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Sports Medicine
Mario Cesar Meoreira de Araujo & Marcelo Riccio Facio (Fifth year medical student of UFRJ)
Medstudents' Homepage
--------------------------------------------------------------------------------
The Use of Anabolic/Androgenic Steroids by Athletes
--------------------------------------------------------------------------------
Introduction
In the world war II , anabolic steroids were reportedly given to Hitler’s troops to increase agression.The illegal use of drugs to enhance athletic ability had been made since fifthies. The russians athletes were the first to use anabolic steroids in official competitions and in 1960’s olympic games, for the first time, the IOC (international olympic comite) detected a case of doping, when a cylclist using amphetamine collapsed and died during a race.
At the last ten years, the use of drugs in sports became epidemic and their use is not only limited in top athletes, being used for non competition athletes too. An alarming statistic is about the age which people starts to use these drugs. A search realized in Michigan high school students(Buckley & Yesalis 1988) repoted a 3% use rate - 5% of the males and 1% of the females used or had used steroids. What is more, they also found that over two-thirds of the users initiated anabolic steroids when they were 16 years old or younger (high risk of growth suppession) , and improvement of “physical appearance” was the main reason for 26.7% of the users.
Classification of Drugs Used in Sports
These drugs fall into three main categories: 1. Performance continuance drugs.This is the only one acceped class which includes: (1)NSAIDs such aspirin, ibuprofen, diclofenac, and naprosyn; (2) asthma preparetions such as albuterol and chromolyn;(3)Corticosteroids. These drugs are used for therapy or treatment of injuries. Side effects can occur with all of these medication and their usage , althoug legal, is unwise. 2. Performance enhancement drugs.These drugs include anbolic/androgenic steroids, amphetamines, HGH ( Human Growth hormony) , Clenbuterol, blood doping, and recombinat erythropoeitin. 3. Recreational (Destructive) drugs. Cocaine, crack, marijuana, heroin, and other psycogenic drugs are the main representants of this class. These drugs are abused equally by athletes or non athletes and this problem is more social then sports related.
Anabolic/androgenic steroids are by far the drug most used by athletes. Due to his importance , we will focus our attention in this kind of drug.
Description of Anabolic/androgenic Steroids
Anabolic/androgenic steroids are analogues of male hormone testosterone. Both have a core 17-carbon steroid chemical structure that gives them anabolic (protein building) and androgenic (masculinizing) properties. Studies were developed to separete the anabolic from the adrogenic effects but this has been only partially accomplished. The androgenic effects of endogenous testosterone are the development of male reproductive system and secundary sexual characteres. The anabolic effects include growth and epiphyses closure of long bones during puberty, enlargement of larynge and vocal cords, improvement of red cells nimber, reduce body fat, and improve corporal mass (muscle).
There are two ways for anabolic steroids administration. Oral steroids are highly potent and are excreted fairly rapidly from the body due to short metabolic half-lives(usually within weeks). So, oral steroids are the first choice from athletes who want to rapidly improve their performance and try to escape from the drug tests. Unhapply, these drugs are the most toxic and which have more side effects. Injectable steroids are less potents and generally exhibit delayed uptake into the body, especially if they are oil-based diluent. They have less liver toxicity than oral steroids, but they are being less used by athletes in having a detectability in drug tests for long periods.
At table I are listed the names (generical and comercial), way of administration, and prices of main steroids used by athletes.
Table 1 GENERICAL NAME COMERCIALNAME ADMINISTRA. WAY RETAIL PRICE BLACK MARKET
OXYMETHOLONE ANADROL ORAL $90/100 TABS $300/100 TABS
TESTOSTERONE
CYPIONATE DEPO-TESTOSTERONE INJECTABLE $35/10mL $200/10mL
STANAZOLOL WINSTROL V INJECTABLE $250/30mL $400/30mL
BOLDENONE EQUIPOISE INJECTABLE $150/30mL $450/30mL
OXANDROLONE ANAVAR ORAL $75/100 TABS $150/100 TABS
METHANDROSTENOLONE DIANABOL ORAL $100/100 TABS $200/100 TABS
Mechanism of Action and Effects Over Muscle Strenth
Studies realized to prove the effects of anabolic steroids were very controversial, half of them had shown no difference in muscle strenth or size, on the other hand half had shown considerable improvement in muscle size and strenth. After a revision in 1984, authors evidenced differences in studies protocol. Conditions which muscle size and strenth were improved by steroids use were determinated, but it is still not accept for all scientific community. These conditions were (1) a hard exercitation before, during, and after steroids use, (2) a high-protein and high-calorie diet, and (3) a technic of non repetitives exercises and always maxim efforts.
