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Anabolic-Androgenic Steroids

The Use of Anabolic-Androgenic Steroids in Today's Athlete

Abstract

Today's youth are using Anabolic-Androgenic Steroids in staggering numbers. Recent studies have shown a drastic increase among almost all age groups from Junior High to College. Steroids have a significant negative effect on the human body. Some of these effects are coronary artery disease; thrombotic and embolic complications, hepatotoxicity, gynecomastia, a decrease in testicular function and premature death. These are very serious and life threatening medical conditions and the family and physicians of these youth need to educate themselves on the side effects and prevent youth from using these life altering drugs. Studies have shown that support groups and educational programs help to prevent youth from making the correct decision and using hard work and not Anabolic-Androgenic Steroids to make themselves bigger and faster.

The Use of Anabolic-Androgenic Steroids in Today's Athletes

Performance enhancing drugs have been part of sports since sports began and today's athletes will do almost anything to make themselves better than their competition. Steroids are being used at virtually all levels of athletics from pee wee league football to the Olympics (Riewald, 2008). There is a disturbing trend of Anabolic-Androgenic Steroid (AAS) abuse in young athletes starting as early as nine years old. The use of AASs in professional sports has exploded and has influenced the young athlete that AASs will make you bigger, faster and stronger. In 2007 The Monitoring the Future survey of the National Institute of Drug Abuse found that, 0.8% of eighth graders, 1.1% of tenth graders, and 1.4% of twelfth graders had used steroids in the recent past. This is a thirty-nine percent increase among eight graders, sixty-seven percent in tenth graders and eighty-four percent among seniors in high school (Spector & Chanoine, 2007). Anabolic-Androgenic Steroids are being used by all ages of athletes and the side effects of AASs can be detrimental to the athlete and it is the health care provider's job to educate their patient's. Detecting steroid use in today's athletes is a never ending problem and needs to be constantly evolving. There has been millions of dollars invested in new testing regimens in the recent years and millions more will be spent in the future.

Anabolic-Androgenic Steroids (AAS)

Anabolic-Androgenic Steroids were first developed to treat catabolic medical conditions to prevent the virilizing side effects in females and children. Anabolic-Androgenic Steroids are thought to be the first doping agent that has an ergogenic effects and has been proven to increase strength and muscle mass (Graham, Davies, Grace, Kicman, & Baker, 2008). Anabolic-Androgenic Steroids are synthetic compounds that are similar to testosterone, which is the main testicular androgen, it is then converted to a more potent androgen know as dihydrotestosterone (DHT) (Evans, 2004). Studies have shown that DHT binds tighter to the androgen receptor (AR) and in lower doses is just as effective as testosterone, with this it has been proven that DHT increases androgen action. When the steroid binds to the AR it creates a positive nitrogen balance in the muscle which in turn produces an anabolic state. In a normal male this seems to be of little importance, but in a person who is over trained there is a continuous breakdown of muscle glycogen for energy by glucocorticoids (Calfee & Fadale, 2006). Steroids are anticatabolic which means that the steroids inhibit binding of catabolic glucocorticoids which preserves muscle mass that has been gained. Steroids also produce an emotional effect which has been shown to push athletes into harder training routines.

Athletes today are using three different classes of AASs. These three classes are identified by how the person consumes the product. The classes are oral, injectable oil-based and injectable water-based. The oral AASs are designed so the stomach acid will not totally degrade the product and make it ineffective. They are absorbed into the stomach and not totally degraded by the liver enzymes. Since the oral AAS has a short half life they must be taken several times a day in order for them to have an effect. The injectable oil-based has a much longer half life then the oral component and may be as long as 4 weeks. This class is mixed with sesame seed oil and alcohol to form the oil based substance. Each injection may include 25 to 250 mg/ml of AAS. Since the oil based class has a slower absorption rate through the liver, there are less liver disorders then in the oral class. The injectable-water based class has a half life of 1 to 2 weeks and has almost the same characteristics of the oil-based class.

AAS Users

Today's youth are following the examples of their childhood sports heroes and abusing AASs at very young ages. Athletes are doing whatever they can to increase their performance level. They see their professional heroes getting bigger and stronger much faster and want to do the same. It has been shown in a recent study that 1 out of 16 High School athletes have used AASs. It has also been shown that an estimated 2 million athletes in the United States are using AASs; twenty percent are in college, four percent to eleven percent are in High School and two to three percent are Junior High students (Pearce, 2005).

