SPORT AND EXERCISE PHYSIOLOGY: PERFORMANCE ENHANCING SUBSTANCES - ANABOLIC STEROIDS

4/14/2014 SPORT AND EXERCISE PHYSIOLOGY, PERFORMANCE· ENHANCING SUBSTANCES· ANABOLIC STEROIDS

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SPORT AND EXERCISE PHYSIOLOGY: PERFORMANCEENHANCING SUBSTANCES - ANABOLIC STEROIDS

Thomas Fahey California State University, Chico Department of Kinesiology, Chico, CA 95929, USA

Michael Kalinski Chair; Department of Applied Health Science, Murray University, 408 B North Applied Science Building, Murray, KY 42071-3347

Michael Fahey Chico, CA, USA

Keywords: anabolic steroids, ergogenic aids, sports, doping, Olympics, USSR,

professional baseball, muscle strength, testosterone, prematme death, androgens, exercise physiology, ethics in sport, athletics, football, bodybuilding

Contents

I .Introduction 2.Anabolic Steroids: Historical Perspective

2.I .Historical Perspective

2.2 .State-Sponsored Doping Research Program in FOlmer Soviet Union 3.How Anabolic Steroids Work

3. 1. Steroid Receptors 3.2.Anti-Catabolic Effects of Anabolic Steroids

3.3 .Psychological Effects 3.4.Neural effects of steroids

4.Anabolic steroids and periol1mnce S .Health effects of anabolic steroids

S. I .Minor side effects S.2.Serious Side Effects: PreJmtlU'e Death, Heart Attack, and Cancer

S.2. l.Steroids and longevily S.2.2.Heatt disease

S.2.3.Cancer 6.lmportance of dosage

6.1. Why low steroid doses are ineffective

6.2.Health risks of higher testosterone doses 6.3.Are athletes guinea pigs for large dose steroid research?

7.Anabolic steroids and the law

7. I .The myth of the level playing field 7.2.Anabolic stero ids are unhealthy

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7.3 .Drug testing and the law 7.4.Should steroid use be pelmitted in sports? Related Chapters Bibliography Biographical Sketches

Summa),y

TIlls article examines the effects of anabolic steroids on health and pelformance. The discussion includes the histmy of anabolic steroid use in spmis, mechanism of action ofthe drugs, side effects, doping control, and legal and ethical considerations. Anabolic steroids are drugs that resemble the male h011110ne testosterone. Athletes use them to gain weight, strength, power, speed, endurance, and aggressiveness. Testosterone was synthesized in 1934 and its use has been controversial ever since. Steroids were used as a tool by the both sides dlU'ing the Cold War to fiuiher national athletic agendas. Professional and amatelU' sports organizations have taken proactive steps to prevent dmg use through comprehensive testing programs. In spite of these efforts, we continue to have a constant stream of drug scandals in sports. Steroids improve physical perfm111ance and body composition, provided the dose is high enough. Side effects increase with dose. Most side effects are minor, but steroid use might cause heati disease, cancer, and prenoature death in some people. WIllie steroids are no more unnatlU'al than weight machines or fiberglass poles, they are conlTaty to goals of sport in the society and should be discouraged.

1. Introduction V This section desclibes the scope of the alticle.

Dozens of "how to" books and websites on anabolic steroids are available on the Internet. The UndergrOlmd Steroid Handbook by Dan Duchaine, originally published in 1981, was the first of many books on steroids that were based largely on personal experience and word of mouth fi'om bodybuilders and weight trained athletes. TI1is is understandable because there was little research on the petfornoance enhancing effects or side effects of these drugs in athletes. The existing studies used low doses that did not in1prove pelformance.

That has changed. Thousands of studies and research reviews give us a clearer pictlU'e of the effects of these drugs and their side effects. Historical docUl1lents fi'om the fmmer Soviet Union and East Gennany, the Mitchell repmi on drug use in Major Leagne Baseball in the United States, and anecdotal reports fi'om athletes and coaches fi'om throughout the world provide a clearer picture of widespread anabolic steroid use in spmi before the advent of comprehensive doping control. This article will help scientists, coaches, athletes, and health professionals understand the science and IllstOty behind this controversial subject.

Anabolic steroids are drugs that resemble the noale hmmone testosterone. Athletes use them to gain weight, strength, power, speed, endurance, and aggressiveness. They are

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widely used in athletics, bodybuilding, weightlifting, and Amelican football Increasingly, men and women who do not play SpOlts use steroids to improve physical appearance. Even school-aged children use them. Studies of children around the world found that about four to eight percent of adolescents have uied the drugs; one quarter of these children are non-atbletes.

Athletes take anabolic steroids because they increase sU'ength, muscle size, and power. Althougll they can sometimes have serious side effects, the Im'e of making rapid gains in sU'ength, power, and muscle size make these dlUgS ilTesistible to many athletes.

Almost all governing bodies of amatem and professional sports ban steroids. Athletes, active people, coaches, and scientists should lmow as much as possible about trainlllg, nuu'ition, and supplements to maximize performance without resorting to drugs.

2. Anabolic Steroids: HistOlical Perspective V 2.1. Historical Pet1>pective V Research on testosterone began more than 125 yeat1> ago. Specialization in spoti has made these drugs a major issue.

Drug use to improve pelformance is almost as old as sport itself Ancient Greek athletes used a variety of concoctions to ilnprove pelformance. Inca warriors in South America chewed coca leaves before doing battle in the rarified air of the Andes. At the tum of the century, athletes often breathed supplemental oxygen to itnprove endurance. Atbletes, such as boxers and soccer players, got a boost by drinking a cocktail composed of snychnille, brandy, and cocaine.

The roots of testosterone research reach back to ancient tinles. Farmers learned that casu'ated anitnals had reduced sex drives and were more docile. Royalty in Persia employed casu'ated men called eunuchs to guard the harem because they had reduced sex drives. Modem scientific research on testosterone began in 1889 when 72-year old French scientist Brown-Sequard reported that testicular exU'acts of dogs and guinea pigs made hinl feel younger and more vitile. His repOli u'iggered widespread use of testicular exU'acts in Europe and North America for more than 30 years. We have no repOli that athletes used the preparations but they were widely heralded as a health tonic, so it is possible that some athletes used them to improve perfoimance.

Ernest Laqueur isolated testosterone fi'om bull testes in 1934 and received the Nobel Plize for his discovery in 1935. This started a lively debate in the medical community regarding testosterone replacement therapy that continues to this day. TIle early interest in testosterone centered on its effect on libido and sexual pelfOlmance.

During World War II, the Gelman and American annies expelimented with testosterone (testosterone propionate) to improve pelfonnance. In 1951, scientists discovered that testosterone could increase lean muscle mass, which made it a serious candidate as a performance-enhancing drug.

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After World War II, international athletic competitions became the cold war surrogates to the battlefield. Eastern and Western bloc countries squared off on the playing fields, ice rinks, basketball courts, and running tracks. Countries poured money into athletics in the hope of promoting their political agendas. Victoty was the only acceptable outcome for both sides. In this climate, widespread drug use to improve peIfonnance was almost inevitable.

Excesses in drug use in sport began to catch up with the athletes. Between 1960 and 1963, the public became disgusted with a selies of drug related deaths in cycling, boxing, and track and field. Many people felt that athletic drug use tln'eatened all Spotts, undennining the very foundations of the Olympic ideal.

The International Olympic Committee (IOC) began to fonnulate its anti-doping policies in the J 960s. 111eir basic philosophy was to J) protect the athletes' health, 2) defend medical and sports ethics, and 3) provide an equal chance for all in a competition. In J 968, the IOC began the first large-scale dmg-testing program at the Grenoble winter Olympics and the Mexico City SUll11ller Olympics.

The early histoty of athletic drug testing was controversial and inconsistent. Dming the early years, amphetamines and anabolic steroids were the most common banned dmgs used by athletes. While amphetamines were easily measmed, anabolic steroid assays were more difficult and expensive. Gradually, anabolic steroid detection became velY sophisticated. Drug testing methods were limited by tlleir sensitivity and specificity and the predictabiIity of doping control schedules at major championships.

The obvious answer was random tests. Unfortunately, the Cold War limited equal access to athletes in Eastem and Western bloc countries. Doping officials had to rely on surplise tests at competitions, such as the Pan Amelican Games held in Caracas in 1983.

That all ended with the close of the Cold War. Beginning in the late 1980s, the IOC instituted random drug testing of elite atllletes. Athletes were expected to infotm officials of their location and be prepared to submit a urine sample within 48 hours at any tinle. If they refused, they would be treated as though tlley tested positive for banned mugs and would receive sanctions. Sanctions ranged ii'om reprilnands to pennanent exclusion from Spott.

In the United States, professional baseball and the National Football League introduced dmg-testing progral11S in 2004 to stem the tide of dmg use in sports. In December of 2007, the Mitchell Report- commissioned by the Commissioner of Major League Baseball at ilie request of the U.S. Congress- concluded iliat dmg use was widespread at all levels of the sport:

"F or more than a decade there has been widespread illegal use of anabolic steroids and other pelfotmance enhancing substances by players in Major League Baseball, in violation of federal law and baseball policy. Club officials routinely have discussed the possibility of such substance use when evaluating players. Those who have illegally used these substances range ii'om players whose major league careers were brief to potential

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members of the Baseball Hall ofFamc. They include both pitchers and position players, and their backgrOlmds are as diverse as those of all major league players."

2.2. State-Sponsored Doping Research Progmm in FOlmer Soviet Union V The State Central Institute of Physical Cultm'e in Soviet Union published a highly classified document that outlined the State-sponsored Soviet research on steroids and "ecommendations for use steroids in spOlis.

