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Anabolic Steroids
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by Nick Zaccardi
University of Massachusetts, Amherst
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I. Introduction
II. History
III. Teen Use
IV. Properties
V. Types of Steroids
VI. Side Effects
VII. Identifying Steroid Use
VIII. Medical Uses
IX. Drug Testing
X. References
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I. Introduction
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 Anabolic steroids are testosterone, or testosterone-like drugs which
produce anabolic activity by increasing protein synthesis and androgenic
activity (enhanced secondary sexual characteristics) in the male. These
compounds can produce a significant increase in muscular size, in
both males and females. Natural testosterone is produced in larger quantities
in the male, but is also present in the female. Anabolic steroids are the
most widely detected drugs taken for ergogenic (performance-enhancing)
purposes. This group of substances has probably exceeded any other in
controversy among those in the super-charged atmosphere of competitive sports.
Drug testing and education on the pros and cons of anabolic
steroid use are essential to maintain the health of both amateur and professional athletes.
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II. History
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Until 1935, no one knew that anabolic steroids were associated with the accumulation
of muscle tissue. In that timeframe, two researchers experimenting on dogs discovered that
testosterone given under certain conditions would increase muscle mass. The current history of anabolic
steroids as abusable drugs began in 1954 among Olympic weightlifters. In 1956, Dianabol
(Methandrostenolone) was first marketed in the United States, clearing the way for the
use of anabolics by U.S. athletes. At first, only world-class athletes in high-strength
sports such as weight lifting abused anabolics. Among Olympic athletes, anabolic
steroids were a problem as long ago as 1964.
Athletes and their trainers developed high dose, multiple-drug regimens that were not
based on scientific research. These methods of use were passed by word of mouth from one
training group to another. Even today, the use of many types of steroids in high doses
has never been examined in controlled scientific studies. Anabolic steroid abusers
mistrust scientific opinions about high-dose steroid use. When it was first noticed
as a growing problem, some scientists and public officials stated that there was no
evidence that steroids caused muscle growth or improved performance, and that use
of large amounts would lead to dramatic, toxic side effects in all users. These
pronouncements went against the common knowledge and experience of the athletes,
who did not see large numbers of their steroid-using friends dropping dead. As their
reputation grew, anabolic abuse spread to other sports. Today, the only Olympic
sports in which anabolic steroids have not been detected are women's field hockey
and figure skating. Steroid abuse spread beyond the Olympics throughout the 1970's and
1980's. In 1983, nineteen athletes were disqualified from the Olympics for steroid abuse.
A 1970 survey of five American universities showed that 15% of college athletes were
steroid abusers. By 1984, 20% of college athletes were using steroids. In 1975,
anabolic abuse in Arizona high schools was 0.7% over all, with 4% of athletes
admitting steroid use. A 1986 survey in Minneapolis revealed a 3% average rate
of steroid abuse in grades 8, 10, and 12. In one of these high schools, the rate
of use was 8% in senior males. In a 1988 survey in a suburban Chicago school, 6.5%
of male students admitted taking steroids, and 2.5% of female students admitted
steroid abuse. Surveys in 1989 estimated that there were 500,000 adolescent steroid
abusers nationwide, and as many as 1 million steroid abusers of all ages in
the United States. In November 1990, U.S. Federal Law classified all anabolic
steroids as Controlled Dangerous Substances (Type 2).
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III. Teen Use
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Increasing numbers of
adolescents are turning to steroids for cosmetic reasons. In a 1986 survey, as many as
45 percent of 200 high school users cited appearance as
a primary reason for taking steroids. Young people who use steroids defy easy
categorization. They come from cities and rural areas, from poor families and
wealthy ones. They are of all races and nationalities. The common link among
them is the desire to look, perform and feel better at almost any cost. Users-and
especially the young-are apt to ignore or deny warnings about health risks. if they
see friends growing taller and stronger on steroids, they want the same benefits.
They want to believe in the power of the drug.
Drug use among adolescents
and young adults across the country has increased on a whole. Steroid use among this age
group has also increased. This has become a growing concern to the medical community,
because of the serious side effects that accompany steroid abuse. From 1989 to
1993 there was a slight, gradual decline in lifetime and annual prevalence of
anabolic steroid use among 8th-, 10th-, and 12th-graders. In 1994 and 1995
the levels remained about the same. Among the class of 1995, 2.3 percent of high
school seniors had used anabolic steroids at least once in their lifetimes; 1.5
percent had used steroids in the past year. In 1995, 2.0 percent of 8th-graders and
2.0 percent of 10th-graders had used anabolic steroids at least once in their lifetimes,
and 1.0 percent of 8th-graders and 1.2 percent of 10th-graders had used anabolic steroids
within the past year.
