Chapter[ II. MLB & Other Sports Must Combat Illegal Use of Performance Enhancing
Substances ] ]
Section[ A. Health Risks from Abuse of Steroids and Other ] ]
A. Health Risks from Abuse of Steroids and Other
Widely Used Performance Enhancing Substances
Anabolic steroids and human growth hormone can have serious negative effects
on the human body.
1. Adverse Effects of Anabolic Steroid Abuse
The term “steroids,” when used in the context of athletic performance enhancing
drugs, refers to a class of drugs more precisely known as anabolic androgenic steroids.21
Anabolic steroids are natural or synthetic versions of testosterone, the primary male sex
hormone.22 Steroids foster the anabolic process (muscle growth and the increase of muscle
mass) and also limit catabolism (the breakdown of protein in muscle cells). As a result, steroid
users can increase the muscle gain resulting from strenuous exercise and maximize the impact of
a high protein diet. In addition, because of their anti-catabolic effect, steroids reduce the
soreness that normally results from strenuous exercise, which allows an athlete using steroids to
21 The two primary characteristics of these drugs are (1) “anabolic” in that they induce
muscle growth and increased muscle mass, and (2) “androgenic” because they promote
development of male sexual characteristics. J.D. Wilson, 9 Androgen Abuse by Athletes,
Endocrine Revs. 181-99 (1988); see also Will Carroll and William L. Carroll, The Juice: The
Real Story of Baseball’s Drug Problems 10, 14, 47-52 (Ivan R. Dee 2005).
22 A.M. Matsumoto, Clinical Use and Abuse of Androgens and Antiandrogens, Principles
and Practice of Endocrinology and Metabolism, 1181-1200 (Kenneth L. Becker ed., 3d ed.
2001).
5
exercise more frequently, even daily. At least until a given anabolic steroid loses its efficacy for
the user, larger doses generally result in more rapid gains in lean muscle mass and strength.23
The adverse side effects of anabolic steroids used at the levels necessary to
achieve these effects can be significant, however. In part, this is because the doses of anabolic
steroids typically used by athletes are much higher than those that would be prescribed for any
legitimate therapeutic use, between 5 and 30 times greater than the level of testosterone naturally
produced by the body.24
Advocates of illicit steroid use by athletes argue that the adverse side effects have
been exaggerated, focusing their arguments on the limited clinical trial data available.25 Medical
ethics have prevented the scientific study of the massive doses of steroids taken by athletes using
these drugs to obtain an athletic advantage.26 Despite this limitation, however, there are
sufficient data to conclude that there is an association between steroid abuse and significant
adverse side effects.27 These side effects include:
23 See S. Bhasin, et al., The Effects of Supraphysiologic Doses of Testosterone on Muscle
Size and Strength in Normal Men, 335 New Eng. J. of Med. 1-7 (1996); S. Bhasin, et al., Older
Men are as Responsive as Young Men to the Anabolic Effects of Graded Doses of Testosterone
on the Skeletal Muscle, 90 J. of Clinical Endocrinology & Metabolism 678-88 (2005).
24 J. Hoffman and N. Ratamess, Medical Issues Associated with Anabolic Steroid Use:
Are They Exaggerated?, 5 J. of Sports Science & Med. 182, 183 (2006) (citing P.J. Perry, et al.,
Anabolic Steroid Use in Weightlifters and Bodybuilders: An Internet Survey of Drug Utilization,
15 Clinical J. of Sports Med. 326-30 (2005)).
25 See, e.g., Daniel Duchaine, Underground Steroid Handbook II 60 (1989); W. Nathaniel
Phillips, Anabolic Reference Guide 123 (6th ed. 1991); William Llewellyn, Anabolics 2007 32
(6th ed. 2007).
26 See C.J. Bagatell and W.J. Bremner, Androgens in Men – Uses and Abuses, 334 New
Eng. J. of Med. 707-14 (1996); Hoffman and Ratamess, supra note 24, at 183-84.
