Recreational sports and gyms
The use of doping agents is not only a problem in elite sports. It has been estimated that there are approximately 10,000 users of doping agents among amateur athletes in Finland. Studies commonly suggest that users of doping agents in recreational sports use them in far larger quantities than would be harmless for health. The adverse effects of doping agents are well known, and Timo Seppälä has written about them for our website.
The Finnish Sports for All Association and FINADA have created a system for gyms to support clean recreational sports by applying for a certificate as a sign of co-operation. The certificate is a recognition of the choices made by the gym concerning values, ethics and attitudes. Gyms that have joined the Clean Recreational Sports Initiative are taking a stand and bearing their social responsibility for clean recreational sports. More information on the initiative can be found on the websites of both the Finnish Sports for All Association and FINADA.
Abuse of anabolic agents
It is known that already in the 1950s some elite athletes attempted to artificially enhance their performance by anabolic agents, such as testosterone and its synthetic derivatives, anabolic steroids.
The International Olympic Committee entered anabolic steroids on its list of prohibited substances in the mid 1970s. Doping analyses became sensitive enough to detect anabolic steroids in the 1980s and their use among elite athletes declined. Using steroids in elite sports did not, however, stop, as the scandalous doping cases in the Los Angeles and Seoul Olympics demonstrated. On the other hand, elite athletes have probably moved on to use anabolic agents undetected by doping tests, such as growth hormones.
In the United States, the use of anabolic agents had spread outside elite sports already by the early 1980s. The users wanted to achieve big muscles and more power to increase their popularity and respect among their peers and girls. According to U.S. studies, 3–7% of teenage boys and even one percent of girls in the 1990s used or had used anabolic steroids for other than medical purposes. The National Institute on Drug Abuse (NIDA) has estimated that in 2001 already over 500,000 young people in the United States use these agents.
According to a Swedish survey, approximately two percent of all Swedes under the age of 25 have used anabolic steroids at some point. Only very few epidemiologic surveys on the use of anabolic steroids have been carried out in Finland. A survey carried out by FINADA and the Finnish Defence Forces among more than one thousand conscripts in 1993 revealed that anabolic steroids had at some point been offered to 6% of conscript-age young men and 1.5% of them had used them. On the other hand, it is known that anabolic agents are used the most around the age of 25. Thus, it can be estimated that there are nearly 10,000 abusers of anabolic steroids in Finland. An estimated couple of thousand of them also use human growth hormones from time to time.
Anabolic agents
Testosterone, or the body’s own androgen, is the best known anabolic agent, or substance that increases the body’s protein synthesis. Its muscle-building, or anabolic, and hormonal, or androgenic, effects are conveyed via intracellular androgen receptors. In many target tissues testosterone also influences through its metabolic product with stronger androgenic effect, 5-dihydrotestosterone (DHT). Testosterone has dozens of different metabolic products. A small part, 0.3%, of testosterone becomes aromatised in the liver into estradiol, or estrogen. Some aromatase inhibitors can also in theory be used as anabolic agents and they are today on the list of doping agents in sport.
Testosterone is used in the form of esterified injections or oral testosterone undecanoate pills. The testosterone preparation most commonly sold on the streets is the injection “Sustanon 250”, which, despite its name, is usually not the original preparation of the same name sold in pharmacies. Instead, they are usually different fakes.
Despite their name, the effect of anabolic steroids is not only anabolic, but also androgenic. The effect mechanism is identical with testosterone, although the metabolic products are less androgenic than DHT.
The anabolic steroids used for growing muscles are not normal legal pharmaceutical preparations. Most anabolic steroids used are smuggled from the East, but also from some Western countries. The preparation most commonly confiscated is "Methandrosterolon" tablets containing 5 mg methandienone. Other orally administered anabolic steroids include stanozolol and oxandrolone. Of the anabolic steroids administered as intramuscular injections, Trenbolone and nandrolone preparations are the most common on the black market.
In recent years, the Internet has become a marketplace for health foods and nutritional supplements containing testosterone precursors (dehydroepiandrosterone DHEA, androstenedione, androstenediol) and nandrolone precursors (19-norandrostenedione, 19-norandrostenediol) that, taken orally, quickly turn into testosterone or nandrolone. In the Finnish legislation these substances are listed as pharmaceutical products and selling them in Finland is illegal.
Other anabolic agents used for non-medical purposes include growth hormones and growth factors, such as IGF-1 and many beta2-agonists that open the bronchial tubes and are used for treating asthma. The most common of these among abusers is clenbuterol, commonly used in veterinary medicine. Other substances favoured by abusers of anabolic agents include placental hormones that increase testosterone production and many antiestrogens, which are used for preventing gynecomastia caused by anabolic steroids and stimulating the secretion of luteinising hormone and testosterone.
