Steroids and Growth Hormones

While the steroid crisis in professional sports blares from the media, the impact of these doping role models is hitting close to home. There is evidence that kids are using these chemical substances to get a performance edge—even for Little League—and that adults are using them just to shave some seconds off their treadmill time. What do you need to know? Dr. Jeffrey I. Mechanick, associate clinical professor at the Mt. Sinai School of Medicine in New York City, outlines the different types of performance-enhancing drugs that exist today and the impact of these drugs on the body.

What are performance-enhancing drugs?
Performance-enhancing drugs are substances that are used to increase certain physiologic functions. They affect things like muscle strength, endurance, the ability to pump blood, the ability to breathe, liver function and kidney function. These substances have an impact on athletic performance and physical performance as they may help somebody do better in competition.

What types of performance-enhancing drugs are there?
There are no true conventional categories of performance-enhancing drugs, but if you had to think about what they are, there would be dietary supplements and drugs that require a prescription, which include steroids. Then there would be peptides, or protein-like chemicals, like growth hormone.

There are other substances that don't really fit into a category that may or may not require a prescription. They are designer compounds because they have been manipulated so that they're not easily detected.

Who uses performance-enhancing drugs?
Performance-enhancing drugs are used by athletes: competitive athletes, recreational athletes, casual athletes and people who just exercise and want to do well, even if it's just running on the treadmill in the gym. There are also those who want to lose weight or burn off fat and increase their muscle mass for cosmetic reasons. They might be children, teenagers or young adults. It could also be the elderly.

How many people use these drugs?
The statistics for usage are derived from surveys, casual questionnaires and retrospective studies of data. There hasn't been a properly designed scientific study yet, so the answer is that experts have no idea what the magnitude of this problem is.

What are anabolic steroids and how do they work?
Steroids are a class of compounds made by the adrenal gland, as well as reproductive organs in the body. Examples of steroids include testosterone, a male hormone, and estrogen, a female hormone.

Anabolic means building up tissue. "So, as we eat protein, we get more muscle," says Mechanick. "If we inject steroids that are anabolic, we hold on to that protein and our muscle mass grows; we get stronger." The normal response to running or weightlifting might be to grow muscles and become stronger to a degree. But to add anabolic steroids to that recipe, so the muscles get even bigger or stronger, is unnatural and there can be hazards from doing that.

What types of anabolic steroids are there?
The anabolic steroids include testosterone and its precursors: androstenedione (andro) and dehydroepiandrosterone sulfate (DHEAS). These are all produced naturally in the body.

What are the approved uses for anabolic steroids?
The approved uses for testosterone right now are in men who have low testosterone levels to replace what they ordinarily would naturally have. For women in early menopause who have a decreased sex drive, doctors will sometimes prescribe a little bit of male hormone to augment the libido.

What are designer performance-enhancing drugs?
An example of a designer performance-enhancing agent might be a chemical that looks like testosterone, but when an athlete gets screened for testosterone, it would come up negative. These drugs may also have a longer half-life, meaning they stay in the body for a longer period of time, causing a more profound effect in growing muscle tissue.

What are the side effects of steroids?
One adverse effect of anabolic-androgenic steroids, such as testosterone, is decreased sperm count in men. If men have a lot of testosterone, the pituitary gland won't be screaming so loud, so it gets turned off. As a result, sperm production gets turned off. However, many of the users and abusers of anabolic steroids have found ways to circumvent this. In fact, there are other medicines that can keep the sperm count up, even when you're using or abusing testosterone.

Testosterone has adverse effects on your lipid profile. Your lipid profile is cholesterol, triglycerides, "good" high-density lipoprotein (HDL) cholesterol and "bad" low-density lipoprotein (LDL) cholesterol. Excess levels of bad cholesterol can predispose you to heart disease.