Students also possessed
differing opinions toward steroid use:
-- 67.6 percent of 8th-graders,
72.5 percent of 10th-graders, and 66.1 percent of seniors perceive great risk in trying
steroids.
-- 87.9 percent of 8th-graders,
90.8 percent of 10th-graders, and 91.9 percent of seniors say they disapprove of people who
use steroids.
-- 23.1 percent of 8th-graders, 33.6 percent of
10th-graders, and 42.9 percent of seniors feel it would be fairly or very easy for
them to get steroids.
Surveys and anecdotal
evidence indicate that the rate of non-medical steroids use may be increasing. In 1990,
a NIDA survey of high school seniors showed that nearly 3-5 percent of
males and 0.5 percent of females-reported using steroids at some time in their lives. The
same survey showed that steroids were used within the last year by nearly as many
students as crack cocaine and by more students than the hallucinogenic drug PCP.
Use among college
females appears to have increased somewhat. A study of 11 universities in 1984 found
that steroid users were reported in only one women's sport--swimming--at a rate of 1
percent. In a follow-up survey in 1988, 1 percent of women in track and field and
basketball also reported taking steroids.
Use among adult or
professional athletes has not been well documented, although anecdotal evidence clearly
supports the suggestion that anabolic steroids have enjoyed popularity among football
players, weightlifters, wrestlers, and track and field competitors, among others.
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IV. Properties
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Anabolic/androgenic
steroids are analogues of male hormone testosterone. Both have a core 17-carbon steroid
chemical structure that gives them anabolic (protein building) and androgenic
(masculinizing) properties. Studies were developed to separate the anabolic from the
androgenic effects, but this has been only partially accomplished. The androgenic
effects of endogenous testosterone are the development of male reproductive
system and secondary sexual characters. The anabolic effects include growth and
epiphyses closure of long bones during puberty, enlargement of larynx and vocal cords,
improvement of red cells number, reduce body fat, and improve muscle mass.
The ergogenic effects of
anabolic steroids use are valued for three main mechanisms of action:
- They shift the nitrogen equilibrium to the positive side for better utilization of
ingested protein and the increased retention of nitrogen. Although temporary and
needing a high-protein complementary diet, this effect helps the body to "build" muscles.
- The formation of a steroid-receptor complex in skeletal muscle stimulates the
RNA-polymerase system which, in turn, increase protein synthesis in the cell.
- Anabolic steroids compete for glucocorticoides receptors, resulting in an
anti-catabolic effect by blocking the protein synthesis inhibition which physiologically
occurs after exercises due to glucocorticoides liberation.
- Frequently, an euphoric and more aggressive behavior are experienced by
anabolic steroids users, stimulating them to practice more and without fatigue for
longer periods.
It should be noted that
doses used by athletes often greatly exceed doses recommended for legitimate medical
reasons, causing the potential for even greater negative consequences. Moreover,
many athletes will use more than one anabolic steroid simultaneously. There are
three common regimens practiced by anabolic steroid abusers:
- Cycling The athlete take the steroid for 6 to 12 weeks and then stops for 10
to 12 weeks. The steroid can be oral or injectable and doses are often 10 to 100
times higher than standard therapeutic dose.
- Stacking This is the use of more than one anabolic steroid at a time
to break through response plateaus that often occurs. About 40% of steroid abusers
use this kind of regimen, presenting a high risk for central nervous system.
- Pyramiding This kind of use starts with low dose of anabolic steroids,
increasing the dose over a period of weeks, then gradually tapering off before ending
the regimen.
None of these regimens are
free of side effects and there aren't yet sufficient studies showing the efficacy and injuries caused
for each one.
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V. Types of Steroids
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Anabolic steroids are
either taken by mouth or injected into a muscle. The "orals," as they are called,
are ingested tablets or capsules. These forms are reportedly more toxic to the liver.
Often the orals are taken in conjunction with injectable forms.
The injectable forms are
known as "oils" or "waters". The oils refer to the long-acting types. They are injected
into a muscle, usually the buttocks, and the steroid is released slowly over time.