Since the passing of Title IX in 1972, which states that no one can be discriminated against because of gender in any activity funded by federal assistance, the participation and pressure to perform in female sports has increased drastically. Surveys have shown the adolescent females use of AASs is approximately 4.8% with an overall lifetime prevalence of High School females at 3.2%. In girls and boys surveyed between the ages of nine and twelve, 2.8% of girls and 2.6% of boys reported AAS use (Matich, 2007). There has also been a very steep incline in AAS abuse in college athletes. In women's college hockey there was a two percent increase from 2001-2005 and continues to increase each year. As sports become more and more competitive there will be a continued trend of increased use. Young athletes want to find the quickest and easiest way to become big and fast so they can compete and be the best at what they're doing. This is a trend that will be getting worse before it gets better. With the continued pressure on younger athletes to win and to be the best, the AAS abusers are going to continue to get younger.

There are many different methods of using AAS by today's athletes. Stacking is when the athlete takes several different AASs at one time; this is believed but not proven to have a synergistic effect. The user may be taking up to 5 different types of drugs to achieve an extremely high anabolic level of forty to one-hundred times the normal level (Modlinski & Fields, 2006). Tapering is when the athlete slowly reduces the amount of steroid they are using. When the athlete believes a certain AAS is not working they begin to take another AAS, this is termed plateauing. Cycling is when the person takes an AAS for a certain amount of time and then stops for the same amount of time and then restart again. Stacking is the most used method of AAS use by body builders. The use of smaller amounts of different steroids is thought to make the liver more tolerant which in turn the liver degrades the product at a much lower amount. This is the same approach medical practitioner's use when administering steroids so that it minimizes the side effects.

Effects on the Human Body

It was originally thought that AAS didn't benefit the athlete but that has now been proven wrong. In double blinded study of twenty-one weight lifters who were assigned to two groups for twelve weeks where one group received AAS and the other a placebo, it was shown that the AAS group had a drastic increase in body weight, fat free mass, arm girth and rectus femoris circumference over the placebo group. The AAS group also had an increase in systolic blood pressure, frontal alopecia, acne and maybe a change in temperament (Micheli & Kocher, 2006). If you look at some pro athletes that bulk up abnormally quickly you can see how they do work and why young athletes want to use them. Athletes are taking ten to one-hundred times larger doses than what was originally tested. The side effects of AASs are overlooked most of the time because of the advantages the athlete thinks they are getting. All AASs have side effects when taken in high doses and these side effects can be life threatening and life altering. Psychological disturbance is the only proven consequence of an acute overdose of AASs. If used long term they suppress gonadotropin secretion which suppresses testicular function, which includes testosterone and sperm production. With this spermatogenesis and fertility are reduced with high doses of AASs. The serious effect of AAS use is dictated by which steroid is being abused and at what amount. When the individual stops taking the AAS their sperm count may return to normal in four months. If they have abused AASs for an extended period of time their testicles may decrease in size and the secretion of gonadotropin and testosterone will remain suppressed for a few months after stopping. Gynecomastia is another side effect of the over use of AASs. This is breast enlargement and possible secretion of milk which is in response to high doses of testosterone being converted to estradiol. It has also been proven that coronary artery disease; thrombotic and embolic complications and bleeding caused by benign liver tumors may be associated with long term use of anabolic steroids. Hepatotoxicity is another effect of abuse of AASs which may cause cholestatic jaundice and peliosis hepatitis, which is blood filled hepatic cysts. Now that adolescents are starting to abuse AASs they can prematurely fuse their epiphyseal plates and stunt their growth. In a study of Indiana High School football players of the kids that used or do use AASs, fifty percent used before the age of fourteen and fifteen percent said they used before the age of ten (Snyder, 2008).

Anytime you are using a needle to inject drugs you run the risk of any infection due to a contaminated needle especially if the person is sharing needles. One report showed that as many as twenty-five percent of adolescent AAS users share their needles. The catastrophic and life changing implications from these infections has lead major health organizations such as American Academy of Pediatrics, the American College of Sports Medicine and the National Strength and Conditioning Association to fight hard against the use of AASs. These infections may include HIV, Hepatitis B and C and septic arthritis. One of the scariest side effects of AASs use is premature death. Myocardial infarction and stroke has been linked to the use of this substance. AASs don't just affect the body physically there are also psychological disorders associated with AAS use. It has been shown that individuals who take AASs have major mood disorders and aggressive behavior. It has also been linked to an increased suicide risk, substance abuse and unprotected sex.

