Anabolic Steroid Use

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Anabolic Steroid Use

Definition

Anabolic steroids are drugs containing hormones, or hormone-like substances, that are used to increase strength and promote muscle growth.

Description

Steroids are a synthetic version of the human hormone called testosterone. Testosterone stimulates and maintains the male sexual organs. It also stimulates development of bones and muscle, promotes skin and hair growth, and can influence emotions and energy levels. In males, testosterone is produced by the testicles and the adrenal gland. Women have only the amount of testosterone produced by the adrenal gland—much less than men have. This is why testosterone is often called a "male" hormone. There are more than 100 different types of anabolic steroids that have been developed, and each requires a prescription to be used legally in the United States. The average adult male naturally produces 2.5 to 11 milligrams of testosterone daily. The average steroid abuser often takes more than 100 mg a day, through "stacking" or combining several different brands of steroids.

Medical uses

Anabolic steroids were first developed in the 1930s in Europe, in part to increase the physical strength of German soldiers. Anabolic steroids were tried by physicians for many other purposes in the 1940s and 1950s with varying 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. Anabolic steroids were slowly replaced by synthetic protein hormones that selectively stimulate growth of blood cell precursors.
Growth stimulation: Anabolic steroids were used heavily by pediatric endocrinologists for children with growth failure from the 1960s through the 1980s. Availability of synthetic growth hormone and increasing social stigmatization of anabolic steroids led to reduction of this use.

Stimulation of appetite and preservation of muscle mass: Anabolic steroids have been given to people with chronic wasting conditions such as cancer and HIV/AIDS.
Induction of male puberty: Androgens are given to many boys distressed about extreme delay of puberty. Testosterone is as of 2005 nearly the only androgen used for this purpose, but synthetic anabolic steroids were often used prior to the 1980s.
To treat certain kinds of breast cancer in some women.
To treat angioedema, which causes swelling of the face, arms, legs, throat, windpipe, bowels, or sexual organs.

Abuse of steroids

The controversy surrounding steroid abuse began in the 1950s during the Olympic Games when the athletic community discovered that athletes from Russia and some East European nations, which had dominated the games, had taken large doses of steroids. Many of the male athletes developed such large prostate glands (a gland located near the bladder and urethra that aids in semen production) that they needed a tube inserted in order to urinate. Some of the female athletes developed so many male characteristics chromosome tests were necessary to prove that they were still women. Competitive weightlifters also began using steroids in the 1950s as a way to increase their athletic performance. Use gradually spread throughout the world among athletes in other sports.

KEY TERMS

Adrenal gland— An endocrine gland located above each kidney. The inner part of each gland secretes epinephrine and the outer part secretes steroids.

Androgen— 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. Testosterone and androsterone are androgens.

Androstenedione— Also called "andro," this hormone occurs naturally during the making of testosterone and estrogen.

Catabolic— A metabolic process in which energy is released through the conversion of complex molecules into simpler ones.

Corticosteroids— A steroid hormone produced by the adrenal gland and involved in metabolism and immune response.

Endocrinologist— A medical specialist who treats endocrine (glands that secrete hormones internally directly into the lymph or bloodstream) disorders.

Estrogen— Any of several steroid hormones, produced mainly in the ovaries, that stimulate estrus and the development of female secondary sexual characteristics.

Hormone— A chemical substance produced in the body's endocrine glands or certain other cells that exerts a regulatory or stimulatory effect, for example, in metabolism.

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.

Progestins— A female steroid sex hormone.

Prohormones— 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.

Testosterone— A male steroid hormone produced in the testicles and responsible for the development of secondary sex characteristics.

Concerns over the growing illicit market and the prevalence of abuse, combined with the possibility of harmful long-term effects of steroids use, led the U.S. 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. Most illicit anabolic steroids are sold at gyms, bodybuilding competitions, and through the mail and Internet. For the most part, these substances are smuggled into the United States. 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, a number of counterfeit products are sold as anabolic steroids.

In 2004, federal health officials initiated a crackdown on companies that manufacture, market, or distribute products containing androstenedione, or "andro," due to concerns about the safety of the substance. Widely marketed to athletes and body builders, androstenedione has been advertised to promote muscle growth, improve muscular strength, reduce fat, and slow aging. Androstenedione acts like a steroid once it is metabolized by the body and can pose similar kinds of health risks. People produce androstenedione naturally during the making of testosterone and estrogen. When people consume androstenedione, it is converted into testosterone and estrogen. Scientific evidence shows that when androstenedione is taken over time and in sufficient quantities, it may increase the risk of serious and life-threatening diseases, including liver failure.

On January 20, 2005, the Anabolic Steroid Control Act of 2004 took effect, amending the Controlled Substance Act by placing both anabolic steroids and prohormones on a list of controlled substances, 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 (now retired), Sammy Sosa, and Curt Schilling to testify. In response, MLB officials promised a crackdown on anabolic steroid use among players.

It has been estimated that at least one in 15 male high school seniors in the United States—more than 500,000 boys—has used steroids. Some are athletes attempting to increase their strength and size; others are simply youths attempting to speed up their growth to keep pace with their peers. In some countries, anabolic steroids are available over the counter. In the United States, a doctor's prescription is necessary.