The fonner Soviet Union began participating in the Olympic Games after World War II, beginning with the Helsinki games in 1952, and soon achieved a dominant position in these sporting competitions. The success of Soviet athletic programs was astounding. It was one of the most successful SpOlt programs of all time. One of the sports in the Helsinki games where Soviet athletes did exceptionally well was weight lifting, with the Soviets winning three gold, three silver, and one bronze -medals.

Following the Helsinki Olympic Games, the United States Olympic weightlifting coach, Bob Hoffinan, accused the Soviet weight lifters of taking hormones to increase strength. This public charge was corroborated by one of the Russian team physicians to the United States weight-lifting physician, Dr. John Ziegler, during the 1954 World Weightlifting Championships in Viel1l1a. Rumors abounded during the 1956 Olympic Games in MelbolU'ne, Australia, that competitors in the weight lifting and throwing events used

androgens.

One of the most damaging Soviet scandals occlUTed in 1984 at the Intemational Athletics Meet of Paris when Tatiana Kazankina, one of the best track and field athletes ever produced in the Soviet Union, was suspended for life for reulSing to suhmit to a chug test for anabolic-anch'ogenic steroids. These long-standing suspicions of testosterone use by the Soviet athletes were ahundant in the Western literature. Nevertheless, even in light of scandals involving Soviet athletes caught doping, no one was able to obtain documentation

of State collusion.

Suspicion of anabolic-androgenic steroid use by athletes in the fOlmer USSR was rampant as early as the 1960s. Although anecdotal repOlts continued, steroid use by certain Soviet athletes cannot be considered proof of the existence of State sponsored research and conspiracy. Athletic success in Olympic games provided extensive privileges in the US SR for the elite athletes, coaches, scientists and sport officials. These privileges included prestige at the state leve~ expensive gifts, cars, apattments, state stipends, increased salaries, and extensive travel abroad.

The security measures that could be llSed routinely in totalitarian societies are difficult to appreciate in Westem countries. During the 1940s through the 1980s, authOlities in those totalitarian countries would have punished any scientist, jOlUnalist, athlete or coach who

published revelations about steroid llSe in elite SpOlt.

In 1972, the State Central Institute of Physical Culture published a classified document that outlined the Soviet research on steroids and recommendations for use steroids in

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sports. The document contains a series of scientific reports providing the times and dosages for the administration of androgenic-anabolic steroids to hlUnan subjects (athletes) and data from experiments conducted at the Research LaboratOIY of Training Programming and Physiology of Sport Pelformance of the State Central Institute of Physical Culture in Moscow. It contains the following subsections: "Introduction", "Anabolics and Endurance", "Anabolics and Strength", "Anabolics and SpOIt Performance", "Anabolics and Sport Results", "Dosages of the Anabolics", "Possible Adverse Effects", "Control of Use". 111ere is no evidence in any of the research repOIts that treatments ofthe athletes with anabolic-androgenic steroids adhered to the guidelines of h= tTeatment for research (use of informed consent, institutional review boards, etc.). It is obvious ii-om the State Central Institute of Physical Culture's report that expeIiments with anabolic-androgenic steroids using athletes as subjects had occmred in the former USSR by 1971 to 1972 or earlier.

All orders to organize and finance such research were given in a highly centralized system Research into the medical and biological aspects of sport was an integral pmt of the athletic agenda in the former Soviet Union. It was conducted in more than 28 State Institutes of Physical Education and State Research Institutes of Physical Culture. It is unlil(ely that crucial decisions about financing and in1plementation of research programs on androgenic-anabolic steroids by the State Central Institute of Physical Culture in Moscow were made without the Imowledge and consent of govel1lmental officials.

Some may argue that androgenic-anabolic steroid nse is widespread and that the ClUTent situation in the West is no different ii-om what occurred in the former Soviet Union. There is, however, an important difference between East Gennany, the former USSR, and Westem colU1l1ies in this regard. In the West, govel1lments do not finance human subject research on steroids to enhance athletic perfonnance. Use of these substances is prohibited and not encomaged. Athletes who choose to nse steroids are doing so on their own initiative, without the suppOIt or consent of govellll11ent agencies.

The doclUnent ii-om the State Central Institute of Physical Culture made clear that within the former USSR, there was a col11pletely different situation - a goverrnnent sponsored scientific effOlt, which apparently did not follow the accepted nonns for treatment of hrnnan subjects. By goverrnnental agencies circulating the research report among elite State SpOlt Institutions in the former Soviet Union, spOIt officials, coaches and athletes were being advised, recommended, and encomaged to use androgenic-anabolic steroids. In East Gennany, for exal11ple, it was repOIted that it was mandatory for any athletes who wanted to participate in the 1988 Seoul Olyn1pics to take anabolic-androgenic steroids.

The classified docrnnent descnbed in this article proves the existence of state-sponsored studies on the effect of anabolic-androgenic steroids on athlete's morphologica~

biochemical, physiological vmiables and athletic performance conducted in the fOImer Soviet Union. The studies were pelfOImed in the Research LaboratOIY of Training Programming and Physiology of the SpOIt Perfonnance at the State Central Institute of Physical Culture in Moscow, and could not have been enacted and finm1ced without govenunent orders. Recommendations for steroid use for different spOIts were given, particularly for elite athletes specializing in endurance and strength-dependent spOIts.

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Ethical considerations do not appear to have been important, as infOlmed consent does not appear to have been obtained and high doses were recommended for weightlifters.

The resuhs and recommendations obtained 1i-om these stndies on androgenic-anabolic steroids were secretly circulated among elite SpOlt institntions in the fOlmer USSR. This infOlmation was classified and accessible only to selected professionals.

3. How Anabolic Steroids Work V Anabolic stemids havc anabolic (tissue building) and androgenic (sex-linked) effects.

Male hormones, mainly testosterone, pattly cause the tremendous increase in height, weight, and muscle mass that occur during pubetty and adolescence. The hormones have androgenic and anabolic effects. Androgenic effects are changes in primaty and secondaty sexual characteristics. 111ese include the enlargement of the penis and testes, voice changes, hair growth on the fuce, underar111S, and genital areas, and increased aggressiveness. The aggressive behavior of teenage boys is at least partly due to increased testosterone levels. The anabolic effects of androgens include accelerated growth of muscle, bone, and red blood cells, and fuster conduction of nerve impulses.

Phannaceutical companies make anabolic steroids to boost their tissue building properties (anabolic effects) and reduce their effects on sexnal tissues (androgenic effects). However, it is inlpossible to create a purely anabolic steroid-one with no sexual side effects. The androgenic effects are really anabolic effects in sex-linked tissues. The effects of male honuones on accessOlY sex glands, genital hair growth, and oiliness of the skin are anabolic processes in those tissues. The steroids with the most powerful anabolic effects are also those with the greatest androgenic effects.

In women, side effects merely reflect the normal action of the hOlTI1One. Facial hair growth, increased sexual desire, deepening of the voice, and enhanced aggressiveness are natural and desirable effects of androgen hormones in mefL However, they tnay be unacceptable in women. Women who take these mugs 111I1st balance the increased mnscle tnass and power they get with undesirable sexual side effects.

3.1. Steroid Receptors V Androgens bind to receptors in the cells, which tIiggers protein synthesis in the cell nuclei.

Steroid hmmones wotie by binding to receptor molecules, which activate specific genes to synthesize proteins. This process works vety much like a lock and key. The key- the anabolic steroid- binds with a testosterone receptor- the lock, which begins a process that makes new proteins. The result of tllis process depends on the target cell In mnscle, steroids stimulate hypertrophy. Oil production increases in oil-secreting glands in the fuce. Steroids stinlulate hair follicles to grow hair, and so on. Steroids increase the production

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of muscle growth fuctors (IGF -1) that is very impOliant for increasing muscle size.

Large doses of steroids promote muscle hypeltrophy, even without weight training. Combining steroids and high intensity training magnifies the gains. Most research studies show that steroids work best in experienced weight lifters who use heavy weights and produce high muscle tension dW'ing exercise. TIle eifuctiveness of anabolic steroids is dependent upon unbound receptor sites in muscle. Intense strength training increases the number of W1bOlmd receptor sites. More receptor sites make anabolic steroids more effective. Diets high in protein and calories may also be inlportant in increasing the effectiveness of anabolic steroids.

3.2. Anti-Catabolic Effects of Anabolic Stemids Y Anabolic steroid prevent protein breakdown after exercise.

Most athletes comment that anabolic steroids help them train harder and recover fuster. They also said that they had difficulty making progress or maintaining the gains when they were off the dlUgs. Anabolic steroids may have an anti-catabolic effect. This means that the dmgs may prevent muscle breakdown that accompanies intense exercise training.

Anabolic steroids may block the effucts of hormones such as cortisol involved in tissue breakdown dW'ing and after exercise. Anabolic steroids may prevent tissue destruction following intense workouts. TIlis would speed recovelY. COliisol and related honnones, secreted by the adrenal cortex, also has receptor sites within skeletal muscle cells. Cortisol causes protein breakdown and helps stop inflal111mtion. DW'ing exercise, increased cortisol helps metabolize proteins for fuel and suppresses inflanmmtion tlmt occms with tissue stress and injwy.

Anabolic steroids nmy block cortisol binding to its receptor sites, which would prevent muscle breakdown and enhance recovelY. WIllie this is beneficial dming the time the athlete is taking the dmg, the effect backfires when he or she stops taking it. Hor11lOnal adaptations occm in response to tile abnOlmal amoW1t of male hormone present in the athlete's body. Cortisol receptor sites and cortisol secretion fi'om the adrenal cortex JI1crease.

Anabolic steroid use decreases the body's natural testosterone production. People who stop taking steroids are also hampered with less male hOlmone than usual dming the "off' periods. The catabolic effects of cortisol are enhanced when the athlete stops taking the drugs and strength and muscle size are lost at a rapid rate.

