TABLE OF CONTENTS
2) Anabolic-androgenic steroid use
3) Effects of anabolic-androgenic steroid use
4) Causes of anabolic-androgenic steroid use
5) Signs of anabolic-androgenic steroid use
6) Supplement use in teenagers
7) Supplement side effects and signs
iii) Appetite suppressants
8) Prevention strategies
i) The parent / teachers’ role
9) Over-the-counter supplements (a guide)
i) Organisations for assistance
ii) Books / articles / websites of value
i) Appendix A - DSM Substance Dependence Criteria
ii) Appendix B – Drugs abused by athletes as compiled from underground guides
iii) Appendix C – Industry Jargon
iv) Appendix D – Signs of developing dependency
v) Appendix E – Mass Building Supplements (SA)
In any paper revolving around teenagers and their use of ‘mass building’ supplements it is important to note that the use of supplements to build mass and the use of steroids are not mutually exclusive. Many authors of works on body image and steroid use believe that they are inextricably linked. It is debatable as to whether the use of over-the-counter supplements are a ‘gateway’ to the use of more damaging steroids but the overwhelming feeling confirms that the risk is increased when teenagers begin to take supplements.
The Centre for Disease Control and Prevention’s (CDC) Youth Risk Behaviour Surveillance- United States, reports that the percentage of students using steroids increased to 6,1% by 2002. The common belief that ‘supplements’ are not potentially dangerous has resulted in a limited amount of information about youths (of school-going age) and their ‘supplement use’ habits. As such, the preliminary information in this paper will focus on the prevalence of steroid use among males. The National Centre for Education Statistics estimated that in 2005, of “16,5 million some 5,4% of the public and private school children between” the ages of 14-17 years (660 000 children) had used or were using steroids. In Body Dysmorphic Disorder in Men, Phillips indicates that between 6 and “7% of high school boys have used these drugs” (Phillips: 2001).
Adolescent anabolic steroid use is a nationwide phenomenon with “prevalence rates among high school males [ranging] from 5-11%”, with high school athletes continuing to use these agents to improve their athletic performance and appearance despite the associated risks (Proctor: 1998). In addition, it is reported that school children begin using anabolic steroids before the age of 16 years and up to 86% of these students have no intention to cease their use of these illegal drugs. In light of these statistics, in any attempt to reduce the associated health risks of steroid use/abuse, it is imperative that implementation programmes to that effect are introduced into the school curriculum at the very latest in junior high.
“Performance enhancing drugs” have been around for centuries; the ancient Greeks used “strychnine and hallucinogenic mushrooms” in preparation for the original Olympic Games; years later (1886), the first athlete died from using performance-enhancing drugs (Luciano: 2001, 175). It is agreed that the initial use of performance enhancers was related to sporting achievement but today we are seeing more males utilizing supplements for non-sporting gains.
Metabolic and anabolic-androgenic steroids were first studied on experimental animals; the influence of the testis on metabolic processes in tissues other than the accessory sex organs has been recognized for a long time. The “dramatic effects on vigour and energy reported by Brown-Seguard (1889) after the self-administration of testis glycerol extracts focused attention on energy metabolism, and later several investigators administered extracts to experimental animals, with small and questionable results on energy and nitrogen metabolism” (Kock, 1989; Moore, 1939) (http://www.teendrugabuse.us/teensteroids.html)
German scientists discovered testosterone, the primary male hormone in the 1930s, and developed analogs (drugs with slight chemical changes to the testosterone molecule) during experimentation. Taking the testosterone molecule and synthesizing its structure lead to the invention of the anabolic-androgenic steroid – this is the term we use today to describe this very large group of substances. In 1956 Dr John B Ziegler produced a testosterone synthesis christened Dianabol (Luciano: 2001, 176). Dianabol was introduced in to the market in the 1950s as a product for the building of muscle mass and strength. The use of anabolic-androgenic steroids in sport had reached critical point by the 1960s and several major sporting organizations had already banned the use of steroids and had extensive drug testing policies in place. (http://www.steroidabuse.com/steroids-101.html)
The dilemma is the fact that testosterone is a naturally occurring entity in the body and is mainly produced by cells in the testicles, called the Leydig cells, and released into the blood stream, which carries it to cells all around the body. Although the testicles are the bodies primary source of testosterone, smaller amounts are produced in the adrenal glands; testosterone is but one of many steroid hormones naturally occurring in the body. They all possess one commonality, in that they are produced from “one basic building block, a fatty substance called cholesterol” (Fitzhugh: 2003, 8).