27 For an overview of the current state-of-the-science, see Hoffman and Ratamess, supra
note 24, at 182-93, and F. Hartgens and H. Kuipers, Effects of Androgenic-Anabolic Steroids in
Athletes, 34(8) Sports Med. 513-54 (2004). For additional references related to side effects of
steroid use, see Bagatell and Bremner, supra note 26, at 707, Matsumoto, supra note 22, at 11811200,
and J.W. Lenders, et al., Deleterious Effects of Anabolic Steroids on Serum Lipoproteins,
6
Psychiatric Effects: studies have found a strong link between steroid abuse and
serious adverse psychiatric symptoms, including mania, hypomania, and severe
depression. Steroid users also appear to be at higher risk of suicide, especially
during withdrawal.28
Cardiovascular Effects: anecdotal evidence suggests a possible connection
between steroid abuse and heart attacks in young and middle-aged bodybuilders.
Steroid abuse has been tied more definitively to adverse effects on cholesterol
levels, and a connection is suspected between steroid abuse and an enlarged heart.
Liver Damage: The use of oral anabolic steroids has been tied to liver injury,
including impaired liver functionality, cholestasis (impaired bile drainage),
jaundice, an elevated risk of liver tumors and liver cancer, and peliosis hepatis
(the life-threatening development of blood-filled cysts in the liver). Abnormal
liver function might be reversible, but recurrent use of steroids at high doses can
lead to serious liver disorders in the long term.
Harm to Reproductive System: Anabolic steroids can have significant adverse
effects on the reproductive system as a result of their interference with the body’s
natural production of testosterone. In men, extended steroid abuse can result in
hypogonadism, in which the body ceases the natural production of testosterone.
Steroid abuse also can result in severe shrinkage of the testes and a reduction in
Blood Pressure, and Liver Function in Amateur Bodybuilders, 9 Int’l J. of Sports Med. 19-23
(1988).
28 Adolescents might be especially vulnerable because they are “already subject to normal
surges of sex hormones during puberty, which are associated with expected, albeit sometimes
problematic changes in mood and behavior.” Restoring Faith in America’s Pastime: Evaluating
Major League Baseball’s Efforts to Eradicate Steroid Use: Hearing Before the H. Comm. on
Gov’t Reform, 109th Cong. 145 (2005) (statement of Dr. Kirk Brower).
7
sperm count to minimal levels, resulting in infertility. Even when reversible, the
effects of steroid abuse on testosterone production and fertility can take many
months or longer. In women, steroids suppress ovarian function and can impair
fertility.
Musculoskeletal Effects: Steroid abuse may cause stunted growth in adolescents
due to the premature fusion of growth plates of the long bones in the legs and
arms. There also appears to be a connection between steroid use and an increased
risk of tendon tears in athletes.
Other Adverse Effects in Men: In men, steroid abuse can cause severe acne,
excess stimulation of sebaceous glands on the face and body, an increase in body
hair, and acceleration of male pattern balding. Enlargement of the prostate gland
can occur. In addition, gynecomastia (male breast enlargement) occurs in some
male steroid abusers as the body converts excess testosterone or testosterone
precursors to estrogenic compounds. Some steroid abusers take anti-estrogen
drugs such as tamoxifen or raloxifene to block the effect of the excess estrogen.
Other Adverse Effects in Women: The hormonal imbalance between estrogen
and androgens caused by steroids can cause breast shrinkage, acne, facial and
body hair growth, loss of scalp hair, and balding. Steroid use also causes
enlargement of the larynx causing a deepening of the voice, and enlargement of
the clitoris. Several of these virilizing effects can be permanent.
Potential for Addiction: A report by the National Institute on Drug Abuse
concluded that some steroid users exhibit addictive behaviors identical to
symptoms of addiction to other drugs of abuse, including “withdrawal symptoms
8
‘such as mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced
sex drive, and the desire to take more steroids.’”29
2. Adverse Effects of Human Growth Hormone
Human growth hormone is a protein hormone produced naturally in the body by
the anterior pituitary gland. It is essential for growth and development and is responsible for
regulation of adult height, muscle and organ growth, and has a role in sexual development.
Since 1985, it has been available in a synthetic form called recombinant human growth hormone.
Human growth hormone acts primarily by stimulating the liver to produce insulin-like growth
factor (IGF-1), the more potent growth stimulant. Both appear to have anabolic effects in adults
in that they enhance protein synthesis and protein turnover in muscles.30
A number of studies have shown that use of human growth hormone does not
increase muscle strength in healthy subjects or well-trained athletes.31 Athletes who have tried
human growth hormone as a training aid have reached the same conclusion. The author of one
29 2006 Steroids Report, Steroids Working Group, United States Sentencing Commission,
at 25 (Mar. 2006) (quoting Nat’l Inst. on Drug Abuse, Anabolic Steroid Abuse, NIH Pub. No. 003721,
at 6 (Apr. 2000)).