Testosterone also causes increased breast tissue. Testosterone is converted into estrogen through a process called aromatization and the estrogen increases the breast tissue formation. Bodybuilders and weightlifters who use testosterone have learned to get around that by taking yet another drug called an aromatase inhibitor, which blocks the conversion.

Testosterone can cause growth of the prostate gland; if you already have a large prostate gland, you can have real problems. Testosterone can also cause acne and hair loss. You can have joint, bone and muscle pains if you take a lot of testosterone. Testosterone can also cause fluid retention, so people may have to counter that by taking diuretics. Steroids can affect the liver, particularly if you take the testosterone by mouth.

It really is a hazardous compound to be administering to yourself when you don't really need it.

What is the effect of anabolic steroids on mood?
Anabolic steroids, particularly male-type anabolic steroids, can make a person more aggressive. On the one hand, that might be beneficial as it may translate in to increased competitiveness on the playing field. There might be less fatigue or less perception of fatigue. They can go that extra mile; they can fight harder; they can win. On the other hand, the use of anabolic steroids is associated with a higher death rate. A lot of these deaths are due to suicides and violent behavior as a result of the effect of these anabolic androgenic steroids on mood.

Are the side effects reversible?
For the most part, the side effects of anabolic-androgenic steroids dissipate after the drug is discontinued. Sometimes, however, the damage is done and that's a problem.

What are growth hormones?
Growth hormone is another performance-enhancing drug. It's a peptide that is made by the pituitary gland, the master gland sitting at the base of the brain. Growth hormone acts on the liver to make other peptides. These other peptides then affect many cells in the body and make them grow. It can affect cartilage, bones and muscle; it can affect function throughout the body. Growth hormone, in theory, should have the athlete performing better, but experts really don't have the evidence that it does that.

What are some of the approved uses for growth hormone?
Approved uses of growth hormone would be children with growth hormone deficiency, chronic kidney problems or certain genetic diseases that affect growth. Growth hormone is also used in adults who have had pituitary problems who have low levels of growth hormone. Growth hormone has been used in treating HIV disease.

What are the side effects of growth hormone?
Growth hormone has some other bad effects on our overall metabolism. It can make your sugar go up, causing diabetes. It can make your triglyceride levels go up; it can make your phosphorous levels go up leading to calcium depletion from your bones. It can cause problems with muscles; you can develop myopathy, a disease in the muscles. Many doctors fear that growth hormone may cause the growth of certain malignancies or cancers.

Growth hormone also causes carpal tunnel because the tendons that control your fingers pass through a channel in your wrist which is wrapped by soft tissue. When you take growth hormone, the tendons and the cartilage grow, so there's less space. It compresses and the tunnel through which those tendons go, tightens up.

Are the side effects of using growth hormone reversible?
When a person stops growth hormone, the blood sugars, the triglycerides and the phosphorous comes down. However, the organ damage may persist, such as damage to the pancreas, muscles or kidneys.

How can you tell if someone is using performance-enhancing drugs?
It would be very difficult to look at someone and know that they were abusing growth hormone, precisely because it may not work anyway. It's not that difficult to recognize drug use by somebody who's been using a lot of androgenic-anabolic steroids. They are just so over the top; it's such an unnatural musculature, something that is just so hard to attain without help from those anabolic steroids.

You'll have acne and hair loss. If this occurs and your son's muscles are disproportionately larger than any of his peers, for example, then a parent should be suspicious. They should seek attention from the child's physician. Certain tests can be done and certain questions can be asked.

What advice do you have for people considering taking performance-enhancing drugs?
Under no circumstance should anabolic steroids or other performance-enhancing drugs be used, particularly without your physician knowing about them. These are drugs that all have hazards. You'll get short-term benefits in terms of looking better, perhaps even feeling better and certainly competing better. But in the long term, they're not good for you. Any person who is using one of these illegal drugs, anabolic steroids or growth hormone for performance enhancement ought to stop because it's going to hurt them in the long run.

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