Anabolic Steroid Use
Anabolic steroid use
Anabolic steroids are a class of man-made drugs that are chemically related to the male hormone testosterone.
Anabolic steroids are more accurately called anabolic-androgenic steroids. This name defines their two principle characteristics. Anabolic means to synthesize or build up; thus anabolic steroids increase skeletal muscle mass. Androgenic means involving male sexual characteristics. Anabolic steroids are related to testosterone and affect the body the many of the same ways as testosterone. Testosterone is the main hormone responsible for male sexual characteristics. It stimulates and maintains the male reproductive organs, stimulates development of bones and muscle, promotes skin and hair growth, and can influence emotions and sex drive. In males, the testes produce testosterone with a small amount also secreted by the adrenal glands. Women have only the small amount of testosterone produced by the adrenal glands.
Several hundred different types of anabolic steroids have been synthesized in attempts to maximize their benefits and minimize side effects. As of 2009, not a single anabolic steroid had been manufactured that was free of negative side effects. In many developing countries, anabolic steroids can be purchased without a prescription. However, in the United States, they have been controlled substances since 1991. Possession of an anabolic steroid without a prescription is illegal and can result in a maximum one-year prison sentence and a minimum fine of $1,000 fine for the first offense.
Anabolic steroids were first developed in the 1930s in Europe in an effort to produce a drug to treat conditions where the testes did not secrete enough testosterone. Physicians tried using these drugs for many other purposes in the 1940s and 1950s with limited success. Disadvantages outweighed benefits for most purposes, and during the later decades of the twentieth century, medical use in North America and Europe was restricted to a few conditions. These include:
- Bone marrow stimulation: During the second half of the twentieth century anabolic steroids were the mainstay of therapy for hypoplastic anemia not due to nutrient deficiency, especially aplastic anemia. In the twenty-first century anabolic steroids have been replaced by synthetic protein hormones that selectively stimulate growth of blood cell precursors oth fewer side effects.
- Growth stimulation: From the 1960s through the 1980s, anabolic steroids were used heavily by pediatric endocrinologists to treat children with growth failure. The availability of synthetic growth hormone (GH) and increasing social stigmatization of anabolic steroids has significantly reduced their use for this purpose.
- Stimulation of appetite and preservation of muscle mass: Anabolic steroids are given to treat chronic wasting syndrome in people with diseases such as cancer and HIV/AIDS.
- Induction of male puberty: Androgens sometimes are given to boys distressed about extreme delay of puberty. Testosterone is, as of 2009, nearly the only androgen used for this purpose, but synthetic anabolic steroids often were used prior to the 1980s.
- Treatment of breast cancer: Testosterone has been reported to slow the development of some, but not all, breast cancer in some women.
- Treatment of hypogonadism: The average adult male naturally produces 2.5-11 milligrams (mg) of testosterone daily. Testosterone is given as a replacement hormone if the testes either do not produce enough hormone or if the testes are damaged or removed (e.g., in testicular cancer).
Abuse of steroids
Soon after the first anabolic steroids were synthesized, experimenters realized that these compounds caused an increase in muscle mass in laboratory animals. This soon led to the abuse of these drugs by bodybuilders and weightlifters. Anabolic steroid use spread to elite athletes looking for an edge in strength and speed. By the 1950s some Olympic athletes, primarily from the Soviet Union, East Germany, and other Eastern European countries, were taking large doses of steroids that allowed them to dominate their sports. Many of the male athletes developed such enlarged prostate glands (a gland near that surrounds the urethra that aids in semen production) that they needed a tube inserted into their urethra in order to urinate. Some of the female athletes developed so many male physical characteristics (e.g., low voices, facial hair, male musculature) that chromosome tests were necessary to prove that they were female.
Concerns over the growing illicit market and the prevalence of abuse, combined with the possibility of harmful long-term effects of steroid use, led the United States Congress in 1991 to place anabolic steroids in Schedule III of the Controlled Substances Act (CSA). The CSA defines anabolic steroids as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promotes muscle growth.
On January 20, 2005, the Anabolic Steroid Control Act of 2004 took effect, amending and expanding the Controlled Substance Act by placing both anabolic steroids and prohormones (substances the body can convert into anabolic steroids) on the controlled substance list and making possession of the banned substances a federal crime. Also in 2005, Major League Baseball (MLB), amid long-time rumors of anabolic steroid abuse among players, was rocked by the publication of Juiced by former Oakland Athletics outfielder Jose Canseco who alleged steroid abuse was wide spread in professional baseball. In response, Congress held hearings in March 2005 on steroid abuse in the MLB, subpoenaing such baseball superstars as home run champion Mark McGwire, Sammy Sosa, and Curt Schilling to testify. MLB officials promised a crackdown on anabolic steroid use among players. Nevertheless, steroid use continued, and in 2007, Barry Bonds, baseball's all-time home run leader was indicted for illicit steroid use. In that same year, the United States Drug Enforcement Agency, in conjunction with many other federal agencies, broke up 56 illegal laboratories producing steroids and seized 11.4 million steroid dosage units and 242 kilograms of raw Chinese steroid power as part of a two-year investigation known as Operation Raw Deal.