Causes and symptoms

While the effects of steroids can seem desirable at first, there are serious side effects. Excessive use can cause a harmful imbalance in the body's normal hormonal balance and body chemistry. Heart attacks, water retention leading to high blood pressure and stroke, and liver and kidney tumors all are possible. Young people may develop acne, sometimes severe, and a halting of bone growth. Males may experience shrinking testicles, falling sperm counts, enlarged breasts, and enlarged prostate glands. Women frequently show signs of masculinity and may be at higher risk for certain types of cancer and the possibility of birth defects in their children. Steroids fool the body into thinking that testosterone is being produced. The body, sensing an excess of testosterone, shuts down bodily functions involving testosterone, such as bone growth. The ends of long bones fuse together and stop growing, resulting in stunted growth.

The psychological effects of steroid use are also alarming: drastic mood swings, inability to sleep, depression, and feelings of hostility. Steroids may also be psychologically addictive. Once started, users—particularly athletes—enjoy the physical socalled benefits of increased size, strength, and endurance so much that they are reluctant to stop even when told about the risks.

In addition to these dangerous 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 and warehouses in Mexico, Europe, and other 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. Counterfeit steroids are also sold as the real thing. So it is often impossible to tell exactly what some products contain.

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 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 can be permanent.

Diagnosis

Anyone who is using anabolic steroids without a prescription and not under the direction of a physician is considered abusing the drug and should seek medical help in stopping the use.

Treatment

Few studies of treatments for anabolic steroid abuse have been conducted. Knowledge as of 2005 is based largely on the experiences of a small number of physicians who have worked with patients 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.

Some medications that have been used for treating steroid withdrawal restore the hormonal system after its disruption by steroid abuse. Other medications target specific withdrawal symptoms, for example, antidepressants to treat depression, and analgesics (pain killers, such as aspirin and ibuprofen) for headaches and muscle and joint pains. Some patients require assistance beyond simple treatment of withdrawal symptoms and are treated with behavioral therapies.

Alternative treatment

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.

Prognosis

Anabolic steroid abuse is a treatable condition and can be stopped. Teenagers and adults can overcome the problem with the help of parents and other 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 increase the risk of liver cancer. A steroid user who quits may suffer a side effect commonly linked to low testosterone—severe depression—which can lead to suicidal thoughts and even suicide. The risk of depression and suicide is highest among teens.

Some physicians recommend that athletes using steroids avoid sudden discontinuance of all steroids at the same time because their bodies may enter an immediate catabolic (sudden release of energy) phase. The cortisone receptors will be free and in combination with the low testosterone and androgen levels, a considerable loss of strength and mass, and an increase of fat and water, and often breast enlargement in males can occur. Breast enlargement is possible because the suddenly low androgen level shifts the relationship in favor of the estrogens which suddenly become the domineering hormone.

Prevention

The best prevention is education to alert young people to the dangers, both medical and legal, in the illegal use of anabolic steroids. In its effort to alert teenagers to the dangers of steroid abuse, the U.S. Food and Drug Administration (FDA) developed a series of pamphlets, posters, and public service announcements. Much of this information is available on-line at 〈http://www.fda.gov〉. Anabolic steroids are in the same regulatory category as cocaine, heroin, LSD, and other habit-forming drugs. This means that, in addition to the FDA, the Drug Enforcement Agency (DEA) helps to enforce laws relating to their abuse.

Athletic organizations have joined the fight. The Olympic Games are now closely monitored to prevent athletes who use steroids from participating. The National Football League has a strict testing policy in its training camps; it delivers fines and suspensions to those who test positive and bans repeat offenders. The National Collegiate Athletic Association, too, has established stricter measures for testing and disciplining steroid users.

Resources

BOOKS

Aretha, David. Steroids and Other Performance-Enhancing Drugs. Berkeley Heights, NJ: MyReportLinks.com, 2005.

Canseco, Jose. Juiced: Wild Times, Rampant 'Roids, Smash Hits, and How Baseball Got Big. New York City: Regan Books, 2005.

Levert, Suzanne. The Facts about Steroids. New York: Benchmark Books, 2004.

Taylor, William N. Anabolic Therapy in Modern Medicine. Jefferson, NC: McFarland & Company, 2002.

PERIODICALS

Adler, Jerry. "Toxic Strength: The Headlines about Illegal Steroids Have Focused on Professional and Olympic Athletes. But the Most Vulnerable Users May Be Kids in Your Neighborhood, High-Schoolers Who Are Risking an Array of Frightful Side Effects that Can Lead to Death." Newsweek (December 20, 2004): 44.

Bates, Betsy. "Elite Athletes Not Alone in Anabolic Steroid Abuse: Missed by Drug Testing." Internal Medicine News (February 1, 2004): 38.

Brown, Tim. "McGwire Appears to Suffer Lasting Damage to Credibility after Refusing to Discuss Steroids, and Baseball Will Tinker with Details of Its Drug Policy." Los Angeles Times (March 19, 2005): D-1.

Goodlad, Terry. "Dancing with the Dark Side: So, You Think You're Ready for Your First Steroid Cycle?" Flex (April 2004): 90-96.

Ingram, Scott. "Buff Enough? More Teens Are Using Steroids to Look Pumped and Do Better at Sports. Do they Know the Terrible Risk They're Taking?" Current Science (September 24, 2004): 4-8.

Poniewozik, James. "This Is Your Nation on Steroids: Why Does a Performance-Enhanced Society Scorn Performance-Enhanced Athletes?" Time (December 20, 2004): 168.

ORGANIZATIONS

National Center for Drug Free Sport Inc. 810 Baltimore St., Kansas City, MO 64105. (816) 474-7329. 〈http://www.drugfreesport.com〉.

National Institute on Drug Abuse. 6001 Executive Blvd., Bethesda, MD 20892. (301)443-1124. 〈information@lists.nida.nih.gov〉. 〈http://www.drugabuse.gov〉.