Steroid Abuse in Sport
As the world is currently looking to the Beijing Olympics, PM Indoe discusses the complicated issue of doping in sport
Within the last year steroid abuse and its repercussions have hit the headlines. A number of elite athletes have tested positive or are under investigation for the use of performance enhancing substances (Tim Montgomery, Marion Jones and Kelli White to name a few). However chasing the drug cheats has become increasingly difficult. Highlighted in 2002, when Dwain Chambers received a two-year ban from athletics and a lifetime Olympic ban for testing positive to a new undetectable “designer” steroid. With many high profile sporting competitions due to take place this summer, sports agencies have the difficult task of trying to ensure a level playing field for all sportsmen and women.
Development of doping
In sport, performance enhancing has been taking place for generations. The ancient Greek Olympians are said to have eaten magic mushrooms to win, whereas Aztec athletes favoured the human heart. However, it wasn’t until 1935 that testosterone was isolated and its anabolic effects were elucidated. Anabolic steroids are rumoured to have been used as early as 1936 in the German Olympics. [1] Although the first recorded use of anabolic steroids appears to be in 1954 at the world weight lifting championships in Vienna, when Dr John Zielger, the U.S. team doctor, observed that many of the foreign athletes, particularly those from Eastern bloc countries, were bigger and stronger than the U.S. athletes. [1] He subsequently discovered through his Soviet counterparts that the Soviet athletes were taking derivatives of testosterone. Zielger returned home and experimented with testosterone on himself. [1] In 1958, he collaborated with Ciba pharmaceutical company to bring testosterone-enhancing steroids to the U.S. in the form of methandrostenolone. [2] After the results of these trials the use of steroids within sport began to expand rapidly so that, by the 1960s, steroids were being used in a variety of sports from field events to football. By 1990, anabolic steroid use was reported amongst Olympic sports such as weight lifting, hockey, swimming, cycling, skiing, volleyball, wrestling, handball, bobsledding and soccer. [3] In 2002, the revelation of “designer” steroids shocked the sporting world. Designer steroids were discovered when an empty syringe from the American anti-doping agency was presented to scientists working at the Olympic analytical laboratory. In this syringe they identified tetrahydrogestrinone (THG). [4] This chemical contained two substances that resembled steroids banned for use by professional athletes: gestrinone and trenbolone. Both of these steroids have powerful anabolic effects. Routine screening at that time would not have picked up THG. The chemical nature of THG means that it can be subtly altered to prevent it being identified, therefore suggesting that there are now numerous “designer” steroids being used that have not yet been detected. [4]
Now the science
All steroids currently used in sport are testosterone derivatives or are structural modifications of testosterone that influence its pharmacokinetics, bioavailability or balance of androgenic to anabolic activity. [5] Whether steroids actually enhance athletic performance is a topic of debate.Anabolic steroids are thought to cause a change in aerobic capacity because they promote the production of red blood cells (via stimulation of erythropoietin), resulting in an increase in oxygen binding capacity and therefore maximum oxygen uptake (VO2 Max). [6,7] Anecdotal and interview reports with top track and field athletes have suggested that they may allow more frequent high intensity training regimes. [8] If this is true, it would benefit almost any athlete, as it would allow them to train more frequently without causing overtraining syndrome and injury. Therefore this is one of the main reasons that anabolic steroids are an attraction for athletes. However evidence for this is contradictory. Some studies have indicated increases in aerobic capacity of individuals at various levels of aerobic conditioning. [6] However others have reported no significant increase in aerobic capacity with steroid use in similar circumstances. [7,9]Anabolic steroids are also thought to alter body composition by increasing lean body mass whilst decreasing fat mass due to increased testosterone levels. [10] Research is again inconsistent. A study comparing body composition, muscle-fibre characteristics, cardiovascular risk factors and liver function in long term anabolic steroid users found that long-term steroid users had a larger percentage lean body mass, increased diameters and circumference of type 1 muscle fibers. [10] However another study comparing the effects of cardiorespiratory variables, body composition, and plasma lipids in resistance trained athletes that were either using or not using anabolic steroids concluded that there was no difference in body composition between those using steroids and those not using steroids. [11] The evidence regarding an alteration in body composition in athletes therefore remains controversial. In terms of strength performance there is a belief that anabolic steroids combined with a high-intensity training regime can improve the strength of some individuals, [12] but research is again contradictory. A recent study found that following administration of 200mg a week of nandrolone decanoate to body builders for a period of 8 weeks there was a significant increase in body mass. [13] Some studies [14,15] reported no strength gains and have suggested that some if not most of the ergogenic benefits of anabolic steroids may derive from their psychological effects. It is possible that anabolic-androgenic steroid abuse may elevate arousal, increase self-confidence and pain threshold and facilitate expression of all out physical effort demanded during training and in a match situation, thus giving a perceived increase in strength.The evidence regarding this subject is further confounded by the fact that athletes tend to take doses in excess of those used in clinical trials. The doses used vary between individuals, but most users will involve some kind of ‘stacking’ and ‘pyramiding’. [3] Stacking is where more than one anabolic steroid is used at the same time and pyramiding involves starting at low doses of steroids and building them up to a maximum halfway through the course and then tapering off for the remainder of the course. [3] Steroid users normally cycle these drugs intensively for a duration of 6-12 weeks. [3] These excess doses lead to a significant increased risk of side effects.The most common short-term and long-term adverse effects that are most commonly associated with steroid abuse are an increase in sexual drive, the occurrence of acne vulgaris, increased body hair and an increase in aggressive behaviour. [17] Other side effects less commonly reported include infertility, azoospermia, reduced cardiovascular function, decreased diastolic relaxation as well as increased platelet aggregation. [16] A serious but very uncommon complication is the development of peliosis hepatitis, when blood filled cysts form in the liver. [16] In athletes anabolic steroids have not been found to be associated with liver problems. [17]
Drug testing in sport
The International Amateur Athletic federation banned drug abuse in 1928 and anabolic steroids were added to the International Olympic Committee’s banned list in 1976. [17] Anabolic agents remain the most detected doping substances in Olympic accredited laboratories. Drug testing is conducted during all competitions, but out of competition testing is not conducted in all countries. The testing must be conducted by a certified doping control officer. Urine and serology analysis are the mainstay of detection.Newer methods for detecting “designer” drugs need to be developed. Currently there is work underway to develop hair analysis testing, which might be a more effective way of identifying anabolic agents that would not otherwise be detected in the urine or by serology. However it is unclear whether this method will be sensitive and specific enough to allow detection of THG and other designer steroids. [18]Dwain Chambers has recently lost his high court appeal against his lifetime ban from the Olympic Games. However the fact that he and many other athletes have a “track record” of using drugs combined with the difficulty of detecting new designer steroids poses a major ethical, moral and legal question. Can sport continue today without proper methods to detect many doping agents?
PM Indoe, Medicine and Dentistry
pi3966@bristol.ac.uk
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