Typically, these drugs are injected only a couple of times a week. The "waters" are
short-acting forms. Again, these are injected, usually in the buttocks, but they work
much faster and are eliminated much more quickly. There are two ways for anabolic steroids
administration. Oral steroids are highly potent and are excreted fairly rapidly from the body
due to short metabolic half-lives, (usually within weeks). So, oral steroids are the first
choice for athletes who want to rapidly improve their performance and try to escape showing
positive results on drug tests. These drugs, however, are the most toxic and have more
side effects. Injectable steroids are less potent and generally exhibit delayed uptake
into the body, especially if they are oil-based diluents. They have less liver toxicity
than oral steroids, but they are being less used by athletes because of having a detectability
in drug tests for long periods.
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VI. Side Effects
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Since anabolic steroids are
synthetic versions of the naturally-occurring male hormone testosterone, they have very
similar pharmacological actions and side effects. In mature males, the body secretes
2.5-10 mg of testosterone each day to promote various body processes. Steroid use often
introduces up to an additional 100 mg of testosterone into the system daily.
When levels become too high, the brain shuts down the body's own production of the
testosterone as well as other substances necessary for the proper functioning of the body.
Some of the body systems at risk include:
- Male reproductive system
- Too much testosterone or related substances (e.g., anabolic steroids) prompts the
pituitary gland to stop producing the hormone gonadotropin.
- This in turn also prevents the production of other intermediate substances which
leads to testicular atrophy (decreased size and function), lowered sperm count,
sterility (reversible), painful, prolonged erection, prostate enlargement and frequent or
continuing erections.
- When steroid use ceases, the entire testosterone producing function may remain shut down,
possibly leading to a permanent imbalance of the hormone.
- Female reproductive system
- These side effects are the result of masculinization due to increased testosterone
and include enlargement of the clitoris*, uterine atrophy, irregularity or cessation
of menstrual cycle, increased body hair*, deepening of the voice*, shrinkage of breast
size and masculinization of female fetuses in pregnant women. (*permanent effects)
- The heart and blood vessels
- Anabolic steroids cause fluid retention, which can lead to high blood pressure.
Steroids also lower high-density lipoproteins (HDLs) in the blood. These HDLs help
rid the body of cholesterol.
- In some cases, production of low-density lipoproteins (LDLs),
which promote the production of cholesterol, increases. Too much cholesterol leads to
buildup of plaque on the walls of arteries.
- Clogged arteries can result in strokes or heart attacks. Deaths have been reported in
both young and older athletes.
- Adolescents
- Bone growth is among the body processes that can shut down with steroid use.
Adolescents on anabolic steroids may find their muscles bulking up, but bone growth stops
with premature fusion of the epiphysis (growth center) of long bones. The result is
permanently stunted growth. There is risk until bones stop growing.
- Psychological Effects
- Steroids change users in many ways, but psychological changes can be the most
drastic of all. These include:
- Aggression. Feelings or irritability and aggression may appear so subtly that
the athlete may barely notice, but his friends or family will. Taking anabolic
steroids keeps an athlete constantly "on edge". Situations that normally would not
disturb him can, with steroid use, generate strong feelings of anger and hostility
(the "roid rage"). Athletes who take anabolic steroids often have difficulty dealing
with people because of these uncontrollable feelings. Anxiety can disturb sleep patterns,
and users may experience paranoia.
- Depression. Anabolic steroids produce psychological addiction. The aggression
and other psychological changes accompanying steroid use make the athlete want to
take more steroids for even larger muscles. When the athlete goes off steroids and the
body decreases in size, depression and other withdrawal symptoms often induce users
to take steroids again.
- Addiction and Dependence. Users may find they have become dependent and
experience withdrawal symptoms of severe depression (including suicidal thoughts), insomnia,
loss of energy or appetite, sweating, nausea, headaches and craving for anabolic steroids.
Withdrawal symptoms will last one to three weeks. Weight loss will also occur.
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VII. Identifying Steroid Use
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Athletes who use steroids
in conjunction with a weight training program can be identified by their quick muscle
and weight gain. Other symptoms and adverse effects include:
- Head: Headaches, hair loss, puffy cheeks, sore throat, unpleasant breath odor,
sore tongue, deepening of voice in females.
- Chest: Increased breast tissue on male pectorals, decrease of breast size in
female, rapid heart rate, heart attack.
- Skin: Increased oiliness and acne, flushed or yellowish skin, bruising,
even with small injuries, increased perspiration, pronounced stretch marks, facial and
chest hair on female, rash or hives.
- Psychological effects: Strained relationships with friends and family,
hyperactivity (restlessness, insomnia, irritability), uncharacteristic hostility or
aggressive behavior, feelings of frustration and anxiety without provocation, psychotic
symptoms paranoia, delusions, hallucinations).