The rebOlmd effect of cOliisol and its receptors presents people who use anabolic steroids with several serious problems: (1) psychological addiction is more probable because they become dependent on the dIugs. This is because tlley tend to lose strength and size rapidly when off steroids. To stave off deconditioning, athletes may want to take the dlUgs for long periods to prevent fulling behind. (2) Long-telm adtninistration increases the chance of serious side effects. (3) Cortisol suppresses the irrunW1e system This makes steroid users more prone to diseases, such as colds and flu, dming the period inlmediately

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following steroid administratiotL

Many athletes combat this cotiisol effect by never going off the dlugs. In the past, athletes cycled on and off steroids because they thought that the receptors "down regulated," and they became less sensitive to the dtug. Some people believe that as long as the dosage is high enough, the receptors do not lose sensitivity and that gains can occw- continuously. WIllie it is difficult to prove this hypothesis one way or another, the incredible size of many modern bodybuilders who pw-potiedly stay on anabolic steroids continuously would support this position.

3.3. Psychological Effects V Anabolic steroids increase aggressiveness, which helps athletes train huder.

Some researchers think that steroids woti( by making athletes feel better and more aggressive. The improved sense of well being and euphoria, as well as an increased tolerance to stress, allows athletes to train harder. This "steroid high", if it exists, helps experienced athletes more than novices because they know how to push themselves harder in practice and competition.

3.4. Neural Effects of Steroids V Anabolic steroids might enhance neuml activation.

The new-a I effects of steroids have been tllder appreciated and under studied by scientists. Growth hormone has much greater anabolic effects than anabolic steroids. Yet, anabolic steroids remain the drugs of choice for power athletes. In the 1970s, several studies by Ariel showed that steroids enhanced new-al activation. Steroids affect protein metabolism in nerve cells that are inlpotiant for nelve-cell swviva~ function, and transmission of nelve impulses.

4. Anabolic Steroids and Performance V Anabolic steroids increase st"ength, power, and muscle mass. They also have a strong placebo effect- they work by the power of suggestion.

The effects of anabolic steroids on physical pelfonnance are tllclear. Well controlled, double blind studies (neither test subject nor researchers lmow who is getting the steroids) have given conflicting results. In studies showing beneficial effects, body weight increased by an average of about fow- POlllds, lean body weight by about six pounds (fut loss accounts for the difference between gains in lean mass and body weight), bench press increased by about 15 pounds, and squats by about 30 pounds. These values represent the average gains for all studies showing a beneficial effect. Almost all studies have fuiled to demonstrate a beneficial effect on maxinlal oxygen constlllption or endw-ance capacity. Anabolic steroids studies have typically lasted six to eight weeks, administered low doses of the drug, and have usually used relatively untrained subjects.

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Most changes in strength during the early part of training are neural: increased strength is mainly due to an improved ability to recruit motor units. Anabolic steroids affect processes associated with protein synthesis in muscle. Studies lasting six weeks (typical study length) would largely reflect neural changes and could easily miss the cellular effects of the drugs.

The gains made by athletes in uncontrolled observations have been more impressive. Weight gains of thirty or forty pounds, coupled with thirty percent increases in strength, are usual Such case studies lack credibility because of the absence of scientific controls. However, it would bc foolish to ignore such observations because the "subjects" were highly trained and motivated athletes.

5. Health Effects of Anabolic Steroids "'fir Anabolic steroids can have side effects ranging from mild to life-threatening.

U.S. President George Bush mentioned anabolic steroids in his 2005 State ofthe Union address and in a speech he made in St. Louis where he threw the first baseball of the season at a Cardinals game. Obviously, people are upset and eonfused about steroid use in spOlis. Notorious eases of purported steroid use, sueh as by football great Lyle Alzedo (died fi'om brain cancer at age 38), major league homerun hitters, and pro wrestler Chris Benoit (murder-suicide) are sensationalized by the media, which makes it even more difficult to objectively assess tlle effects, health risks, and ethics of anabolic steroid use. Unfortunately, the drugs have become so politicized that most people do not care about tlle tmili. As usual, discussions about steroids and doping in general received considerable media attention at the Olympic games in London and Beijing.

For years, physicians told athletes that steroids do not work and cause catastrophic side effects. In reality, anabolic steroids improve pelfonnance- particularly in high doses. While steroids sometimes have side effects, they are usually minor. Steroids- along with progress in training, technique, and sports nutrition-- are patiially responsible for improved pelfonnance in baseball, track and field, and swimming and the increased size of bodybuilders and athletes in contact sports.

Athletes- particularly bodybuilders, throwers, weight1iflers, and football players- have been taking steroids since the 1950s. Physicians predicted increased I110rtality and morbidity for these atlJ!etes, but no one has ever produced the epidemiological evidence to support those claims.

This does not mean that steroids are safe or that they do not cause people to die prernaturely- it only means that the health risks have not been documented scientifically. In spite of dire wamings against steroids and scores of laws and regulations prolnbiting their use, only one population study that has examined the long-term health risks of anabolic steroids (Parssinen et ai, 2000). 111at was a small study that did not provide lnany answers.

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5.1. Minor Side Effects V Minor side effects typically reverse themselves when athletes stop taking the drugs.

Minor side effects occur with steroid use- particularly at higher doses. Most bodybuilders and strength- trained athletes experience acne, increased sex drive and aggression, and fluid retention. Spetm count drops in ahnost evetyone who takes the dmgs for more than 4-6 weeks, but they usually return to normal within several months. Prolonged use will cause shrinkage of the testes. Many athletes take hun1an chorionic gonadotropin toward the end of a steroid cycle and into recovety to help n1aintain natural production of testosterone and nOlmal testicular function. These side effects are common but variable and depend on the type and dosage of the dmg.

Steroid side effects are greater in children and women than in adult men. Steroids can cause the bone growth centers to close prematurely, increase the severity of acne, and trigger psychological disturbances in already volatile teens. Women who take steroids may experience hair loss, abnormal hair growth, clitoral hypertrophy, ll1ascu1inization, increased sex drive, and abnormal menstrual cycles.

The psychological side effects- the so-called "roid rage"- have become an urban legend. The psychiatric literature shows that clinical cases of steroids-induced psychosis are extremely rare but do occur. The media immediately linked the murder-suicide of pro wrestler Chtis Benoit to steroid use. It is impossible to say for sure what role, if any, steroid use had in tlle tragedy. Y Olmg people- even athletes- sometimes develop mental illnesses. That does not mean they are cause by steroids. There are no definitive studies linking steroid use to mental illness. Steroids increase aggressiveness and the risk of psychotic episodes in some people.

Other common side effects are more variable. Steroids uigger high blood pressure in some athletes, but the effects usually reverse themselves when going off the dmgs. Others experience l1air loss that can be u'eated with anti-balding medication. Gynecomastia- the development offell1ale-like breast tissue- occurs in some people, particularly those who use dmgs that aroll1atize easily to estrogen. Some athletes take an aroll1atase inhtbitor to prevent breast growth. This problem often requires surgery. Finally, some athletes experience muscle cramping and nasal bleeding that are annoying but not life threatening.

5.2. Serious Side Effects: Premature Death, Heart Attack, and Cancer V Steroids might cause premature death, but we need more evidence.

Health experts cite premature death, heatt attack, and cancer as the ll1ajor reasons for avoiding anabolic steroids. Surprisingly, most of these opinions are based on circumstantial evidence rather than experimental research.

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5.2.1. Steroids and Longevity V In spite of widespread usage of steroids since the 1960s, we have little evidence that they decrease longevity.

Widespread steroid use in athletics started in the late 1960s. Athletes who competed then

- the baby boom generation- are reaching retirement age. It is curious that only one small study examined longevity in fo=er steroid users and that study did not provide many answers. Finnish researchers examined death rates of 62 male power1ifters who

competed between 1977 and 1982 compared to a control population of over 1000 men. They assumed a high rate of anabolic steroid use in the powerlifters. They found that

12.9% of the powerlifters died, compared to only 3.1% of the control population.

Powerlifters died fi'om suicide (3 people), heart attacks (3 people), liver fuilure (1 person), and non-Hodgkin's lymphoma (1 person). The authors stated that these findings

add to the growing amount of evidence of an association between anabolic steroid abuse and early death, and support the view that measures to decrease steroid misuse in both

competitive and amateur athletes is justified.

While the researchers may be right- steroid users may not live as long as other peopletheir conclusion is an example of using selective evidence to condemn steroids. They

based their conclusions on the deaths of eight athletes, three of whom were suicides. No study has ever linked past steroid use (30 years prior to their deaths) with suicide.

The lifestyle off01mer powerlifters may have a lot to do with their longevity. Many studies

of old athletes show that life-long exercise, diet, and health habits are critical for a long life. Power1ifters may die young because they may not practice endurance exercise. They may

have other habits that contribute to early death, such as excessive alcohol consumption or poor diet. Many studies show that men who are shorter, lighter live longer than those who

are taller and heavier. Powerlifters may die at a younger age because they have more muscle than the average person.

Steroid use may indeed sh01ten your life. Some studies paint a bleak picture of the longtelm use of steroids. For example, a study by Bronson and co-workers gave mice

anabolic steroids for 6 months at doses either 5 times or 20 times their n01mal circulating levels of testosterone. Fifty-two percent of the mice given the high dose of steroids died

compared with 35% of the mice given the low dose and only 12% of the control mice given no steroids. Steroid using mice that died showed sel10us heart and liver damage. Tlying to assess the health risks of anabolic steroids is a scientific minefield. Steroid abuse

can cause serious, sometimes life-threatening side effects.

Other studies show that these dlUgs may playa role in improving the quality of life in older adults. Middle aged men given high doses of testosterone (600 mg per week) showed

increases in muscle mass and strength and decreases abd01ninal fut. They showed no signs of heart disease, elevated blood pressure, prostate enlargement, or serious changes in

blood fats. It is lmclear whether these benefits outweigh possible risks, but prescriptions

for testosterone to aging men have increased substantially.

