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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 l.jpg

Anabolic Steroids: Truth and Fiction

Thad J. Barkdull, MAJ, MC

Fellow, Sports Medicine

Department of Family Medicine, USUHS


Goals l.jpg
Goals

  • History of Steroids

  • History of Performance Enhancement

  • Definition

  • Function

  • Benefits/Adverse Effects

  • Government/Athletic Policies

  • Non-adrogenic uses


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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


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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


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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


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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


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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


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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


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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.


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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


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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


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Effects

  • Androgenic

    • Virulizing

    • Changes in sexual characteristics

  • Anabolic

    • Muscle building

    • Muscle hypertrophy

    • Decreased fat deposition


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How do they work?

  • Effects on the body

    • Neuro

    • CV

    • Derm

    • Psych

    • MSK

    • GI/GU/Sexual


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Others

  • Liver damage

  • Abscesses

  • Infectious Disease

  • Allergies



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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


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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


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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%)


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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


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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


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The “Other” Data composition and health responses to the use of testosterone enanthate: a double blind study.

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.”


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“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.”


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Other Anecdotes 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 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


Acsm stand 1984 l.jpg
ACSM Stand 1984 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…

“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]


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ACSM Stand 1984 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…

  • 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


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Government Policy 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…

  • 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


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Athletic Policies 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…

  • Steroid Ban

    • IOC, NCAA, MLB, NBA, NFL, NHL

  • Steroid Precursors Banned

    • IOC, NCAA, NFL


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VHSL Policy 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…

  • 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


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Anabolic Steroid Use by Students 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…2006 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.


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Fact or Fiction? 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…

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


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Summary 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…

  • 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


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Questions? 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…


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