What you should know about steroids

[David Baxter PhD]

What You Should Know About Steroids
June 2, 2004, KidsHealth.org

For the past few years, it's been all over the news - stories about athletes, steroids, and body image. In 1998, there was plenty of talk about home-run king Mark McGwire and his controversial use of androstenedione (which he has since stopped using). Professional wrestlers are much admired by kids and teens for their bulked-up appearance and strength. Female athletes are becoming more visible role models for teen girls, who are more aware than ever of a "buffed" muscular body type.

Unfortunately, many professional athletes use various forms of anabolic steroids (illegally, in some sports) and admit that they believe they are bigger and stronger, and perform better, when they do. This undoubtedly influences many teen boys and girls, who think that they too will be bigger, better athletes if they use supplements and steroids. Recent studies indicate that as many as 5% of teen males and 2.5% of teen females are using some form of anabolic or androgenic steroids in the United States.

As a parent, you're probably concerned about the increasing use of steroids by young athletes and you may even be concerned about your own child's health. What do you need to know about steroids and how can you talk to your child about them?

What Are Steroids?
Drugs commonly referred to as "steroids" are classified as anabolic, androgenic, and corticosteroids. Corticosteroids, such as cortisone, are drugs used to control inflammation, and are not the steroids that build muscle and receive so much media attention. Rather, it is the anabolic steroids that are used by athletes and bodybuilders to bulk up and improve athletic performance.

Anabolic steroids are synthetic hormones that cause the body to produce muscle and prevent muscle breakdown. (The word "anabolic" is derived from a Greek word that means to "build up.") Some athletes take steroids in the hopes that they will improve their ability to run faster, hit farther, lift heavier weights, jump higher, or have more endurance. You should be aware that anabolic steroids are a drug like any other. In the United States, it is against the law to use anabolic steroids without a prescription.

Androstenedione, or "andro," is a weaker anabolic androgenic steroid, and, like other anabolic steroids, it is taken by athletes who want to build muscle. It has been suggested in some recent studies that if andro is taken in very large daily doses, it can significantly increase levels of testosterone and muscle proteins that would be extremely harmful to every body system.

How Do Anabolic Steroids Work?
The human body produces many forms of steroids naturally. Anabolic steroids are drugs that resemble the chemical structure of the body's natural sex hormone testosterone. Androstenedione is a steroid hormone that can be broken down into testosterone. Testosterone is naturally made by the bodies of males and, in much smaller amounts, females. The hormone directs the body to produce or add male characteristics such as increased muscle mass, facial hair, and deep voices, and is an important part of male development during puberty.

When athletes take anabolic steroids, these drugs stimulate the muscle tissue in their bodies to grow larger and stronger, exaggerating the effects of testosterone on the body. The effects of too much testosterone ciculating in the body is harmful over time.

Dangers of Anabolic Steroids
Steroids are dangerous for two reasons: they are illegal, and they can damage a person's health, especially if used in large doses over time.

Although they may build muscle, steroids can produce very serious side effects in both males and females. Using steroids for a long time can negatively affect the reproductive systems. In males, steroids can reduce the amount of sperm produced in the testicles and even reduce the size of the testicles. Steroids also can cause impotence in males.

Females who use steroids may have problems with their menstrual cycles because steroids can disrupt the maturation and release of eggs from the ovaries. This disruption can cause long-term problems with fertility.

Steroids taken for an extended period of time can also:
o stunt growth in teens by causing the growth plates in the bones to mature too fast and fuse
o cause irreversible liver damage
o enlarge the heart muscles
o cause violent, aggressive mood swings
o contribute to heart disease and increase cholesterol and lipid levels
o increase breast growth in males, especially teens
o create irreversible stretch marks
o heighten a person's tendency to lose hair
o cause muscles to ache

In addition to these, teen girls and women risk additional side effects:
o permanent effects of male hair growth or male-pattern baldness
deepening of the voice
o enlargement of the clitoris

The health problems caused by steroids may not appear for years after the steroids are taken. The risk of steroids causing bones to fuse early and preventing a teen from reaching full growth potential is significant - and at an all-time high. The National Institutes of Drug Abuse estimates in recent studies that 325,000 teenage boys and 175,000 teenage girls are using steroids.

"A testosterone measurement of more than 200 nanograms per milliliter would signal steroid abuse, and I have seen athletes with levels in the thousands," says Larry Bowers, MD, a steroid expert. "Although it may take 20 years, case studies of long-term steroid use indicate negative effects on almost every system of the body."