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5.2.2. Heart Disease V Low testosterone levels increase the risk of heart disease. The effects of recreational use of anabolic steroids on cardiovascular health are unknown.

Go to almost any locker room around the world and you will see warning signs against using anabolic steroids and testosterone. The signs wam-- in bold letters- that steroids promote atherosclerosis and heart attack.

A look at the medical literature quickly shows that not only is testosterone not linked to atherosclerosis, but it may promote the health of the cells lining the blood vessels- the endothelimn-- and prevent disease. Men with higher testosterone have less abdominal fat, better functioning endothelial cells, and better blood sugar control---- showing that having at least nOl1nal levels of testosterone is good for you. In fact, low levels of fi'ee testosterone may be a lisk fuctor for atherosclerosis. Treatment with testosterone could protect against the disease.

What about the high doses of testosterone and anabolic steroids used by some bodybuilders? That may be another StOlY. Some studies suggest that abnonnally high levels of testosterone (or testosterone-like dmgs) lnay pro11lOte insulin resistance and the negative side effects that go with it- high blood pressure, abnOlmal blood lipids, and blood clotting proble11lS. At this point, we do not know the longtelm effects of high doses oftestosterone on the heatt and blood vessels.

Large doses of steroids build muscle even in the absence of exercise. The heatt is a muscle and will grow in response to heavy weight lifting and anabolic hormones. Heart damage is the biggest long-term risk of heavy steroid use. The evidence for heart damage is not that cleat-. Bodybuilders and power athletes often have enlarged heatts- even when they do not take steroids. While high doses of steroids decrease lIDL, the dmgs have no effects or decrease LDL and triglycerides- blood lipids that pro11lOte heatt disease. In addition, steroids increase an antioxidant that protects against heart disease.

The decrease in blood levels ofHDL choiesterollllight not promote hemt disease. It might reflect an accelerated rate of cholesterol transport. lIDL levels decrease dramatically in steroid users. A normal value for a young man is 45 rnilligra11lS per 100 miIliliters of blood. Steroid users often have levels less than 20 mgllOO ml---- anything under 35 mg per 100 ml of blood suggests an increased risk of coronaty artery disease. Yet, in spite of years of steroid use, no study has obselved an increased death rate fi-om heart disease in aging bodybuilders and other weight trained athletes.

Some athletes who died from heart attacks and heatt fuihn'e were steroid users. Some auimal studies show that high doses of steroids can damage hem'! muscle. We do not have large population studies showing an increased death rate among, so it is premature to say . that steroids cause heatt proble11lS. Strength trained athletes who used steroids should be aware of wanling signs of hemt proble11lS, such as hypeltension, abnOlmal blood lipids (high cholesterol, LDL, and triglycerides and low lIDL), shortness of breath, chest pain, abnonnal blood chemisny (e.g., elevated creatine kinase, lactate dehydrogenase, C-

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reactive protein).

5.2.3. Anabolic Steroids and Cancer V Anabolic steroids increase the growth rate of cells, but we have little evidence that it causes or promotes cancer.

When the fumous pro football player Lyle Alzedo died of brain cancer at age 38, many people blamed anabolic steroids- even without evidence. UnfOltunately, young people sometimes die fi'om cancer. Just because one of these patients also took anabolic steroids in the past does not mean that steroids caused the problem.

High doses of anabolic steroids increase growth fuctors- such as IGF-I, which might promote cancers of the colon, pancreas, and prostate. Oral anabolic steroids can be toxic to the liver and may trigger liver tumors. As with heart disease, we can infer fi'om indirect evidence that taking high doses of steroids may increase the Jisk of cancer. Anything that triggers high tissue growth rates might increase the growth of cancer cells, too. However, there are no large population studies linking anabolic steroid use to increased cancer risk.

6. Importance of Dosage V Anabolic steroids al'e most effective at higher doses. However, side effects also increase with dosage.

It was not until the early 1970s that scientists began studying the effects of anabolic steroids on muscle mass, strength, and athletic pelformance. SurpJisingly, many of these studies showed that the drugs did not improve peIiormance or change body composition. Scientists believed that the placebo effect caused most of the gains.

Mainstream scientists and professional organizations- such as the American College of Sports Medicine- came out strongly against steroids. They said that any gains in muscle mass, strength, or endurance are small and not wOlth the potential deadly health risks. In the gym, many men made substantial gains with minimal side effects. Serious strength athletes knew that most sports scientists and physicians were seriously misinformed about anabolic steroids.

How could anabolic steroids appear to work so well in bodybuilders and power athletes in the real world but fuil to reach significance in well-controlled scientific studies? A series of studies led by Shalender Bhasin fi'om Boston University and Tom Storer fi'om El Camino College helped answer the question. They found that steroid dosage was the key the effectiveness of the drug. They gave 600 mg of testosterone enanthate or placebo to subjects who were either lifting weights or sedentalY for 10 weeks. Unlike most previons studies, they showed that steroids had marked effects on muscle and strength. People who take large doses of testosterone gain lean tissue, strength, and muscle size- even if they did not lift weights. Subjects given testosterone gained 20 pounds in the bench, 30 pounds in the squat, and made substantial gains in arm and thigh muscle size- without

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lifting weights.

Subjects who lifted weights and took the steroids did even better. TIley gained nearly 50 pOlmds in the bench and 80 pOlmds in the squat and put on more than 12 pounds oflean tissue. The gains people made in this study rivaled those we hear about in gym legends. Scientific studies showing that steroids did not work were wrong because they used low doses of the dmgs.

Bhasin's group pelformed several other studies showing that gains in strength vary directly with blood testosterone levels- the higher the blood testosterone the greater the gains in strength and muscle size £i'om the weight training program Just as important, taking low doses of testosterone or anabolic steroids decreased testosterone production in the testes and reduced the capacity for muscle hypertrophy.

6.1. Why Low Steroid Doses Are Ineffective

© UNESCO-EOLSS Encyclopedia ofLi£ SuppOl1 Systems

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4/14/2014 WHY LOW STEROID DOSES ARE INEFFECTIVE

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SPORT AND EXERCISE PHYSIOLOGY: PERFORMANCEENHANCING SUBSTANCES - ANABOLIC STEROIDS

Thomas Fahey California State University, Chico Department of Kinesiology, Chico, CA 95929, USA

Michael Kalinski Chair, Department of Applied Health Science, Murray University, 408 B North Applied Science Building, Murray, KY 42071-3347

Michael Fahey Chico, CA, USA

Keywords: anabolic steroids, ergogenic aids, sports, doping, Olympics, USSR, professional baseball, muscle strength, testosterone, prematw'e death, androgens, exercise

physiology, ethics in sport, athletics, football, bodybuilding

Contents

l.Introduction 2.Anabolic Steroids: Historical Perspective 2.1.Historical Perspective

2.2.State-Sponsored Doping Research Program in Fonner Soviet Union

3.How Anabolic Steroids Work 3.1.Steroid Receptors

3.2.Anti-Catabolic Effects of Anabolic Steroids 3.3.Psychological Effects

3.4.Nelll'al effects of steroids 4.Anabolic steroids and performance

5.Hea lth effucts of anabolic steroids 5. I .Minor side effucts

5.2.Serious Side Effects: Prematlll'e Death, Heart Attack, and Cancer 5.2.I .Steroids and longevity

5.2 .2 .He31t disease 5.2.3.Cancer

6.lmpOltance of dosage 6.1. Why low steroid doses are ineffective

6.2 .Health lisks of higher testosterone doses

6.3.Are athletes guinea pigs for large dose steroid research? 7.Anabolic steroids and the law

7. I .The myth of the level playing field

7.2.Anabolic steroids are unhealthy

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7.3 .Drug testing and the law 7.4.Should steroid use be permitted in sports? Related Chapters Bibliography Biographical Sketches

6.1. Why Low Steroid Doses al'e ineffective V Anabolic steroids suppress the nonnal release of testosterone. Taking low doses replaces natural testosterone with exogenous hormone.

The body controls testosterone levels much lil(e the thermostat in a house controls room temperature. The testes make most testosterone. When blood testosterone levels are low, the brain 01ypothalamus and pituitary) releases chemicals that stimulate the testes to make new testosterone. Likewise, when blood testosterone is high, the brain tmns off these controlling chemicals, which slows down normal testosterone production in the testes.

Taking low doses of testosterone or anabolic steroids have little effect on pelformance or body composition. Initially, supplementation increases blood testosterone levels, which gives the training program a temporary boost. However, the body's hormone control system quickly kicks in, which decreases the levels of testosterone control chemicals (GRH, LH, FSH) and reduces blood testosterone to normal or below. Difficulties alise when athletes stop taking testosterone supplements. They have lower than nonnal blood testosterone levels and it takes time to restore normal androgen control.

Testosterone is either bound or unbound. Some is bound to sex hormone binding globulin, which severely decreases its biological availability. Bhasin and co-workers showed that bound testosterone increases during low dose testosterone supplementation. Low-dose testosterone supplements shuts down normal testosterone production, and the relnaining testosterone does not work as well Athletes taking low doses of testosterone or anabolic steroids decrease their capacity for making training gains. They quickly lose any gains they made and deplete natural testosterone levels.

6.2. Health Risks of Higher Testosterone Doses V The health l1Sks of anabolic steroids increase at higher doses.

Normal blood testosterone in young men (18-40 years old) v31ies between 350-1200 nanograms per 100 milliters of blood. Even without supplements, the ability to gain strength depends on how much testosterone is in the blood. To increase gains in strength or muscle mass, athletes must increase blood testosterone above normal levels. Bhasin and co-workers showed that it took 300 mg or more of testosterone per week to increase blood testosterone above nonnal levels. Taking 600 mg per week increased blood testosterone to 2500 ng'100 ml of blood, which is more than double the highest level ofthe nonnal range.

