Steroids in Sports Performance: Effects, side effects and regulations

The use of anabolic steroids by athletes can be traced back as far as 1954 to the World Weight Lifting Championships in Vienna. During this competition, the Soviet team doctor reportedly told the US team physician that Soviet competitors were taking testosterone. Since then, further experimentation with anabolic drugs has continued in attempts to enhance strength, power and muscle mass in various types of athletes.

The Ben Johnson incident at the 1988 Olympics and the inquiry that followed brought attention to the widespread use of anabolic steroids among athletes competing in many different sports.

In recent years, a new anabolic steroid story surfaced. This time it involved slugger Mark McGwire, who broke the home run record set by Roger Maris in 1961. Newspaper reports indicated that McGwire admitted to using a steroid substance called Androstenedione, which can be legally purchased in the United States from many health food stores, sports nutrition centers and drug stores.

Androstenedione is legal because it is not a form of testosterone, but it is the immediate building block of testosterone in the body. From a biochemical standpoint, the more Androstenedione there is available, the more testosterone the body can produce.

Under the influence of higher testosterone levels, muscles respond by synthesizing a greater number of protein contractile bands, known as myofilaments. A greater number of myofilaments within each muscle fiber translates into greater strength and increased muscle size (hypertrophy). Thus, higher levels of testosterone can aid an athlete’s strength and muscle mass development in an attempt to go beyond his genetic limitations.

As a result of testosterone’s proven anabolic properties, there has been intense interest in developing testosterone-related drugs that can provide athletes with a competitive edge. In 1958, Ciba Pharmaceutical Company released Dianabol (methandrostenolone), a synthetic testosterone. Reports about the efficacy of the drug spread by word-of-mouth throughout the weight lifting community. By the 1964 Olympics, anabolic drugs were being used by almost all athletes in the strength sports.

New federal laws (1990) have made anabolic steroids illegal to possess or distribute in the United States. This is primarily due to the potential health hazards associated with their use. Nevertheless, Dr. Charles Yesalis, world expert on drug use in sports at Penn State University, estimates that 75-90 percent of NFL players have used steroids.

A 1991 survey reported that 5 percent of college athletes admit steroid use, although other reports are as high as 14.7 percent. Even at the high school level, reports suggest that as many as 5-12 percent of young athletes take anabolic steroids.

Traditionally, there have been two ways of using anabolic steroid drugs — by injectables or by ingesting them orally. As a rule, injectable steroids are most potent because they most closely resemble the body’s own testosterone and have been chemically manipulated to deliver an even greater anabolic effect.

When taken orally, the majority of testosterone is partially destroyed by enzymes in the intestinal tract and the liver. As a rule, only 5-10 percent survive degradation to reach the systemic circulation and target tissues, such as muscle fibers.

Oral anabolic steroids, however, have been created by modifying testosterone in such a way as to enhance its longevity in the circulation and slow down its rate of destruction by liver enzymes.

Athletes typically use very high doses of these substances, and this is what adds to the danger of their use. For instance, men requiring testosterone injections for medicinal reasons have received a replacement dose of Dianabol of approximately 15 mg/day; athletes have reported using up to 300 mg/day. Although this drug has not been available for medical use in the United States for over a decade, it is readily obtained through black market sources, and remains one of the most-used oral anabolics. Testosterone enanthate, now used medicinally for some rare diseases and for men with low sperm counts, is typically injected at doses of 75-100 mg/week (250 mg maximum). Athletes may use this drug at 1000 mg or more per week.

The dangers of using these drugs are well documented. For an adolescent boy using synthetic anabolic steroids, the primary risk is accelerated puberty and early closure of the ends of the long bones, thus terminating bone growth and potentially resulting in short stature for the boy.

The oral anabolics are known to cause liver damage. The risk of liver tumors (hepatoma) and peliosis hepatitis (the formation of blood-filled cysts within the liver) increases with oral anabolic use. There are almost 100 cases of liver cancer in steroid users reported to date.

Adverse effects also include a drop in HDL blood levels, which increases the risk of coronary artery disease. Steroids can pathologically enlarge the heart and make blood platelets more sticky, both of which increase risk of heart attacks in athletes. Three cases of stroke have also been reported by athletes taking high doses of steroids.

Early onset prostate cancer is also a risk. High levels of testosterone increase growth of normal prostate cells as well as growth of any cancerous cells that may be present in a dormant state. It’s very common for even young men to have cancerous lesions in the prostate gland that may never pose a threat to one’s life. The introduction of high levels of testosterone acts as a tumor promoter, encouraging the cancer cells to grow and spread.

Other more peculiar side effects of anabolic drug use involves acne on the face and trunk of the body, impotence, gynecomastia (male development of breasts, due to some testosterone converting to estrogen), and decreased size of the testes. Sodium retention, jaundice and a lower sperm count are also associated with anabolic drug use, as is increased aggressive behavior.

As for Androstenedione and its effects, biochemistry principles suggest that higher levels of Androstenedione will raise testosterone levels, yielding an anabolic effect. To appreciate how this is possible, one need only examine the testosterone synthesis pathway that occurs most predominantly in the male testes. In women, the bulk of testosterone is produced in the adrenal glands via the same pathway, but adult males secrete 6-7 mgs per day of testosterone, whereas women produce only 0.15- 0.4 mg per day (approximately 1/20 the male production). Nevertheless, all testosterone is made from cholesterol through the following biochemical steps:

Cholesterol > Pregnenolone > 17 Hydroxypregnenolone > DHEA > Androstenedione > Testosterone

As for all steroids, the rate-limiting step in testosterone production is the conversion of cholesterol to pregnenolone, which is normally regulated by luteinizing hormone (LH). As can be seen, by ingesting Androstenedione, an athlete bypasses the regulation step of testosterone synthesis (cholesterol > pregnenolone), providing the body with the immediate building block of testosterone.

