Thank you Mark for this VERY IMPORTANT question. Your sports doc is very right. And unfortunately these high profile athletes who apologize when caught have decided that it sounds better if they say they took PEDs for an injury than if they say, “yes, I took them to increase my size, speed and strength to become a super human to get larger money contracts and set all types of records.”These cheats and liars (if you will) have cheated all fans as well as clean athletes and continue to lie when caught. And unfortunately the youth in America are getting the wrong message, just as you did. Time to set the record straight about what these substances are and why they are banned. But first….Why am I on this bully pulpit. As a sports doc in NYC, I see patients like you. As past president of the New York Chapter of the American College of Sports Medicine, I have been speaking out about this because sports docs everywhere are seeing this problem, especially in our youth. It has become an epidemic. Recently, we have seen use moving down to middle school students (where there is the additional problem of premature closure of growth centers and subsequent loss of 4-5 inches of height potential.) A little history: use of anabolic steroids goes back to the East German and Russian weight lifters and track athletes. Their sudden prominence necessitated the rest of the world’s elite athletes to begin to catch up. Over the years, usage spread to the colleges and more recently to the high schools, where it is one of the two greatest abuse problems, the other being alcohol. The last widespread survey was done about 10 years ago by the AMA and Penn State and put forth the following statistics: 1. Six to 10 percent of all male high school students will be on steroids at some point in their four years;
September 9, 2013
Do steroids assist in healing injuries?
Running Doc: PEDs don’t help heal injuries, despite what athletes say
Dear Running Doc:
If you listen to the apologies of major league ballplayers for using PEDs (performance enhancing drugs) or steroids (like Pettitte and Braun, for example) they always say they had “nagging injuries” and took them to get back to play. I am a 15-year-old high school football player with “nagging injuries” to my hamstrings, quads and right shoulder. So after hearing Braun say that he took steroids because he had injuries and so did Pettitte, I saw my local sports doc and asked him to give me some testosterone so I can play. He said PEDs do not heal injuries and refused. Who is right? I can always get some if this sports doc is lying! Mark P., Dallas, TX.
2. At any given moment 250,000 – 400,000 students are using these dangerous substances (and they are NOT getting them from their doctors); Although these statistics are relatively old, we know by newer surveys and questioning that the numbers are higher and continuing to increase at present. Interestingly, the largest increase recently has been in the non-athlete, those who feel size is important for self-esteem. The problem lies in the fact that these drugsare extremely dangerous with a wide range of side effects. Not everyone will get all of the side effects, however we are not able to predict who will get which effects, when they will occur, and at what point they will be irreversible. First, it is necessary to understand that there are two types of steroids, the anabolic steroids that we will spend time talking about and are banned and the cortico-steroids, which are not banned. Cortico-steroids are the in cortisone group and have anti-inflammatory and healing effects. The two have absolutely no relationship, but are often confused by the public.
Anabolic steroids have no healing power whatsoever. Their only medical uses are in cases of delayed sexual maturation in males, certain neurological diseases where there is muscle wasting, and to suppress estrogen activity in some forms of cancer of female organs.The anabolic steroids are all related to the basic male hormone testosterone. They are available in various forms; pills, injections and creams. Users often use combinations and vary what they take during training to accomplish specific effects and hide from detection of testers. Anabolic steroids are widely used by athletes to increase size and strength and by body builders and those who want to be bigger to increase their own self-esteem. There is absolutely no question that doses of steroids, combined with a high protein diet and a heavy weight training program can bring about 50-60 pounds of muscle weight gain and increased speed (running and bat speed). The following are what sports docs see, starting with the mildest and increasing in severity: 1. Development of severe acne over the upper trunk. This will usually clear when the drugs are discontinued; 2. Male pattern baldness with the hair loss being permanent. It is interesting to me that the “ego” users will risk this; 3. Changes in sexual characteristics (also interesting and when I speak at high schools about this, THIS seems to stop users and stop those contemplating use);
a) Testicular atrophy (testicles getting smaller). With the ingestion of testosterone the testicle does not need to produce testosterone, so it stops functioning. b) Sterility. When the testicle stops functioning, sperm production stops or slows down. This is usually reversible over a very long period of time after stopping the PED. c) Impotence. A common side effect. I first suspect anabolic steroid use when a teenager asks for Viagra. d) Acute prostatic enlargement, which may be so severe as to necessitate surgery to relieve urinary retention. e) Gynecomastia, a painful enlargement of breast tissue. This can only be changed by surgical removal of this newly formed breast tissue.
4. Calcium depletion. There is a softening of bones and increase in fractures and stress fractures;5. Increase in muscle and tendon injuries. An increase in muscle strength causes injuries to tendons and ligaments which don’t increase in size to handle the new strength. The athlete who is always “nicked” is cause for suspicion; 6. Liver disease. Early on, the user will show marked changes in liver function in laboratory blood tests. These changes are reversible cystic degeneration takes place; then they can actually be fatal. Also, the incidence of primary liver cancer is 16 times more common in users than non-users; 7. Cardio-vascular changes; a) Steroid use causes marked increases in cholesterol levels. Also the level of HDL (good cholesterol) is markedly decreased. Therefore, there is no protection against deposit of high cholesterol in the arteries. This is the reverse of the pattern with exercise in the absence of steroids. As a result we are seeing unexpected heart attacks in the 20’s-30’s age groups. b) Myocarditis. Steroid use can cause deterioration and inflammation of the heart muscle and again, an unexpected young athlete’s death. c) Hypertension. There can be fairly marked increase in blood pressure because of the huge mass of new muscle. This can be dangerous when combined with the normal rise during weight lifting. 8. Personality change. The use of high doses of steroids leads to very aggressive personality changes. Large amounts of male hormone can cause explosive, violent behavior swings. This is known as “steroid rage.” The changes can vary from subtle to severe disorders requiring hospitalization and psychiatric treatment. Fortunately, stopping the drug usually stops this mental disorder. In women, all the above except the sexual changes can occur. The calcium depletion is even more severe since the female has an increased tendency toward osteoporosis. In addition there are other effects, all of which are irreversible except for loss of menstrual periods:
1. Growth of facial hair and change from female to male pattern of body hair; 2. Deepening of the voice; 3. Sexual changes; a) Loss of menstruation; b) Enlargement of the clitoris; c) Loss of breast tissue. Human Growth hormone (HGH) is not an anabolic steroid but is a PED. It also has NO HEALING properties. HGH is a hormone produced by the pituitary gland that is responsible for normal growth and development. Approved medical uses are: 1. Short bowel syndrome, a condition in which nutrients are not properly absorbed due to severe intestinal disease or the surgical removal of a large portion of the small intestine; 2. HGH deficiency due to rare pituitary tumors or their treatment; 3. Muscle-wasting disease associated with HIV/AIDS; 4. It increases muscle and bone size, strength and speed and also increases the size of bone mass. Those with hip problems due to impingement of muscles and tendons around the hip and labral tears are suspected of HGH use due to increased size of the femoral neck into the hip and increased torque on the cartilage due to increased strength about the hip. Other possible side effects of HGH use include: 1. Nerve, muscle, and/or joint pain; 2. High cholesterol levels leading to early heart disease and death as with steroids; 3. HGH can also increase the risk of diabetes; 4. HGH can increase the growth of cancerous tumors. So Mark, I hope this information helps you see why these drugs are banned and why you should not use them. Hopefully, with everyone understanding this, our sports “heroes” won’t encourage use by lying that they help them heal. Lewis G. Maharam, MD *** Lewis G. Maharam, MD, is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series . He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.