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Anabolic Steroids: Truth and Fiction

Anabolic Steroids: Truth and Fiction Thad J. Barkdull, MAJ, MC Fellow, Sports Medicine Department of Family Medicine, USUHS Goals History of Steroids History of Performance Enhancement Definition Function Benefits/Adverse Effects Government/Athletic Policies Non-adrogenic uses

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Anabolic Steroids: Truth and Fiction

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  1. Anabolic Steroids: Truth and Fiction Thad J. Barkdull, MAJ, MC Fellow, Sports Medicine Department of Family Medicine, USUHS

  2. Goals • History of Steroids • History of Performance Enhancement • Definition • Function • Benefits/Adverse Effects • Government/Athletic Policies • Non-adrogenic uses

  3. History of Steroids • 1849: Berthold removes testes from roosters • 1889: Charles Eduard Brown-Séquard—testicular extracts • 1931: Adolf Butenandt obtains 15 mg androstenone from 10K+ L urine • 1934: Leopold Ruzicka synthesizes androstenone

  4. Hx (cont.) • 1935: Karoly Gyula David et al. identify the male sex hormone--testosterone • 1935: Butenandt and Ruzicka teams independently synthesize artificial testosterone • 1937: first mention in scientific literature of steroids used for performance

  5. Hx (cont.) • 1938: mention of steroid use in letter to editor in U.S. bodybuilding magazine • 1939: Butenandt Nobel Prize • 1939-1945: German soldiers hope to increase aggression; concentration camp experiments in chronic wasting

  6. Steroid Abuse • 1940s: USSR athletes use for performance enhancement • 1954: John Ziegler attends World Weightlifting Championships in Vienna • 1958: CIBA markets “Dianabol”—methandrostenolone • 1960s: multiple studies question the effectiveness of anabolic steroids

  7. Steroid Abuse (cont.) • 1972: 68% olympic athletes purported to use steroids • 1976: Steroids banned at Olympics, and first testing done • 1990: FDA identifies steroids as Schedule III drugs • 1998: Reunified Germany begins prosecution of sports officials who treated unknowing athletes with steroids

  8. Abuse Today Scandal rocks ‘83 Pan Am Games Chinese “juicing” at World Championships ‘88 Jones suspected of steroid use Sprinter Collins stripped of medals Future Home Run King suspected of steroid use Tour de France winner tests positive Tainted Race? East Germans admit extensive abuse Russians stripped of medals in Salt Lake Gaitlin may lose medals Canadian stripped of gold medal Steroid use rampant in baseball, writes former star

  9. Commonly Used Androgenic-Anabolic Steroids Ethylestrenol * 1-Methyl Derivatives Mesterolone * Methanolone acetate* Parenteral Agents Testosterone proprionate Testosterone cypionate Testosterone enanthate Methanolone enanthate * Nandrolone phenproprionate Nandrolone decanoate Boldenone undecylenate † Mibolerone † Oral Agents 17α-Alkyl Substituted Derivatives Methyltestosterone Stanozolol Fluoxymesterone Oxandrolone Oxymetholone Danazol Methandrostenolone * Norethandrolone * Testosterone Esters Testosterone undecanoate Oxymesterone * *Not available in United States for human therapeutic use but available through illicit channels. †Veterinary product. From “Ford: Clinical Toxicology” 1st ed.

  10. Mode of Use • Cycling • set cycles that may have periods during which no steroids are taken • different anabolic steroids are rotated. • Stacking • Use more than one type at a time. • Usually PO and IM • Pyramid stacking • Up-tapering or down-tapering doses of a steroid • Steroids usually taken at 100x physiologic doses

  11. What are steroids? • Chemical composition • Similar to cholesterol • Derivatives of testosterone • Modifications for use • Esterification of 17β-hydroxyl group • Alkylation at 17α-position • Modification of steroid ring structure

  12. Effects • Androgenic • Virulizing • Changes in sexual characteristics • Anabolic • Muscle building • Muscle hypertrophy • Decreased fat deposition

  13. How do they work? • Effects on the body • Neuro • CV • Derm • Psych • MSK • GI/GU/Sexual

  14. Others • Liver damage • Abscesses • Infectious Disease • Allergies

  15. The Studies

  16. King DS, Sharp RL, Matthew DV, et al. Effect of oral androstenedione on serum testosterone and adaptations to resistance training in young men. JAMA 1999; 281:2020–8. • 30 males randomly assigned to androstenedione vs. placebo • 8 weeks resistance training • Increases in serum levels at 60 minutes and 90-270 (175 and 325-350% resp.) • LH, FSH, Testosterone, lipids, LFTs, iron, CBC unchanged • Except 12% HDL decrease! • No change in strength, composition, fiber types

  17. Van Marken Lichetenbelt WD, Hartgens F, Vollaard NB, Ebbing S, Kuipers H. Bodybuilders’ Body Composition: Effect of Nandrolone Decanoate. Med. Sci. Sports Exerc 2004; 36(3): 484-489. • 16 male bodybuilders randomized to ND (weekly IM) or placebo • 8 weeks of exercise and nutrition monitored • 2.2 kg increase in body mass • 2.6 kg increase in fat free mass • 1.4 kg increase in total body water • No changes in bone density, ECW, ICW, and hydration of FFM