- Psychological effects of withdrawal: Severe depression, feelings of inadequacy
and weakness as body size decreases, suicidal thoughts, lethargy and listlessness,
lack of interest in exercise or sports, inability to maintain normal sexual functions,
desire to return to steroid use.
- Genitals and abdomen: Testicles decrease in size, clitoris enlarges, changes
in bowel and urinary habits, kidney stones, gallstones, liver tumors.
- Extremities: Joint stiffness, pain, swelling, increased chance of injury to
muscles, tendons, and ligaments, stunted growth in adolescents.
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VIII. Medicinal Uses
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The FDA has approved some
uses for anabolic steroids, which include:
1. Weight gain for chronic nutritional deficiencies or AIDS wasting syndrome
2. Relief of bone pain accompanying osteoporosis
3. Corticosteroid-induced catabolism
4. Severe anemia
5. Hereditary angioedema
6. Metastatic breast cancer in women
7. Hormone deficiency states in males
One option for the treatment
of AIDS-related wasting syndrome is an anabolic steroid; this class of drugs is known to
actually build muscle. Up to now, the only available steroids had to be injected.
An oral anabolic steroid called oxandrolone (brand name Oxandrin) has once again
become available in the US. This drug was approved by the FDA over 30 years ago to
promote weight gain after surgery, trauma and serious infection. However, because of
stringent US regulation of steroids, it became largely unavailable.
Now the drug's manufacturer,
BTH Pharmaceuticals, is re-studying oxandrolone as treatment for AIDS-related wasting.
In an as yet unpublished study of 67 people with AIDS-related wasting, those on 15 mg of
oxandrolone per day for 16 weeks showed weight gain, those on 5 mg per day stabilized
their weight, and those on placebos lost weight. Depending on the dosage, oxandrolone
costs from $4-$30 per day; in contrast, Serono's Human Growth Hormone costs $140 per day.
There are less expensive anabolic steroids, but they must be injected. (Being Alive
Newsletter, January 1997)
Another medicinal use of
anabolic steroids deals with HIV infection; summarized here by Wayne Dodge, MD:
Steroids comprise an
important class of biologic compounds in the body. Cholesterol is a steroid. Cortisol,
which is the basic well-being hormone of the body, is a corticosteroid. It, and
medications like it, such as prednisone, have strong anti-inflammatory properties.
They are useful in conditions such as acute PCP or HIV-related persistent oral/esophageal
ulcerations, but are also immune suppressing in high doses. Hormones and drugs called
mineral corticosteroids govern how the kidneys handle the salts in the blood and thereby
maintain blood pressure. The sex hormones are also steroids and include testosterone--the
primary anabolic steroid in humans.
It is known that testosterone
levels decrease in HIV infected men as the disease progresses, (refs 2,3,4,5,6,7)
although not all studies have agreed with this finding. (refs 8,9) This decrease in
testosterone level has been correlated with both CD4 lymphocyte depletion and weight
loss. (ref 7) It is also known that reduced libido and increased incidence of impotence
are frequent complaints in males with AIDS. (ref 3)
The problem for health care
practitioners is that during chronic severe illnesses endocrine systems often show
abnormalities that are caused by the illness but are not necessarily the cause of the illness.
A prime sample would be tests for thyroid which may be abnormal during a severe illness,
although treating the individual on the basis of these lab tests does not help the individual
(and may cause harm). An additional complication is that an individual's testosterone
level may fall into the normal range for most laboratories, while more sophisticated
tests would indicate abnormality. This leaves the clinician and the individual in a dilemma.
If an HIV-infected individual
has had significant weight loss, significant fatigue, or muscle wasting (especially
proximal--e.g., thigh and upper arm), and particularly if associated with a significant
decrease in libido and erections, a serum testosterone level should be obtained. If it is
in the low or low-normal range (less than 300 mgng/dI) then a trial of testosterone therapy
could be tried. The individual and the clinician should decide what result would constitute
a successful trial--e.g., weight gain of 15 pounds, a 30% improvement in sense of well-being,
a successful erection once a week, etc. Then a testosterone (depo-testosterone) injection
of 200 mg every two weeks can be given over two to three months with periodic evaluation.
If the treatment is "successful," continued use of the medication is probably warranted.
If not, the individual's own hormonal system will rapidly readjust when the medication is
stopped.
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IX. Drug Testing
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The International Olympics
Committee banned steroids use by all athletes in its member associations in 1975.