As a result, testosterone synthesis can be greatly enhanced as the enzyme 17-beta-dehydrogenase readily converts Androstenedione into testosterone. Athletes ingesting Androstenedione claim it achieves this anabolic outcome, although sufficient controlled studies are lacking.

The point is, however, that it is biologically plausible that Androstenedione can significantly elevate testosterone levels. This suggests that it carries similar health hazards as other anabolic drugs. Although it presently is available over the counter at many locations, many experts feel that athletes are putting themselves at risk for liver disease, liver cancer, heart disease, stroke, stunted growth, and early prostate cancer by using this substance. Its presence in the marketplace is an attempt to circumvent the Anabolic Steroids Control Act established in November 1990.

Unlike DHEA, which the body can convert into estrogen or testosterone, Androstenedione is converted exclusively into testosterone. Thus, higher testosterone levels and more testosterone-related side effects would likely result from its use. Thus, many authorities  recommendation that young athletes avoid this substance until its safety can be established.

Anabolic steroids are dangerous because they impose super-physiological levels of testosterone on the body, which act directly on our genetic blueprints. This unnatural and powerful effect results in an increased risk of premature disease and death in an attempt to gain a competitive edge in a sport or competition.

In contrast, the supplementation of vitamins, minerals and various herbal products at appropriate levels is associated with a variety of positive health benefits, and their safety has been well-established.

As such, supplements must be evaluated individually. Androstenedione supplementation may pose a serious threat to one’s life, whereas, for instance, the ingestion of a saw palmetto supplement by a middle-aged man can reverse prostate enlargement and possibly reduce the risk of future prostate cancer.

References:

1. Friedl, K.E. Performance-enhancing substances: Effects, Risks and Appropriate Alternatives. In Essentials of Strength and Conditioning. Human Kinetics, 1994.
2. Di Pasquale, MG. Drug Use and Detection in Amateur Sports. MG.D. Press, 1984.
3. Marks, B., Marks, A. and Smith, C. Basic Medical Biochemstry. Williams and Wilkins, 1996.
4. Fleck, S.J. Designing Resistance Training Programs. Human Kinetics, 1997.
5. Johnson, F.L., et al. Association of androgenic-anabolic steroid therapy with the development of hepatocellular carcinoma.. Lancet, 1972, Vol.2, pp 1273-1276.
6. National Household Survey on Drug Abuse; Population Estimates 1991. Publication No ADM-92-1887. Rockville, MD: Department of Health and Human Services, 1991.
7. Anderson, W.A. et al. A national survey of alcohol and drug use by college athletes. Physician and Sportsmed 1991;19-91, 104.
8. Yesalis, CE, et al. Athletes’ projections of anabolic steroid use. Clin Sports Med 1990;2:155-171.
9. Forbes, G. Steroid users know all the tricks. USA Today, 8 October 1991;3C.
10. Yesalis, C.E. ed. Anabolic Steroids in sport and Exercise. Champaign, IL; Human Kinetics, 1992.
11. Kuipers, H. et al. Influence of anabolic steroids on body composition, blood pressure, lipid profile and liver functions in bodybuilders. Int J Sports Med 1991;12:413-418
12. Matsumoto, A.M. Effects of chronic testosterone administration in normal men. J Clin Endocrin Metabolism 1990;70:282-287
13. Ajache, A.E. Surgical treatment of gynecomastia in the bodybuilder. Plas Reconstruct Surg 1989;83:61-66
14. Noble, R.L. Androgen use by athletes: a possible cancer risk. Canadian Med Assoc j 1984;130:549-550.
15. Larkin, G.L. Carcinoma of the prostate. J Engl J Med 1991:324;18982.
16. Roberts, J.T. Essenhigh, D.M. Adenocarcinoma of prostate in 40-year old bodybuilder. Lancet 1986;2:742.
17. Lenders, J.W.M., et al. Deleterious effects of anabolic steroids on serum lipoproteins, blood pressure, and liver functions in amateur bodybuilders. Int J Sports Med 1988;9:19-23.
18. McKillop, G. Todd, I.C., Ballantyne, D. Increased left ventricular mass in a bodybuilder using anabolic steroids. Br J Sprts Med 1986;20:151-152.
19. De Piccoli, B. et al. Anabolic steroid use in bodybuilders: an echo-cardiographic Study of Left Ventricle Morphology and Function. Int J Sports Med 1991;12:408-412.
20. Longhurst, J.C. et al. Echocardiographic left ventricular masses in distance runners and weightlifters. J App Physiol 1980;48:154-162.
21. Johnson, M. Ramey, E. Ramwell, P. Androgen mediated sensitivity in platelet aggregation. Am J Physiol 1977;232:H381-H385.
22. Everly, R.S. et al. Severe cholestasis associated with stanozolol. Brit Med J 1987;294:612-613.
23. Lin, G.C., Erinoff, L, eds. Anabolic Steroid Abuse. Washington, D.C.: Government Printing Office, 1990.
24. Udry, J.R. et al. Serum androgenic hormones motivate sexual behavior in adolescent boys. Fertility and Sterility 1985;43-90.