Anabolic Steroids: Uses and Abuses

I have just had the misfortune of reading several articles that discuss the taking of 'steroids'. There are few areas in which half truths and outright misinformation is so commonly presented as factual information. This is a very complex subject. Normally, I would shy from writing a brief essay to cover a topic of such complexity, but I feel a need to provide at least some information that is accurate. So, in unfortunately abbreviated form, here it is.

Medically, the word 'steroid' refers to two completely different classes of substances. Cortico-steroids, those substances, and their relatives produced by the adrenal cortex have complex effects on the human body. Although they are chemicals that are normally produced in the body, they are sometimes introduced exogenously (orally, parentally, or locally) for various medical purposes. A major effect is to reduce inflammatory responses of the soft tissue and they are, therefore, useful in treating various disorders that produce inflammation and pain, such as arthritis. There are uses in many other disorders, but in general, they are more palliative (reducing symptoms) than curative.

However, cortico-steroids, are not generally what is referred to when people talk of 'steroids' as in performance enhancing drugs. Technically, this class of drugs is called anabolic steroids because they are normally produced by the body in greater concentration in men than women and control the development of male sexual characterisitics. In addition, they help govern normal growth and repair functions. They are not produced in the adrenal cortex, but rather in several places, most particularly in the testicles in men, but also other places in the bodies of both men and women. This is predominantly the male sex hormone, testosterone. Testosterone enhances growth processes during normal development of the body and is, in general, responsible for many of the size and strength differences between men and women. Anabolic steroids are effective in muscle hypertrophy in such a way as to increase the effects of exercise in producing stronger and bulkier muscles. When used along with HGH (human growth hormone) they increase the effects of exercise on conditioning and enhance repair functions in the body. The combination, in fact, will increase the growth rate and eventual size in children (before the bone growth stops) and is often used to increase the size of exceptionally small children. It is important to note that if the testosterone is used alone for this purpose, it is likely to have the opposite effect by stimulating the rate of bone maturation and thereby cause growth to stop early because the epiphysies (bone ends) close prematurely.

Moreover, there are several legitimate medical uses for testosterone in adult males, all of them related to normalizing an abnormally low level of the substance in the body. Hypogonadism, traumatic damage to the testes, the effects of some treatments, particularly for cancer, and several diseases can all lower the amount of testosterone in the body. So replacement therapy is instigated and the testosterone is administered in some way that bypasses the so called 'first pass effect' which means that it would be broken down by the liver. In other words, it is introduced into the body, usually by imbedding it into a carrier that allows it to cross the skin and be absorbed directly into the blood stream. It simply cannot be taken by mouth because of the 'first pass effect'.

In adults, when testosterone and HGH are given in such manner (usually injected into the body), in the proper doses, they can actually slow and even slightly reverse some of the effects of aging. Do they help performance in athletics? You bet! So what is the 'downside'?

It is often stated with great authority that this use can and will stimulate cancers, increase the risk of heart attacks, destroy the liver, and wither the gonads. However, authoritatively stated or not, the evidence for some of these claims is shaky. As the best summary of current knowledge, along with a little extrapolation from the way in which they actually work, I shall comment on these effects. 1) They almost certainly do stimulate or act as risk factors for some cancers, particularly liver, but there is also anecdotal evidence linking them to a wide variety of other tumors; 2) Cardiac effects are complicated by the fact that those who use anabolic steroids are also likely to engage in much more physically stressful activities than most other people. Exercise itself, of course, is generally good, but could be a risk factor for negative events in people with certain heart defects. Otherwise, the evidence for deleterious heart effects is not strong; 3) Destroy the liver? Probably not in any reasonable dosing, but there are numerous hepatic effects and it can be risky, particularly in people with abnormalities or who are on other medications. 4) Shrink the gonads? Well, yes; if used over a long enough period of time, because they suppress endogenous steroids (your own body's production), the parts of the body that manufacture them will show some atrophy. However, it is reversible, usually, when the steroid use is stopped.

An increase in testosterone changes the normal balance between male and female hormones and tends to increase aggression and sexual response (in both genders). Therefore, personality characteristics can be affected in substantial ways, most of them unpleasant. It also increases male characteristics in females, including hair distribution and other secondary sexual characteristics. In men, it can increase baldness and cause or exacerbate prostatic hypertrophy. How great are these effects? Well, they are dose dependent; that is the more you use, the greater are all effects, both good and bad; both those you wish, and those you don't.

Testosterone is classified as a schedule III drug, meaning it is a controlled substance with relatively stiff penalties for abuse. HGH is beastly expensive. These facts have combined to spawn a market for 'prodrugs' (drugs that convert into the active drug in the body) and growth hormone or testosterone agonists (drugs that stimulate the release and manufacture of the bodies production of these substance). Do they work? Not very well, partly because some are entirely ineffective and others cannot produce a large enough and predictable enough response to be useful.

In other words, casual experimentation is not likely to produce good results and is dangerous. However, there is a thriving market for the substances in professional sports. There are many people in sports who know enough to use these substances effectively (but rarely safely) and have access to them. Moreover, the pressure to use them is very high because you are at a competitive disadvantage if you don't in sports where their use is not well regulated - and that means most of them. Contrary to many claims, they definitely are performance enhancing and if your competitor's performance is enhanced and yours isn't, you're out of a job.

Conclusion? Anabolic steroids have their place in medicine. They have no place in sports and should be monitored much more effectively than currently. Without such increased control, the use will remain high simply because high levels of athletic performance are the livelihood for most of the players and if they are at a competitive disadvantage, there goes the paycheck.