January 20, 2014
It's time for those who cheat to fade away
by: A. Marc Gillinov, M.D., Heart Surgeon at Cleveland Clinic and author of Heart 411: The Only Guide to Heart Health You’ll Ever Need Worldwide, thousands of athletes take performance enhancing drugs (PEDs), cheating their opponents and endangering their health. The practice is rampant, an apparent constant in high school, college and professional sports. But we pay attention to this problem only when a professional sports star is caught. And even then, we focus only on suspensions and money, ignoring serious health risks. PEDs are dangerous. Biologically active compounds, PEDs have real effects on bodily systems, health and wellbeing. Many of them are actual medicines, used to improve health when administered in appropriate doses to people who need them (e.g., growth hormone for those with pituitary growth hormone deficiency). Let’s examine three popular PEDs that can increase muscle mass and have therefore bridged the gap between real medicine and cheating in sports. Testosterone and Anabolic Steroids Within the category of PEDs, steroids garner the most attention. Here we are talking about testosterone and related compounds. These are termed “anabolic steroids.” Athletes use them to increase muscle mass and to speed recovery from strenuous workouts. A quick Internet search reveals that these substances are widely available. While it is true that your body produces testosterone and that doctors sometimes prescribe testosterone to treat certain illnesses, the use of testosterone and other anabolic steroids to promote athletic performance has not been proven to be safe and is likely harmful. In men, excess testosterone can promote baldness and breast development while causing the testicles to shrink; surely no athlete wants to accumulate these side effects on the way to larger biceps! More importantly, taking testosterone and related anabolic steroids has been associated with increased LDL cholesterol, high blood pressure, heart attacks, liver abnormalities and psychiatric issues. These are “major league” health problems. While the overall risk of these serious health conditions is likely small, the fact that they can occur should warn young athletes away from testosterone and other anabolic steroids. Androstendione (Andro) Like testosterone, androstenedione (andro) is a naturally occurring chemical. The body produces andro in the adrenal glands, the ovaries and the testis. Because the body can convert andro to testosterone, many athletes and trainers believe that taking andro boosts testosterone levels and thereby increases strength. When a person takes andro, the body converts much of it to estrogen rather than to testosterone. Estrogen is the primary female hormone. While andro may cause a slight increase in muscle mass, it is also likely to increase breast size. In addition, andro can decrease HDL cholesterol (the good cholesterol), and this may increase the risk of a heart attack down the road. Human Growth Hormone Another naturally occurring substance, human growth hormone (HGH) has been coopted by the cheaters. Like anabolic steroids, HGH has real medical uses, including the treatment of HGH deficiency, some intestinal conditions and certain genetic disorders. While HGH probably does increase muscle mass in many, it has not been shown conclusively to enhance performance. In addition, it can cause problems with the pituitary gland (where HGH is made), high blood pressure, diabetes and, in some people, heart problems. Other PEDs Creative cheaters have identified a huge variety of other PEDs. Erythropoietin (epo) increases red blood cell production, meaning a greater capacity to deliver oxygen to exercising muscles; this has been a favorite of cyclists and other endurance athletes. Stimulants like ephedrine and pseudoephedrine (both found in some cold medicines) and amphetamines can boost physical performance and aggressiveness. These stimulants have real medical risks, ranging from blood clots and heart attacks to violent psychoses. PEDs in History The history of PEDs provides a clue concerning where they should fit in today’s world. The use of PEDs did not originate with modern pressures to win championships and secure enormously lucrative long-term sports contracts. Anabolic steroids have been around for nearly a century. Their story starts around the time of World War II. The chemical structure of testosterone was discovered in 1932, and scientists quickly realized that they could synthesize a new class of drugs with similar structure and function to testosterone — anabolic steroids. Recognizing potential medical uses of the compounds, doctors used them to treat a variety of conditions, including impotence, depression and starvation. But others saw the potential to move these drugs beyond the medical arena. The first abuse of anabolic steroids is credited to the Nazis. During World War II, Nazi soldiers were supposedly treated with anabolic steroids to increase their aggressiveness and strength. Decades later, use of anabolic steroids was a well-established practice among competitive weight lifters, cyclists and track-and-field athletes. Today, their market extends from high schools to professional teams, with annual sales exceeding $1 billion. That’s an amazing run for a dangerous and unfair practice pioneered in Nazi Germany. Fair Play My high school’s motto is “Fair Play.” When it comes to PEDs, let’s recognize their health risks and add an additional word, making the goal “Fair, Safe Play.” It’s time for those who cheat to fade away, replaced by a generation of athletes that follow this motto.