Poison or Medicine?

Although performance enhancing drugs have always been part of professional sports, the media's interest in them has been cyclical. In spite of the fact that steroids and other drugs permeate high-level sport, the sporting press only gets involved when they have to, like when a few star athletes get busted or when the circumstantial evidence becomes overwhelming (read Barry Bonds.)

If there was a way to actually get rid of all performance enhancing drug use in sports, ESPN and Sports Illustrated wouldn't have much to write about: the Olympics would get boring really fast as no records would ever get broken and attendance-boosting homerun races would be a thing of the past. The Tour De France? Just boys with tight shorts on bikes.

Because they have to "do the right thing" and support the network agenda, these journalists must then turn around and bite the hand that feeds them. That means they must write article about steroids. This, for me, is where the problem starts.

When it comes to topics that are debatable, such as the morality or legality of performance enhancing drug use, I couldn't care less about what these guys write about. But when it comes to the discussion of drugs and the pharmacology thereof, I have a very big problem. In short, the average sports reporter knows dick about steroids, growth hormone, and legal sports supplements. The things they put in print and say on the air make those of us who do know something about these topics groan and smack our foreheads in frustration.

Instead of pointing out every unchecked false statement, myth, misconception, and outright lie I see daily concerning androgens, I'll focus on one recent ESPN.com piece, "The Dangers of Steroids" by Chuck Hirshberg. I'll quote or paraphrase the author, then rebut.

Make sure you've got your cup on, Chuck.


Rebuttal: I'm sick and tired of reporters stating that the mechanism of action with anabolic steroids is increasing endogenous Testosterone production. Androgens decrease endogenous Testosterone production!

The only androgen that would ever result in supraphysiological levels of Testosterone is Testosterone itself! Even in that case, endogenous (natural) Test production is still suppressed. It's people like Mr. Hirshberg – who have no background in any science and don't bother to check with someone who does – who continually perpetuate myths and misinformation. If the topic here was masturbation, journalist like this would still be writing about spontaneous vision loss and the epidemic of hairy palms.

And what's this about creatine being safe? Yes, it is safe, we've always known it's safe, but wasn't it just a few years ago when the media was running huge stories about the supposed harmful side effects? Remember the clueless (but no doubt copy selling) articles about kidney and liver damage? As I recall, these same reporters even pulled aside a few "experts" like local high school coaches and 87-year old physicians (who haven't cracked a book or research report in 30 years) and confirmed the "dangers" of creatine with them. Yet now that it's been accepted that creatine monohydrate is safe, the media somehow forgets about this.

I think I remember something similar with low carbohydrate, high protein diets. Yes, that's right, apparently these too cause kidney damage and are completely unhealthy and haven't even been shown to be efficacious. Oh that's right, the media was again wrong, weren't they? But where were the retractions? Where were the big stories about the safety of creatine and low carb diets? What's wrong, does good news not sell as many magazines and newspapers? Hey, maybe the lay press should either do their research or (gasp!) keep their mouths closed when it comes to topics they know little about!

The sad thing here is the general public derives most of what they know from the popular media. Not just the average Joe either; this is even true when it comes to those in the scientific community. I honestly can't tell you how many times I've argued with college professors in the past. It got to the point where I just had to bite my tongue.

I've had a PhD in biochemistry tell me that thyroid hormone is a steroid and then proceed to tell me that it might cause liver damage. For those who don't know, thyroid hormone isn't a steroid hormone and doesn't cause liver damage. Anabolic steroids might, but only 17 alpha-alkylated steroids can do this and then only if misused and abused. Even then, the liver toxicity issue is blown way out of proportion.

I've had a PhD in molecular genetics tell me all steroids can cause gynecomastia. Oh really? Corticosteroids and even cholesterol are chemically steroids. So these cause gyno too? Afraid not.

Does this mean these people are stupid? Of course not. In fact, one of them is a top scientist working in research focusing on neurodegenerative disorders. I know firsthand they're very intelligent, but the fact is that their research interests have nothing to do with anabolic steroids, nor have they really received any direct education on the matter. Instead they derive their information, for the most part, from the media.