The ergonogenic effects of anbolic steroids use are adquired for 3 main mechanism of action: 1. They shift the nitrogen equilibrium to the positive side for better utiliztion of ingested protein and the increased retention of nitrogen. Although temporary and needing a high-protein complementary diet, this effect helps the body to “build” muscles. 2. The formation of a steroid-receptor complex in skeletal muscle stimulates the RNA-polymerase system which, in turn, increase protein syntesis in the cell. 3. Anabolic steroids compete for glucocorticoides receptors, resulting in an anti-catabolic effect by blocking the protien syntesis inhibition which physiologicaly occurs after exercises due to glucocorticoides liberation. 4. Frequentlly, an euphoric and more agressive behavor are experienced by anabolic steroids users, stimulating them to practice more and without fatigue for longer periods.
Dosing
There are three common regimens practiced by anabolic steroid abusers: 1. Cycling . The athlete take the steroid for 6 to 12 weeks and then stop for 10 to 12 weeks. The steroid can be oral or injectable and doses should be 10 to 100 times higher than standard therapeutic dose . 2. Stacking. It is the use of more than one anabolic steroid at a time to break through response plateaus that often occurs. About 40% of steroid abusers use this kind of regimen , presenting a high risk for central nervosus system. 3. Pyramiding. This kind of use starts with low dose of anabolic steroids, increasing the dose over a period of weeks, then gradually tapering off before ending the regimen.
None of these regimens are free of side effects and there aren’t studies showing the efficacy and injuries caused for each one.
Adverse Effects
The prevalence of adverse effects of steroids is difficult to ascertain because of underreporting, but it has recently become clear that the abuse of anbolic/androgenic steroids by athletes is associated with serious adverse effects to the liver and cardiovascular, central nervous, muculoskeletal, endocrine, and reproductive systems.
Table II lists the side effects and the reversibility if the drugs are discontinued.
Table 2.
SYSTE ADVERSE EFFECT REVERSIBILITY
Cardiovascular Increased LDL cholesterol
Decreased HDL cholesterol
Hypertension
Eleveted triglycerides
Arteriosclerotic heart disease
yes
yes
yes
yes
no
Reproductive-Male Testicular atrophy
Gynecomastia
Impaired spermatogenesis
Altered libido
Male pattern baldness yes
possible
yes
yes
no
Reproductive-Female Menstrual dysfunction
Altered libido
Clitoral enlargement
Deeping voice
Male pattern baldness yes
yes
no
no
no
Hepatic Elevated liver enzymes
Jaundice
Hepatic tumors
Peliosis hepatis yes
yes
no
no
Endocrine Altered glucose tolerance
Decreased FSH, LH
Acne yes
yes
yes
Musculoskeletal Premature epiphyseal closure
Tendon degeneration no
?
Central Nervous Mood swings
Violent behavor
Depression
Psycoses yes
yes
yes
yes
Sports Medicine for Primary Care- Table 25.1. Adverses Effects and Reversibility of Anabolic/Androgenic Steroid Usage
Legal Usage of Anabolic Steroids
The FDA approved some uses for anabolic steroids, which include :
1. weigh gain for chronic nutritional deficiences or AIDS wasting syndrome
2. relief of bone pain accompanying osteoporosis
3. corticosteroid-induced catabolism
4. severe anemia
5. hereditary angioedema
6. metastatic breast cancer in women
7. hormone deficiency states in males
Is very clear that these uses requires close supervision by an experient physician and always being attempt to side effects .
How to Identify Anabolic Steroid Use ?