  18. Schroeder ET, Vallejo AF, Ling Z, Stewart Y, Flores C, et al. Six-Week Improvements in Muscle Mass and Strength During Androgen Therapy in Older Men. J. Gerontol. A Biol. Sci. Med. Sci. 2005 60: 1586-1592. • 32 men, aged ~72 years old randomized 2:1 to oxandrolone vs. placebo over six weeks • Given at doses recommended by FDA for weight loss • Changes at week 6 in lipids, normalized by week 12; mild LFT elevation; otherwise no adverse effects noted • Increases in LBM and muscle strength noted at 6 weeks; maintained to 12 weeks (>90%)

  19. Grunfeld C, Kotler DP, Dobs A, Glesby M, Bhasin S. Oxandrolone in the Treatment of HIV-Associated Weight Loss in Men: A Randomized, Double-Blind, Placebo-Controlled Study. JAIDS Journal of Acquired Immune Deficiency Syndromes 2006; 41(3):304-314. • 262 HIV+ men randomly selected to various dose of Oxandrolone vs. placebo • 12 weeks later, significant increases in LBM, body cell mass (BCM) • Increases in LFTs, Lipids, decreased HDL

  20. Giorgi A, Weatherby RP, Murphy PW. Muscular strength, body composition and health responses to the use of testosterone enanthate: a double blind study. J Sci Med Sport. 1999; 2(4):341-55. • 21 males randomized (double blind) to TE vs. placebo • 12 monitoring phase, 12 week follow up • 1RPM bench press significant improvement • Body composition, body weight, arm girth, rectus femoris circumference increased • Abdomen skinfold decreased • Increased SBP, frontal alopecia, muscle tightness, acne, transient libido, aggressiveness, irritability, lability

  21. The “Other” Data From http://www.anabolicsteroids.com/steroidexp.html “We are not trying to paint a positive or negative picture of steroid use. Our goal is to paint an accurate picture. As the number of accounts posted here increase they, as a whole, will allow people to draw an accurate picture of the risks and benefits of steroid use. We do not recommend or encourage anyone to use anabolic steroids or other illegal drugs.”

  22. “It was late 2004 when I boarded the plane for Thailand, I was 21 years old, and had been in the gym on and off since the age of sixteen. I had naturally bulked up to just shy of 240 pounds by the age of 19, but I made an effort to cut out the fat so to speak before my first cycle, and arrived in the Land Of Smiles, at a somewhat leanish 198 pounds… “I was a bit nervous approaching the pharmacist, coming from a Country where steroids are illegal, I couldn't help feeling I was breaking the law. After a few words in broken English I managed to work out that I had to write what I wanted down on a piece of paper and hand it over. I did this, and the pharmacist went out the back and got what I wanted. I'm sure the grin on my face when I paid for my gear and left was priceless… “I would like to jump ahead now to the 30 day mark, one month on and the testosterone was fully kicked in. I found myself not in Thailand anymore but a small city called Na Trang, Vietnam. I was now weighing in at 231 pounds, and I would stay at this weight for the rest of my cycle, yet get bigger stronger and leaner.”

  23. Other Anecdotes • I put on muscle fast • He could score more girls • Get back into good shape [like] when I was young • I wanted power • Helped me build muscle fast • I noticed that a nice body gets the chicks • I started… to bulk up for football • The sports medicine doctor gave me a shot… and I was pain free • Gave me a 94 MPH fastball • I was able to lift far more than ever • The mental power you experience…the first time is incredible

  24. ACSM Stand 1984 “Anabolic-androgenic steroids can contribute to an increase in body weight in the lean mass compartment of the body. The amount of weight gained in the training studies has been small but statistically significant… [however it is] not exhibited by all individuals.” [stated in 1977 that there was no benefit from steroids]

  25. ACSM Stand 1984 • Reviewed studies that showed • Increases in body weight (mostly LBM) • Gains can be increased with bodybuilding when steroids are used • No increases in aerobic power (VO2 max) or muscular exercise capacity • Adverse hepatic, cardiovascular, reproductive, and psychological health shown

  26. Government Policy • Anabolic Steroid Control Act 1990 • Schedule III • Requires prescription • Includes marinol, GHB, narcotics, ketamine • Anabolic Steroid Control Act 2004 • Added 32 more steroids to list of Schedule III drugs • Increased authority of DEA to regulate and enforce laws • 1st time possession: $1K max 1yr • 2nd time: double • 1st trafficking: felony, $250K 5yrs • 2nd time: double

  27. Athletic Policies • Steroid Ban • IOC, NCAA, MLB, NBA, NFL, NHL • Steroid Precursors Banned • IOC, NCAA, NFL

  28. VHSL Policy • 27-15-1 (9) • Student found to have used anabolic steroids during training or participation shall be ineligible for a period of two years • No current policy for mandatory or random drug testing

  29. Anabolic Steroid Use by Students2006 Monitoring the Future Survey from the 2006 Monitoring the Future Survey, funded by the National Institute on Drug Abuse, National Institutes of Health, DHHS, and conducted by the University of Michigan's Institute for Social Research.

  30. Fact or Fiction? FICTION FICTION • Decreased penis size • Steroids increase suicidality • Increased lipids • Hair loss • Steroids cause “rage” • Hypertension • High Mortality with use • Increased LBM • Gynecomastia • Increased muscle mass • Causes Cancer • Decreases bone mineral density FACT FACT FICTION FACT FICTION FACT FACT FACT FICTION FICTION

  31. Summary • Long history of use and abuse • Good science is lacking • Lots of benefit • Weightlifting • Chronic wasting disease • ?Future with myopathies, spinal cord injury, cancer, dystrophy research • Lots of side effects • Currently banned, but still used

  32. Questions?

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