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From healthlink.mcw.edu: Anabolic Steroid Users Pay a Heavy Price

From Congressional hearings and investigations to stepped-up drug enforcement activities to one-on-one educational consultations with young athletes in doctor's offices, the fight against the abuse of anabolic steroids is building steam nationwide.

So what's all the fuss about? According to a Medical College of Wisconsin physician who specializes in sports medicine, it's about the perceived benefits of using anabolic steroids to enhance performance versus the real risks to the health of all athletes, not just professionals but youngsters as well.

"Anabolic steroids basically do two main things," said Mark W. Niedfeldt, MD, Medical College Associate Professor of Family and Community Medicine. "They're 'anabolic', which is related to building muscle, and they're 'androgenic', which is related to male characteristics. (Androgen is a term for a male sex hormone, such as testosterone.)

"To understand what they do, think of puberty in a male. Anabolic steroids increase muscle mass and masculinize features such as facial hair and deepening of the voice. These anabolics are synthetic derivatives of testosterone. They've been used to treat wasting diseases in some people, including HIV wasting more recently, and in the past in treating some types of dwarfism."

Dr. Niedfeldt practices at the Froedtert &The Medical College Sports Medicine Center and works regularly with professional and other elite athletes engaged in a wide range of sports. He noted that anabolic steroids are very different from corticosteroids, which are anti-inflammatory agents that are commonly used medically.

Many Risks, Some Irreversible
"There are several significant risks involved in using anabolic steroids," said Dr. Niedfeldt. "Short term, there's going to be 'negative feedback' to the testes so that you will not put out your normal testosterone. So one risk is general shrinking of the testes in the male. Anabolic steroid users also may experience increased acne especially on the back, baldness, gynecomastia (breast development in males), increased facial hair, deepening of the voice, damaging effects to the liver especially with oral steroids, increased blood pressure, increased injuries to the tendons, rage or increased aggression.

"Some of these anabolic steroids were actually used back in Nazi Germany to increase aggression in soldiers. 'Roid rage' is one of the big things we hear about. There's also the issue of dependence, which is probably more of a psychological dependence. When you take these drugs, especially if you're lifting weights and exercising hard, there are large gains in muscle mass in very short periods of time. The result is that when you come off these, you lose a lot of the 'gains' that you had and that can be depressing.

"There can also be some sexual dysfunction in women who take anabolic steroids as well as some irreversible masculinization of some of the features I mentioned. A lot of these things, such as the facial hair increase and deepening of the voice, will stay with women even after they've stopped taking steroids."

In the high-pressure universe of top-caliber sports in the US at both the professional and amateur levels, Dr. Niedfeldt said, a small number of athletes choose to take anabolic steroids primarily to help them get to the 'top of their game' and sometimes to help them make more money while doing so.

"The benefit is that they will have that increased muscle mass, which may contribute to increased strength and increased performance in their chosen sport," said Dr. Niedfeldt. "It may help them jump higher and run faster. Tim Montgomery, the sprinter who was just banned from the sport for using a banned substance, set a world record."

Bans, Enforcement, Education
"There's really no appropriate use for an anabolic steroid, that is if you don't want to cheat," said Dr. Niedfeldt. "The NCAA (National Collegiate Athletic Association) and the Olympics have banned them. Professional baseball, football, basketball, hockey and other leagues either have or will soon have strict policies on steroid use (including more random testing and severe penalties for those who fail the tests).

"If you ask me if steroids 'work', the answer is yes. But as a physician I would never have a medical reason to prescribe the anabolic steroids that some athletes are taking. Certainly, testosterone is used a bit for hormone replacement in older men, for example, but for an athlete I would never have a reason to prescribe."

While a lot is being done to "grow" public awareness about anabolic steroid abuse, there is a long way to go, said Dr. Niedfeldt. He added that the motivation to use performance enhancers will likely remain very high as long as sports are such a big part of our society, and that there are other performance-enhancing agents being used that remain 'under the radar'.

"We're in a tough situation right now," said Dr. Niedfeldt. "The pendulum seems to swing every couple of years; I can remember being in medical school as they were talking about the increase in anabolic steroid use in young athletes and then it seemed to go back down. Now it may be up again, but we don't know if the actual use is increasing or if we just have more awareness of the use.

"With younger athletes, one of the other side effects to anabolic steroid use is premature growth plate closure," said Dr. Niedfeldt. "So if a male athlete takes this when he is fourteen or fifteen years old, before he's achieved his maximum height, he may never achieve his potential maximum height. Also, if you're shutting down your body's natural testosterone, at a time of life when it's pumping out a lot of testosterone, that can cause a lot of problems. We don't know yet what a lot of the long-term issues are."

Young Athletes, Take Note
Physicians can help young athletes become aware of the dangers of anabolic steroids by sending a strong message, said Dr. Niedfeldt. "These things can hurt you," he said. "It's tough, though, because you have adolescents who are at the 'invincible' stage of their lives. They're looking at enhancing performance, but they're not looking long term.

