Anabolic Steroids

Patrick Lenehan

• Publisher: CRC Press
• Year: 2003
• ISBN:
  9781134464760
• Edition: 1
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Anabolic steroids have traditionally been controversial in the sporting arena. Today, research indicates a dramatic increase in the use of anabolic steroids and other performance-enhancing drugs outside of competitive sports. With evidence of widespread steroid abuse among the general population, health professionals are citing the emergence of an

CHAPTER 1

Introduction

This book is designed to provide information about the use of anabolic steroids and some of the other drugs that are used in conjunction with them. I have tried to keep the book accessible to all readers so I have attempted to keep the amount of technical jargon to a minimum but on occasions it has proven necessary to include some medical, chemical or biological terminology. My own interest in performance-enhancing drugs has developed over the past fifteen years, less from their use in sport than in their noncompetitive use. This is discussed in more detail later.

The book has four parts:

1. An overview of the social history of anabolic steroids including their development, prevalence and implications for society.
2. The medical side-effects of the use of anabolic steroids, both physical and psychological.
3. It is impossible to discuss the issue of anabolic steroids without making reference to sport. Traditionally, the use of these drugs has been considered to be almost exclusively the domain of sportsmen. It also affords the opportunity of using the banned drug list of the International Olympic Committee as a framework to discuss other performance-enhancing drugs.
4. The final section looks at how anabolic steroids are used, other performance-enhancing drugs and supplements, a discussion of the problems associated with counterfeit drugs and drug profiles of some of the more commonly used drugs.

1.1 What are anabolic steroids?

The effects of anabolic steroids mimic those of testosterone. Naturally synthesized hormones, such as testosterone, are types of lipids. They have a four-ring carbon skeleton and are synthesized in the adrenal cortex, ovaries or testes. Production of testosterone takes place in the male testes and the female ovaries; it is present in the male at significantly higher levels than in females, two of the main effects being androgenic and anabolic.

Androgenic changes involve secondary sexual characteristics in the male (e.g. facial hair and deepening of the voice).

Anabolic changes include the growth and development of many body tissues, perhaps most obviously muscles.

The production of testosterone is itself stimulated by another hormone, luteinizing hormone, produced in the pituitary. As well as controlling the growth, development and function of the male sex organs, testosterone and the other hormones present are responsible for the ‘masculinizing’ or ‘virilizing’ effects of male puberty. When males reach the end of puberty, the amount of testosterone rises suddenly and stays at a high level for four to six months before returning to normal. During this time, the growth plates in the long bones of the arms and legs close, the voice deepens, facial hair begins to grow and the male sex organs grow in size. It is this surge in testosterone that completes the sexual maturation of males.

At one time, researchers thought that anabolic and androgenic steroids were different. It was thought that chemists could create new versions of steroids to build up muscle tissue without causing masculine side-effects. However, they discovered that anabolic and androgenic effects were both caused by the same drug action on different tissue types. Thus, any anabolic steroid that builds up muscle tissue also causes masculinizing side-effects. Because of the possible impact on women and children prescribed anabolic steroids therapeutically, synthetic steroids are manufactured to enhance their anabolic but diminish their androgenic properties, although they cannot be entirely suppressed. Therefore, it is more correct to call this group of drugs anabolic-androgenic steroids (AAS); however, for the purposes of this book I continue to call them anabolic steroids (AS).

1.2 Why a book about anabolic steroids?

Anabolic steroids have been used in sport since the 1950s but their use has long ceased to be solely a sporting problem. For instance, it was estimated in 1993 that 83,000 11–18-year-old Canadians had taken them during that year (Melia, 1994). Drug use among those involved in health and fitness is perceived to be a Europe-wide public health issue (Council of Europe, 1998, 2001), although precise data on the prevalence of their use are lacking. Studies in Britain estimate that up to 50% of gym users may have taken them at some time (Korkia and Stimson, 1993; Lenehan et al., 1996). A survey of 1000 school children in Sefton in the north-west of England showed that AS were the third most commonly offered drug behind cannabis and amphetamines (Clarke, 1999) and had been offered to 6.4% of boys and 1.3% of girls, suggesting that the potential for AS use has gone beyond the gym setting.

