What are the risks of Anabolic-Androgenic Steroids (AAS) within sport?

Chapter one: Introduction

Sporting performance can be influenced by many differing factors. Aside from training, nutrition is the most important influence. To reach one’s highest potential, all of the body’s systems must be working optimally (ADA, 2000). Alongside a healthy diet many performers supplement an ergogenic aid; increasingly however many others use drugs to gain an advantage over their opposition.

Anabolic-Androgenic Steroids (AAS) are one such drug used within sport to boost performance. In 1993 more than one million sports participants, ranging from recreational gym users to elite athletes were using anabolic steroids regularly (Yesalis, Kennedy, Kopstein, Bahrke, 1993). More recently it has been reported that 6.1% of 15-18 year olds within US high schools had taken a form of anabolic steroid (ADA, 2003).

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This review aims to address the rationale behind the use of anabolic steroids, the relative risks and benefits of the drug, as well as previous research within the field, ultimately determining whether sporting organisations are correct in illegalising the drug and providing the reader with the information to make an guided decision for themselves.

1.1 Background to anabolic steroids

Anabolic steroids are the derivatives of testosterone (Bahrke and Yesalis, 2002). Primary research of testosterone in 1935 led to the development of AS. Testosterone is the primary natural male hormone. It is responsible for the androgenic and anabolic effects observed during male adolescence and adulthood. By 1935 testosterone had been isolated and chemically characterised (Kockakian and Yesalis, 2000). Testosterone itself is not considered an anabolic steroid due to it retaining its’ full androgenic effect on the body (Herbert, Hapt & Rovere, 1984).

1.2 Rationale behind Anabolic Steroids

Anabolic steroids are used, variably, by athletes and others to increase lean body mass, to reduce fat, to enhance performance and sustain periods of training (Hartgens and Kuipers, 2004). Anabolic steroids, dependent on chemical structure, bind to specific androgen protein receptor sites in the sarcoplasm of cells found within skeletal muscles. Complexes are formed through such binding with the product being transported through the cells nuclear membrane to interact with intra-nuclear chromatin and activate RNA polymerase, protein synthesis is triggered. Protein synthesis is the process in which cells build protein (Bruce, 2002) ultimately this increase is protein results in a build up in cellular tissue within the muscle, thus increasing muscular mass. Average male skeletal muscle consists of six to twelve kilograms of protein (McArdle et al., 2010). Strenuous physical activity such as weight training constantly increases the body’s protein requirements, as well as stress upon the body. Both in which Anabolic steroids are rumoured to remedy. Physical activity comprises any body movement produced by the skeletal muscles that results in substantial increase over resting energy expenditure (Bouchard, 2006). In a day and age where millimetres win races, every edge a performer believes they can gain is crucial. Common belief that No one is guilty of steroid use except the other guy, the other team (Yesalis SR, 1934) aids widespread usage.

1.3 Differing types

Anabolic steroids can be taken by four different methods: Injection, Orally, Nasally and transdermally. For each method there are countless steroids available (steroids.com, 2010). Most individuals who use anabolic steroids obtain the drugs from the black market (Tolliver, 1998). Table 1 shows the number of steroids currently available on the market. However this list can never be fully complete as athletes, researchers and trainers are always developing new drugs and in particular, combinations of drugs to try pass the stringent tests. Each modification to testosterone results in distinct changes in the deliverability, potency and the body’s adaptive responses to AAS (Hall, 2006).

1.4 Guidelines

Anabolic steroids are banned by athletic organisations to protect athletes from potentially harmful side effects (Quinn, 2010). Due to banning by all leading sports organisations it is important to note that no guideline amount can be stated. Doses used by weightlifters and bodybuilders have been at least 100 times those indicated for therapeutic use (Rogol and Yesalis, 1992).

Chapter Two: Scientific evidence

Following its’ development from 1935 onwards AAS has become one of the most researched performance enhancing substances available. (Celotti and Negri-Cesi, 1992). Almost all research has been into effects the drug has on the physical and psychological body, both positively and negatively. A number of reviews and they’re point of study are available in appendix two following.

