Steroids & Stimulants

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

Pre-performance Medications - what is safe, what is allowed? - Thomas Carter, MD (4.13, 2018 Winter SKS)

Anabolic Steroid Use and Abuse in Sports Medicine - Dr. Scott Rand