Anabolic Steroids: To Race Against Risk

Surely the Bulgarian weightlifters were aware, certainly Canadian Ben Johnson was aware--that all Olympic medalists would be required to provide a urine sample following completion of their competition, and that the methods for detecting anabolic steroids in urine are exquisitely sensitive, capable of picking up drug use that ceased months before.

They must have known that these tests were successful in uncovering steroid use by competitors in the 1983 Pan American Games and the 1984 Olympics, and that drug-using athletes were purged from events. Then why would any athlete of sound body and presumably sound mind--especially a world-class athlete in top physical condition who has been in international competition--use anabolic steroids and risk public censure, suspension from competition and ostracizing by the society of athletes? The obvious answer is that such athletes believe anabolic steroids enhance their strength, energy and aggressiveness enough to make them victorious--and that the abuse will not be detected. These beliefs are based on several misconceptions and a heavy dose of anecdotal reports from other athletes and coaches.

Anabolic steroids are synthetic derivatives of the naturally occurring male hormone testosterone. Testosterone has both androgenic and anabolic effects. Androgenic effects are responsible for growth of body and facial hair, deepening of the voice and genital growth during normal male puberty. The anabolic activities promote muscle growth and retention of dietary protein in the body. Anabolic steroids were developed in an attempt to preserve the protein-retention properties while discarding the androgenic activities of testosterone. Although a large number of drugs have been developed, none have been able to separate these two properties effectively.

Anabolic steroids will increase the amount of muscle and muscle strength in women and children who have levels of male hormones that are substantially less than those in fully grown men. However, there is no clear-cut evidence that anabolic steroids given in therapeutic doses can increase muscle size and strength when given to men with normal levels of testosterone. Anabolic steroids do lead to water retention, an increase in the blood volume and an increase in weight in many individuals. This may result in an apparent increase in bulk, but not in strength.

Numerous scientific studies have examined the effects of anabolic steroids on athletic performance and the majority have failed to demonstrate a significant increase in performance. Even in the studies that suggest a beneficial effect of the drugs, the gains in muscle strength are minimal at best and do not occur in all individuals.

Unfortunately, most of the studies suffer from defects in experimental design and many do not control for the placebo effect. Athletes who are given a placebo--but think they are receiving an anabolic steroid--show significant gains in strength. Some athletes claim that anabolic steroids increase their aggressiveness, allowing them to train harder and longer. Rather than being a pharmacological effect of the drug, the behavior in reality may be a self-fulfilling prophecy; the athlete believes the drugs will increase aggressiveness and therefore becomes more aggressive.

Advocates of anabolic steroid use argue that scientific studies evaluating the effects of steroids on strength and performance may not be relevant since they do not mimic the way anabolic steroids are actually used by athletes. The studies generally used a single anabolic steroid given in normal therapeutic or pharmacologic doses on a constant basis for weeks to months. In contrast, athletes who use steroids often take multiple, different steroid preparations simultaneously or sequentially, in massive doses, and for variable periods of time. Although no valid data exists to either confirm or refute claims that the high-dose, multiple-steroid regimens do increase strength, principles of pharmacology suggest that there are few benefits to be expected and a greatly increased risk of side effects when the drugs are used in this fashion.

Indeed, anabolic steroids are associated with numerous side effects. In addition to weight gain, acne and enlargement of the breasts, some shrinkage of the testes commonly occur. Minor alterations in liver function may be found, so may abnormalities in cholesterol that could predispose the athlete to cardiovascular disease. Fortunately, the most serious side effect--development of liver cancer--is rare. Women and children are particularly susceptible to unpleasant adverse effects from these drugs. Since the androgenic and anabolic effects cannot be separated, women may become virilized and children may have puberty advanced but their growth irreversibly stunted.

Most steroid-using athletes obtain their drugs illegally. The drugs are often smuggled into the country and distributed through a large black market. Some obtain injectable preparations developed for veterinary use; perhaps a third of the users receive them from physicians. The last-named source is particularly disturbing to me, since one of the basic tenets of medicine is primum non nocere-- first do not harm. The administration of these medications by physicians for the purpose of enhancing an athlete’s performance raises serious questions of judgment and ethics.

The lack of clear, objective scientific evidence that anabolic steroids increase muscle strength or athletic performance, the real potential for adverse health effects from the drugs and the prohibitions against their use by the various athletic regulatory agencies should be enough to dissuade athletes from using them.

The concept of good sportsmanship, in addition, demands that an athlete not gain unfair advantage over an opponent through artificial means. Winning performance should be the result of natural talents, training, good nutrition and an appropriate mental attitude. Yet the lure of new world records, gold medals and lucrative endorsement contracts may be so powerful that some athletes will use whatever they can to gain even a minimal edge over competitors. The belief among some athletes that drug use can be effectively masked by altering the urine with other medications--such as a diuretic--is a misconception that undoubtedly contributes to the feeling that the monitoring system can be beaten.

We can hope the results from Seoul will convince future athletes that anabolic steroid use carries high personal risks--over and above potential health hazards.