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Glenn D. Braunstein, M.D. Headshot

Muscles From a Bottle: Take a Pill and Hit a Home Run?

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By now, most of us are probably pretty immune from being shocked when a star athlete admits to using anabolic steroids for performance enhancement. We certainly have a right to be disappointed and feel a bit cheated that one of our heroes attained his or her records with the help of pharmaceutical drugs or agents mixed up by the local chemist. Besides the inherent unfairness of an athlete not competing on a level playing field, they are abdicating their responsibility to be a role model to our youth. In fact, over 6 percent of high school students admit to using anabolic steroids to enhance their physique and athletic performance, in part because of the common knowledge that these agents are often used by the professional athletes who the students want to emulate.

Anabolic steroids are synthetic androgens closely related to the male hormone testosterone with much the same properties and biological effects. When testosterone or other anabolic steroids are given to men whose testes do not produce enough of the hormone, there is growth of muscle mass, loss of fat tissue, improvement in bone density and an increase in strength of the dominant muscles.

Athletes realized long ago that taking large amounts of testosterone or anabolic steroids could increase strength, aggressiveness and enhance their performance. In highly competitive professional sports, some athletes will do anything to get an edge. This led to widespread use of the drugs in many sports until testing programs were developed to detect their presence. Even after the drugs were banned from sports and testing programs put into place, some athletes continued to use the drugs and take other drugs to try and mask the presence of the steroids. Others switched to anabolic steroids purposely produced by chemists to avoid detection by the usual testing procedures (Google the BALCO scandal for an example). Whatever the motivations, some athletes decided that the benefits clearly outweighed the risks.

So, besides the risks of being caught, having athletic records expunged, losing the opportunity to occupy a place in the Hall of Fame and being disgraced, what are the medical downsides of anabolic steroid abuse? Large doses can lower the good cholesterol (high density lipoprotein [HDL]), increase the bad cholesterol (low density lipoprotein [LDL]), increase the risk of cardiovascular disease including heart attacks and strokes, and some can cause serious liver disease including cancer. In addition, overuse can result in acne, balding, enlargement of the breasts, infertility and shrinkage of the testicles. Indeed, I vividly remember one conversation that I had with the ex-wife of a Major League Baseball player who told me that because of anabolic steroids, her "husband's balls were the size of grapes." You can imagine what that did to my image of her ex-husband whenever I saw him come up to bat.

For female athletes, anabolic steroid use often leads to facial and body hair growth, deepening of the voice, irregular periods, acne and clitoral enlargement. Unfortunately, many of these unwanted effects are not reversible.

Children and adolescents who use anabolic steroids to bulk up in an effort to emulate their favorite athletes or help achieve a higher level of competitive success often develop severe acne, enlarged breasts and aggressive behavior. In addition, the steroids will accelerate the growth and closure of the growth plates of the hips and legs, which can result in a significant, permanent loss of height.

The Endocrine Society has issued a useful position statement (PDF) on anabolic steroid abuse.

The bottom line is that when it comes to sports, the risks of anabolic steroid use clearly outweigh the benefits, and the culture of 'winning at all costs' needs to be discarded.