Performance-enhancing drugs snare nonathletes, too
High school athletes aren’t the only ones seeking an edge. Here are the red flags and unexpected drugs to watch for
Anabolic androgenic steroids: Often paired with energy drinks
Teenagers may refer to AAS as “pumpers,” “gym candy,” or “juice.” Trade names for AAS are Dianabol, Anadrol, Deca Durabolin, Parabolin, and Winstrol. AAS are often used with nutritional supplements like creatine, multivitamins, and energy drinks, in the belief that these regimens will make the user stronger, more muscular, and a better athlete.6,7
AAS are synthetic analogues of testosterone and come in oral, injectable, and transdermal forms.8,9 At supraphysiologic doses, testosterone has been found to increase lean body (fat-free) mass and muscle strength in humans.10 The anabolic effects are more pronounced when AAS are used at higher doses over longer periods of time, especially when combined with a strength training program.9,10 AAS have also been found to stimulate the production of growth hormone and insulin-like growth factor and to counteract the catabolic effects of cortisol.11
The use and possession of AAS without a doctor’s prescription is illegal in the United States. A majority of AAS users buy their medications through Internet suppliers, with some of the drugs being manufactured overseas or in illicit labs.3 Substandard quality control in manufacture poses an increased health risk to consumers.
Adverse effects include injection site pain, acne, baldness, gynecomastia, testicular atrophy, sexual dysfunction, and psychological disturbances (also known as “roid rage”).8,9,11-13 Increases in liver enzymes with the oral forms of AAS have also been noted.8 In the prepubertal athlete, premature physeal closure may occur, resulting in permanent short stature.14 Women who take AAS may have virilization effects, menstrual irregularities, and early menopause.11
The cardiovascular risks of AAS use are substantial. High-dose and long-term AAS use has been linked to cardiomyopathy and sudden death.15-20 Some data suggest the development of accelerated atherosclerosis with AAS use, leading to hypertension, coronary artery disease (CAD), and acute myocardial infarction.15,16,18-21 An unfavorable lipid panel has also been noted, with an increase in LDL and decreased HDL.18-21
Under the provisions of the 1994 Dietary Supplement Health and Education Act (DSHEA), supplement manufacturers, not the Food and Drug Administration (FDA), are responsible for guaranteeing the safety of their products.52 Components of the various supplements available are not uniform, and do not need to be submitted to the FDA for analysis. A study analyzing several nutritional supplements revealed the presence of anabolic androgenic steroids (AAS) (14.8% of 634 products) not mentioned in the labeling.53
Using supplements can result in positive drug tests for banned substances and unwanted side effects. It is important to ask about supplement use during annual checkups and sports physicals—especially if the patient has unexplained high blood pressure or other somatic complaints.
Tetrahydrogestrinone: A “designer” steroid
Tetrahydrogestrinone (THG) was initially developed to avoid detection by testing protocols current at the time.22-24 This drug has garnered significant media attention in the past few years because of scandals involving professional and Olympic athletes. THG is chemically related to 2 other banned steroids, trenbolone and gestrinone.22,24 It is used similarly to AAS to increase muscle bulk and enhance performance. It is more hepatotoxic than AAS, with highly potent androgenic and progestin properties in in vitro bioassay studies.22,25
Marketing of this agent is banned in the United States. There are no long-term studies of its effectiveness or side effect profile.
Androstenedione: Initially an anti-aging drug
Androstenedione, aka Andromax and Androstat 100, is a precursor of testosterone. This substance is produced in the adrenal glands and gonads.2 Initially marketed as a dietary supplement and anti-aging drug, it was banned by the FDA in 2004 because of its potent anabolic and androgenic effects.26 Ergogenic use includes promoting muscle building and strength and fat reduction.2 Studies on healthy young men found no improvement in skeletal muscle adaptation to resistance training with androstenedione supplementation for 8 to 12 weeks.27,28 Studies of its effect on increasing blood testosterone levels are conflicting.27,29 Several studies noted an increase in estradiol levels after oral androstenedione supplementation.9,11,27-29
Endocrine pathways with this drug are similar to AAS, and the side effect profile is similar as well, although not as pronounced. Larger, long-term studies are needed to fill out this drug’s profile and document its effects on the athletes who use it.