Apart from synthetic growth hormones produced by pharmaceutical companies with the help of genetic engineering, anabolic agents are usually significantly cheaper on the street than in pharmacies, which naturally require a doctor’s prescription. The costs associated with one course of treatment vary depending on the substance and quantities used. The costs can be as high as 2,500 to 3,000 euros. Health foods containing precursors of testosterone and nandrolone bought over the Internet are particularly expensive compared to steroid tablets bought on the street. They also include more fake products.
Nature of use
The most important motive for using anabolic steroids is to acquire a muscular appearance. The use of anabolic agents also aims at speeding up gaining power and increasing one’s status in the young people’s peer hierarchy. In the early stages of use, anabolic steroids often cause a feeling of pleasure, and the users do not think of the substances as hazardous to health.
It is characteristic of steroid use by amateur athletes that the medical recommended doses are exceeded many dozens of times (overdosing). Table 1 gives an example of the maximum doses used by an athlete during one course of treatment.
The dosage directions are usually gleaned from underground guides written by American hormone gurus. The authors are bodybuilders, who base their ideas on their own or their friends’ experiences on increasing muscular tissues for bodybuilding competitions. Although some writers have attempted to consult medical textbooks, the result is usually a mess of misconceptions and medically unsustainable theories.
The dosage instructions in hormone guidebooks stress cycling the hormones so that periods of use, lasting from a few weeks up to six months, are followed by breaks lasting a few months. In the beginning of the cycle, the amount of steroids is increased in gradual steps, and towards the end of the cycle, the amounts are decreased by steps over a few weeks (pyramiding). On the other hand, steroids are taken in turns during a long period of use (staggering) and several different anabolic agents are used simultaneously (stacking). It is thought – erroneously – that such a method prevents affinity changes in androgen receptors and enhances the effect increasing muscle tissue.
In addition, the guides recommend using agents that reduce the adverse effects of steroids simultaneously with the steroids (array). Such agents include human chorionic gonadotrophin, antiestrogens and various antiacne medications.
Adverse effects of anabolic agents
The adverse effects of androgens depend on the doses. The side effects are negligible when androgens are used as replacement therapy in testicular or pituitary hormone deficiencies. Only the beneficial and therapeutic effects are then manifest in the user. When abnormally high amounts of androgenic hormones are introduced into the body, they disturb the body’s own hormonal activity and have an adverse effect on many organs. The adverse effects are best known for doses that are used for treating chronic catabolic diseases or male hormonal birth control, for instance. At these dose levels, well researched by pharmaceutical companies, androgens are, however, quite well tolerated.
The adverse effects of clear overdoses, such as the ten- or hundred-fold overdoses used by amateur athletes, have still been studied relatively little. Their effects on many organs and systems, such as hormonal activity, the heart and circulation, liver and the central nervous system, have nevertheless been researched quite reliably. The premature mortality rate of long-term anabolic steroid abusers has been calculated to be approximately five times as high as in the control group.
Table 2 lists possible side effects of anabolic steroids. Hormonal side effects of anabolic steroids occur in all users during and after the course of treatment. Infertility after use can continue for months, even years. Gynecomastia is a typical side effect. It is caused by the fact that in the body anabolic steroids turn into estrogen, which stimulates the growth of mammary glands. Male athletes using anabolic steroids in giant doses have exhibited estradiol concentrations up to seven times as high as those of healthy young women. By the same token, the testosterone concentrations of female users can greatly exceed the normal testosterone concentrations of adult men.
As regards mortality, the heart and circulatory effects of anabolic steroids are the most significant. They can result from direct effect on the myocardium, development of insulin resistance, changes in the lipid metabolism, changes in blood’s coagulation factors or indirect hemodynamic effects. There are reports in the literature of cases of myocardial infarcts and massive pulmonary embolism associated with steroid use on previously healthy athletes. When steroids are used in connection with growth hormones, the cardiac myofibrils may thicken and grow unphysiologically so that the fibrils in the conduction system of the heart stretch and the electric pace-making of the heart suffers. This increases the risk of serious arrhythmia and sudden deaths.
Anabolic steroids bias the lipid values in an atherogenic direction. They reduce the HDL cholesterol concentration to approximately half of the initial value and increase the LDL concentration by approximately a third. After a short anabolic steroid course of treatment ends, the lipid values return to normal in a few weeks, but years of anabolic steroid use constitute a grave risk of developing coronary artery disease, for instance.
In the brain, the areas testosterone and anabolic steroids affect are closely linked to the areas in the brain that control moods, sexuality and aggression. Most users experience feelings of pleasure and a heightened libido in the beginning of use, but not all users experience psychic effects. Research shows that 20–30% of those taking anabolic steroids in excessive doses exhibit symptoms of an affective syndrome that clearly fulfil the criteria set out in psychiatric classification of diseases. Depression, anxiety, psychotic reactions with hallucinations, hypomania and reduced cognitive capacity are all possible.