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Taking 150 mg of testosterone per week never increased blood testosterone above 500

ngilOO mi. In other words, taking even standard doses (2 cc of most types of testosterone) does not increase blood testosterone to levels needed to build muscle and

strength at a Jaster rate than nOlTIJal Athletes need at least 300 mg per week to exceed

norllJal blood testosterone by even a little. Low doses shut down norllJal testosterone production, so they quickly lose any gains they llJade when they cycle off the dtugs.

Serious bodybuilders and strength athletes who nse steroids typically take stacks of at least 600-2000 mg per week of various fonTIS of testosterone and anabolic steroids,

combined with other anabolic supplements, such as growth hOlTI10ne, IGF-l, clenbuterol, and creatine monohydrate. They also take drugs, such a N olvadex, to prevent

gynecollJastia (growth of breast tissue), and human chorionic gonadotropin (HeG) to

boost normal testosterone production. These anabolic supplement programs account for the incredible increase in size and strength that we have seen in bodybuilders and other

weight trained athletes.

Side effects increase with dosage. Large doses decrease HDL cholesterol and APO-Al,

which are thought to protect against heart disease. Only time will tell if athletes who take

high dose testosterone supplements will have an increased lisk of he31i attack. Surprisingly, there is little evidence that high dose testosterone supplements cause prostate

gland enlargement. This is a big fear in the medical comnnU1ity. However, prostate specific

antigen values (PSA; a test used to predict prostate enlargement and cancer) rellJain norllJal during high dose testosterone administratioIL

Another risk is roid rage. Most objective studies show that "roid rage" is largely a myth.

However, it does occur in susceptible people, particularly at high doses. About 10% or more of the bodybuilders who take more than 600 mg per week of testosterone can

expect sel10ns and possibly dangerous psychological effects.

What the Studies Tell Us about Dosage and Anabolic Steroid Effectiveness

• Doses below 300 mg per week will not raise testosterone levels above nOlma~ except for a ShOli tinte after the injection. After injecting the hOlmone, the body

decreases its natural production oftestosterone. This will reduce blood testosterone levels to nOlmal or even below nOlmallevels.

• It takes at least 300 mg of testosterone per week to increase blood levels above nonna!. Taking 600 mglweek, will at least double blood testosterone levels.

Strength and mnscle mass gains are directly propOliional to blood testosterone levels- the higher the blood levels of the hOlTI10ne, the greater the gains in mnscle

llJaSS and strengtll.

• The risk of side effects increase at higher doses. The type of steroid (oral or injectable, oil or water based) also influences the nature and sel10nsness of these

side effects. Sedons bodybuilders and strength-trained atllletes who nse steroids

typically also use drugs to prevent gynecollJastia and testicular atrophy.

• High doses of oral anabolic steroids can be toxic to the liver. Oral drugs stay in the

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system longer, which can damage liver fimction when they are taken in high doses.

• High doses of testosterone increase the chances of testing positive dUling a drug test. The test measmes the ratio of testosterone to epitestosterone- a natmal breakdown product of testosterone. High doses will elevate the ratio above allowable levels. Athletes who take high doses are more likely to test positive dming doping control Taking low doses to escape detection provides few benefits because testosterone levels will drop to nOlmal or below.

Almost eveIY bodybuilder or strength athlete is tempted to tty steroids. Research sttriies tell us that long- term effectiveness requires high doses of testosterone, but high doses cause more side effects. Effective, inexpensive supplements, such as creatine monohydrate, may work just as well or better than taking low doses of testosterone or testosterone-like anabolic steroids. High doses of testosterone- 300 mglweek or more - will increase muscle mass and strength--- even without weight tt'aining but will invariably cause some side effects in ahnost all athletes.

6.3. Are Athletes Guinea Pigs for Large Dose Steroid Research? V We don't know the long-term effects of anabolic steroid use in athletes.

In the 1970s, a typical steroid dose for serious bodybuilders in the United States was 200 mg of Deca-Dmabolin per week, stacked with 25-50 mg of Dianabol per day, and perhaps 20 milligrams of Anavar per day. Today, many athletes greatly exceed these levels. Some athletes take more than 3000 mg of testosterone per week stacked with growth honnone, insulin, clenbuterol, and a host of nutritional supplements. Any substance - even water- used in excess will cause side effects. Modem stt'ength tt'ained athletes who take large doses of these drugs will undoubtedly have potentially lethal side effects. Will high doses of steroids cause prematme death, heati attack, and cancer? We will not know until scientists conduct large-scale epidemiological studies. With more than 17 million anabolic steroid users in America and millions more arolmd the world, scientists have a large population to sttldy.

7. Anabolic Steroids and the Law V Laws against anabolic steroid use in many countties has placed athletes who use steroids in legal jeopardy.

In 1990, the United States Congress passed the Anabolic Steroid Contt'ol Act, which became effective on February 21, 1991. The Steroid Act classified 27 anabolic steroids as Schedule III substances. The law gave the U.S. Drug Enforcement Agency power to resttict the impOltation, expOltation, distribution, and dispensing of anabolic steroids. The law was amended in March II, 2004 (S.2195) to include "pro-hormones," such as androstenedione, which are metabolized to testosterone. Physicians were prohibited fi'om prescribing anabolic steroids to athletes for enhancing athletic pelformance.

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As discussed, President Bush mentioned anabolic steroids use in his State of the Union address in 2004: 'To help children make right choices, they need good examples. Athletics play such an impOliant role in our society, but, unfortunately, some in professional sports are not setting much of an example. TI1e use of pelformance-enhancing dmgs like steroids in baseball, football, and other sports is dangerous, and it sends the wrong message - that there are shortcuts to accomplishment, and that pelformance is more impOliant than character. So, tonight I call on team owners, lmion representatives, coaches, and players to take the lead, to send the right signal, to get tough, and to get tid of steroids now."

Dmg scandals plague sport at ahnost evelY level. Allegations of dmg use by professional and Olympic athletes in the BALCO affair and by athletes competing in the Tour de France are only the latest incidents in the long history of dmg use in sport. CBS SpOlis list of notorious sports doping incidents included:

• Institutionalized sports drug programs in the USSR, East Gennany, and China,

• TIle lnassive exodus of athletes fi'om the Pan American Games in 1983 to avoid mug testing,

• Ben Johnson's steroid disqualification from the 1998 Olympic Games,

• Institutionalized cover-up of American athletes who tested positive for banned substances by the United States Olympic Committee,

• Wide-spread use of elythropoietin (EPO) and blood doping by athletes in the Tour de France and Nordic ski racing

• Anabolic steroid use in baseball and American football,

• Contamination of over-the-counter food supplements with anabolic steroids.

These drug controversies involve athletes taking prolubited substances to maximize perfOlmance and the spOlis hierarchy's attempts to stop them

Dmg use is widespread in spOlis but politicians, professional health organizations and athletic administrators want to prevent athletes ji-om using them Other scientists and ethicists argue that we are losing the war on drugs and spOli and needlessly squandering resources that could be devoted to the sports themselves. The issues sUiTounding prohibiting steroid use in amateUl', Olympic, and professional sports are complex and include steroids and the "level playing field," the health l1$ks of anabolic steroids, the

U1llaturamess of anabolic steroids, the 4 til Amendment and drug testing, the balance between the goals of athletes versus the goals of society, and institutional responsibility for preventing drug use in sport.

Anabolic steroids should be banned in sports but not for the reasons cited by politicians, physicians, sports administrators, and the media. While steroids help some athletes inlProve their performance, they are contraty to goals of sport in the society. The benefits

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of allowing a few elite athletes to use drugs to prepare them for competition is overshadowed by the harm caused to society by allowing the widespread use of drugs by people who have no chance of excelling in sports.

University of Texas, Austin historian John Hoberman discussed the ambivalence and inconsistency in America regarding the general use of perfOlmance enhancing mugs and drug testing athletes in his book Testosterone Dreams: Rejuvenation, Aphrodisia, Doping (2004). Hucksters promoted testicular extracts to increase vitality and sexual potency since the 1880s. Testosterone was synthesized and used clinically beginning in 1933 to treat sexual problems in men and women and, later to promote muscle growth and strength. Hoberman said that while drug use was fi·owned upon in amateur sports, it was accepted in professional spOlis. Incidents that turned the tide of public opinion included Ben Johnson's steroid disqualification in the 1988 Olympics, Mark McGuire's alleged use of anm·ostenedione (a legal supplement), and the BALeO drug scandal These incidents conflicted with sacred traditions and Ametican folklore, such as Babe Ruth's season homerun record and the myth of the amateur purity of Olyrnpic athletes.

The public embraces performance-enhancing substances to help people excel in schoo~ the workplace, and in the bedroom. Millions take mood stabilizers, such as Prozac, and "mind enhancers," such as modafinil (Provigil). Symphony conductors and public speakers often take beta-blockers or tranquilizers to reduce anxiety before perfOlmances or lectures. These drugs increase productivity and mental focus, and perhaps income, but few people fimlt those who use them. Nobody fuults mouutain climbers for using supplemental oxygen, yet some record setting climbs could not be accomplished without it. D11lgs that treat erectile dysfuuction, such as Viagra, have boosted sexual perfOlmance in an entire generation of aging men.

Geriatrics and quality of life enhancement of older patients in general practice are the fustest growing areas in medicine. Many physicians prescribe testosterone and growth honnone to aging patients to improve sexual capacity, vitality, and physical fitness. Few of these patients need hormone replacement therapy (HRT) to compensate for h0l1llOne deficiencies. Rather, they take hOlmones to improve the quality oflife. Should athletes be deprived of medical treatments used by average people that retard some of the effects of aging and improve physical perfOlmance?