Aside from that, my own siblings (two Pharm D's and an MD) are misinformed about anabolic steroids. Unfortunately, these are the types of people who reporters turn to, whether they be PhD's, MD's, or Pharm D's. They look for those who'll support their own misinformed views. Did you know that T-Nation has been contacted many times by reporters gathering "facts" about steroids? We give them the facts too, but oddly enough, not much of what we tell them ever gets printed. Why? Do I smell an agenda?

For once, just once, I'd like a reporter to interview a person like Shalender Bhasin, M.D., who's the Chief of the Division of Endocrinology in the Department of Internal Medicine at Charles R. Drew University of Medicine and Science. Anyone who's familiar with his research will know that he's brought forth some of the best data in terms of androgens and their biological effects in humans. But no, the local Ears, Nose and Throat doc always gets the call and always gives the reporter the info he's looking for. For once, I'd like one of these reporters to interview someone who actually researches androgens and their effects in humans.

I once asked a local reporter why it seemed that the media so often tries to create mass hysteria by reporting untrue or somewhat falsified stories or taking things completely out of context. His reply? "What's the fun in reporting the truth?" Which do you think is going to draw more of the public's attention, the boring truth or the truth with a bunch of BS thrown on top to get people panicking or at the very least intrigued? In other words, who wants to read that steroids are compounds that have legitimate medicinal uses and few side effects when used properly? Nah, that's no fun, but stories of instantaneous death, violent behavior and cancer? Now that sells magazines and boosts ratings, doesn't it?

Back to Mr. Hirshberg. Part of his reasoning is that things like creatine are safe because they're found "naturally" in the body. Well, if he's using that argument, maybe someone should tell him that Testosterone is found "naturally in the body" and that it, too, must be safe. Granted, the analogues of Testosterone aren't found naturally in the body, but regardless, his logic is a bit circular in this regard.

As for having more muscle and less fat than a man would normally have.... oh no, we certainly don't want that! I mean it's obvious that increasing lean body mass has so many detrimental effects like...um...well, let's see, um... heck, I can't think of any. What you do get is decreased LDL, increased HDL, decreased triglycerides in addition to decreased blood pressure, and even improved glycemic control that results from an improvement of insulin sensitivity. It may also improve your sleep and mood and you'll likely even feel more energetic. Nasty side effects, huh?

Obviously, these changes will essentially lower your risk of developing heart disease, diabetes, hypertension, hyperlipidaemia, stroke, and even some major cancers. I'm not saying that you'll be "immune" to all metabolic diseases, but you'll have a much lower risk of developing them.

Also, keep in mind that if you follow the normal aging pattern, you'll likely lose muscle and gain fat as you get older, thus increasing your chances of experiencing one of the above diseases or disorders. With the judicious use of androgens, we can prevent such a thing from occurring. In general, you can expect to live a longer, happier, more productive life. But that doesn't sell copies, increase TV ratings or cause people to log on to the ESPN website, does it?

Mr. Hirshberg, I hate to break it to you, but weight training and a high protein diet also allow one to have more muscle than we normally would. Creatine monohydrate allows one to have more lean body mass than he normally would. So, please tell me where the logic is there?

Rebuttal: "Shriveled testicles" is properly referred to as testicular atrophy. He mentions that because a person's pituitary gland senses the "outrageous oversupply of Testosterone" it then signals the testicles to shut down. That's right people, he said the pituitary gland signals the testicles to shut down.

Oh really? Is that so? So you mean the suppression of endogenous Testosterone isn't actually from a lack of LH (luteinizing hormone) being secreted from the pituitary and reaching the testicles? You mean this lack of LH secretion isn't actually caused, for the most part, by androgen and estrogen receptor agonism at the hypothalamus and pituitary? You mean, the lack of LH reaching the Leydig cells of the testicles, thereby reducing cAMP formation, therefore decreasing Testosterone formation (steroidogenesis) isn't the cause? Wow, this is news to me! It's so interesting that endocrinologists worldwide have it all wrong yet a reporter has it all figured out!