30 C. Ehrnborg, et al., Supraphysiologic Growth Hormone: Less Fat, More Extracellular
Fluid but Uncertain Effects on Muscles in Healthy, Active Young Adults, 62 Clinical
Endocrinology 449-457 (2005); J. Gibney, et al., Growth Hormone and Testosterone Interact
Positively to Enhance Protein and Energy Metabolism in Hypopituitary Men, 289 Am. J. of
Physiology-Endocrinology & Metabolism E266-71 (2005).
31 R. Deyssig, et al., Effect of Growth Hormone Treatment on Hormonal Parameters,
Body Composition and Strength in Athletes, 128 Acta Endocronologica 313-18 (1993); K.E.
Yarasheski, et al., Effect of Growth Hormone and Resistance Exercise on Muscle Growth in
Young Men, 262 Am. J. of Physiology-Endocrinology & Metabolism E261-67 (1992);
K.E. Yarasheski, et al., Short-term Growth Hormone Treatment Does Not Increase Muscle
Protein Synthesis in Experienced Weight Lifters, 74 J. of Applied Physiology 3073-76 (1993).
A more recent study concluded that high doses of growth hormone did significantly reduce body
fat in young adults but did not have any effect on muscle mass. M.J. Rennie, Claims for the
Anabolic Effects of Growth Hormone: A Case of the Emperor’s New Clothes? 37 Brit. J. of
Sports Med. 100-05 (2003).
9
book targeted at steroid abusers observed that “[t]he most curious aspect of the whole situation is
that I’ve never encountered any athlete using HGH to benefit from it, and all the athletes who
admit to having used it will usually agree: it didn’t/doesn’t work for them.”32
The primary attraction of human growth hormone for athletes seeking
performance enhancing effects appears to be that it is not detectable in any currently available
drug test.33 In addition, because human growth hormone stimulates growth in most body tissues,
athletes use it to promote tissue repair and to recover from injury.34
As is the case with steroids, however, use of human growth hormone is associated
with potentially severe adverse side effects. The most remarked upon of these are acromegaly,
the overgrowth of bone and connective tissue that leads to protrusion of the jaw and eyebrow
bones, and gigantism, the overgrowth of the entire body in children or adolescents. (In adults,
gigantism cannot occur because growth zones in bones have sealed).35 Other possible side
effects include cancer, impotence in men, menstrual irregularities in women, cardiomyopathy,
hypothyroidism, and arthritis.36
32 Duchaine, Underground Steroid Handbook II, at 74; see also Phillips, Anabolic
Reference Guide, at 39; William Llewellyn, Anabolics 2007 501.
33 C.M. McHugh, et al., Challenges in Detecting the Abuse of Growth Hormone in Sport,
51 Clinical Chem. 1587-93 (2005).
34 M. Hedström, et al., Positive Effects of Short-Term Growth Hormone Treatment on
Lean Body Mass and BMC After Hip Fracture, 75 Acta Orthopaedica Scandinavica 394-401
(2004).
35 See George Fan, Comment, Toward a Rational Drug Policy: Anabolic Steroid and
Human Growth Hormone Abuse: Creating an Effective and Equitable Ergogenic Drug Policy,
1994 U. Chi. Legal F. 439, 455-56 (1994) (citing H.A. Haupt, Anabolic Steroids and Human
Growth Hormone, 21 Am. J. of Sports Med. 468, 471 (1993)).
36 Id.; see Import Alert No. 66-71, Food & Drug Administration, Detention Without
Physical Examination of Human Growth Hormone (HGH), also known as Somatropin (Jan. 23,
2007).
10
Additional risks arise from using human growth hormone that has been fabricated
in compounding pharmacies, often using undiluted human growth hormone of unknown or
questionable origin. Before recombinant human growth hormone was introduced, for example,
HGH was derived from cadavers and some users were diagnosed with Creutzfeldt-Jakob
syndrome, the human counterpart of mad-cow disease.37 As with steroids, multiple use of
needles to self-administer HGH carries the risk of infections with Hepatitis C, HIV, and other
serious diseases.
Finally, it appears that insulin is often used by athletes in combination with
human growth hormone in an attempt to achieve a synergistic effect. This can give rise to severe
medical risks caused by resulting precipitous drops in glucose levels.38
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