Steroid Research Introduction

Moreover a wide range of consequences after steroid use have been reported. Consequences that have been reported have ranged from acne to sudden death. A study by Lindstrom et.,al (1990) on 138 male body-builders on ASS found that 94% considered ASS to be dangerous with 84% experiencing significant side effects. The most startling statistic however is that 74% would still continue on ASS. This appears to be in line with the majority of literature, athletes are willing to run the risk to win. The willingness to tolerate any physical and/or reproductive adverse drug effect to achieve an athletic goal is unique among ASS administrating athletes (Kutsher et.,al 2002). In addition, athletes are known to doubt physician’s impartiality and knowledge of performance-enhancing drugs and instead rely on their coach for often misguided guided information (Dawson (2001). The negative consequences coupled with the perceived advantage of steroid abusers have led to ASS being prohibited in sport since 1974. Androgenic-anabolic steroids are still banned by almost all major sporting bodies.

Nevertheless, steroid use is still prevalent amongst athletes today. Research has indicated a lifetime prevalence of AAS use for adolescent males of 4-6% and for females of 1.5-3%, indicating a problem involving millions of athletes and a potential epidemic of AAS related pathologies (Harmer 2010). Recently the much publicised BALCO scandal has highlighted steroid use at the highest level. This court case is still ongoing as of 2010 and has led to several high profile athletes such as Dwain Chambers, Marion Jones and Barry Bonds all being publicly exposed as steroid users when competing. However due to tougher and stricter testing steroid use appears to have dwindled. An investigation by Franke & Berendonk (1997) found that after the implementation of doping controls and testing, steroid use levels lessened along with associated performance.

(Source: Franke &Berendonk, 1997, p.1267)

Figure 1:
Decreased performances in women’s strength-dependent events experienced worldwide after implementation in 1989 of some (though still insufficient) out-of-competition doping controls: ordinates present meters of performance of the world best (upper curve) and the average of the ten best (lower curve) athletes in the javelin throw (A), discus throw (B), and shot-put (C) for the years 1987–1993. In 1996, for example, no woman put the shot beyond 21 m, only two reached 20 m, and the average of the 10 best is now only 19.89 m. In 1996, many athletes were 2 m or more below their personal best from previous years. In the discus throw, no woman in 1996, including the Olympic champion, threw beyond 70 m, well short of the junior record of 74.40 m set in the GDR in 1988 by the then 18-year-old champion to be. And the best javelin throw of 1996 was shorter than the 1988 world record by .10.5 m (Franke and Berendonk 1997).

The graphs in figure 1 highlight the reason athletes are drawn to steroids. Before implementation of doping controls athletes especially females were on supraphysiologic doses of steroids and achieving huge results. The results they achieved have been hard to reciprocate since.

When looking though the literature it’s important to analyse several key areas before drawing conclusions. To properly elucidate the benefits that occur with steroid use the frequency, dosage administered, steroid being used and length of time (cycle) has to be evaluated. Likewise the physiological consequences that can occur must be compared with the dose taken by the given subject to fully reach any conclusions. A study by Evans, NA (1997) on 100 athletes found that Anabolic steroid doses ranged from 250 to 3200mg per week. This included more than half of the subjects taking 500mg or more a week and 88% of subjects taking at least two different steroids. The cyclic use of steroids is characterized by a progressive increase in dosage, followed by its decrease, using both the oral as well as the parenteral route (Torres-Calleja et al. (2001). Typically, ASS are taken in cycles of about 6–12 weeks or 7-14 weeks (the ‘on period’) followed by a variable period off the drugs, from 4weeks to several months (the ‘off period’) in an attempt to reduce the likelihood of undesirable effects. Bodybuilders in-particular will however take them almost incessantly (Kicman, 2008).

Taking two or more off different steroids is known as ‘stacking’ and involves injections, oral consumption and sometimes patches. Again the majority of literature on the effects of ASS shows no standard correlation between doses taken by athletes as there are no well-established guidelines for the management of steroid abuse (Papazisis et.,al 2007). This is perhaps due to conflicting evidence on what can be obtained and what can possible be negatively affected by high doses of steroids in-particular. Similarly this is why athletes take ASS in cycles, to limit the possible consequences.  Therefore conclusions reached in this review will take into account the dose dependant affects both beneficial and otherwise that can occur with steroid use.

Figure2 -Commonly used ASS (Source: Kam and Yarrow 2005)

In addition, conclusions are based on sound scientific investigations with established scientific parameters. This includes the use of randomized controlled trials, double blind protocol and respected test procedures (echocardiograph, Buss-Durke Hostility Inventory, muscle biopsies etc).   Ethically the use of ASS on subjects in a controlled lab environment for a sustained period of time is nearly impossible due to the potential health implications. Knowledge therefore is profoundly anecdotal or gained through case studies, medical patients, surveys and retrospective studies.  Although medical studies are one of the few areas in which steroids can be studied in a placebo-controlled manner they must be interpreted with caution as only low doses for a limited time can be studied (Hartgens and Kuipers (2004). These studies do not coincide with most sporting practises which limits the conclusions that can be drawn when talking about athletes. Athletes are known to take supraphysiological doses of multiple AAS at a time which has to be taken into account when comparing results against athletes. Similarly the questioning of athletes has led to many misconceptions on both the benefits and consequences of steroid use. Athletes being surveyed often attribute physiological changes both positive and negative to steroids without any scientific evidence. Indeed different athletes have different aims; increased strength, power, muscle-mass and weight are the most common. These pre-conceived thoughts could in theory lead to a placebo effect.  However, the questioning of athletes is one of the few methods that provides any real insight to the implications of steroid use in sport.

The purpose for this review is to provide clarity on some of the issues, misconceptions and home truths of AAS. Furthermore this review aims to weigh up the benefits against the consequences and analyse if the risk is worth the reward for the competitive athlete. The use of AAS has long been controversial and it is vital that definitive conclusions are made so athletes can be educated on the risks and benefits of AAS and left with no ambiguity. Many of the consequences will also occur in recreational users and therefore some examples will be taken and presented from the view of the athlete.  A review from 1997 found that the dose-response relationships of anabolic actions versus the potentially serious risks to health of AAS use are still unresolved (Wu 1997). This review will look to resolve some of these issues. The long list of consequences described in much of the literature needs both consolidation and clarification. Similarly, the pro’s of AAS use need to be analysed in detail. Athletes will take AAS for a particular reason and these reasons must be investigated fully so that AAS use can be understood and dealt with in the correct manner. For example the pioneering studies by (Bhasin et al., (1996)) found that prior to their investigation the efficacy of AAS use for improvements in strength was unsubstantiated. Thus, the quality of each individual study and investigation presented in this review shall be analysed and confirmed that the data is described accurately.

End of Steroid Research Introduction