The majority of AS users inject the drug (Korkia and Stimson, 1993; Lenehan et al., 1996; Dawson, 2001) and needle-exchange schemes have been known to provide AS injectors with advice and free sterile injecting equipment. In 1995, they were the second most commonly injected drug encountered by services in the Liverpool area (Lenehan et al., 1996). The Drug Misuse Database for Merseyside and North Cheshire confirms that the trend for more AS users attending needle exchanges continues and that in 2001, for the first time, more AS users attended these services than opiate users ( J. McVeigh, personal communication). In the North-East, 60% of people accessing needle-exchange services were AS injectors (Dawson, 2001).

Anabolic steroid use may be implicated in increased mortality and morbidity (Parssinen et al., 2000). Besides the use of black market drugs of unknown quality and content (Perry, 1995), concurrent use of additional illicit drugs is also common among AS users. The use of drugs in conjunction with anabolic steroids has also been linked to increased aggression and violence. Black market drugs carry an additional and sometimes an extreme health risk (Perry and Hughes, 1992).

It is clear that the prevalence of AS use could have a significant impact on society. Many of the issues relating to this issue remain unaddressed. The increasing prevalence of AS use among adolescents presents a major cause for concern. There appears to be inadequate provision of services for AS users in the UK; previous studies have noted how inaccessible this group of drug users can be to health professionals (Best and Henderson, 1995; McVeigh and Lenehan, 1995; Lenehan et al., 1996). This may present particular problems in terms of availability of clean injecting equipment, advice, general medical help, and treatments for AS withdrawal. There have already been reports of HIV being contracted as a result of AS users sharing injecting equipment (Sklarek et al., 1984; Scott and Scott, 1989; Henrion et al., 1992), and the incidence of this means of contracting infections may be underestimated.

Even though there is evidence that AS use is widespread in the UK, there are few reliable sources of information for users and health professionals alike. I hope that this book will go some way to redress this situation.

CHAPTER 2

Social history of anabolic steroids

Anabolic steroids (AS) have been used for a variety of therapeutic and nontherapeutic purposes. AS are derivatives of the male sex hormone, testosterone. In the mid-1930s two research groups, Ruzicka and Wettstein and Butenandt and Hanisch, isolated androstenedione and converted it to what is now known as testosterone. Following this research the anabolic properties of testosterone were documented (Kochakian, 1935, 1975; Kochakian and Murlin, 1935). Since these discoveries, various research groups have made modifications to the basic structure of testosterone and produced a range of closely related compounds that are marketed as anabolic steroids. The purpose of the majority of these modifications has been to dissociate the androgenic (masculinizing) properties from the anabolic properties, although this has not yet been successfully achieved (Kochakian, 1993a).

2.1 Early discoveries of the anabolic and androgenic properties of testosterone

Primitive medicine holds an early clue about the medical applications of testosterone. The practice of treating an organ with itself, also known as similia similibus, or organotherapy, was frequently applied by the ancient Greeks, and later by the Romans, to treat a wide variety of complaints. Human or animal tissues would be used to treat various complaints; for example, the eating of brain tissue was recommended to improve a low intellect (Newerla, 1943; Hoberman and Yesalis, 1995). The centuries-old practice of castration provided evidence that the testes were involved in the development of secondary male sex characteristics (Hoskins, 1941). This knowledge led to the belief that the consumption of testicular tissue could be used to treat an array of complaints, specifically including impotence (Taylor, 1991). These practices were also applied to the improvement of sporting performance. Athletes in ancient Greece would eat lambs’ testes in an attempt to increase their strength and muscle size. Further medical and scientific discoveries served to reduce the frequency with which these practices were applied, but interest in the effects of testicular extracts and testes transplantation has continued. The use of animal experimentation to provide a model of testicular function and hormonal regulation is still applied today, and experiments involving human subjects are often conducted.