Most illicit anabolic steroids are sold at gyms, bodybuilding competitions, and through the mail and Internet. Many of these substances or the raw materials to make them are smuggled into the United States from countries where their possession without a prescription is legal (e.g., China, Mexico). The drugs are available both as pills and injectable liquids. Anabolic steroids commonly encountered on the illicit market include: boldenone (Equipoise), ethlestrenol (Maxibolin), fluoxymesterone (Halotestin), methandriol, methandrostenolone (Dianabol), methyltestosterone, nandrolone (Durabolin, DecaDurabolin), oxandrolone (Anavar), oxymetholone (Anadrol), stanozolol (Winstrol), testosterone (including sustanon), and trenbolone (Finajet). In addition, new anabolic steroid compounds specifically designed to be undetectable by current drug tests are constantly being developed. Many of these drugs are produced in unsanitary, illicit laboratories with little or no quality control. In addition, many counterfeit products that do not contain any steroids or that are mislabeled relative to the type and dose of steroid they contain are sold over the Internet.
Steroid abuse has spread downward from elite and professional athletes to college and then high school athletes and younger. According to the a survey by the United States Centers for Disease Control and Prevention (CDC), in 2005, 850,000 high school students in the United States had used anabolic steroid pills or shots without a prescription. A more recent 2007 study found that 1.5% of eighth graders and 2.2% of twelfth graders (2.3% of boys and 0.6% of girls) had at some time used illicit steroids. Anabolic steroid users generally take extremely high doses of steroids that can add up to 100 mg a day or more through "stacking" or combining several different types or brands of steroids. Often athletes take these drugs on a schedule called "cycling," where they take steroids for a period of 12-16 weeks followed by a steroid-free period. Another approach to illicit anabolic steroids use is "pyramiding," in which doses are gradually increased to mid-cycle, then decreased to zero.
Causes and symptoms
Anabolic steroids do increase muscle mass. While this may seem desirable at first, these drugs have very serious side effects. Anabolic steroids fool the body into thinking that testosterone is being produced in large quantities. Excessive use causes a harmful disturbance of the body's normal hormone levels and body chemistry. Cardiovascular side effects are the most common. They include increased heart rate (tachycardia), heart attack (myocardial infarction) even in young athletes, high blood pressure (hypertension), an increase in low-density lipoprotein (LDL or "bad" cholesterol and a decrease in high-density lipoprotein (HDL or "good" cholesterol that increases the risk of stroke. Other negative side effects may include liver damage, liver tumors (usually not cancerous), and a decrease in blood clotting factors. Young people may develop severe acne. Males may experience shrinking testes, falling sperm count, increased risk of infertility, enlarged breasts, and an enlarged prostate gland and baldness. In addition, the ends of long bones fuse together and stop growing, resulting in permanently stunted growth and short stature. Women frequently show signs of masculinity including the development of facial hair, lower voice, and male-type musculature. They may stop menstruating, may be at higher risk for certain types of cancer and have an increased risk of birth defects in their children.
Anabolic steroids also affect mental health. Their use can cause drastic mood swings, inability to sleep, depression, and feelings of hostility. There is some evidence that young men may become more volatile and violent when taking these drugs, a condition know "roid rage." Steroids also may be psychologically and physically addictive to some users. Withdrawal symptoms may include insomnia, fatigue, restlessness, reduced sex drive, depression, and suicidal thoughts.
In addition to these physical and mental side effects, steroid abuse brings other risks, some of which are connected to the way some steroids are manufactured and distributed. The drugs are often made in motel rooms, bathrooms, and warehouses in developing countries and then smuggled into the United States. The potency, purity, and strength of the steroids produced this way are not regulated; therefore, users cannot know how much they are taking. Some users of injectable steroids share needles, increasing the risk of contracting HIV or hepatitis.
Most data on the long-term effects of anabolic steroids on humans come from case reports rather than formal scientific studies. From the case reports, the incidence of life-threatening side effects appears to be low, but serious adverse effects may be under-recognized or under-reported. Data from animal studies seem to support this possibility. One study found that exposing male mice for one-fifth of their lifespan to steroid doses comparable to those taken by human athletes caused a high percentage of premature deaths. Most effects of anabolic steroid use are reversible if the abuser stops taking the drugs, but some, such as short stature, can be permanent.
Diagnosis is often difficult, since anyone using anabolic steroids without a prescription and not under the direction of a physician is considered abusing the drug. Many athletes either do not understand what they are taking or strongly resist admitting that they are using performance-enhancing substances. Sudden increase in musculature, as well as the symptoms listed above are clues that anabolic steroid abuse could be occurring. Virtually all major professional sports leagues in the United States test for steroids and other performance-enhancing drugs, as do most intercollegiate athletic leagues. Many steroids are detectable in urine samples, however new compounds are constantly being developed in a deliberate attempt to produce compounds that are undetectable by current tests.