Moving on, the fact is that this "shutdown" of endogenous Testosterone production is completely reversible upon cessation of anabolic steroid use. I'd like to point out that ethanol ingestion (ever drink liquor?) temporarily decreases endogenous Testosterone production too, which eventually returns upon cessation of use. With chronic abuse, ethanol causes testicular atrophy and infertility as well. So why is there no article focusing on the negative and temporary effects of ethanol ingestion? Why is there no focus on long-term ethanol abuse?

Hirshberg fails to realize that many medications have temporary side effects that subside upon cessation of use. Acetaminophen, antibiotics and ethanol can all be considered hepatotoxic, yet don't pose a problem unless you use large dosages for prolonged periods of time.

Rebuttal: Is that so? Well, it's unfortunate that this "foremost expert on how steroids affect the brain" you quoted (whom I've never heard of by the way) doesn't know that there have been many studies performed with anabolic steroids being administered to humans. There have been even more done on animals. Maybe he needs to get out a bit more or at least check out Medline once or twice per week.

The "expert" states that when hamsters are administered androgens, they turn ferociously aggressive (as a result of decreased serotonin levels) and long-lasting changes occur in the brain. Well, first off, there have been studies performed in humans that have demonstrated that "roid rage" is not an issue when it comes to normal human beings.

There have been many double blind, placebo-controlled studies performed in humans, not rodents, which demonstrated that androgens do not significantly increase aggression or angry behavior in normal men. One, in fact, involved 43 normal men, ages 19 to 40 and they were given 600 mg/week of Testosterone enanthate over a ten-week period. There was no increase in angry behavior.

By the way, 600 mg/week of Testosterone enanthate most certainly increases Testosterone levels far into the supraphysiological range. However, in those men who have preexisting psychological conditions, administering exogenous androgens could possibly, in some cases, cause an episode of angry behavior.

More importantly, since when did we extrapolate data from one species to the next? In this case, we have data that demonstrates what occurred in the hamsters after administration of androgens isn't occurring in humans. We shouldn't even need to present such data as any responsible scientist knows that extrapolation across species is completely inaccurate.

Lastly, I'd like to point out that it's when Testosterone levels are below the normal physiological range that you begin to see a decline in positive mood. So, if at any point one would become irritable and depressed, it would be after a steroid cycle, not during. Along those lines, this is something that people in the community have known for quite some time and thus is the reason why clomiphene (an estrogen antagonist) is used in order to stimulate endogenous Testosterone production after the steroid cycle has ceased.

Rebuttal: Can you please point me to this overwhelming evidence that supports the idea that he died as a result of anabolic steroid use and not Growth Hormone use? Honestly, it's sloppy and lazy reporting to make such a ridiculous statement. The man was using Growth Hormone and anabolic steroids. The reporters catch on to the fact that he used steroids and suddenly become experts in pharmacology and cancer cell biology and decide that anabolic steroids caused his brain tumor.

Anyone who knows a thing about cancer cell biology will tell you that Growth Hormone is the culprit in such a case. And besides, thousands of athletes are using these drugs and thousands more have in the past. Why aren't they all falling over dead from brain tumors? If it's true that Alzado died from a condition caused by his drug use, then this single case (so often used by the press to prove how dangerous steroids are) really shows how safe these drugs can be!

Rebuttal: Hirshberg then goes back to the idea of "roid rage" citing another "expert" who states that he's documented a handful of crimes where the person who committed the act of violence was also using anabolic steroids.

Well, as I explained previously, anabolic steroids haven't been shown to cause any negative behavior in normal humans. So, in the few cases where such crimes were committed, wouldn't it be just a tad bit more responsible to state that the people who committed these crimes more than likely would have done so even if they hadn't used anabolic steroids? "Roid rage," in this case, sounds more like an excuse fabricated by a sleazy defense attorney.