2.1 Physical effects – Positive

Several studies have examined the positive effects AAS has on both the animal and human body. Despite their development in the 1930s, as recently as 1996 the true anabolic effects were often disputed.

Early studies in the physical effects of AAS by Wright (1980) showed that inexperienced weightlifters did not benefit from a dose of AAS but that more experienced weightlifters showed an increase in both muscle and strength. Due to the study coupling protein supplements along with AAS it was widely believed that it was in fact the protein supplement that benefitted the weightlifter, and that the strength was as a result of the extra muscle mass gained by the added protein.

Bhasin et al., (1996) remedied all doubt regarding the anabolic properties of AAS. It was shown that a relatively high dose of 600mg/wk added to a group of males performing weight training resulted in a 6.1kg increase in lean muscle mass over a ten-week period. In fact, even males not performing weight training increased lean muscle mass by 3.2kg. This is mirrored by Sjoqvist et al., (2008) who reached a conclusion that since adequate doping tests have been introduced in powerlifting, records have seized to be broken.

Herbst and Bhasin (2004) reported that high doses of AS in any adult male resulted in a significant decrease in lipid molecules within the body. A common result of increased muscle mass is an increase in metabolic rate. An increase results in more energy being expended throughout the day than being taken in through the diet. Fat stored in the body is used as a fuel source in situations such as this, thus resulting in a decrease in body fat levels.

Kuhn (2002) hypothesised that steroids may also block any catabolic effects of glucocorticoids released during training, thus allowing for a high intensity, longer workout.

2.2 Physical effects – Negative

Though AAS produces many benefits within the body to enhance athletic performance, many scientists believe that they also result in negative and dangerous consequences. During studies physiological side effects are broken down into: Cardiovascular, Liver, Reproductive and Dermatologic.

In relation to cardiovascular, there are many risk factors: blood volume, salt and water retention, hypertension, ventricular function, effects on blood lipids and lipoproteins and blood clotting. Of the above risks most research has been concerned with AAS’s effect on blood lipids and lipoproteins and blood clotting. AAS has an adverse effect on plasma levels of lipids within the blood (Thiblin and Petersson, 2005). This has particularly been present in athletes who took AAS orally (Lombardo et al., 1991). Rockhold (1993) reported high-density lipoproteins (HDL) fell by 22%. The reduction in HDL have been linked with an increasing risk of cardiovascular disease (Wagner, 1991). In terms of blood clotting many animal studies suggest a relationship between AAS dosages and the clotting of blood. The clotting of blood results in several conditions, such as stroke. So far, during study only one death has come from a stroke-linked death (Lombardo et al., 1991).

In relation to the liver. Peliosis hepatitis is associated with orally ingested AAS in particular. Tumours can also be caused, though rare. Tumour rupture ultimately prove fatal (Friedl, 2000). Liver failure occurs in extreme cases (Evans, 2004).

In men high doses result in quantity and quality of sperm being greatly reduced (Torres et al., 2001). Testicular atrophy ultimately results if long term use continues. There is very little research exploring AAS and the reproductive system of women. Hartgens and Kuipers (2004) showed an increase in clitoral size, reduction in breast size and uncommon menstrual irregularities. Parssinen and Seppala (2002) found that acne and loss of hair were very common dermatological effects in men of using AAS.

All effects have been shown to be fully reversible within several months of the dosage being ceased (Friedl, 2000). Haff and the NSCA stated that the effect of long term use of excessive high doses of AAS is virtually unknown. Parssinen and Seppala (2002) conducted a study that followed the participants of the Finnish powerlifting competition in 1977 for a period of 12 years. Premature death was 4.6 higher in these participants than the average population of Finland. As powerlifting does not cause mortality, AAS was widely blamed.