Few studies of treatment for anabolic steroid abuse have been conducted. Knowledge as of 2009 is based largely on the experiences of a small number of physicians who have worked with individuals undergoing steroid withdrawal. The physicians have found that supportive therapy is sufficient in some cases. Patients are educated about what they may experience during withdrawal and are evaluated for suicidal thoughts. If symptoms are severe or prolonged, medications or hospitalization may be needed. Depression needs to be monitored closely.
Sometimes medications are used to restore hormone balance after its disruption by steroid abuse. Other medications target specific withdrawal symptoms, for example, antidepressants to treat depression, and analgesics (pain killers) for headaches, muscle, and joint pains. Some individuals are psychologically addicted to steroids and benefit from behavioral therapies.
There is little data on alternative medicines or treatments for anabolic steroid abuse. However, anabolic steroid manufacturers recommend saw palmetto to be taken in conjunction with androstenedione as it can help reduce associated hair loss and is useful in controlling prostate enlargement.
Anabolic steroid abuse is a treatable condition. Abusers can overcome the problem with the help of family members, support groups, psychotherapy, medication, treatment programs, and family counseling. These programs are customized to help teens and adults lead productive and normal lives. However, heavy steroid use-even if it is stopped after a few years-may stunt growth and increase the risk of liver cancer. A steroid user who quits may experience severe depression that can lead to suicidal thoughts and suicide attempts or completion. The risk of depression and suicide is highest among teenage abusers.
Some physicians recommend that athletes using steroids avoid sudden discontinuance of all steroids simultaneously because their bodies may enter an immediate catabolic (metabolic breakdown of compounds) phase. This can lead to a considerable loss of strength and mass, an increase of fat and water in the body, and breast enlargement in males. Breast enlargement occurs because the suddenly low androgen level shifts the hormone balance in favor of estrogen compounds, which suddenly become the dominant hormone.
Educating young people to the dangers of anabolic steroid abuse is the best way to prevent their misuse. The National Institute on Drug Abuse in conjunction with the Oregon Health & Science University has developed two programs for use with high school sports teams. The Adolescent Training and Learning to Avoid Steroids (ATLAS) program is aimed a teaching high school football players how to improve performance with training and healthy behaviors. The Athletes Targeting Healthy Exercise and Nutrition Alternatives (ATHENA) has similar goals but is designed for female athletes. Both programs have been shown to reduce steroid abuse and decrease other risky behaviors such as alcohol and marijuana use. These programs were awarded the 2006 Sports Illustrated magazine Champion Award for improving the safety and healthy of high school athletes.
- Adrenal gland
- An endocrine gland located above each kidney. The inner part of each gland secretes epinephrine (adrenaline) and the outer part secretes steroid hormones.
- A natural or artificial steroid that acts as a male sex hormone. Androgens are responsible for the development of male sex organs and secondary sexual characteristics.
- Also called "andro," this hormone occurs naturally during the making of testosterone and estrogen.
- A metabolic process in which energy is released through the breakdown of complex molecules into simpler ones.
- A steroid hormone produced by the adrenal gland and involved in metabolism and immune response.
- Any of several steroid hormones, produced mainly in the ovaries, that stimulate estrus and the development of female secondary sexual characteristics.
- A chemical messenger that is produced by one type of cell and travels through the bloodstream to change the metabolism of a different type of cell.
- Hypoplastic anemia
- Anemia that is characterized by defective function of the blood-forming organs (such as bone marrow) and is caused by toxic agents such as chemicals or x rays. Anemia is a blood condition in which there are too few red blood cells or the red blood cells are deficient in hemoglobin.
- Female steroid sex hormones.
- A physiologically inactive precursor of a hormone.
- Prostate gland
- An O-shaped gland in males that secretes a fluid into the semen that acts to improve the movement and viability of sperm.
- A male steroid hormone produced in the testes and responsible for the development of secondary sex characteristics.
For Your Information
- Canseco, Jose. Juiced: Wild Times, Rampant 'Roids, Smash Hits, and How Baseball Got Big. New York City: Regan Books, 2005.
- "Anabolic Steroids." MedlinePlus. January 14, 2009 [cited January 16, 2009]. http://www.nlm.nih.gov/medlineplus/anabolicsteroids.html.
- Kishner, Stephen and Frank Svee. "Anabolic Steroid Use and Abuse." eMedicine.com. October 8, 2008 [cited January 16, 2009]. http://emedicine.medscape.com/article/128655-overview .
- "NIDA InfoFacts: Steroids (Anabolic-Adrogenic)." National Institute on Drug Abuse. June 2008. [cited January 16, 2009 ]. http://www.drugabuse.gov/infofacts/steroids.html.
- "Steroids." Drug Enforcement Administration. August 2006 [cited January 16, 2009]. http://www.usdoj.gov/dea/concern/steroids.html .
- National Center for Drug Free Sport Inc. 2735 Madison Avenue, Kansas City, MO 64108. Telephone: (816) 474-8655. Fax: (816) 502-9287. Email: firstname.lastname@example.org http://www.drugfreesport.com.
- National Clearinghouse on Alcohol and Drug Information. P. O. Box 2345 , Rockville, MD 20847. Telephone: (800)729-6686 TDD: (800) 487-4889. http://www.drugabuse.gov.
Drugs and athletes
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.