Characteristic signs and symptomps can help to identify steroid abusers. None of these signs or symptoms are exclusive to steroid abuse, but the presence of one or more symptoms must allert the phisician to steroid abuse. A list of commonly signs and symptoms is given below :
1. Rapid weigh gain
2. Alterations in body composition with marked muscular hypertrophy
3. Disproportionate development of upper torso
4. Severe acne
5. Needle marks in large muscle groups
6. Development of male pattern baldness
7. Gynecomastia
8. Increased susceptibility to tendon injuries
9. Jaundice
10. Edema
11. Elevetade blood pressure and epistaxis
12. Hirsutism
13. Atrophied breast in females
14. Deeping of the voice in females
The use of anabolic steroids offers advantages and improved performance only for anaerobic sports, opposed to aerobic or skilled sports. In anaerobic sports are concentrate the great use of steroids, and are the ones which the phisician should be very attempt to identify abusers. Statistcally, football, wrestling, weight lifting, swimming, bodybuilding, shot-put, discus, javelin throwing, and some trak and field events are the primary sports for steroids users.
A Glossary of Terms
Steroids use in sports has spawned a glossary of its own:
1. Blending. Mixing different drugs.
2. Bulking up. Increasing muscle mass through steroids.
3. Cycling. Taking multiple doses of steroids over a specified period of time, stopping for a time and starting again.
4. Doping. Using drugs and other nonfood substances to improve athletic performance and prowess.
5. Ergogenic drugs. Performance enhancing substances.
6. Megadosing. Taking massive amounts of steroids, by injection or pill.
7. Plateauing. When a drug becomes ineffective at a certain level.
8. Roid rages. Uncontrolled outbursts of anger, frustration or combativeness that may result from using anabolic steroids.
9. Shotgunning. Taking steroids on a hit-or-miss basis.
10 Stacking. Using a combination of anabolic steroids, often in combination with other drugs.
11. Tapering. Slowly decreasing steroids intake.
Bibliography
1. The Pediatric Clincs of North America, Vol. 37, Num. 25 Anabolic Steroid Use in Young Athletes - Mimi D. Johson
2. Sports Medicine for Primary Care, Drugs Abuse in Sports- Willian E. Moats
3. Goodman, The Pharmacological Basis of Therapheutics, Nineth Edition, Goodman & Gilman’s
4. The Medical Clinics of North America, Vol 78, Num 2 , Gray I. Wadler.
5. Anabolic Steroids, Robert J. Fuentes, MS, PharmD, Glaxo Research Institute and Jack M. Rosemberg, PharmD, PhD, The International Drug Information Center Arnold and Marie Schwartz College of Pharmacy and Health.
6. NIDA Research Report - Anabolic Steroids
Sports Medicine
Mario Cesar Meoreira de Araujo & Marcelo Riccio Facio (Fifth year medical student of UFRJ)
Medstudents' Homepage
--------------------------------------------------------------------------------
The Use of Anabolic/Androgenic Steroids by Athletes
--------------------------------------------------------------------------------
Introduction
In the world war II , anabolic steroids were reportedly given to Hitler’s troops to increase agression.The illegal use of drugs to enhance athletic ability had been made since fifthies. The russians athletes were the first to use anabolic steroids in official competitions and in 1960’s olympic games, for the first time, the IOC (international olympic comite) detected a case of doping, when a cylclist using amphetamine collapsed and died during a race.
At the last ten years, the use of drugs in sports became epidemic and their use is not only limited in top athletes, being used for non competition athletes too. An alarming statistic is about the age which people starts to use these drugs. A search realized in Michigan high school students(Buckley & Yesalis 1988) repoted a 3% use rate - 5% of the males and 1% of the females used or had used steroids. What is more, they also found that over two-thirds of the users initiated anabolic steroids when they were 16 years old or younger (high risk of growth suppession) , and improvement of “physical appearance” was the main reason for 26.7% of the users.
Classification of Drugs Used in Sports
These drugs fall into three main categories: 1. Performance continuance drugs.This is the only one acceped class which includes: (1)NSAIDs such aspirin, ibuprofen, diclofenac, and naprosyn; (2) asthma preparetions such as albuterol and chromolyn;(3)Corticosteroids. These drugs are used for therapy or treatment of injuries. Side effects can occur with all of these medication and their usage , althoug legal, is unwise. 2. Performance enhancement drugs.These drugs include anbolic/androgenic steroids, amphetamines, HGH ( Human Growth hormony) , Clenbuterol, blood doping, and recombinat erythropoeitin. 3. Recreational (Destructive) drugs. Cocaine, crack, marijuana, heroin, and other psycogenic drugs are the main representants of this class. These drugs are abused equally by athletes or non athletes and this problem is more social then sports related.
Anabolic/androgenic steroids are by far the drug most used by athletes. Due to his importance , we will focus our attention in this kind of drug.
