Monday, September 6
Anabolic steroids
 Editor's note: This is the first of an eight-week series of articles examining the effects of commonly abused substances on athletic performance and overall health.

There should not be a controversy over anabolic steroid use in athletics -- non-medical use of anabolic steroids is illegal and banned by most, if not all, major sports organizations. Still, some athletes persist in taking them, believing that these substances provide a competitive advantage. But beyond the issues of popularity or legality is the fact that anabolic steroids can cause serious physical and psychological side effects.

In light of these hazards, measures to curtail the use of anabolic steroids are escalating. One of the nation's foremost authorities on steroid use, Dr. Gary Wadler, is part of a concerted effort to educate the public about the dangers of anabolic steroids. Dr. Wadler, a New York University School of Medicine professor and lead author of the book Drugs and the Athlete, serves as a consultant to the U.S. Department of Justice on anabolic-androgenic steroid use. He has also won the International Olympic Committee President's Prize for his work in the area of performance-enhancing drugs in competitive sports. He joined us to address the issue of steroids and sports.

What are anabolic steroids?

Anabolic steroids -- or more precisely, anabolic-androgenic steroids -- are the synthetic derivatives of the naturally occurring male anabolic hormone testosterone. Both anabolic and androgenic have origins from the Greek: anabolic, meaning "to build," and androgenic, meaning "masculinizing." Testosterone's natural androgenic effects trigger the maturing of the male reproductive system in puberty, including the growth of body hair and the deepening of the voice. The hormone's anabolic effect helps the body retain dietary protein, which aids in the development of muscles. "Although there are many types of steroids with varying degrees of anabolic and androgenic properties, it's the anabolic property of steroids that lures athletes," says Dr. Wadler. "They take them to primarily increase muscle mass and strength."

How are steroids taken?

Steroids can be taken orally or they can be injected. Those that are injected are broken down into additional categories, those that are very long-lasting and those that last a shorter time. In recent years, use has shifted to the latter category -- shorter-lasting, water-soluble injections. "The reason for that is that the side effects associated for the oral form were discovered to be especially worrisome for the liver,"says Dr. Wadler. "But the injectable steroids aren't free of side-effects either. There is no free ride and there is a price to be paid with either form."

Who takes anabolic steroids and why?

It is not only the football player or weightlifter or sprinter who may be using anabolic steroids. Nor is it only men. White- and blue-collar workers, females and, most alarmingly, adolescents take steroids -- all linked by the desire to hopefully look, perform and feel better, regardless of the dangers.

Anabolic steroids are designed to mimic the bodybuilding traits of testosterone. Most healthy males produce less than 10 milligrams of testosterone a day. Females also produce testosterone but in minute amounts. Some athletes however, may use up to hundreds of milligrams a day, far exceeding the normally prescribed daily dose for legitimate medical purposes. Anabolic steroids do not improve agility, skill or cardiovascular capacity.

What are the health hazards of anabolic steroids?

"There can be a whole panoply of side effects, even with prescribed doses," says Dr. Wadler. "Some are visible to the naked eye and some are internal. Some are physical, others are psychological. With unsupervised steroid use, wanton 'megadosing' or stacking (using a combination of different steroids), the effects can be irreversible or undetected until it's too late." Also, if anabolic steroids are injected, transmitting or contracting HIV and Hepatitis B through shared needle use is a very real concern.

Additionally, Dr. Wadler stresses that "unlike almost all other drugs, all steroid based hormones have one unique characteristic -- their dangers may not be manifest for months, years and even decades. Therefore, long after you gave them up you may develop side effects."

Physical side effects

Men - Although anabolic steroids are derived from a male sex hormone, men who take them may actually experience a "feminization" effect along with a decrease in normal male sexual function. Some possible effects include:
  • Reduced sperm count
  • Impotence
  • Development of breasts
  • Shrinking of the testicles
  • Difficulty or pain while urinating

Women - On the other hand, women often experience a "masculinization" effect from anabolic steroids, including the following:

  • Facial hair growth
  • Deepened voice
  • Breast reduction
  • Menstrual cycle changes
With continued use of anabolic steroids, both sexes can experience the following effects, which range from the merely unsightly to the life endangering. They include:
  • Acne
  • Bloated appearance
  • Rapid weight gain
  • Clotting disorders
  • Liver damage
  • Premature heart attacks and strokes
  • Elevated cholesterol levels
  • Weakened tendons

Special dangers to adolescents

Anabolic steroids can halt growth prematurely in adolescents. "What happens is that steroids close the growth centers in a kid's bones", says Dr. Wadler. "Once these growth plates are closed, they cannot reopen so adolescents that take too many steroids may end up shorter than they should have been."

Behavioral side effects

According to Dr. Wadler, anabolic steroids can cause severe mood swings. "People's psychological states can run the gamut." says Wadler. "They can go from bouts of depression or extreme irritability to feelings of invincibility and outright aggression, commonly called "'roid rage. This is a dangerous state beyond mere assertiveness."

Are anabolic steroids addictive?

Recent evidence suggests that long-time steroid users and steroid abusers may experience the classic characteristics of addiction including cravings, difficulty in stopping steroid use and withdrawal symptoms. "Addiction is an extreme of dependency, which may be a psychological, if not physical, phenomena," says Dr. Wadler. "Regardless, there is no question that when regular steroid users stop taking the drug they get withdrawal pains and if they start up again the pain goes away. They have difficulties stopping use even though they know it's bad for them."