Anabolic-Androgenic Steroid use affects men and women differently. Studying the effects of AASs is hard due to athletes mixing AASs with other supplements and also taking doses higher then what is recommended. Tests have shown an increase in muscle mass in men by two to five kilograms and an increase in strength five to twenty percent. There is limited data on the performance enhancing effects of AASs on women. Women have been taking AASs to increase strength and lean muscle mass. Androgenic side effects have been reported by women taking AASs. This includes deepened voice, acne, male pattern baldness, clitoromegaly, menstrual irregularities and increased facial hair. It has been shown that the females who use AASs have been shown to participate in other risky behaviors. In a survey of steroid using women bodybuilders, sixty-four percent reported having adverse psychological effect, including labile mood, irritability or aggressive behavior more frequently then prior to the use of AASs (Matich, 2007).

Provider Education

Anabolic-Androgenic Steroids are going to be a part of sports for a long time and the only thing a provider can do is to make sure they educate their patients on the risks of taking a non prescribed or illegal AASs. Snyder (2008) articulated the value of screening young children about drugs:

The United States Preventive Services Task Force found insufficient evidence to recommend for or against routine screening for drug abuse in adolescents, including abuse of anabolic steroids. The American Academy of Family Physicians, American Medical Association Guidelines for Adolescent Preventive Services, and the American Academy of Pediatrics all suggest that clinicians discuss the dangers of drug abuse with children and adolescents and include questions about substance abuse as a part of routine adolescent visits. Physician may also suspect abuse of androgens in adolescents who have problem behavior. (p. 1)

If these interviews are done on a regular basis and with the proper technique they may be able to stop the abuse of these substances before it's too late and the young patient has already done too much damage to their bodies. Studies have also been shown that programs that threaten or use scare tactic actually increase the interest to use these substances. The most effective approach that has been found is teaching athletes of alternatives to AAS use. Programs such as weight training and nutritional classes have been proven to be more effective. Programs such as Adolescents Training and Learning to Avoid Steroids (ATLAS) which is team centered and gender specific can reduce the rates of AAS use in today's youth (Micheli & Kocher, 2006).

One of the major problems is the doctors and so called sport nutritionists who are suppose to be protecting patients; are the ones that are prescribing AASs illegally. Steroids can also be bought through the internet which is usually from Mexico. It is the coaches, parents and health care provider's jobs to educate young kids about the risks of abusing AASs. Pediatric practitioners need to educate themselves on the performance enhancing supplements so that they can help their young patients through the downtimes of supplement use. In 2004 a Swedish health promotion targeted all sixteen and seventeen year olds and taught them about steroid hormones. The program lasted two years and used youth leaders and health care providers to discuss adolescent steroid use. The program was well received and the misuse of AASs decreased after the program (Gregory & Fitch, 2007). It has been proven that educating young athletes on good health and proper diet may help to reduce the use of AASs. A very important role as a health care provider is to educate the coaches and parents of these athletes so they can continue to educate their young athletes.

Detecting AAS Use

Testing for AASs has been a headline in many of the major sporting events over the past decade. Most recently Major League Baseball has had some of their best athletes test positive for steroids. Most athletes use AASs during their off season training to avoid being caught. Most of these players are either using trainers or they are very educated on the pharmacokinetics of the drugs they are using, and this has made it easier for them to pass their drug tests. Since some of these drugs clear the body quickly they can be used for intense training and then test negative, oral preparation takes two to fourteen days, water soluble take four weeks (Graham et al., 2008). In 2005 the World Anti-Doping Agency said that AASs are the most frequently used drug in athletes. In a recent mail in survey that was sent to twenty-six member of the United States Power Lifting team, ten replied stating they had used AASs and out of those ten, five stated they were able to go undetected by the International Olympic Committee (Snyder, 2008). The way those organizations have tried to stop AAS use has been to do testing during the off season as well as during the season.