Description of Anabolic/androgenic Steroids
Anabolic/androgenic steroids are analogues of male hormone testosterone. Both have a core 17-carbon steroid chemical structure that gives them anabolic (protein building) and androgenic (masculinizing) properties. Studies were developed to separete the anabolic from the adrogenic effects but this has been only partially accomplished. The androgenic effects of endogenous testosterone are the development of male reproductive system and secundary sexual characteres. The anabolic effects include growth and epiphyses closure of long bones during puberty, enlargement of larynge and vocal cords, improvement of red cells nimber, reduce body fat, and improve corporal mass (muscle).
There are two ways for anabolic steroids administration. Oral steroids are highly potent and are excreted fairly rapidly from the body due to short metabolic half-lives(usually within weeks). So, oral steroids are the first choice from athletes who want to rapidly improve their performance and try to escape from the drug tests. Unhapply, these drugs are the most toxic and which have more side effects. Injectable steroids are less potents and generally exhibit delayed uptake into the body, especially if they are oil-based diluent. They have less liver toxicity than oral steroids, but they are being less used by athletes in having a detectability in drug tests for long periods.
At table I are listed the names (generical and comercial), way of administration, and prices of main steroids used by athletes.
Table 1 GENERICAL NAME COMERCIALNAME ADMINISTRA. WAY RETAIL PRICE BLACK MARKET
OXYMETHOLONE ANADROL ORAL $90/100 TABS $300/100 TABS
TESTOSTERONE
CYPIONATE DEPO-TESTOSTERONE INJECTABLE $35/10mL $200/10mL
STANAZOLOL WINSTROL V INJECTABLE $250/30mL $400/30mL
BOLDENONE EQUIPOISE INJECTABLE $150/30mL $450/30mL
OXANDROLONE ANAVAR ORAL $75/100 TABS $150/100 TABS
METHANDROSTENOLONE DIANABOL ORAL $100/100 TABS $200/100 TABS
Mechanism of Action and Effects Over Muscle Strenth
Studies realized to prove the effects of anabolic steroids were very controversial, half of them had shown no difference in muscle strenth or size, on the other hand half had shown considerable improvement in muscle size and strenth. After a revision in 1984, authors evidenced differences in studies protocol. Conditions which muscle size and strenth were improved by steroids use were determinated, but it is still not accept for all scientific community. These conditions were (1) a hard exercitation before, during, and after steroids use, (2) a high-protein and high-calorie diet, and (3) a technic of non repetitives exercises and always maxim efforts.
The ergonogenic effects of anbolic steroids use are adquired for 3 main mechanism of action: 1. They shift the nitrogen equilibrium to the positive side for better utiliztion of ingested protein and the increased retention of nitrogen. Although temporary and needing a high-protein complementary diet, this effect helps the body to “build” muscles. 2. The formation of a steroid-receptor complex in skeletal muscle stimulates the RNA-polymerase system which, in turn, increase protein syntesis in the cell. 3. Anabolic steroids compete for glucocorticoides receptors, resulting in an anti-catabolic effect by blocking the protien syntesis inhibition which physiologicaly occurs after exercises due to glucocorticoides liberation. 4. Frequentlly, an euphoric and more agressive behavor are experienced by anabolic steroids users, stimulating them to practice more and without fatigue for longer periods.
Dosing
There are three common regimens practiced by anabolic steroid abusers: 1. Cycling . The athlete take the steroid for 6 to 12 weeks and then stop for 10 to 12 weeks. The steroid can be oral or injectable and doses should be 10 to 100 times higher than standard therapeutic dose . 2. Stacking. It is the use of more than one anabolic steroid at a time to break through response plateaus that often occurs. About 40% of steroid abusers use this kind of regimen , presenting a high risk for central nervosus system. 3. Pyramiding. This kind of use starts with low dose of anabolic steroids, increasing the dose over a period of weeks, then gradually tapering off before ending the regimen.
None of these regimens are free of side effects and there aren’t studies showing the efficacy and injuries caused for each one.
Adverse Effects
The prevalence of adverse effects of steroids is difficult to ascertain because of underreporting, but it has recently become clear that the abuse of anbolic/androgenic steroids by athletes is associated with serious adverse effects to the liver and cardiovascular, central nervous, muculoskeletal, endocrine, and reproductive systems.
Table II lists the side effects and the reversibility if the drugs are discontinued.
