Steroids & Stimulants - Knee & Sports

Anabolic steroids
- Introduction
  - cause increase in muscle strength
  - increase aggressive behavior
  - increased erythropoiesis
  - side effects
    
    hypertension
    
    liver tumors
    
    increased LDL
    
    decreased HDL
    
    hypercholesterolemia
- Intake
  - either oral or injection routes possible
- Evaluation
  - an abnormally low high-density lipoprotein level should alert the physician to the possibility of steroid use in an athlete.
  - blood testing examines for testosterone to epitestosterone ratio of > 6:1
- Physical exam
  - increased body weight
  - testicular atrophy
  - irreversible deepening of female voice
  - alopecia (irreversible)
  - reduction in gonadotropic and sex hormones (estrogen and testosterone)
    
    can lead to decreased bone mineral density
    
    oligospermia or azoospermia
  - growth retardation
  - gynecomastia
- Type of steroids
  - Human Growth hormone (HGH)
    
    the most abundant substance produced by the pituitary gland. Growth hormone has a direct anabolic effect by accelerating the incorporation of amino acids into proteins. It is becoming an increasingly popular anabolic steroid substitute;
    
    similar effects from insulin-like growth factor (IGF-1)
    
    increased muscle size but not strength
    
    Side effects:
    
    myopathic muscles development
    
    carpal tunnel syndrome
    
    insulin resistance
  - Androstenedione
    
    an androgen produced by the adrenal glands and gonads
    
    acts as a potent anabolic steroid and is converted in the liver directly to testosterone with a resultant increase in levels after administration.
  - DHEA
    
    is a naturally occurring hormone made by the adrenal cortex.
    
    it is converted to androstenedione, which in turn is converted to testosterone.
    
    the beneficial and adverse effects of DHEA can be correlated directly with those of testosterone.
  - Erythropoietin (EPO)
    
    stimulates hemoglobin production and increases O2 carrying capacity
    
    side effects
    
    increased blood viscosity which can lead to stroke or myocardial infarctions
  - Somatotropin
    
    a growth hormone that causes hypertrophy of type 1 muscles and atrophy of type 2 muscle

Catabolic Hormones
- Glucagon
  - has a catabolic effect on skeletal muscle

Supplements
- Creatine
  - Introduction
    
    derived from glycine, arginine, and methionine
    
    a muscle and power building supplement (not an anabolic steroid)
    
    mechanism is that creatinine is converted to phosphocreatine, which acts as a source of ATP for muscle
    
    studies have shown although it can increase work in anaerobic trials, it cannot increase peak force
    
    widely used in conjunction with off-season weight lifting programs
  - Outcomes
    
    studies show mixed results with regard to enhanced sports performance
  - Risks
    
    pulls water from blood vessels into cells, creating a theoretical risk of dehydration
  - Reports of
    
    cramps
    
    increased muscle injury
    
    renal insufficiency (rare)

Stimulants
- Includes
  - caffeine
    
    doses of 2 to 3 mg/kg have been shown to improve performance
    
    works by reducing fatigue and increasing alertness
    
    previously banned by the International Olympic Committee (IOC)
    
    now allowed up to 12 micrograms per milileter of urine
  - ephedra
  - ephedrine
  - "ma huang"
    
    often included in energy drinks
  - amphetamines
- Risks include
  - dehydration
  - impaired heat management
  - high blood pressure
  - nervous system impairment