Price of Glory? He Awaits Transplant

He was one of professional football’s mightiest men, a 295-pounder who could bench press twice his weight. Now, Steve Courson is thrilled to lift 15-pound weights.

The former offensive lineman, now 33, suffers from cardiomyopathy, a mysterious disease that turns heart muscle into flab and eventually kills its victims unless they undergo a transplant.

Though his doctors can’t blame Courson’s condition on his long, heavy use of anabolic steroids, they can’t rule it out. Neither can he.

“There are so many ironies about my situation,” he said. “That’s why I can’t discard them as being an accident. Why is all this happening to me? I’ve had two strikes. Strike three, you’re out.”

Courson, formerly of the Pittsburgh Steelers and Tampa Bay Buccaneers, is believed to be the first professional athlete to be put on the waiting list for a heart transplant after years of taking anabolic steroids.

Experts fear more may follow.

“I wouldn’t be surprised. I think it’s going to happen,” said transplant pioneer Dr. Thomas E. Starzl of the University of Pittsburgh. “It might be liver disease that comes out of those things, too.”

Said Dr. Lyle Micheli, president of the American College of Sports Medicine: “The potential health hazard and the impact on the national health care system . . . it’s very frightening.”

Anabolic steroids are derivatives of the male sex hormone testosterone. They stimulate development of bone, muscle and skin.

Courson first took anabolic steroids in 1974 before his sophomore year at the University of South Carolina. In four weeks, he went from 230 pounds to a solid 260. He continued the off-season habit after being drafted by the Steelers in 1977 and playing on two Super Bowl teams.

Not long after being traded to the Buccaneers in 1984, Courson boasted a 60-inch chest and 22-inch biceps and was pressing up to 605 pounds.

“Anyone who’s trained with weights or trained that seriously at world-class level realizes those types of gains don’t occur by eating Wheaties,” Courson said.

At one point, Courson was spending $1,500 a year for steroids, “not that big a tradeoff when you’re making $300,000 a year,” he said.

In March of 1985, in the midst of an 1,800 milligram-a-week regimen, his highest ever, doctors told him he had an irregular heartbeat. The problem cleared in two weeks with medication, and Courson quit steroids for the next year.

At the end of the 1985 season, Courson lost his starting job. He took his last dose of anabolic steroids before the Buccaneers’ training camp in 1986 in hopes of earning a starting spot. “I wanted to maintain a competitive edge and I realize it had to do with my age, too, the wear and tear on the body.”

Courson was waived at the start of the season, got no other offers, and retired. He lived in Wyoming and Florida, then returned to the Pittsburgh area in early 1988 to finish his autobiography and train as a professional wrestler.

On Nov. 23, 1988, Courson went to Allegheny General Hospital for what he thought was an ulcer. It turned out to be cardiomyopathy.

For years, doctors have warned of the immediate side effects of steroids: acne, sexual dysfunction, rashes and unusually aggressive behavior. Less is known about long-term effects, although animal tests suggest the drugs accelerate cardiovascular disease.

“Anybody who’s used steroids and has any malady, it’s immediately assumed steroids caused it,” said Dr. Charles Yesalis of Pennsylvania State University. “We haven’t even done those studies yet.”

Said Dr. Judith Orie, Courson’s cardiologist: “We don’t know frankly what is the bottom line. But we do know anabolic steroids cause high blood pressure in patients. High blood pressure after a point in time causes the heart to fail.”

Also, “steroids can alter the immune system. We don’t know whether that has played a role and allowed a virus to affect his heart or not,” Orie said.

Complicating matters is the fact that doctors don’t always know what causes cardiomyopathy.

“There are many people who have cardiomyopathy and had nothing to do with steroids,” said Dr. Barry Maron of the National Institutes of Health. “That’s the problem there is in establishing a connection in this one person. It’s a very iffy kind of thing (although) I’m not saying it’s impossible.”

About 40% of all heart transplants are performed on cardiomyopathy patients, said Dr. Michael Kaye of UC San Diego. Kaye keeps the international registry of heart, heart-lung and lung transplants, of which there had been 11,181 by late June. The vast majority--10,154--were heart transplants.

There were 1,223 Americans awaiting heart transplants as of June 26, according tothe United Network for Organ Sharing.

“The transplant community is concerned (about steroids) because of the tremendous need for organs and lack of donors,” Kaye said.

Courson, who has been on the list since March 31, could wait a long time because of his body size. Doctors give him two years without a transplant.

Experimental heart medication has enabled Courson to go from an all-time adult low of 225 pounds late last year to 255 pounds. It has also allowed him to stay in shape by walking treadmills and lifting light weights at Allegheny General’s cardiac rehabilitation laboratory.

Because of the scarcity of organs, some wonder whether former steroid users should get the same priority as individuals who never took illicit drugs. Transplant doctors, however, say they merely take into account patients’ current life styles and ability to maintain healthy habits.

Cigarette smokers and alcoholics, for instance, usually are told they must stop before they can be considered for a transplant. That’s no guarantee, however, that they will stop for good.

Doctors say they extract a promise and hope for the best.

“We really need that commitment,” Starzl said. “But just because someone drank in the past, just because Steve Courson once took steroids so he could compete, I don’t believe should be determining factors. I think he’s been punished plenty.”

Courson feels no shame or guilt. “Everyone’s got their faults. But when you were doing something that you got paid for and was glorified, are you totally to be blamed?”