Anabolic-androgenic steroids are usually synthetic substances similar to the male sex hormone testosterone; ‘anabolic’ refers to a steroid’s ability to help build muscle and ‘androgenic’ refers to their role in promoting the development of male sexual characteristics. There are however very legitimate medical uses for these drugs; the initial utilization of steroids focused on inadequate male sexual development, people suffering with asthma, anemia and breast cancer. The article by Pandina & Hendren (1999) unfortunately suggests that approximately 2% of males will use these drugs illegally.
Although, originally synthesized for legitimate medical practice, the effects produced by the drug has ‘morphed’ into a thriving underground market of producers and suppliers getting rich from the male need to be bigger and stronger.
2. Anabolic-androgenic steroid (AAS) use…
The fact that “prescription steroids are classified as schedule III” substances, means that medical practitioners may ethically and legally not supply them to young healthy males in the attempt to build muscles for personal reasons. The originally legitimate medical uses of steroids has transformed into the illegal acquisition of ‘roids’, (often referred to as ‘juice’ by some users), for both physique and performance enhancement, and as such the development of a ‘black market’ of supply and demand for ‘steroid pushers’.
Steroids have two basic forms:
- Actual testosterone (naturally occurring)
- A clinically modified version (synthetic)
Anabolic-androgenic steroids promote cell growth and division in the body which results in the rapid increase in development of muscle tissue, cartilage and bone. This is achieved through ‘anabolism’ which is the process of building larger molecules from smaller ones. When we add an acid group to the testosterone molecule (during synthesis), causes it to undergo esterification, the increase in carbon atoms is directly proportional to the increased affect of the steroid resulting in increased performance of the drug. As an organic molecule, the addition of carbon atoms to the host molecule is virtually infinite and as such, the variants of synthetic steroids in the market is becoming extensive. In simpler terms “increasing the number of carbons sequentially increases the affinity of the anabolic steroid” (www.femmefan.com/site/featuredarticles& www.steroidabuse.com/steroids-101). This escalation in mass building drugs is a serious concern for me, as an educator I feel a personal responsibility to ensure that the ‘gateways’, that will be mentioned later, are minimized or eradicated to limit if not prevent the progression into steroid use by our young, school aged males.
Anabolic-androgenic steroids development was encouraged due to deficiency in the hormone testosterone in males, this condition is known as hypogonadism. However, since their inception, AAS have also been useful in treating various other conditions such as cancer, HIV and AIDS. In addition to having ‘anabolic’ uses they also have physiological implementation properties, such increasing protein synthesis in the body, resulting in an increase in muscle mass, strength, appetite and bone growth in the user (www.steroidabuse.com/steroids-101).
Recently, a condition known as ‘andropause’ which is a decline in the levels of androgen found in older males, has lead to the medical approval of the use of anabolic-androgenic steroids in these patients. The application if steroids has four basic forms of administration, these are listed below:
- Intramuscular injection- injected deep within the muscle, typically in the buttocks
- Oral administration- tablet, capsule and liquid forms
- Transdermal administration- creams, gels or patches, absorbed through the skin, or rubbed in directly
- Subcutaneous injection- human growth hormone (HGH) and other related compounds applied by injection under the skin
The ability of steroids to increase muscle mass and strength in the user has been harnessed by manufacturers and thus makes them very desirable to the male who feels ‘wanting’, either in the sorting arena or with their physique.
Supplementary to these methods of administration, in ‘Effects and Warning Signs of Teen Steroid Use’, the author extends the list into ten major forms of anabolic steroids administration based on how they are introduced into the body and what method of ‘carrier solvent’ is utilized in their administration: (http://forum.bodybuilding.com/showthread.php?t=512317)
- Injectable oil-based
- Injectable water-based
- Patch or gel
- Aerosol, propellant based preparation
- Homemade transdermal preparation
- Androgen-estrogen combination
- Counterfeit anabolic steroid
- Over the counter (OTC)
In Kanayama (2009) it is claimed that AAS use began to emerge in the 1980s among males who wanted to look more muscular and leaner, what is interesting is the fact that they were not competitive athletes. (www.archido.de/index.php) Health food stores boomed in the 1980s with the sales of a central nervous system depressant used to stimulate muscle growth; GHB (gamma hydroxybutyrate) or liquid ecstasy was being sold over-the-counter, marketed as a ‘health product’ (Barlow & Durand: 2005). In research studies by Fitzhugh (2003) the suggestion is that approximately half of all users of anabolic-androgenic steroids are teenagers, and more of a concern is that around half of these teenagers are using the drugs for aesthetic purposes, in that they are seeking to change their physical appearance instead of initially being a means to improve their sporting prowess.
