The recent discovery of a “designer” steroid used by athletes to enhance performance continues to highlight the problem of doping in sports (9). Although attention to this problem has been widespread for many years, it is likely to be even higher as the San Francisco-based investigation into doping by a number of American professional athletes continues. It is also likely that the 2004 Summer Olympics in Athens will draw additional attention to doping in sports. Although a comprehensive review of all elements of doping is far beyond this simple commentary, recent events make it reasonable to highlight a number of issues related to doping in sports in an effort to enhance the scholarly discussion of this societal problem. More comprehensive background information is available from many sources, including key position papers developed by the American College of Sports Medicine.
ANABOLIC STEROID USE CAN NEGATIVELY AFFECT CARDIOVASCULAR RISK FACTORS IN HUMANS
By the early 1980s, it was clear that endurance exercise training had a positive effect on a variety of cardiovascular and metabolic risk factors. At that time, little was known about the impact of regularly performed resistance or strength training on these risk factors, but evidence began to emerge that resistance training could have a favorable impact on blood lipids and glucose homeostasis in humans. In celebration of the 1984 Olympics, the Journal of the American Medical Association (JAMA) published an edition devoted to sports medicine and exercise physiology. In this edition of JAMA, Hurley et al. (6) clearly described the effects of resistance training by elite body builders and power lifters on a variety of cardiovascular risk factors. Some of the subjects were also observed as they self-administered anabolic steroids, and the effects of the anabolic steroids on blood lipids in particular were noted. These studies demonstrated that self-administration of anabolic steroids could have a dramatic and negative impact on high-density lipoprotein cholesterol and was one of the first scientific and nonanecdotal demonstrations of the potentially negative health effects of doping.
EFFECTS OF HIGH LEVELS OF RESISTANCE TRAINING ALONE AND IN COMBINATION WITH SELF-ADMINISTERED ANABOLIC STEROIDS
Some studies have reported that there can be dramatic increases in both systolic and diastolic blood pressure in power athletes self-administering anabolic steroids. Additionally, some but not all studies have indicated that the normal cardiac hypertrophy seen in these athletes can be augmented by steroid use (4,5,8). The three studies referenced above were conducted by outstanding scientists and seem to have been carefully controlled. It is unclear why there are discrepant findings, and this is an area clearly deserving of more scientific investigation.
WHAT ARE THE PSYCHOSOCIAL CONSEQUENCES OF ANABOLIC STEROID USE?
The exercise and applied physiology community has been interested in anabolic steroids primarily as they relate to our collective interest in human performance and to our basic interest in how skeletal muscle adapts to exercise. Frequently lost in our physiological perspective are the psychosocial elements associated with anabolic steroid use and the psychosocial consequences of this use. This is especially important because there have been anecdotal reports about changes in mood and temperament when athletes cycle on and off these compounds. Several recent articles stand out in this regard (1,3,7). These papers take a look at the psychological impact of cycling on and off drugs and at so-called biobehavioral risk factors for anabolic steroid use. Another important issue clearly deserving of more attention is the “arms race” mentality that has emerged in high-level competition where suspicion of use by nonusers leads previously clean athletes to conclude that their only hope of success in elite-level competition is to resort to doping. Although the impact of doping and the risk factors associated with it for the individual users is of clear importance, the effects of the perception of doping on nonusers may be equally important. Increased interactions between the biobehavioral research community and the physiology community will be important in addressing many issues related to steroid abuse by athletes.
“NEW” WAYS TO DOPE: WHAT’S ON THE HORIZON?
Several reports in the popular press have suggested that power athletes may be exploiting the anabolic effects of supplemental insulin before, during, or after strength training. The concept seems to be that insulin, in conjunction with appropriate dietary manipulations, may suppress muscle protein breakdown, may activate muscle protein synthesis, and may direct amino acids and glucose into the trained muscle cells and thus promote increased skeletal muscle hypertrophy (2). These ideas seem reasonable based on the known effects of insulin, and numerous recent studies that have shown that the timing and composition of postexercise meals can enhance muscle protein synthesis. The obvious risk of supplemental insulin injection would be catastrophic hypoglycemia leading to neurologic injury and perhaps death. Additionally, no well-controlled trials on supplemental insulin, dietary manipulation, and strength training in experienced power athletes seem to have been conducted at this time. The use of insulin for doping purposes highlights the general problem associated with doping by using readily available natural biological compounds with very short half-lives. If insulin works, it is likely to be very hard to detect. Similar problems are associated with the use of synthetic erythropoietin and human growth hormone. These lifesaving hormones, used to treat a variety of devastating medical conditions, are very difficult to detect when they are used for the purposes of doping in sports.
Another front in the “war” on doping is the subject of speculation. The emergence of gene transfer technology and the development of animal models with extreme skeletal muscle hypertrophy have raised the question about when gene transfer techniques will be used to enhance human performance (10,11). So far, there has been much attention to the potential use of gene therapy to treat a variety of common and rare medical diseases, but there have been no major successes to date. However, progress marches on in animal models, and eventually, a broad array of techniques to manipulate genes in humans likely will be available. Therefore, based on the seemingly endless quest of at least some humans to do almost anything to enhance their performance, it would seem to be just a matter of time until genetic techniques are deployed in an effort to enhance athletic performance.
In summary, the doping wars continue as governing bodies, regulatory agencies, and, increasingly, law enforcement develop ways to detect and limit common approaches to doping, the misuse of human ingenuity is likely to make doping a continuing problem in the genomic era.
1. Clark, A.S., and L.P. Henderson. Behavioral and physiological responses to anabolic-androgenic steroids. Neurosci. Biobehav. Rev.
27: 413–436, 2003.
2. Evans, P.J., and R.M. Lynch. Insulin as a drug of abuse in body building. Br. J. Sports Med.
3. Fudala, P.J., R.M. Weinrieb, J.S. Calarco, K.M. Kampman, and C. Boardman. An evaluation of anabolic-androgenic steroid abusers over a period of 1 year: seven case studies. Ann. Clin. Psychiat.
4. Grace, F., N. Sculthorpe, J. Baker, and B. Davies. Blood pressure and rate pressure product response in males using high-dose anabolic androgenic steroids (AAS). J. Sci. Med. Sport.
5. Hartgens, F., E.C. Cheriex, and H. Kuipers. Prospective echocardio-graphic assessment of androgenic-anabolic steroids effects on cardiac structure and function in strength athletes. Int. J. Sports Med.
6. Hurley, B.F., D.R. Seals, J.M. Hagberg, A.C. Goldberg, S.M. Ostrove, J.O. Holloszy, W.G. Wiest, and A.P. Goldberg. High-density-lipoprotein cholesterol in bodybuilders v powerlifters. Negative effects of androgen use. JAMA
7. Kanayama, G., H.G. Pope, G. Cohane, and J.I. Hudson. Risk factors for anabolic-androgenic steroid use among weightlifters: a case-control study. Drug Alcohol Depend.
8. Karila, T.A., J.E. Karjalainen, M.J. Mantysaari, M.T. Viitasalo, and T.A. Seppala. Anabolic androgenic steroids produce dose-dependent increase in left ventricular mass in power athletes, and this effect is potentiated by concomitant use of growth hormone. Int. J. Sports Med.
9. Kondro, W. Athletes’ designer steroid“ leads to widening scandal. Lancet
10. Lippi, G., and G. Guidi. New scenarios in antidoping research. Clin. Chem.
11. McCrory, P. Super athletes or gene cheats?Br. J. Sports Med.