Approximately 30% of people using anabolic steroids in overdoses exhibit aggressiveness, hostility and irritability during the course of treatment. Several case histories suggest the hormones weaken impulse control. For instance, there are reports of cases in which previously balanced individuals have become violent and committed unpremeditated manslaughter after beginning a course of hormone treatment. Violence has been most prevalent in people who have experienced a degree of psychic disorders previous to steroid use.
One in hundred long-term users of human growth hormone contracts Creutzfeldt-Jakob disease (CJD). Genetic disposition influences the risk of contracting idiopathic CJD. Since the incidence of the disease in a normal population is approximately 1:1,000,000, the long-term use of human growth hormone increases the incidence 10,000-fold. Genetically engineered growth hormone does not cause CJD.
Quitting the use
According to studies applying the U.S. DSM-III-R criteria, 10–60% of anabolic steroid users can be classified as drug dependent. Psychic addiction is manifest as inability to break away from the substances despite emerging health hazards. Physical addiction is evident as withdrawal symptoms after the use ends. Somatic symptoms in men are caused by the depression in the men’s own testosterone production in particular. The psychic effects of the withdrawal symptoms include depression, decreased sexual desire, sleep disorders, fatigue, lack of appetite and irritability.
There is no established practice for treating the withdrawal symptoms. Furthermore, the users do not readily seek the help of a physician to treat the withdrawal symptoms.
Anabolic agents and law
The new Finnish penal code entered force in the beginning of September 2002. Its Chapter 44 prescribes on doping agents in society. The law encompasses testosterone and its derivatives, anabolic steroids, growth hormones and agents promoting their formation in the body, such as human chorionic gonadotrophin and antiestrogenic agents. However, numerous substances, such as clenbuterol, are left outside the scope of the law.
The primary aim of the law is to prevent harmful anabolic agents from reaching the street and their widespread use in gyms. The law makes punishable the illegal import, manufacture and distribution of doping agents and attempts at them. Using doping agents has not been criminalised as such, but possession is punishable if there are grounds to suspect, for instance, based on the amount of the substance in possession, that the possessor intended to distribute the substance. The law prescribes that a doping offence is defined as an aggravated doping offence if the activities involve a significantly large amount of doping agents or the crime otherwise aims at significant financial gain or the doping agents are being distributed to minors. The penal scale for an aggravated doping offence varies from 4 months to 4 years imprisonment.
Timo Seppälä
D.Med.Sc., Docent
National Public Health Institute
Literature
Lin G C, Erinoff L (ed.): Anabolic steroid abuse. National Institute on drug abuse, Research monograph 102. pp 1-249, 1990
Pärssinen M, Kujala U, Vartiainen E, Sarna S, Seppälä T: Increased premature mortality of competitive powerlifters suspected to have used anabolic agents. Int J Sports Med 21:225-227, 2000
Seppälä T: Anaboliset aineet. In Päihdelääketiede, edited by Salaspuro, Kiianmaa and Seppä, Duodecim 1998, pp 454-459
Yesalis C E (ed.): Anabolic steroids in sport and exercise. pp. 1-325. Human Kinetics Publishers Champaign 1993
Table 1
Maximum daily doses of anabolic agents used by an athlete. DDD (daily defined dose) = the normal daily dose in treating patients as estimated by medical authorities. Intramuscular injections are proportioned to the gap days preceding the injection.
Agent Method Maximum dose per day DDD
Testosterone p.o. 320 mg 120 mg
Testosterone i.m. 143 mg 18 mg
Methyltestosterone p.o. 10 mg
Methandienone p.o. 60 mg 15 mg
Stanozolol p.o. 40 mg
Stanozolol i.m. 210 mg
Oxandrolone p.o. 40 mg
Clenbuterol p.o. 100µg
Growth hormone i.m. 8 ky 2 ky
Tamoxifen p.o. 20 mg
Table 2.
Possible adverse effects of anabolic steroids:
Disorders in the secretion of sex hormones
Men:
Shrinkingof testicles
Increased libido (during course of treatment)
Impotence (after course of treatment)
prostatic hyperplasia
prostatic cancer
Gynecomastia
Baldness
Women:
Irregular menstrual cycle
Breasts reduced in size
Hair growth
Baldness
Deepening of the voice
Enlargement of the clitoris
Young people:
Growth stops
Changes in the heart and blood vessels:
Changes in the myocardium
Embolism
Decrease in HDL cholesterol
Changes in the skin:
Acne
Swelling of the skin
Strias ("stretch marks")
Changes in the liver:
Hepatocytedamage
Jaundice
Peliosis hepatis
Benign neoplasms
Malign neoplasms
Psychic effects:
Feeling of pleasure
Mood swings
Anxiety
Aggressiveness
Depression (after the course of treatment in particular)
Sleep disorders
Psychosis
Others:
Headache
Increased risk of sports injuries
Weakened immune response
Infections spread by unsterile needles |
