toward the end of the cycle. Time and again, steroid abusers pyramid their doses in cycles of 6 to 12 weeks.  At start of a cycle, the person starts with low doses of the drugs being stacked and then gradually escalates the doses. In the second half of the cycle, the doses are slowly tapered to zero. This is at times followed by a second cycle in which the person continues to train but with no drugs. Abusers trust that pyramiding allows the body time to regulate to the high doses, and the drug-free cycle lets the body’s hormonal system time to recover. Same as stacking, the perceived benefits of pyramiding and cycling have not been validated scientifically. (Will H. Courtenay, 2000)

Anabolic steroid abuse has been related with a wide range of unfavorable side effects ranging from some that are physically unattractive, such as acne and breast development in men, disfiguring of facial appearance to others that are life threatening, such as heart attacks and liver cancer etc. They can have impact on abusers hormonal system, musculoskeletal system, cardiovascular system, liver, skin and immune system as well. Most of them are reversible if the abuser quit taking the drugs, but some are everlasting, such as voice deepening in females. (Will H. Courtenay, 2000)

Case reports and small studies indicate that anabolic steroids, when used in high doses, increase irritability and aggression. Some steroid abusers confessed that they have committed aggressive acts, such as physical fighting or theft, robbery, burglary and rape. Abusers who have committed violent acts or property offenses generally account that they engage in these behaviors usually when they take steroids than when they are drug free. A recent study suggests that the mood and behavioral effects noticed during anabolic steroid abuse may result from secondary hormonal changes. (Will H. Courtenay, 2000)

An undetermined percentage of steroid abusers may become addicted to the drugs, as evidenced by their continued abuse despite physical problems and negative effects on social relations. The most dangerous of the abandonment symptoms is depression, because it sometimes leads to suicide efforts. If left untreated, some depressive symptoms related with anabolic steroid withdrawal have been acknowledged to continue for a year or more after the abuser quits using the drugs. (Matthew J. Mitten, 2005)

Most prevention efforts in the United States today focus on athletes involved with the Olympics and professional sports; few school districts test for abuse of illicit drugs. Research on steroid educational programs has revealed that simply instructing students about steroids’ adverse effects does not persuade adolescents that they can be unfavorably affected. Nor does such lesson discourage young people from using steroids in the upcoming days. Presenting both the benefits and risks of anabolic steroid use puts additional effect in convincing adolescents regarding steroids’ harmful effects. (Robert E. Sallis, 1997)

Few studies of treatments for anabolic steroid abuse have been conducted. Current information is based largely on the understandings of a small number of physicians who have observed patients undergoing steroid removal. The physicians have found that supportive therapy is enough in a few cases. Patients are educated about what they may experience during withdrawal and are assessed for suicidal feelings. If subjective symptoms are grave or prolonged, medicines or hospitalization may be required. (Matthew J. Mitten, 2005)

Some medicines that have been used to treat steroid withdrawal reinstate the hormonal system after its disturbance by steroid abuse. Other medications aim specific removal symptoms—for example, antidepressants to treat depression and analgesics (pain killers) for headaches and muscle and joint pains. (Matthew J. Mitten, 2005)

Some patients require help beyond medicinal treatment of withdrawal symptoms and are treated with behavioral rehabilitation. (Matthew J. Mitten, 2005)

 

“A real life Interview with Dr. Robert”

 

An interview was held with the head of the department of family medicine of an American University. In this interview, Dr. Robert explains the role of family physicians in identifying and educating their patients regarding prohibited substances. He is the author of numerous scientific publications. (Stephens, T. 1988)

 

“Tips that alert physicians”

 

There are symptoms that can be connected to specific types of substances. If you’ve got people coming in for infertility, concerns related to the prostate, breast enlargement in males, or acne — these can be signs of anabolic steroid abuse. In females, acne, deepening of voice and facial hair growth can be suspect. If you have known a patient for many years and see atypical changes in their morphology or anatomy, you can start to be critically suspicious. A few changes are so visual, you can not miss it. Physicians have both the visual assessment of the patient as well as symptoms record. Other tips might be libido disorders or aggression. An enlargement of the jaw, protruding forehead, a sudden improvement in vision, or signs of abnormal foot growth in adults could be from misuse of growth hormones. (Stephens, T. 1988)

 

“A diseased person has a prospect of getting well by personal effort. He cannot borrow health from others.”