Public expectations add to the inconsistency. Spectators pay to see elite athletes playing at the top of their game. Pro football linemen ji-om the 1950s often weighed less than 220 pouuds, while the average lineman in 2013 weighs more than 320 pouuds. Division I football players in some positions increased in size and strength by more than 20 percent in the last 20 years. While players fi·om 25 years ago were great athletes, they did not have the crowd appeal of to day's lightning-fust behemoths. People want to see largerthan-life bodybuilders, hitters pouuding the baJJ over the outside wall, and sprinters ruuning faster than ever. New tr·aining methods, improved sports nutrition, and effective supplements and drugs have pushed performances to higher levels.

The economic incentive to use steroids is almost irresistible in some SpOltS. However, players make so much more money than the average person that people hold them to a

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higher moral standard than ordinaty people. This phenomenon was described by Paul Weiler: "In 1947 the average baseball player earned $11,000 a year, a little rnore than four times the pay of the average American worker. In 1967, the average player earned $19,000, about 3.5 times the $5,500 average for workers. In 1973 baseball salaries had jumped to $36,000, but workers too had generally experienced a large gain (to $9,500), leaving the player-worker ratio still a little under the 1947 level However, by 1999 the average baseball player was earning $1.57 million, while the average worker earned just $28,000: a ratio of 56 to one. Although the gap between CEOs' and workers' earnings is still much larger, the ratio of baseball players' pay to that of workers has been rising much faster." Elite athletes are cultural icons who have enormous influence on the behavior of ordinary people. Purity of pro and Olympic athletes is part of the popular tradition and folklore.

Business executives can take Prozac or modafinil to increase productivity and graduate students take those drugs to improve peJformance on the Graduate Record Examination, but athletes call11ot take steroids to break legendalyathletic records. Steroids violate our perceptions and illusions about sport, which is the real reason they are banned in athletic competitions.

7.1. The Myth ofthe Level Playing Field V Do anabolic steroids create an unfair advantage?

Per-Olaf Astrand, a illmous physiology professor Ji-orn Sweden, once said, "Choose your parents velY carefully if you want to be an Olympic champion." Elite athletic competitions in Olympic spOlis, professional baseball, football, basketball, and hockey are contests between genetically gifted men and women.

The Genome project, completed in 2002, identified the human gene sequences. Most genes have variants called polymOlphisms that cause individual differences in every human characteristic, including intelligence, susceptibility to disease, reaction to drugs, muscle strength, and appearance.

Researchers discovered more about genes in the last 10 years than dUlIDg our entire histOlY. Athletic pelformance has a strong genetic component. Scientists have identified more than 800 genes linked to endmance, strength, power, illt deposition, and illt use.

The Heritage Family Study is a massive research project that explored the role of genetics in weight loss, diet, and exercise programs. The study showed the important contribution to genetics in response to exercise and diet. People showed highly variable responses when following the same diet or exercise program Some people make 50 percent improvements, willie others inlprove only 2 to 3 percent. Changes in fitness and illt are more difficult in non-responders.

The level playing field is a myth. People without key gene valiants call11ot achieve elite levels of pelfonnance. Athletic officials propagate the myth that anyone can be a champion if they work hard enough. Typical is a statement by Juan Antonio Samaranch,

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past president of the Intemational Olympic Committee who said, 'Doping is not only a danger for the health of athletes, and it also constitutes a fOlm of cheating which we cannot accept. Such behavior makes a mockery of the very essence of sport, and our most sacrosanct ideals: the inner desire to swpass one's own limits, the social need to compete with others, to find one's identity within society and to develop at all levels. " Is it a level playing field when people with genes that naturally give them superior athletic ability compete against those who do not?

Two notable bioethicists-Nonmn Fost, Director of the Medical Ethics Program at the University of Wisconsin Medical School and Julian Savulescu, Chair in Practical Ethics at Oxford alluded to the fallaciousness and hypoctisy inherent in of the level playing field argument. Fost rejected the idea that athletes are coerced to use steroids to be successful. Steroids, along with weight training, confer an advantage but athletes are fi·ee not to pmiicipate. Football also requires backbreaking work, hours in the weight room, and chronic pain fi·om contact that can last a lifetime. Athletes who say they are coerced to use steroids fail to distinguish an oppOliunity fi·om a threat. They m·e also fi·ee not to use space-age weight tmchines, food supplements that work like drugs, mental techniques designed to improve focus, downhillmnning tracks, and plyometric benches.

F ost agreed that steroids are unnatural, but so are mnning shoes, weight machines, and athletic fluid replacement beverages. Why not insist that athletes lift rocks instead of training on space age weight lifting machines? There is no moral distinction between natural and artificial perfonmnce aids. In the 1988 Olympics in Soul, Ben Johnson was disgraced for taking steroids. He was called a cheater for taking advantage of his opponents. The sweethemi of the Olympics was swimming star Janet Evans who won in part because she wore a "speed suit" developed by American engineers that was kept secret fi·om the East Genmns. Evans used a performance aid that nobody else had while Johnson used steroids that were available to anyone and probably used by the majority of the athletes in the field. Johnson's problem was that he was caught- not that he had created an wlequal competition.

Fost argued that while steroids provide a competitive advantage, so does weight training, good nutrition, coaching, and equipment. Connuies such as the U.S., Russia, Britain, and China spend millions of dollars developing elite athletes. Poor countries, such as Sierra Leone, have difficulty providing u·ack shoes to their athletes. In third world counu·ies, socioeconomic status is highly related to physical factors such as height, weight, body tmss index, fat mass, and lean body mass- all of which are impOliant for athletic success.

Technological advances have always been part of spOlis. People used shoes to help them run on rocky, uneven surfaces, added spikes to increase u·action, and used high tech components to lighten their weight. In the 1940s, Comelius Warmerdam broke the 15-foot (4.57 m) bmTier in the pole vault using a bamboo pole. Bamboo was an improvement on rigid poles made fi·om pine. Today, 15-feet is not even a good high school mark. Advances in pole technology have enabled pole-vaulters to exceed 20 feet (6.10 Ill). The best vaulting poles are so expensive that they are unavailable to most athletes. Is this a level playing field?

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East African distance runners dominate the sport- in part- because they have greater running economy and higher ii-actional utilization of maximal oxygen consumption, possibly because of higher hemoglobin levels and mitochondrial density, than people in other parts of the world. Hemoglobin and mitochondria are impottant fuctors in oxygen metabolism Savulescu and Foddycited the case of Finnish skier Eoro Maentyranta. "In 1964, he won 2 gold medals. Subsequently it was found he had a genetic mutation that meant that he "natmally" had 40 to 50 percent more red blood cells than average. Was it fuir that he had a significant advantage given to him by chance? Why not match tUnning competitions by hematocrit (percent cells in the blood) and mitochondrial content just as they do by gender? Yet, when athletes take the chug EPO (erythropoietin) to increase their blood count, they are called cheaters.

Bobsledding is another good example where technology gives some people advantages over others. Nobody complained when the famous but rag-tag Jamaican bobsled team, shown in the film Cool Runnings, competed and lost using second-rate equipment against teams, such as Switzerland and Austtia, that used technologically advanced sleds. Yet, if the Jamaicans had tested positive for steroids there would have been an international

uproar.

Similar inequities exist in professional Spotts, such as baseball and American football. According to the New York Times, ''Big markets such as New York, Boston and Chicago offer more revenue opportunities than Kansas City, Minneapolis or Tampa. While the Yankees produced more than $300 million in local revenue last year, teams at the bottom of baseball generated less than $50 million, according to baseball executives." Major League baseball has a revenue shating plan, but it does not "level the playing field" in the abi1ity to hire the best players and create the optimal training environment.

Spotts are invented by people and have ever changing rules. Homerun hitters, such as Bany Bonds and Made McGuire who used petfonnance-enhancing substances electtified a dying game because of their stellar exploits. These brilliant athletes used supplements to help them prepare to play their best and they succeeded marvelously. Rule changes have accommodated the fotward pass, fiberglass poles, starting blocks, and the Fosbury flop. Anabolic steroids are in this tt·adition.

In sumrnaty, there is no level playing field in Spotts and there never has been. Steroids represent a training innovation that is no more unnattU"al than weight machines, sports dtinks, running shoes, or fiberglass poles. As stated by Savulescu and Foddy, ''Perfotmance enhancement is not against the spitit of sport; it is the spitit of sport. To choose to be better is to be hunJan. Athletes should be given this choice. Their welfare should be paramount. However, taking drugs is not necessatily cheating. The legalization of dtUgs in Spott may be fuirer and safer."

7.2. Anabolic Steroids are Unhealthy V Taking anabolic steroids in effective doses is unhealthy but are the health risks any higher than playing some sports?

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The Intemational Olympic Corrnnittee, politicians, media, and athletic administrators cite the health risks of anabolic steroids as a major reason for baIIDiog the dmgs. The media has whipped up a frenzy about steroids that is not based on scientific fact. Steroids have some side effects but most are reversible and mild. For some irrational reason, the press distorts and overstates them. They continue to dwell on the evils of steroids when the infonnation is patently fulse.

Betterman summarized the difficulty doing objective research on steroids: "Several athletes that I have worked with have accused spOlis scientists of using only selective evidence to show that steroids are dangerous. We cite random observations for evidence of adverse side effects. On the other hand, we require strictly controlled studies for evidence that the dmgs boost pelf0l11lance. Scientists cannot have it botll ways. They must look at the pluses and minuses ofthese drugs objectively."

Athletes often have trouble getting accmate infonnation fi'om physicians and scientists about the side effects of anabolic steroids. Steroids are so politicized that it is impossible to get an honest assessment of their risks fi'om healfu experts. Their typical reaction is to advise athletes to stay away fi'om steroids because tlle drugs are illegal and dangerous. There is a long list of side effects associated with anabolic steroid use, including acne, testicular atrophy, arteriosclerosis, prostate and liver cancers, and psychianic disturbances.