Some of the earliest experiments to investigate the function of the testes were conducted by Berthold in the mid-nineteenth century. He conducted experiments with roosters and showed that transplantation of testes into castrated roosters (capons) led to regression of the changes that occurred as a result of castration, namely the regrowth of comb and wattles and changes in behaviour. Berthold concluded that a secretion from the transplanted testis was responsible for these changes. Berthold’s experiments were repeated by different scientists with variable success. Eventually, Berthold’s conclusions were verified, as a result of work by McGee (1927) and Gallagher and Koch (1934). Both of these groups conducted modified versions of the Berthold experiment, in which they used an alcohol extract of bull testicle to stimulate the regrowth of the combs of castrated roosters. Following research that proved extracts from men’s urine had a similar stimulatory effect upon regrowth of the comb of castrated roosters (Ruzicka et al., 1934), it became accepted that the testes produced an active extract responsible for the development and maintenance of male characteristics (Kochakian, 1993b).

2.2 Effects of testicular extract (testosterone) and related substances upon humans

A number of experiments were carried out in the nineteenth century by Brown-Sequard, a French physiologist, in which he injected the aqueous extracts from animal testes into himself as well as into a range of animals. In 1889 Brown-Sequard reported his observations, declaring that he had reversed his own decline into old age. Although Brown-Sequard’s discoveries were not accepted because of the lack of experimental controls, his idea that the testes release physiologically active substances proved to be true (Kochakian, 1993a). His self-experimentation provided the basis for further studies into the effects of ingestion of testicular extracts, and ultimately the effects of testosterone, upon people.

Surgeons developed the technique of transplanting human and animal (e.g. monkeys) testes into patients whose testes were damaged or dysfunctional. Claims were made that these operations had relieved pain and discomfort and promoted bodily well-being in hundreds of patients. People began to seek treatment for all manner of disorders: senility, asthma, epilepsy, diabetes, impotence, tuberculosis, paranoia, gangrene and more (Hoberman and Yesalis, 1995). However, this method of treatment was not accepted by the scientific community, who did not believe many of the claims made. An international committee that was appointed to investigate these claims concluded that claims of rejuvenation as a result of testicular transplantation were unfounded (Parkes, 1985). Subsequent to the research outlined above, testosterone has been isolated and its structure discovered.

2.3 Early uses of testosterone and its derivatives

There are rumours that German soldiers were administered anabolic steroids during the Second World War, the aim being to increase their aggression and stamina (Yesalis et al., 1993a). These rumours have often been reported (Verroken, 1996) but are, as yet, unproven. Hitler was also believed to have been treated by his physician with injections of testosterone (Taylor, 1991). A more ethical application of anabolic steroid treatment was also applied at the end of the Second World War, whereby these drugs were used to treat the malnourished victims of the Nazi concentration camps (George, 1996a).

Other early uses were found for testosterone derivatives in the treatment of men and women with abnormal hormone production. The mode of action of these treatments works on almost identical principles to the primitive transplantation of testicular tissue; exogenous testosterone circulates around the body to fulfil the roles of endogenous testosterone. The first documented case of testosterone being used to treat a patient was by Hamilton (1937). This physician administered a total of 550 mg of testosterone acetate, given via 14 injections with three injections per week, to a 27-year-old male patient who was suffering from sexual underdevelopment (hypogonadism). Hamilton’s experiment proved to be successful, the patient experienced penile erections, deepening of voice, elevation of mood, and growth of body hair. Hamilton’s work also provided an early indication of the potential side-effects of testosterone, or testosterone derivatives; the patient was recorded to have developed acne on his back and chest and experienced hot flushes. Testosterone derivatives are still used to treat this disorder today, although the doses used and the drugs themselves have undergone significant development and modification.

Following the work of Hamilton, a series of reports documented the use of testosterone in the treatment of male involutional melancholia (Barahal, 1938; Danzinger and Blank, 1942; Goldman and Markham, 1942; Davidoff and Goodstone, 1942); this syndrome is believed to be caused by the decrease in testosterone level brought about by the aging process. The research had varying levels of success, but primarily served as a precursor for later research into the application of testosterone-derived treatments in the field of mental health.