"There have been studies done where they've talked to Olympic-caliber athletes and asked them: 'If you can take a substance that will win you a gold medal but will kill you in five years, would you do it?' And fifty percent of them would do it. That's the mentality we're dealing with. And as a younger athlete, what would you do if somebody said 'gee, take steroids and you can sign a big league contract and make a million dollars?'

"What's being done at this point is education and enforcement. The (US) Drug Enforcement Agency has come out and said that they are targeting anabolic steroids. They're looking for them, and they're going to arrest people who are distributing them. Possession of anabolic steroids is a felony. Penalties for distributing anabolic steroids near a school or athletic facility are being greatly increased. So the government is trying to crack down on the supply of steroids, and there are a lot of efforts going on to try and educate kids that this is bad stuff."

Dan Ullrich
HealthLink Contributing Writer

From whitehousedrugpolicy.gov: Steroids today

Overview

Anabolic steroids were developed in the late 1930s primarily to treat hypogonadism, a condition in which the testes do not produce sufficient testosterone for normal growth, development, and sexual functioning. The primary medical uses of these compounds are to treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection or other diseases.

During the 1930s, scientists discovered that anabolic steroids could facilitate the growth of skeletal muscle in laboratory animals. This led to abuse of these compounds by bodybuilders and weightlifters and then by athletes in other sports.

Anabolic steroids can be taken orally, injected intramuscularly, or rubbed on the skin when in the form of gels or creams. These drugs are often used in patterns called cycling, which involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. Users also frequently combine several different types of steroids in a process known as stacking. By doing this, users believe that the different steroids will interact to produce an effect on muscle size that is greater than the effects of using each drug individually.

Another mode of steroid use is "pyramiding." This is a process in which users slowly escalate steroid use (increasing the number of drugs used at one time and/or the dose and frequency of one or more steroids) reaching a peak amount at mid-cycle and gradually tapering the dose toward the end of the cycle.

Extent of Use

Results from the 2006 Monitoring the Future Study, which surveys students in eighth, tenth, and twelfth grades, show that 1.6% of eighth graders, 1.8% of tenth graders, and 2.7% of twelfth graders reported using steroids at least once in their lifetimes.

Regarding the ease by which one can obtain steroids, 17.1% of eighth graders, 30.2% of tenth graders, and 41.1% of twelfth graders surveyed in 2006 reported that steroids were "fairly easy" or "very easy" to obtain. Furthermore, 60.2% of twelfth graders surveyed reported that using steroids was a "great risk during 2006.

The Centers for Disease Control and Prevention (CDC) also conducts a survey of high school students throughout the United States, the Youth Risk Behavior Surveillance System (YRBSS). Nearly 5% of all high school students surveyed by CDC in 2005 reported lifetime use of steroid pills/shots without a doctor's prescription.

Approximately 1.9% of young adults (ages 19–28) surveyed in 2005 reported lifetime use of steroids.

Health Effects

Anabolic steroid abuse has been associated with a wide range of adverse side effects ranging from some that are physically unattractive, such as acne and breast development in men, to others that are life threatening. Most of the effects are reversible if the abuser stops taking the drug, but some can be permanent. In addition to the physical effects, anabolic steroids can also cause increased irritability and aggression.

Some of the health consequences that can occur in both males and females include liver cancer, heart attacks, and elevated cholesterol levels. In addition to this, steroid use among adolescents may prematurely stop the lengthening of bones resulting in stunted growth.

People who inject steroids also run the risk of contracting or transmitting hepatitis or HIV. Some steroid abusers experience withdrawal symptoms when they stop taking the drug. These withdrawal symptoms include mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and depression. This depression can lead to suicide attempts, and if left untreated, can persist for a year or more after the abuser stops taking the drugs.

Production & Trafficking

Illicit anabolic steroids are often sold at gyms, competitions, and through mail operations after being smuggled into this country. The most common sources for obtaining steroids for illegal use are Internet purchases and smuggling them into the U.S. from other countries such as Mexico and European countries. These countries do not require a prescription for the purchase of steroids, making it easier to smuggle them. In addition to this, steroids are also illegally diverted from U.S. pharmacies or synthesized in clandestine laboratories.

Legislation

Concerns over a growing illicit market and prevalence of abuse combined with the possibility of harmful long-term effects of steroid use led Congress to place anabolic steroids into Schedule III of the Controlled Substances Act (CSA) in 1991. It is therefore illegal to possess or sell anabolic steroids without a valid prescription. Some States have also implemented additional fines and penalties for illegal use of anabolic steroids.

The International Olympic Committee, National Collegiate Athletic Association and many professional sports leagues (including the Major League Baseball, National Basketball Association, National Football League, and National Hockey League), have banned the use of steroids by athletes due to their potentially dangerous side effects and because they give the user an unfair advantage.

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