Table 2.
SYSTE ADVERSE EFFECT REVERSIBILITY
Cardiovascular Increased LDL cholesterol
Decreased HDL cholesterol
Hypertension
Eleveted triglycerides
Arteriosclerotic heart disease
yes
yes
yes
yes
no
Reproductive-Male Testicular atrophy
Gynecomastia
Impaired spermatogenesis
Altered libido
Male pattern baldness yes
possible
yes
yes
no
Reproductive-Female Menstrual dysfunction
Altered libido
Clitoral enlargement
Deeping voice
Male pattern baldness yes
yes
no
no
no
Hepatic Elevated liver enzymes
Jaundice
Hepatic tumors
Peliosis hepatis yes
yes
no
no
Endocrine Altered glucose tolerance
Decreased FSH, LH
Acne yes
yes
yes
Musculoskeletal Premature epiphyseal closure
Tendon degeneration no
?
Central Nervous Mood swings
Violent behavor
Depression
Psycoses yes
yes
yes
yes
Sports Medicine for Primary Care- Table 25.1. Adverses Effects and Reversibility of Anabolic/Androgenic Steroid Usage
Legal Usage of Anabolic Steroids
The FDA approved some uses for anabolic steroids, which include :
1. weigh gain for chronic nutritional deficiences or AIDS wasting syndrome
2. relief of bone pain accompanying osteoporosis
3. corticosteroid-induced catabolism
4. severe anemia
5. hereditary angioedema
6. metastatic breast cancer in women
7. hormone deficiency states in males
Is very clear that these uses requires close supervision by an experient physician and always being attempt to side effects .
How to Identify Anabolic Steroid Use ?
Characteristic signs and symptomps can help to identify steroid abusers. None of these signs or symptoms are exclusive to steroid abuse, but the presence of one or more symptoms must allert the phisician to steroid abuse. A list of commonly signs and symptoms is given below :
1. Rapid weigh gain
2. Alterations in body composition with marked muscular hypertrophy
3. Disproportionate development of upper torso
4. Severe acne
5. Needle marks in large muscle groups
6. Development of male pattern baldness
7. Gynecomastia
8. Increased susceptibility to tendon injuries
9. Jaundice
10. Edema
11. Elevetade blood pressure and epistaxis
12. Hirsutism
13. Atrophied breast in females
14. Deeping of the voice in females
The use of anabolic steroids offers advantages and improved performance only for anaerobic sports, opposed to aerobic or skilled sports. In anaerobic sports are concentrate the great use of steroids, and are the ones which the phisician should be very attempt to identify abusers. Statistcally, football, wrestling, weight lifting, swimming, bodybuilding, shot-put, discus, javelin throwing, and some trak and field events are the primary sports for steroids users.
A Glossary of Terms
Steroids use in sports has spawned a glossary of its own:
1. Blending. Mixing different drugs.
2. Bulking up. Increasing muscle mass through steroids.
3. Cycling. Taking multiple doses of steroids over a specified period of time, stopping for a time and starting again.
4. Doping. Using drugs and other nonfood substances to improve athletic performance and prowess.
5. Ergogenic drugs. Performance enhancing substances.
6. Megadosing. Taking massive amounts of steroids, by injection or pill.
7. Plateauing. When a drug becomes ineffective at a certain level.
8. Roid rages. Uncontrolled outbursts of anger, frustration or combativeness that may result from using anabolic steroids.
9. Shotgunning. Taking steroids on a hit-or-miss basis.
10 Stacking. Using a combination of anabolic steroids, often in combination with other drugs.
11. Tapering. Slowly decreasing steroids intake.
Bibliography
1. The Pediatric Clincs of North America, Vol. 37, Num. 25 Anabolic Steroid Use in Young Athletes - Mimi D. Johson
2. Sports Medicine for Primary Care, Drugs Abuse in Sports- Willian E. Moats
3. Goodman, The Pharmacological Basis of Therapheutics, Nineth Edition, Goodman & Gilman’s
4. The Medical Clinics of North America, Vol 78, Num 2 , Gray I. Wadler.
5. Anabolic Steroids, Robert J. Fuentes, MS, PharmD, Glaxo Research Institute and Jack M. Rosemberg, PharmD, PhD, The International Drug Information Center Arnold and Marie Schwartz College of Pharmacy and Health.
6. NIDA Research Report - Anabolic Steroids