As discussed, steroids do not pose a deadly lisk in most people. Athletes have used steroids since fue 1930s, yet only one epidelniological smdy exists showing a link between steroids and premature death, and this smdy used only nine subjects. Steroids have side effects, but the risks are small compared to the risks in many sports. Legions of fonner football players are pennanently disabled fi'om playing the spOli. Gymnasts, downhill skiers, divers, lacrosse and rugby players, bike racers, boxers, wrestlers, equestrian athletes, and kayakers take lisks fuat fur exceed fuose posed by steroids. Should we ban fuese sports because they are dangerous and bad for the health? The risks posed by these sports far exceed fuose fi'om taking anabolic steroids. Shouldn't a competent adult who can make a rational decision about playing a crippling game make an infonned choice about taking anabolic steroids tlmt have relatively mild side effects?

7.3. Drug Testing and the Law V Athletes have a decreased expectation of privacy while under the protection, guidance, and supervision of organized sp0l1.

The Fourth Amendment of fue U.S. Constimtion states, ''The right of fue people to be secme in their persons, houses, papers, and effects, against unreasonable searches and seizmes, shall not be violated, and no wan'ants shall issue, but upon probable cause, supported by oafu or ajfumation, and paJiicularly describing the place to be searched, and the persons or things to be seized."

In summer of2005, Senator John McCain [R-AZ] introduced S.1114, the Clean Sports Act of2005. The lnain components of the bill included:

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4/14/2014 I,Iv}IY LOW STEROID DOSES ARE INEFFECTIVE

• It mandated that professional spot15 team conduct dlUg testiog of their players.

• It required public disc10sme of the names of athletes who test positive for banned substances.

• Athletes who test positive will be suspended for a minimwn of two years for the first violation and a lifetime ban for the second violation.

• It treated violations of this Act as unfair or deceptive acts or practices under the Federal Trade Commission Act.

TIle bill had not been passed as of the SWllmer of20 13.

Marvin Miller, former executive director of the Professional Baseball Players Association, said that the law is Wlconstitutional because players will be tested whether or not they are suspectcd of using performance-enhancing dlUgs:

"An employer can do this, and a union can agree to do tbis, as part of collective bargaioiog, but Congress can't. No govel111uent agency can conduct a search without first going to cowi and swcaring before a judge that there's a probable cause to believe that player 'X' is guilty. Until the judge gives that order, the person can't be searched."

Workers employed in occupations affecting public safety, such as airline pilots, railroad engineers, and truck drivers who tr'anspoti goods on interstate highways may be dlUg tested and are exceptions to Fowth Amendment when it comes to their job. Athletes do not meet that criterion, so dlUg testiog is a matter for collective bargaioiog. College and Olympic athletes, on the other band, are tested routinely because they are members of organizations that require it as a prerequisite for membership and participation in their events.

College and Olympic athletes are tested without probable cause, but they agree to yearroWld drug testing through membership in the governing bodies of their various spot15. Supporters of the bill cOWlter that Congress does have the power to mandate dlUg testing because maintaioiog pmity in sport is in the national interest. Keith Ausbrook, chief counsel for the House Govel111nent Refotlli Committee, speaking in favor of the bill said, "We think the record shows there's compelling interest in doing it to protect the integrity of the game and protect the health of players and children who look up to them."

Three cases, Ferguson v Charleston (532 U.S. 67), Chandler v. Miller (520 U.S. 305), and Vernonia School Dist. 47J v. Acton (515 U.S. 646) are particularly germane to government mandated dlUg tests for professional athletes. In Ferguson, the Medical University of South Carolina instituted a testing program in cooperation with the Charleston police to identny and prosecute expectant mothers who tested positive for cocaine. They did not obtain informed consent fi'om the patients. The court lUled, "While state hospital employees, like other citizens, may have a duty to provide the police with evidence of criminal conduct that such employees inadvertently acquire in the cow'se of routine treatment, such employees have a special obligation to make sme that the patients

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are fully infol1ned abont the patients' lights under the Federal Constitution's FOlUih Amendment--as standards of knowing waiver require--when such employees undertake to obtain such evidence from patients for the specific pmpose of incJiminating those patients."

In Chandler, a Georgia statute required a drug test before candidates could run for state office. The Libertalian Party nominees filed an action in the District Court. The District Comi and later the Eleventh Circuit Comi ruled against the petitioners based on precedents involving student athletes (Vemonia School Dist. 47J v. Acton 515 U.S. 646), Customs Service employees (Treasmy Employees v. Von Raab, 489 U.S. 656), and railway workers, (Skilmer v. Railway Labor Executives' Assn. 489 U.S. 602). While the comi ruled in Chandler that the m'ine tests were searches, "the statute served 'special needs' ," interests other than the ordinaty needs of law enforcement." Balancing the individual's privacy expectations against the State's interest in the dIug-testing program, the comt held the statute, as applied to petitioners, was consistent with the Fourth and Fomieenth Amendments. The US Supreme Comt overtumed these decisions lUling that, "Georgia's requit'ement that candidates for state office pass a drug test does not fit within the closely guarded categOlY of constitutionally pennissible suspicionless searches."

The Supreme Court's ruling in Vernonia School Dist. 47 J v. Acton has applicability to the question of F omih Amendtnent lights of professional athletes. The Vernonian School District is a small collection of schools located in Vemonian, Oregon. Due to a burgeoning dIug problem the school district initiated a dlUg-testing program for athletes in 1989 with the advice and consent of parental groups. The pmpose of the program was "to prevent student athletes fi'om using dlUgs, to protect their health and safety, and to provide dIug users with assistance programs."

In 1991, a seventh grade student named James Acton, was not allowed to patiicipate on the football team because his parents refused to sign the dI'ug testing consent form The parents filed an action on behalf of theil' son but the District Court ruled that the clailn was without merit and dismissed the action. The US Comt of Appeals for the Ninth Circuit reversed the decision, holding that the dlUg testing policy violated the Fourth and FOlll'teenth Amendments of the US Constitution and Atticle I of the Oregon Constitution. The US Supreme Court ruled that the school district athletic drug testing policy was acceptable because "the Policy was undeliaken in fiutherance of the government's responsibilities, under a public school system, as guardian and tutor of children entrusted to its care. For theil' own good and that of their classmates, public school children are routinely requit'ed to submit to various physical examinations and to be vaccinated against valious diseases . . . In the 1991-1992 school year, all 50 States requit'ed public school students to be vaccinated against diphtheria, measles, rubella, atId polio. Students within the school enwol11llent have a lesser expectation of privacy than members of the population generally. . . Legitimate privacy expectations are even less with regard to student athletes. By choosing to "go out for the team," they voluntarily subject themselves to a degree of regulation even higher than that imposed on students generally. . . . Somewhat like adults who choose to paliicipate in a "closely regulated industry," students who voluntalily participate in school athletics have reason to expect intrusions upon

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normal rights and plivileges, including plivacy. "

How do these nilings relate to professional sports? In Vemonia, the Court allowed random dlUg testing after demonstrating a selious dlUg problem in the school district. We agree with Glassman, who wrote, "In the absence of finding of a special need, no school district should be able to extend suspicionless dlUg testing to include participants in nonathletic extracullicular activities." As stated in Vernonia, "Students have a decreased expectation of privacy while under the protection, guidance, and supervision of the public school system" Is the same tlUe for professional athletes?

7.4. Should Steroid Use Be Pennitted in SpOlis? V Elite athletes are role models for millions of athletes around the world who will never achieve Olympic or professional levels in sport. Rules banning steroid use in spOlis are .iustified because they serve a greater good for society.

Two questions are critical: 1) Do the actions of professional athletes have a significant effect on the general population, and 2) Is there a demonstrated special need to single out professional athletes for waITantless searches? The answer to both questions is yes.

Athletes play an impOliant role in society. Children and adults look up to tllem and emulate their behavior. Last year nearly 3 million children played Little League baseball in the U.S. but only 750 athletes played in the llJajor leagues. The prospects for becoming a professional basketball player in the National Basketball Association are grimmer because team rosters are sllJaller. In Olympic spOlis, only threeatllletes can. compete in individual sports- if they meet mininlum quaIiJYing standards. In weightlifting, only three American men and women competed in the London Olympics because the U.S. team did not have enougI1 athletes who met the pelfOlmance standards. Most children have a better chance to win the lottery than to play elite sports.

There is no level playing field when it comes to athletic excellence. Elite athletes have genetic prerequisites. The average person without these genes has no chance to play pro baseball or compete in the Olympics- no matter how hard they train. However, people see the money, fume, and glOly heaped on athletic stars and they want to be one of them

Higl1 school and college athletes- and non-athletes- will use steroids if they think the dlUgs will improve pelfonnance. They say to the111Seives, "Bany Bonds broke the home nm record and he allegedly took steroids. IfI take steroids, I can be more like Bonds." Instead of developing life-long habits associated with a healthy lifestyle, they take dlUgs with dangerous side effects.

SpOli plays an impOliant role in society. It inlProves metabolic health, instills a sense of community, fosters a cOl11petitive work ethic, and promotes cooperation. While these benefits are debatable, they represent core values of oW' society. With tile exception of ll11proved metabolic health, the values of sport to the society are difficult to demonstrate experimentally. Like religion, they are a lnatter offuith rather than science.

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411412014 WHY LOW STEROID DOSES ARE INEFFECTIVE

As a society, we value Babe Ruth's 60 home rLms, futhers and sons playing catch on the li-ont lawn, families watching their kids play soccer, or li-iends watching the Olympics or a football game on television. Somehow, taking steroids ruins these images and SpOlt loses some of its wholesomeness. It does not matter that taking steroids is no more unnatural than training on weight machines, wearing support clothing in weight lifting, or using running shoes. Society will not SUppOlt steroid use.