It's really quite ridiculous. I want people to think about how many crimes occur each year. A crime where a person who, in most cases, has no previous criminal record, snaps and attacks someone. Are we to assume that all of these people were using anabolic steroids? So, all of the various serial killers with no previous records, the teenagers who've committed murder in and out of schools, the DC sniper, and every other violent killer in the past were all using steroids?

I wonder how many of these individuals were consuming caffeine in the form of soda or coffee? Maybe we should do a study on crimes and see how many murderers and wife beaters consumed caffeine on the day they committed their crimes. I bet the number would be very high. That must mean that caffeine, a proven stimulant and mind-altering drug, causes people to turn into maniacs and commit murder. Ridiculous? Sure, yet the lay public accepts this logic readily when it's applied to steroid users.

Whatever happened to the idea that some people are born with psychological conditions or had a horrendous childhood that screwed them up permanently? Whatever happened to the idea that some people are predisposed to certain types of behavior? It sure is odd that the other people who use anabolic steroids haven't committed any crimes. You'd expect more cases, wouldn't you?

Rebuttal: Really? That's amazing. Well, at that rate it should easily be up there with certain forms of cancer and heart disease, right? Oh, it's not? Hmm, well it should at least be on the DAWN (Drug Abuse Warning Network) Annual Medical Examiner Data, where they keep track of the number of deaths per year in which a medical examiner mentioned the drug as a possible cause of death? It's not? Wow, you mean there wasn't even one death that was attributed to anabolic steroid use? Then where, Mr. Hirshberg, did you get this info? Surely you didn't just make it up to support your personal bias? Nah, the press would never do that!

Unlike Hirshberg, I did do some research. I was surprised to see that androgens/anabolic steroids did make the top 150 list for DAWN's Detailed Emergency Department Tables for 2002, example of which I've included below. In past years I haven't seen steroids on the list, but it's finally made it. Usually when I include these types of tables, one or two people shoot me an e-mail explaining that this data doesn't mean anything as the drugs compared are used so commonly that the chance for adverse reaction is much greater. In other words, if only 2,000 people use a drug, of course it will rank lower than a drug that nearly every person in the US has in his medicine cabinet.

So, this time I've included drugs that are commonly used, drugs which are rarely employed, and an intermediate between the two. As expected, alcohol in combination with another drug is at the top of the list. Anabolic steroids barely squeaked in at 142. These numbers reflect the number of mentions each drug received in regard to emergency room visits:

Drug Name – Number of Mentions (Rank out of Top 150 drugs)

So, if we really want to ban substances harming "thousands of people daily," we better get rid of caffeine, Tylenol, aspirin, and freakin' multivitamins before we worry about steroids. What's wrong, Hirshberg, don't want to give up your morning coffee or Diet Coke consumption? Come on, do it for the kids, you bad role model you.

Speaking of kids, Hirshberg also mentions teenagers who buy steroids over the internet. He sited the ad copy of one of these places in his article. Sorry, Hirshberg, what you found was a site selling legal supplements with steroid-sounding names. Come on, these shady sites are designed to fool dumb kids and people who don't know much about supplements or drugs, but you fell for it hook, line and sinker, didn't you? Interesting. Allow us to educated you. Read this article so you won't make such embarrassing mistakes again.

Wrap Up

In closing, I want to touch quickly on a few things. First, I'd like everyone to realize that pharmacists and physicians receive little to no education when it comes to anabolic steroids. I can personally attest to the fact that I've seen no more than one page on the subject in my formal studies. On the other hand, the general public should expect this as anabolic steroids are but one small class of therapeutic drugs in what is a rather long list. Aside from that, they're rarely employed.

The general public often seems to think that because a person has a PhD or a Pharm D or an MD, they're automatically an expert in a given area. The fact is that in order to be truly knowledgeable about something, you need to focus on a small area you're extremely interested in and research, research, research. An example would be people in cellular biology who spend their entire lives researching things like cell adhesion molecules, chaperone proteins, elements of the cytoskeleton, and the list goes on and on.

