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ANDROGEN ABUSE IN SPORT
Mike Wheeler
Consultant Clinical Scientist, Clinical Chemistry Department, Guys
and St. Thomas' Hospitals. Honorary Senior Lecturer, Kings College.
Director, Supra Regional Assay Service for Peptide and Steroid Hormones.
The.Wheelers@virgin.net
Substances to enhance athletic performance have been taken for hundreds
of years but it was not until the 1950s that testosterone and anabolic
steroid abuse became a major issue in sport. Despite being banned
by the International Olympic Committee in 1976 these substances
are still being abused by athletes and reports appear every year
of another athlete testing positive for steroid or hormone abuse.
There are people, like Victor Conte in the States, who are prepared
to try and help athletes cheat the system, either by special preparations
that will avoid detection of the abuse, or by developing the so
called 'designer' drugs for which no test has been developed. New
'designer' anabolic steroids have been synthesised over recent years
and these may be bought over the web as nutritional supplements.
Very little research will have been carried out on these substances
so side effects are unknown.
As well as the synthetic anabolic steroids there are, of course,
other natural hormones like androstenedione, androstanediol and
dehydroepiandrosterone (DHA) occurring in the body. These, taken
in sufficient quantity, will increase testosterone concentrations
particularly in women. Our own work has shown that testosterone
concentrations in women can be increased twenty times with micronised
androstenedione. DHA ingestion is also able to increase testosterone
concentrations in women. Preparations of these natural steroids
were, until recently, sold as nutritional substances in the UK.
They are no longer available from sports shops in this country but
are available in other countries or over the web as nutritional
substances.
Anabolic steroids, particularly the orally active steroids, are associated
with a number of adverse side effects, some life threatening. Elite
athletes are usually able to obtain good medical advice about nutritional
supplements and drugs, and serious body builders are very aware
of the dangers involved in steroid abuse. There are a number of
handbooks available giving them advice, although some are inaccurate
and misleading.
Worryingly it is not only mature elite athletes and body builders
abusing these substances. Most abusers start taking steroids as
teenagers at a time when they may be ignorant of side effects. A
Canadian study reported children as young as 11 years abusing steroids.
Of equal concern is that a significant number of gym users take
anabolic steroids. Although it appears to be relatively easy to
obtain steroids while at the gym, a number of users report getting
their steroids from their GPs!
So how might GPs be involved in steroid abuse? Well evidently in
supply, but it is also evident that they have a role in recognising
anabolic steroid abuse and providing advice and counseling. There
are a number of side effects that may bring the concerned abuser
to their GP. This is even more important when it is appreciated
that a whole range of substances might be abused along with the
anabolic steroids. The major question must be whether GPs are equipped
to meet the challenge.
References
Mullis PE (ed) Doping in sport. Clinical Endocrinology and Metabolism
(2000) 14 part 1
Yesalis CE (ed) Anabolic steroids in sport and exercise. Human Kinetics,
IL, USA (2000) Laure P, Binsengeer C, Lecerf T. General practitioners
and doping in sport: attitudes and experience. British Journal of
Sports Medicine (2003) 37: 335-338.
Baker JS, Graham MR, Davies B. Steroid and prescription medicine
abuse in the health and fitness community: A regional study. Eurpean
Journal of Internal Medicine (2006) 17: 479-484.
Hoffman JR, Ratamess NA. Medical issues associated with anabolic
steroid use: Are they exaggerated? Journal of Sports Science and
Medicine (2006) 5: 182-193.
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