—    Gandhiji

Our role is to look into this, and we know human metabolism fairly well. We know the chemical structure of substances and their metabolites. Modern anti-doping tests are quite sensitive. We work with pharmaceutical companies who have primary information on their substances to really understand how the drug is metabolized. (Stephens, T. 1988)

On the other hand, there are substances present in certain foods that could be part of the composition of certain medicines that can be abused for doping. With these, we usually create a threshold to make sure we would not t consider an undesirable analytical finding. Or we try to find another metabolite, which is usually possible, to keep away from misidentification. We are very careful about this. Mostly, it is not a problem.

We sometimes hear of athletes getting in trouble because of use of over-the-counter cold and allergy remedies. (Stephens, T. 1988)

Antihistamines are not on the list of prohibited substances, but some related products like ephedrine contain prohibited substances. You have to read the label to make sure before use. Ephedrine is on the prohibited list but has a threshold substance. People taking those kinds of substances in standard quantities prescribed by a physician are not at risk of testing positive. (Stephens, T. 1988)

 

“What Sports having a serious problem with doping?”

 

They all do, and at all levels. The bad news is that there is no sport and no country that’s immune to the risk. The good news is that “cat is running after the mouse, it tries to catch it when the later tries to escape”. (Stephens, T. 1988)

If one takes micro doses of substances, can be easily overlooked alone with classical physical examination. You have to use blood analysis and see if your patient has high hematocrit values. Further, not all substances can be suspected with visual examination. (Stephens, T. 1988)

They should be alert that abuse of performance enhancing drugs is not unusual. I’m convinced that if they are careful, doctors can identify some of those people in their patient population. Talking to athletic patients, asking if they use anything to boost their performance, some patients might be admitting it. Doctors are in a much honored position to inform patients of the risks related with performance enhancing drugs. (Stephens, T. 1988)

Anabolic steroids, human growth hormone, and other doping substances can lead to kidney problems, cardiovascular risks, mood swings, and many other health disorders. They can not only have an impact on sexual aspects of people’s lives but also on personality as well. The impact on their private lives is huge. Many risks are misrepresented by the manufacturers of those products, by people who are selling them in gyms, or by associates who really don’t know the risks. They enjoy the immediate benefit of taking the drugs without forecasting the long-term toxicity and bad health impact. (Stephens, T. 1988)

I think the primary role of physicians, when they recognize such patients, is to inform them look, between you and me, you’re taking this substance, but do you know the risks? And remember, abusers of these substances can be pretty creative in their clarifications. (Stephens, T. 1988)

The independent U.S. Anti-Doping Agency (USADA) tests athletes for banned substances, investigates doping allegations and imposes sanctions. The agency is aggressively working with the federal government to root out drug cheats before the Athens Games.

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USADA conducts random drug tests, and all elite athletes are tested several times a year. 1,275 tests were conducted on track and field athletes last year – 618 out of competition, 657 during meets.

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USADA imposed bans on four athletes who tested positive for the steroid THG last year. The agency has begun prosecuting athletes for a “non-analytical positive” – meaning circumstantial evidence of doping can be used to sanction an athlete absent conclusive test results. USADA recently notified several U.S track stars that they are under suspicion for drug violations and could face suspensions. Cases may be expedited at the USADA’s discretion.

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Kelli White was the first major casualty if the BALCO scandal. After admitting to doping violations based on evidence uncovered in a federal probe of the lab, White received a two-year ban by the USADA and was forced to forfeit the 100- and 200-meter world titles she won last year in Paris.

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White tested positive for the stimulant modafinil after the 2003 World Championships. She said a doctor connected with BALCO prescribed the drug to treat narcolepsy. White later admitted to also taking banned steroids and the blood-boosting hormone EPO. White’s coach, Remy Korchemny, is one of four men connected with BALCO who have been charged with steroid distribution. White has said she may not return to track when her suspension is lifted.

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In conclusion, the problems associated with the use of drugs in sport are many and complex and it is not possible to provide any quick or easy solution. Indeed, in this particularly difficult policy area, it might be appropriate to recall once again the words of Goode to the effect that, in such policy areas, there may be no ideal solution and that it may well be that we are forced to accept, “the least bad of an array of very bad options” (Goode, 1997).

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