In addition to the health risks, steroids are illegal. Drug testing for all athletes has become more prevalent, and athletes who fail a drug test for steroids can face numerous legal consequences: jail time, monetary fines, exclusion from an event or from the team, or seizure of trophies or medals.

Although the health problems associated with steroid use are well documented, it's important to remember that the rules about the legal use of steroids can be confusing. Even professional athletes don't always agree on the issue. For instance, when Mark McGwire freely admitted that he used androstenedione on the way to setting baseball's single-season home run record, he wasn't kicked out of the league or stripped of his achievement. That's because the use of andro - what some people in sports still consider a dietary supplement, although it is proven to be a form of anabolic steroid - is still permitted in Major League Baseball and National League Hockey. But andro is banned in other sports organizations. The International Olympic Committee, the National Football League, the National Basketball Association, the National Collegiate Athletic Association, the Association of Tennis Professionals, and most high school athletic associations currently ban the use of androstenedione.

Andro is banned as an illegal substance in Canada, but in the United States can be easily obtained as a dietary supplement.

Talking to Your Kid About Steroids
It's important to understand the pressures that may drive young athletes to experiment with steroids. Although most athletes exercise hard, eat properly, and take care of their bodies to maintain optimal fitness and performance levels, athletic competition and the desire to look physically toned and fit can be fierce.

To help your child handle these pressures, you should talk to him about healthy competition and drugs. Ask your child what his concerns are and what are his coach's and team members' attitudes toward steroids. You should also encourage your child to prepare mentally and physically for competition by eating well and getting enough rest.

If you suspect your child is using steroids, watch for these warning signs:
o exaggerated mood swings
o worsening acne
o unusually greasy skin with stretch marks
o a sudden increase in muscle size

If you have strong suspicions that your child is using these drugs, you should call your child's doctor. He or she may recommend that you have your child take a simple urine test at the doctor's office to detect the presence of steroids.

And if your child is using steroids, what should you do? There's no easy answer.

"Unless young people are taught to know where and how to draw the line, to know that it's not right to try to win at all costs, they're not going to listen when you tell them steroids put their lives at risk for the glory of winning," says Charles E. Yesalis, MD, a steroid expert and editor of Anabolic Steroids in Sports and Exercise.

It may help you to consider your child's desires to look fit and perform well. Understand that these desires can be very strong and that to forbid the use of steroids may not be enough to help him quit. You should schedule an appointment with his doctor so that he can learn healthy ways (through diet and exercise) to boost performance and physical appearance.

Steroids may give your child the sense that he or she is stronger and more athletic, but the consequences are too dangerous to risk. The chance that your teen's growth and long-term health could be jeopardized by steroids is especially worrisome. Help your child stay away from steroids by encouraging a healthy lifestyle that is followed by your entire family. And be sure to promote your child's self-esteem so that body image doesn't take over your child's self-worth.

 

[David Baxter PhD]

FDA Warning on Androstenedione (Andro)

FDA Warning on Androstenedione (Andro)
Cathy Wong, N.D., About.com
Consumer Advisory

On March 11, 2004, the U.S. Food and Drug Administration (FDA) announced a crackdown on products containing androstenedione, commonly known as "andro." The products are marketed over the counter as dietary supplements that enhance athletic performance. In the body, androstenedione is converted into testosterone and estrogen.

While ads claim that andro-containing supplements promote increased muscle mass, research has not shown this to be the case. In addition, studies have shown side effects and potential long-term risks; androstenedione poses the same kinds of health risks as anabolic steroids. Given the lack of proven benefits and the risks, the FDA is requesting companies to stop distributing dietary supplements containing androstenedione.

The FDA is also encouraging Congress to consider legislation to classify these products as a controlled substance.

Potential Long-Term Risks
o For men--shrinkage of testicles, growth of breast tissue, impotence
o For women--male pattern baldness, increased facial hair, increased risk for breast cancer and endometrial cancer, blood clots
o For youth--acne, early start of puberty, stunted growth

Advice to Consumers
Consumers should understand that there are risks for serious side effects. Do not take supplements with andro.

Q: What action did FDA take?
A: As part of the Department of Health and Human Services crackdown on companies that manufacture, market and distribute products containing androstenedione, or, "andro," the FDA sent warning letters to 23 companies asking them to cease distributing products sold as dietary supplements that contain androstenedione and warning them that they could face enforcement action if they do not take appropriate actions.

Q: Why did FDA take this action?
A: FDA concluded that there is inadequate information to establish that a dietary supplement containing androstenedione will reasonably be expected to be safe. In fact, FDA believes that these products may increase the risk of serious health problems because they are converted in the body to testosterone which is an androgenic and anabolic steroid.