Basically, "expertise" is really only something applied to a very small and specific area. There are really very few people who are knowledgeable when it comes to anabolic steroids. Two things are required of these true experts: some sort of advanced formal education and a keen interest and consequently a great deal of time spent researching them. The vast majority of those in the scientific community only have the former.

The lay press, on the other hand, labels any doctor who says steroids are bad an "expert." If the doctor agrees with the reporter's bias, he's an expert. If he disagrees, he's a kook who's conveniently left out of the article or TV segment.

Also, I'd like to mention that anabolic steroids are not "poison" but rather drugs, which are approved by the FDA to treat several conditions. Treatment of bone pain associated with osteoporosis, anemia, reversing weight loss in patients (who are suffering from severe trauma, infection, long-term corticosteroid therapy), hereditary angioedema, breast cancer, delayed puberty, hypogonadism, just to name a few. They have also recently been looked at more closely because of the fact that hypogonadal men are at an increased risk for coronary artery disease. They may also have a role in treatment for certain forms of heart disease. (1-13)

Feel free to ignore these facts in your future work, Mr. Hirshberg. I wouldn't want the truth to interfere with your ability to publish articles and "educate" the public.

References Cited

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2) O'Connor DB, Archer J, Hair WM, Wu FC. "Exogenous testosterone, aggression, and mood in eugonadal and hypogonadal men." Physiol Behav. 2002 Apr 1;75(4):557-66.

3) Anderson RA, Bancroft J, Wu FC. "The effects of exogenous testosterone on sexuality and mood of normal men." J Clin Endocrinol Metab. 1992 Dec;75(6):1503-7.

4) Alexander GM, Swerdloff RS, Wang C, Davidson T, McDonald V, Steiner B, Hines M. "Androgen-behavior correlations in hypogonadal men and eugonadal men. I. Mood and response to auditory sexual stimuli." Horm Behav. 1997 Apr;31(2):110-9.

5) Friedl KE, et al. "The administration of pharmacological doses of testosterone or 19-nortestosterone to normal men is not associated with increased insulin secretion or impaired glucose tolerance." J Clin Endocrinol Metab 1989 May;68(5):971-5

6) Lean ME, et al. "Pathophysiology of obesity." Proc Nutr Soc 2000 Aug;59(3):331-6

7) Pasanisi F, et al. "Benefits of sustained moderate weight loss in obesity." Nutr Metab Cardiovasc Dis 2001 Dec;11(6):401-6

8) Muscelli E, et al. "Metabolic and cardiovascular assessment in moderate obesity: effect of weight loss." J Clin Endocrinol Metab 1997 Sep;82(9):2937-43

9) Eckardstein A, Wu FC. "Testosterone and atherosclerosis." Growth Horm IGF Res. 2003 Aug;13 Suppl A:S72-84.

10) Malkin CJ, Pugh PJ, Jones RD, Jones TH, Channer KS. "Testosterone as a protective factor against atherosclerosis–immunomodulation and influence upon plaque development and stability." J Endocrinol. 2003 Sep;178(3):373-80.

11) Callies F, Stromer H, Schwinger RH, Bolck B, Hu K, Frantz S, Leupold A, Beer S, Allolio B, Bonz AW. "Administration of testosterone is associated with a reduced susceptibility to myocardial ischemia." Endocrinology. 2003 Oct;144(10):4478-83. Epub 2003 Jul 10.

12) Bhasin S. "Effects of testosterone administration on fat distribution, insulin sensitivity, and atherosclerosis progression." Clin Infect Dis. 2003;37 Suppl 2:S142-9.

13) Pugh PJ, Jones RD, Jones TH, Channer KS. "Heart failure as an inflammatory condition: potential role for androgens as immune modulators." Eur J Heart Fail. 2002 Dec;4(6):673-80.