“Steroids are most commonly found in gyms, which offer not only supplies of the drugs, but role models, especially for the young” (Luciano: 2001, 178).
At the British Medical Association conference of 2002 research conducted suggested that there was “45 000 British gym-goers who regularly [used] steroids”, with many more gym-goers having tried them at some stage in their gym attendance. It was estimated that anabolic steroids were being used by some 5-9% of gym goers, however, this is believed to be a very conservative estimate and the number is probably somewhere from 20-40% (Fitzhugh: 2003).
Under British Law, anabolic steroids are treated as Class C drugs by the 1971 Misuse of Drugs Act. The Medicines Act classes them as ‘Prescription Only’ drugs, and since 1994 the maximum penalty for any other kind of supply is five years imprisonment or an unlimited fine or both (Fitzhugh: 2003, 14).
These drug-like training aids do not include simpler nutritional supplements such as multivitamins or protein drinks, such as:
- Ephedrine, caffeine, androstenedione (andro), and nandrolone precursors
By definition, a supplement is described as “any product intended for ingestion as a supplement to a diet” (www.timeslive.co.za). AAS are not presently available over the counter but can easily be ordered over the internet. The criteria for dependence, with specific reference to “anabolic-androgenic steroid (AAS) dependence (see Appendix A) has been [interpreted] for” diagnosis (Kanayama et al. ), the crux of dependence is characterized by the regular, patterned use of AAS, this use then leads to impairment or distress (both of which must be significant) and additionally three or more of the criteria, as listed, within a 12-month period. Anabolic steroid abuse is becoming an increasing problem particularly for boys and men, and around “30% of AAS users appear to develop a dependence syndrome, characterized by chronic use despite adverse effects on physical, psychosocial or occupational functioning” (Kanayama: 2009).
We can not deny that “steroids work” and this is probably one of the biggest frustrations for professionals wishing to eliminate the use and abuse of anabolic-androgenic steroids. The effects of the drugs speak for themselves and it is this unquestionable fact that promotes the continued and increased use of AAS. “AAS dependence is a valid, diagnostic entity and probably a growing public health problem” (http://lib.bioinfo). I believe that the use of anabolic-androgenic steroids in South Africa is on the increase, and I believe that the ‘gateway’ to steroids is the use of supplements for mass growth use among teenage boys. This suggestion will be discussed later in this paper.
3. Effects of anabolic-androgenic steroid use…
The most common anabolic-androgenic steroids used include; andro, oxandrin, dianabol, winstrol, deca-durabolin and equipoise; although there is an extensive number of variations. ‘Prevention is better than cure’ and as such, it is agreed that one shouldn’t begin using steroids to prevent the problem of abuse developing but how do you determine when use has become abuse? Addiction involves two basic components; drug seeking behaviour and dependence. AAS users pop pills, others use hypodermic needles- taking the use of steroids to the level of abuse when users are taking quantities from 10 to 100 times the dose that would be prescribed or administered by the doctor for legitimate purposes; with doses of this nature being taken it is evident that the use of steroids can have fatal consequences for the user (http://teens.drugabuse.gov/facts/facts_ster1.php).
‘Abuse’ can be “defined as the inability to refrain from using or participating in something that is dangerous to one’s health”, despite the associated risks. (http://www.steroidabuse.com/steroids-101.html).