In the late 1930s and early 1940s, research was also conducted into the use of testosterone derivatives in the treatment of cardiovascular disorders (Taylor, 1991). Medical and scientific knowledge of today suggests that there is an association between the use and misuse of testosterone and its derivatives and cardiovascular disorders such as myocardial infarction, hypertension and cardiomyopathy (Greenberg et al., 1974; Pearson et al., 1986; Ferenchick, 1990; Ferenchick et al., 1991; Rockhold, 1993; Melchert and Welder, 1995). The use of testosterone as an anti-oestrogen treatment for female breast tumours led to a secondary and more controversial use for testosterone. It has been reported that, during this period, testosterone was administered to homosexual men in the belief that homosexuality was caused by abnormally high levels of female hormones in men (Lenehan et al., 1996).

2.4 The use of testosterone and anabolic steroids for ergogenic purposes

Perhaps the first suggestion that testosterone might be useful in aiding sporting performance came from the work of Oskar Zoth and Fritz Pregl in 1886. As an alternative to testicular transplantation, Zoth and Pregl undertook a study using testicular extracts. These two Austrian scientists aimed to determine whether the aqueous extracts could improve muscle strength and, thus, improve athletic performance. They injected themselves with a liquid extract from bull’s testicles and then measured the strength of their middle fingers throughout a series of exercises. Their paper, published in 1896, concluded that the extract had improved the strength and condition of their muscles. Moreover, they went on to suggest that further research be carried out within the athletic community for practical assessment of their initial results. The writer Paul de Kruif reported on the developments in the synthesis and therapeutic applications of testosterone. During the 1940s he commented on the potential of these substances to improve the athletic performance of baseball teams. However, these reports were essentially indications of the potential performance-enhancing abilities of testosterone and its derivatives. The first accurate and controlled studies into this aspect of sports doping were produced in the 1950s.

The American scientist Dr John Ziegler produced some of the most influential work into the effects of AS upon sporting performance. Indeed, Ziegler was responsible for the original synthesis of AS (Taylor, 1991; Goldman and Klatz, 1992; Yesalis et al., 1993a; Hoberman and Yesalis, 1995). In 1956 Ziegler attended the World Games, and at this competition he learnt of the Russian athletes’ use of hormonal treatments for performance enhancement. On his return Ziegler reported his findings and, funded by the pharmaceutical company Ciba, went on to synthesize the first AS. He named this compound Dianabol.

Since the development of Dianabol an enormous range of AS has become available. Pharmaceutical companies have continued to research methods to dissociate the ‘desirable’ anabolic effects from the androgenic effects, but as yet they have had very limited success. Some of the AS available have lower androgenic components than others, but androgenic effects have not been entirely eliminated from any product (Haupt and Rovere, 1984).

The period of the 1960s and 1970s saw an increase in the number of people using AS, and also an increase in the range of AS commercially available (Taylor, 1991). However, the medical and sporting institutions were still viewing these substances with suspicion. In both America and Britain, research as to whether AS did improve athletic performance was conflicting ( Johnson and O’Shea, 1968; Freed et al., 1975; Hervey et al., 1976; Ryan, 1978). In 1975, the British Association of Sport and Medicine (BASM) announced that AS were not capable of producing an improvement in performance. The policy of the American College of Sports Medicine (ACSM) was published in their 1977 annual report; this report stated that there was no conclusive scientific evidence to suggest that AS improve athletic performance.

In fact, it was only in the 1980s that it became accepted that, under specified circumstances, AS are capable of producing an improvement in sporting performance. The specific circumstances were that:

the athlete must have been undergoing an intensive weightlifting programme before starting the course of AS;

the athlete must continue this intensive training programme throughout the course of AS;

the athlete must consume a high protein diet.

It also recommended that changes in the strength of the athlete must be measured by the single repetition-maximal weight technique for the exercises in which the athlete trains (Haupt and Rovere, 1984).

After it had become widely accepted that ...