2.3 Psychological effects

Psychological and behavioural changes in participants, such as increased aggressiveness and irritability have been presented by Goldman et al., (1984) and Wright (1982). Several reports (Pope and Katz, 1987) suggest that AAS causes clinical depression amongst many other mental disorders. While Schulte, Hall and Boyer (1993) studied one male taking AAS over a four-month period. The subject was observed to become aggressive towards his wife and child. No previous aggressive behaviour had previously been recorded. Steroid abuse would appear to make subjects aggressive and depressed as well as easily irritated. Out of one million or more steroid users within the U.S. in 1993 only an extremely small percentage experience enough disturbances to result in clincical treatment (Yesalis, Kennedy, Kopstein & Bahrke, 1993). In terms of psychological benefits it is believed that an improvement in physical looks, as well as the enjoyment of winning would boost confidence as well as a short period of happiness. This however is not a direct effect of AAS and simply an effect of winning and hard work that can be achieved by other means.

A summary of all effects found can be found in Appendix two.

2.4 Numbers using anabolic steroids

Highest levels of use of AS have been attributed to American football players, weightlifters, powerlifters and bodybuilders since the 1960s (Yesalis, Courson & Wright, 2000). Several studies were carried out throughout many years, categorised as: adolescent, college and athlete studies.

In 1987 the first national study occurred in the U.S. at adolescent school level by Buckley et al., (1988). Investigations discovered that 6.6% of male school children were/or had taken AAS. 38% of this 6.6% population had taken the performance enhancing substance before the age of 16. In the mid 1990s these findings were confirmed by multiple state studies carried out. Whilst the more prevalent studies have been carried out within the U.S. it is important to note that many other studies in Britain, Sweden and Canada have also taken place. Showing a 1.2 – 5.9% generalised usage (Williamson, 1993).

Amoung college atheletes Anderson et al., (1985 – 1993) and the NCAA (1997, 2001) conducted a series of five surveys on both males and females. Finding that steroid use had seemingly dropped from 4.9% in 1985 to 1.4% in 2001. However Yesalis et al., (1990) believed that athletes were lying about their use. Yesalis used indirect questions aimed at others around the performers to divulge such information. A massive 14.7% usage in all sports was recorded when asking others, compared to roughly 4.9% when the performers themselves were asked.

In terms of the professional athlete many researchers used the Olympics (both summer and winter) as a base for their study as it is the pinnacle of all sports. Silvester (1993) surveyed athletes in the 1972 olympics in Munich. It was found that 68% of all the track and field athletes admitted using AAS. Widespread athlete usage was supported when in the 1992 Winter Olympics 80% admitted AAS use (Pearson and Hanson,1992) while 75% of medallists admitted the use (Pearson, 1994). Due the illegalisation, by WADA and the IOC, of all drugs these findings are now deemed useless as often any athlete who attempts the use of AAS is caught, for example British athlete Dwain Chambers, who received a two-year ban from the sport.

Chapter three: Conclusions

In conclusion it has been widely demonstrated and acknowledged recently that a high dose of Anabolic-Androgenic Steroids, when coupled with a healthy diet and effective training program, improve a performer’s strength and muscular size, and decrease levels of fats and muscle catabolism. Thus resulting in an overall improvement in sporting performance in almost all sporting events. The continued use of AAS can also be associated with a variety of health problems, both physically and psychologically, that outweigh the positive effects. Due to the cycling requirement and short-term damage caused deemed unacceptable, much more research needs to be undertaken to fully investigate the long term effects of high-level doses.

AAS has ultimately been banned by the IOC and many other leading sporting organisations to protect the health of their athletes. Whilst this is the case many performers still increasingly chose to take them in some form to gain ‘the edge’ over their opposition. There are many other socially acceptable ergogenic aids available to sports performers, such as creatine. It has been estimated that creatine is used by up to 99 percent of elite athletes in today’s world, thus deeming it socially acceptable and fair. If 99 percent of elite athletes used anabolic steroids would they also be deemed fair also?

Figure 1.0: Mechanism of Anabolic Steroid effect

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