The abuse of AAS has the potential to produce serious liver disease; this can manifest in the growth of tumours and malignant cancers. Pelosis hepatitis results from the rupture of blood filled sacs causing internal bleeding. The user’s liver aims to metabolize the steroids and it is evident that steroids taken orally are more difficult for the liver to metabolize. The levels of low density lipoprotein (LDL) are increased and the levels of high density lipoproteins are reduced, this throws the chemical balance of the body. In addition to damage to the liver, there is potential risk to the heart. “[Cardio vascular disease] encompasses a wide range of complications including arteriosclerosis [causing fatty] deposits on the inner lining of arterial walls; the clogging and partial blockage of arteries which can be fatal, restricting blood flow to the heart and brain”. Testosterone has the potential to be converted in the body to form other hormones; this can lead to the development of or an increase in acne in the user, (one of the earliest signs of use), male pattern baldness and enlargement of the prostate. During conversion of testosterone, the female hormone estrogen may result; this produces abnormal growth of the breast tissue resulting in gynecomastia. Increased estrogen levels also reduce the sexual desire of the user and diminish the ability to attain and maintain an erection, having obvious psychological implications. Many steroids are injected into the user under the skin, and poor injection technique can result in bacterial infection causing abscesses, scar tissue, cellulitis and even gangrene. When needles are being shared for steroid use it can also have the added risk of contracting HIV, AIDS and Hepatitis B or C. It has been discovered that the use of steroids in adolescents, because they are still growing, can cause permanent alteration to the child’s brain chemistry; with all of these associated risks, it fascinates me that the abuse of steroids continues (www.steroidabuse.com).
In order to avoid the side effects of steroid use, many users ‘cycle’ and supplement AAS in such a way that they simply don’t suffer from negative effects. Of the banned substances, anabolic-androgenic steroids are the most widely accessible, with ampoules intended for veterinary use being imported from Asia and Central America. Steroids are often blended or mixed with a variety of different drugs and abusers will megadose by taking huge quantities of drugs (Morgan: 2008). Steroids aren’t the only drugs in the bodybuilding business; also available from underground dealers are human growth hormone, thyroid hormones (easily available on the black market), human chorionic gonadotropin, amphetamines, gamma-hydroxybutyrate, clenbuterol (a drug used largely for veterinary purposes), Nubain and an array of others. (See Appendix B for an extensive list of drugs abused by athletes). Boys and men may experience aggressive and sometimes violent reactions while taking steroids, but also depressive reactions while coming off steroids. In the gym circles, the most popular new injectable drug seems to be Nubain or nalbuphine, a prescription painkiller chemically related to morphine. Users may also take prescription-only stimulants such as amphetamine and methamphetamine- the latter typically known as Methedrine or crystal meth (Pope et al.: 2000).
“Stromba, Deca-Durabolin, Primobolan, Anavar, Winstrol, Anadrol, Dianabol, Sustanon 250” and Equipoise are some of the commercial names used for steroids (www.thesite.org). Users generally self administer their drugs for blocks of time called ‘cycles’, planned cycles of increasing and decreasing AAS doses, called ‘pyramiding’ allow users to avoid plateauing. The hypothalamic-pituitary-testicular (HPT) axis can be suppressed by the administering of exogenous AAS which leads to decreased endogenous testosterone production in males; this syndrome has been recognized for more than 20 years. In Luciano (2001) we find that within two months of AAS use, the “sperm counts can drop by nearly 75%” in users. The human growth hormone (HGH), used by approximately “5% of 10th grade boys in Chicago”, is a steroid derived “from the pituitary gland of cadavers” and can potentially cause acromegaly, “an irreversible disease that distorts the growth of the face, hand, feet and even the genitals” (Luciano: 2001). Many body-shaping drugs are abused by millions of boys and men with a complete disregard for the physiological and psychological side-effects of steroid use.
The effects of steroids can be summarized into two broad components, physiological effects and psychological effects. (Fitzhugh: 2003 & NIDA for Teens).
- prematurely stunted growth (hormonal increases signal bones to stop growing)
- jaundice (yellowish colouring of skin, tissues and body fluids)
- fluid retention
- high blood pressure
- viral infections (from sharing of needles)
- increased LDL (bad cholesterol)
- decreased HDL (good cholesterol)
- severe acne
- osteoarthritis (ruptured tendons or torn muscles)
- bruising of the skin, stretch marks, hives, itchy rashes
- colds and flu
- liver & kidney tumours
- shrinking of the testicles
- reduced sperm count
- infertility (temporary impotence)
- increased rate of bodily maturation (a risk particularly for teens)
- gynecomastia (female-like breast tissue caused when steroids aromatize, i.e. convert to high levels of estrogen)
- increased risk of prostate cancer (some AAS convert to Dihydrotestosterone or variants of that hormone)
- atherosclerosis (fat deposits that obstruct blood flow)
- cardiovascular disease (weakens the immune system)
- increased risk of strokes and heart attacks
- chronic gonadotropin (in teens)
- testicular atrophy (shrinkage in teens)