Since then, most major amateur and professional organizations have put the drugs on their
list of banned substances. They include:
The National Football League
International Amateur Athletic Federation
National Collegiate Athletic Association
International Federation of Body Builders
Evidence suggests that in the
past, up to 100% of national and international competitors in the sports of weight lifting,
shot-put, discus, javelin throwing, and bodybuilding illegally used anabolic steroids
(Hough, 1990). Among college athletes, surveys taken between 1970 and 1988 at five
major universities showed a 15% to 20% use rate (Pope, 1988). Recent NCAA surveys
for self-reported drug use have detected a steroid usage rate of approximately 2.5%
overall (5.0% among football players), suggesting that random drug testing initiated in
1989 has gradually deterred the abuse of anabolic steroids in the college ranks
(NCAA Sports Sciences Education Newsletter, Winter 1993).
The major national and
international sports associations enforce their ban against anabolic steroids by periodic
testing. Testing, however, is controversial. Some observers say the tests are not reliable,
and even the International Olympic Committee tests, considered to be the most accurate,
have been challenged. Athletes can manipulate results with "masking agents" to prevent
detection, or they can take anabolic steroids that have calculable detection periods.
The USOC and the NCAA
have established strict penalties for the use of anabolic steroids by athletes. The
testing for anabolic steroids began at the 1976 Olympic Games in Montreal, when laboratory
technology first became available and made enforcement of these regulations possible.
At the present time, the USOC mandates a 2-year suspension for athletes who test positive,
and a life ban for those with a repeated offense.
The NCAA initiated year-round
testing for anabolic steroids and related masking agents (diuretics and urine-manipulating
drugs) in August 1990. Under this new program, at least 6,000 football players in Divisions
I-A, I-AA, and II are tested at any time during the academic year--not just during the
football season. The selected teams are notified 2 days in advance of the urine specimen
collection, and 18 players from each team's official squad list are randomly tested.
Furthermore, at least 25% of teams initially tested are retested during the same year for
continued compliance. The rule allows for testing of freshmen who have been red-shirted
and all regular players. The NCAA extended this year-round testing program for anabolic
steroids to Division I track and field teams in 1992, and Division II football in 1994. A
positive test results in the loss of eligibility for at least 1 year for the student-athlete.
Despite the problems,
testing remains an important way of monitoring and controlling the abuse of steroids among
athletes. Efforts are underway to make testing more accurate.
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X. References
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Internet Websites
http://www.health.org/pubs/nidarr/
http://www.mmm.co.uk/localfo/bolton/highlow/druginfo/drugs10.html
http://freeway.net/~shack/steroid.htm
http://www.elitefitness.com/steroids/guide.html
http://www.medibolics.com/jekot/jekot6.htm
http://www.geocities.com/HotSprings/3069/androgen.htm
http://www.mackaos.com.au/Articles/isu93.html
http://www.bsos.umd.edu/cesar/cesarbd.html
http://www.medibolics.com/main2.htm
http://www.digiweb.com/~mmooney/index.htm
http://software2.bu.edu/COHIS/subsabse/steroids/steroids.htm
http://www.cma.ca/canmed/policy/dopage_e.htm
http://freenet.uchsc.edu/2000/protect/fdsafety/fda/fdaster.html
http://www.muscle-fitness.com/wwwboard/wwwboard.html
http://www.helix.com/member/coned/test_steroids.html
http://www.immunet.org/atn/ZQX16604.html
http://www.nau.edu/~fronske/steroids.html
http://www.aidsnyc.org/network/simple/steroids.html
http://ovchin.uc.edu/htdocs/hopeline/anabolic.html
http://hartinc.com/siv/roids.htm http://www.wdn.com/mirkin/fc80.html
http://www.medstudents.com.br/sport/sport2.htm
http://web.univnorthco.edu/pub/~dbrown/Drugs.htm
http://www.projinf.org/fs/anabolic.html
http://ovchin.uc.edu/~dpichome/fact_sheets/anabolic.html
http://www.aaos.org/wordhtml/papers/position/steroids.htm
http://www.masconomet.org/department/health/steroids.html
http://www.mtp-online.com.sg/style/man/steroid1.htm
http://www.health.org/pubs/PRIMER/steroids.htm
Articles & Books
The Medical Clinics of North America, Vol 78, Num 2, Gray I. Wadler
Anabolic Steroids, Robert J. Fuentes, MS, PharmD
Glaxo Research Institute and Jack M. Rosemberg, PharmD, PhD
The International Drug Information Center Arnold and Marie Schwartz College of
Pharmacy and Health.
Copyright Nick Zaccardi
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