EvelY sport has lules. For example, the American football field is 100 yards, a discus weighs 2 kilograms, the height of the basketball hoop is 3.05 meters, and players are allowed two selves for each point in tennis. Why not increase the length of the field to 140 yards or raise the basket to 4 meters? Sports organizations establish rules and players abide by them- even if the rules are arbitralyand ambiguous.

Most SPOltS have rules against taking steroids, so athletes must abide by them If they do not, they must be sanctioned just as they would be for breaking other rules. For example, in football a team is penalized 5 yards when a player is off sides. If a baseball player is abusive to the umpire, he can be ejected fi'om the game, fined, or suspended. Under the doping regulations, athletes who break the rules and take prohibited drugs are penalized with suspensions.

Sport has a special status in om society. Children and adults look up to elite athletes and emulate their behavior. TIle rights ofa few thousand elite athletes are of little consequence compared to the hatm dleir dmg use does to om perceptions about the value and wholesomeness of SpOlt.

Related Chapters V Click Here To View TIle Related Chapters

Bibliography V BloodwOlth, A., McNamee M. (2010) Clean Olympians? Doping and anti-dopnlg: the views of talented young British athletes. Il/t.J Drllg Policy 21:276-82 .. [Most athletes support anti-doping effolts by organized spOlt. This study summarized the attitudes of young British athletes toward doping].

Bronson, F. H., Matheme C. M. (1997) Exposure to anabolic-androgenic steroids shortens life span of male mice. Med Sci Sports Exerc 29: 615-9. [This study provides evidence ill animals that anabolic steroids decrease longevity].

Brown-Sequard C.(1989) Note on the effects produced on man by subcutaneous illjections ofa liquid obtained liOln the testicles of annnals. Lancet 2: 105-107.[This was a pioneerillg study on the physiology oftestos terone.

Duchaine, D., (1989) UI/dergrollnd Steroid Handbook II Venice, CA: HLR Technical Books, 1989. [This book, and its predecessor "The Underground Steroid Handbook" provided practical advice far illegal steroid use].

Fahey, T. D. (1997) Phannacalogy of bodybuildillg. In: The Clinical Pharmacology of Sport and Exercise, cditcd by T. Reilly and M. Onuc. Amsterdam' Excepta Medica, p. 145-155. [This book is the proceedings of an intcmational conference on drug use in sport.

Fast, N. (1986) Banning Dmgs in Sports: A Skeptical View. Hastings Cel/ter Report 16: 5-10. [This

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article discussed the ethics of drug use in SpOlt].

Golestani R, Slart RH, Dullaart RP,Giaudemans AW, Zeebregts 0, Boersma RH, Tio RA, DierckxRA , . (2012) Adverse cardiovascular cffccts of anabolic steroids: pathophysiology imaging. Eur J Clin Invest 42: 795-803. [This review of literaturc discussed imaging studies showing the pathological effects of anabolic steroids on the cardiovascular system].

Graham, M. R , et a1. (2008) Anabolic steroid use: Pattems of use and detection of doping. Sports Med. 38: 505--525. [This revicw of litcrature discussed used patterns of anabolic stcroids and doping control techniques.

Hoberman , 1. (2004) Testosterone Dreams: Rejuvenation, Aphrodisia, Doping Berkcley, CA: University of California Press. This book discusses the histOlY of testosterone research and the controversy surrounding this dlUg].

Kalinski, M. 1., Kerner M. (2002) Recommendations for androgenic-anabolic steroid use by athletes in the former Soviet Union: Revelations fi·om a secret document. Deutsche Zeitschrifijil1' Spol'tmedizill, 53, NI, 7-14. [This article summarizes a secret document fi'ol11 the fonner Soviet Union outlining statesponsored use of anabolic steroids].

Kalinski, M.I. (2003) State-sponsored research on creatine supplements and blood doping in elite Sovict sport. Perspectives in Biology and Medicine (USA), 46: N3, 445-451, SunIDler 2003. [This article describcs rescarch on sports supplements and blood doping in the Sovict Union].

Mitchell, GJ. (2007) Rcport To The Comnissioner Of Baseball Of An Tndcpcndentinvestigation into The Illegal Use Of Steroids And Other Performance Enhancing Substances By Players In Major League Baseball. Office of the Conunissioner of Major League Baseball. This repOlt summarizes drug use in American profcssional baseball].

Oberlander, J.G., Penatti CA., POlter D.M., Henderson L.P. (2012) Thc buzz about anabolic androgenic steroids: Electrophysiological Effccts in excitable tissues . Neuroendocrillology, published online. [This alticle describes the electrophysiological effects of anabolic steroids].

Parssinen, M., Kujala u., Valtiainen E.,Sama S, Sepnala T. (2000) Increased premature mortality of competitivc powerlifters suspected to have used anabolic agents. Tilt J Sports Med 21: 225-7. [This study found an increased risk of premature death in suspected anabolic steroid usel~ in Finland].

Savulescu, J., Foddy B., Clayton M. (2004). Why we should allow pelfonmnce-enhancing drugs in SpOlt. BrJ Sports Med. 38: 666-670. [This article discusses legalizing pelformance-enhancing drugs in SpOltS].

Thc Hcritagc Family Study: http://www.pbrc.edu/helitage/homc.htm [This web site sununarizes studies from the Heritage Family Study that investigated the role of genetics in physical fitness, the adaptation to exercise, and weight loss].

Turillazzi, E., Perilli G., Di Paolo M., NeriM, Riezzo I, Fineschi V .. (2011) Side effects of AAS abuse: an ovelview. Mini Rev Mcd Chcm II: 374-389. [This review of literature summarizes the health risks of anabolic steroids].

Urban, RJ. (2011) Growth hormone and testosterone: anabolic effects on muscle. Harm Res Paediatr. 76 Suppll: 81-83. [This review of literature sunUllarizes the anabolic effects of anabolic steroids and growth hOlmone].

VUlgren, J.L., Kraemer WJ., Ratamess N.A., et al. (2010) Testosterone physiology in resistance exercise and training: the up-stream regulatOlY elements. Sports Med 240:1037-53. [This review of literature sununariz.es the physiology of testosterone and its association with exercise and training].

Vollwv, N. 1. (1990) Bioenergetics of human strcnuous excrcise and the methods to increase exercisc capacity of athletes [Russian]. PhD. disseltation repOlt, Allochin's Research Institute of Physiology, Medical Academy of Scicnce, Moscow. [This doctoral dissertation discusses techniques for improving pelformance in elite athletes].

Wood, R.I., Stanton S.J. (2012) Testosterone and sport: cunent perspectives. Hor/ll Belial'. 61: 147-155. [This atticle discusses the psychological aspects of androgen use in SPOlt, patticularly its effects on women].

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Yesalis C. C, Courson S. P., Wright J. E. (2000) HistOlY of anabolic steroid use in SpOlt and exercise. In: Anabolic Steroids in Sport and Exercise, edited by Yesalis cc. Champaign, IL: Human Kinetics, p. 51-71. [ This book chaptcr sU1l1lmrizes the histOlY of anabolic steroid use in SpOlt through the year 2000].

Biographical Sketches Y lllOmas Fahey receivcd B.A and M.A. degrees in physical education hom San Francisco State University and an Ed.D. limn the University of California, Berkeley. He is the author of 19 books and more than 600 refereed journal and magazine articles. Thomas Fahey js also a masters level discus thrower. He is a professor of Kinesiology at California State University, Chico.

Michael Fahey received a B.A . degrec in anthropology from University of California, Los Angeles and a JD. degree fimB the Sandra Day O'Connor College of Law at Arizona State University. He is a practicing attomey in Chico, CA.

Michael Kalinski received B.S. degrees fi·om Kyiv Institute of Physical Education and Schevehenko National University, M .S. degree /i·om Uzhorod University and Ph.D. from Palladin Research Institute ofBioehemistJy all in Ukraine.

Dr. Kalinski has served as a Chair of the Department of Exercise Biochemistry, as Research ViccPresident of Kyiv State Institute of Physical Culture, Coordinator of Physical Education and Exercise Science programs at the School of Exercise, Leisure & Sport at Kent State University, and Chair ofthe Department of Applied Health Science at MUiTay State University. Dr. Kalinski is an author of 12 research monographs and textbooks and 80 refereed journal articles. Dr. Kalinski served as a Chair of

the Exercise Physiology Symposium at the 14rh COlllmonwcalth Intemational Sports Sciences Congress in 2010, as a Chair of Exercise Biochemistry Symposiulll at laternational Convention on Science, Education and Medicine in SPOlt, ICSEMIS 2012, as a session Chair at the XVI International Scientific Congress "Olympic SPOlts and Sports for All" & VI latemational Scientific Congress "Sport, Stress, Adaptation", 2012. Dr. Kalinski is a member of Editorial Boards of six scientific joumals in Europe and Asia. He is Fulbright Scirolar, Honorary Professor and Honorary Doctor of Bulcovinian State Medical University, Life member of National Association of Physical Education and Sport Science, India.

To cite this chapter Thomas Fairey, Michael Kalinski, Michael Fahey, (2014), SPORT AND EXERCISE PHYSIOLOGY: PERFORMANCE-ENHANCING SUBSTANCES - ANABOllC STEROIDS in Sports Sciellce alld Physical Educatioll, [Ed Luminita Georgescu], in Encyclopedia o/Life Support Systellls(EOLSS), Developed under the Auspices of the UNESCO, Eolss Publishers, Oxford ,UK, [http://www.eols s .net] [Retrieved April 14, 2014]

I .Introduction

© UNBSCO-EOLSS Encycl opedia orLi~ SUppOlt Systems

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SPORT AND EXERCISE PHYSIOLOGY: PERFORMANCE ENHANCING SUBSTANCES - ANABOLIC STEROIDS

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