Q: What do you mean by androgenic?
A: Androstenedione is converted to testosterone and estrogen, and when taken in sufficient quantities androstenedione can cause masculinizing and feminizing effects. Androstenedione is considered an androgenic steroid precursor because testosterone is an androgen or male hormone.

Q: What is an anabolic steroid precursor?
A: An anabolic steroid is a steroid, such as testosterone, that induces muscle growth. An anabolic steroid precursor is a steroid that does not itself cause muscle growth, but can be converted by the body into such a steroid. Androstenedione is an anabolic steroid precursor because it is converted to testosterone in the body.

Q: How are these dietary supplements marketed?
A: Androstenedione-containing supplements are widely advertised for anabolic effects (building muscles) and for enhancing athletic performance.

Q: What makes FDA believe these products are not safe?
A: Based on a limited number of studies of androstenedione's actions in humans and existing knowledge about steroid hormone metabolism and action in the body, FDA believes that the use of dietary supplements containing androstenedione may increase the risk of serious health problems because of their conversion in the body to active hormones with androgenic and estrogenic properties.

Q: When androstenedione is sold as a dietary supplement, it doesn't require FDA approval. On what basis can FDA take this action?
A: Under the Dietary Supplement Health and Education Act of 1994, the dietary supplement manufacturer is responsible for ensuring that a dietary supplement is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market.

In addition, there are certain requirements that must be met in order for dietary supplements containing new dietary ingredients (dietary ingredients that were not marketed in the United States before October 15, 1994), not to be deemed adulterated under the act. These requirements have not been met for androstenedione, and therefore, androstenedione cannot be lawfully marketed in dietary supplements.

Furthermore, FDA is not aware of the existence of adequate information to establish that a dietary supplement containing androstenedione will reasonably be expected to be safe. In fact, FDA believes that these products may increase the risk of serious health problems because of their androgenic properties.

Q: These products have been on the market for a while. What prompted FDA to take action now?
A: As part of its public health mission, FDA is committed to removing unsafe products from the market. When the agency becomes aware of potential safety concerns with a marketed product, we will investigate and take appropriate steps to ensure that unsafe products do not continue to be marketed. In taking this action, the Department of Health and Human Services and FDA are, in part, responding to concerns about the safety of androstenedione-containing dietary supplements that have been raised by consumers, medical organizations, and members of Congress.

Q: Is FDA planning to take actions against other steroids or steroid precursors that may be marketed as dietary supplements?
A: FDA is aware that other steroid precursors are being marketed as dietary supplements.

The agency intends to continue to examine information about these different substances being marketed as dietary supplements and evaluate their status under the Act. Depending on the results of these deliberations, FDA may take further enforcement actions if any are found to violate the Act.

FDA is particularly concerned about other steroid precursors that are promoted to help build muscle mass or improve sports performance. If they have powerful enough androgenic properties to have these effects, then they may also be more likely to cause the serious health risks that accompany these effects.

Q: Are there other groups that support FDA's position?
A: Yes. Organizations such as the National Collegiate Athletics Association, the National Football League and the International Olympic Committee have banned use of androstenedione. The American Academy of Pediatrics, the Endocrine Society, the American Medical Association, and other health professional groups have cautioned against the use of androgenic and anabolic steroids and their precursors, like androstenedione, because of potential long-term adverse health consequences.

Q: How do these products work in the body?
A: Widely marketed as "performance enhancers," androstenedione and other steroid precursors have been advertised to promote muscle growth, improve muscular strength, reduce fat, and slow aging. Some studies suggest that androstenedione can raise the levels of testosterone and estrogen. Taken over time and in sufficient quantities, androstenedione may have serious adverse health consequences.

Q: What are the side effects of dietary supplements containing androstenedione?
A: Potential long-term adverse health consequences in men include testicular atrophy, impotence, and the development of female characteristics such as breast enlargement. Women who use these products may develop male characteristics such as male pattern baldness, deepening of the voice, increased facial hair, and enlargement of the clitoris, as well as abnormal menstrual cycle and abnormal bleeding, and blood clots. Women may also be at increased risk for breast cancer and endometrial cancer. Children and adolescents are at risk for androgenic and estrogenic effects as in adults, for early onset of puberty, and for premature cessation of growth, such that they will be short as adults.

Source: Food and Drug Administration
http://www.fda.gov/bbs/topics/news/2004/hhs_031104.html