Due to the increased testing in sports new “designer steroids” are being produced. The steroids are designed so that they go undetected in the athlete. These steroids are being produced deliberately by medical and governmental agencies to try and promote drugs in sports (Graham et al., 2008). This was proven in a classified document that stated since 1983 a pharmaceutical company in the collapsed German Democratic Republic had been producing a steroid for the government's doping program that was undetectable by the tests being used. As recently as a few years ago the Bay Area Laboratory (BALCO) in California was linked to producing “designer steroids” known as “The Cream” and “The clear”, that were thought to be undetectable.

A urine sample is the preferred fluid in testing for drugs of abuse. The testing process for AASs is a very challenging process. There are many key steps to make sure it is done correctly and legally. There must be a chain-of-custody for each sample so if it is brought in as evidence into a court of law it can withstand any challenges. The individual being tested must urinate into two glass bottles. There will be two samples an A sample, 70 mL, and a B sample, 30 mL. These samples are then sent off to a lab with a tamper proof lid. The A sample is tested first and if it fails the test, the B sample will be tested at a later date. The athlete does have the right to witness the testing as long as there is an independent scientific expert and legally qualified representative present.

Testing for AASs is constantly changing and creates a difficult task for the different authorities that are fighting against doping in sports. The preferred tool to test of AAS is the quadrupole gas chromatograph-mass spectrometer (GC-MS) which offers specificity, sensitivity and precise data handling. This test can detect steroid metabolites, which is important because most of the parent steroid is not excreted in the urine. This testing was shown to work in 2004 when the designer drug THG
“The Clear” was identified at UCLA and several athletes where caught and banned from competition (Graham et al., 2008).

There are many different recommendations in detection procedures currently being used. Testing should be done independently by officers that are independent of the governing organization. These tests need be random and done throughout all phases of training and competition. The tests must be reliable and effective in order for them to be legal and respected. Each athlete should know the rules regulating what substances are considered illegal and be willing to follow these standards. If the athlete does not follow the standards set forward they should be punished by strict and effective guidelines. Education and prevention are important in enforcing these standards.

The World Anti-Doping Agency's goal is to produce a level playing field among athletes worldwide. This includes all athletes being subject to the same standards and protocols throughout. The World Anti-doping Agency is now using a scientific approach to select athletes to be tested. Some of the key factors in their selection are recent performance, history of steroid use and temptation to use performance enhancing drugs.

Anabolic-Androgenic Steroids are being used by all ages of athletes and the side effects of AASs can be detrimental to the athlete and it is the health care provider's job to educate their patient's. Detecting steroid use in today's athletes is a never ending problem and needs to be constantly evolving. This is especially true for the sports medicine doctors because there is a good chance they will be the one treating the patient with the adverse effects (Foster & Housner, 2004). If today's society doesn't get a strong hold on the illegal use of AASs then the trend will continue and we will continue to see young athletes abusing them and continue to hurt their bodies. Professional sports of all types have really started to crack down on the use of AASs and this has been shown to help show the youth that it isn't worth the risk. Society as a whole needs to stay educated on what the recent trends are and continue to educate the youth of the risks and side effects of such a lethal drug. There needs to be programs developed in youth sports from Junior High through college to teach young athletes that hard work is much safer then the quick fix of injecting themselves with AASs. It needs to be instilled in the youth that if they want to be the best that it takes hard work and that a quick injection is not the answer. Parents need to be involved in their child's activities and influence them on the right decisions. Sometimes it is the parents pressure that may push their kid's to make a bad decision. Anabolic-Androgenic Steroids are not the answer for today's youth to become the super star athlete they wish to be, with education and the proper mentoring we may be able to save them from the bad decision and abuse of AASs. Testing for illegal use of AASs also needs to be continually evolving because the athletes that are using these drugs are becoming smarter and know that a positive test can end their career. There needs to be continual monitoring for new designer steroids and reliable tests that will detect these new AAAs. There also needs to be strict penalties for all athletes that are caught so today's youth will understand that it is not ok to use drugs to become a better athlete. The government also needs to go after those that are producing these drugs. These so called sport nutritionists have become unregulated and bring in an estimated $17.7 billion in annual sales (Wertheim, 2003). Performance enhancing drugs are not only detrimental to the health of athletes themselves, but also call into question the integrity of sports (Noakes, 2004).

References

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