With months to go before the Beijing Olympics, performance-enhancing drugs are hogging the headlines in an unprecedented way as confession contagion in United States courts sees elite athlete after athlete admit to drug use.
Steroids use is hotly debated. Some believe that banning them is hypocrisy: that measures to control anabolic steroid use in international sport are honoured in the breach and that going through the motions to catch occasional abusers merely allows cheats to do better than honest sportsmen and women.
But the ubiquity of the drugs is explained by one South African athlete with a long history of injectable abuse:
“The whole thing is a farce. The life of a professional rugby player, particularly a forward, is probably four or five years. After that, if you haven’t made enough money to buy a business, it’s coaching junior sides for some, or selling used cars along Ontdekkers Road or, worst of all, becoming a security guard because people think you are tough. Given that, everyone who plays rugby for a living takes roids — everyone. There are no exceptions.”
The sports fanatics gathered at the sports bar with us murmured their agreement.
The next morning I did some reading on the most widely known performance enhancers: anabolic steroids.
Anabolic steroids are fat-based hormones related to the naturally occurring testosterone. Testosterone was first isolated in the early 1930s and synthesised in the lab within 10 years.
During World War II German doctors experimented with testosterone on concentration camp inmates to see if the wasting induced by starvation could be reversed. Soldiers were also experimented on to see if testosterone could increase their aggressiveness in battle. Hitler himself is reported to have received testosterone injections from his physician.
Extraordinarily, between 1950 and 1980 scientists believed the effects of testosterone were achieved by a placebo effect — in other words, that any differences were based on patients’ belief that they were being given a booster rather than the real effect of the drugs. It was only in 2001 that a clinical trial categorically showed an effect on size, strength and stamina.
Since then the growth of the anabolic steroid market has been phenomenal and they are now familiarly known as roids. Amateur, professional and “recreational” abuse has mushroomed. The difficulties of accessing an illegal product have caused an explosion of internet sites selling, advising or warning of their dangers — Google recorded an unrefined number of 1 850 000 sites. Anecdotally many users buy veterinary products or steroids manufactured in little sweat shops with little quality control. Many end up with bogus products as sellers cash in on the buying frenzy. Long-term medical use of roids is almost non-existent these days although some in the US use it to counter wasting as a result of HIV.
The effects of anabolic steroids on the body are well understood. Broadly they have two effects: they increase cell growth, particularly growth of muscle fibres and red cell production from the bone marrow; and they cause or maintain virilising effects — increasing the manliness of women and men.
Surprisingly the overall dangers seem to be overestimated. The side effects seem to be dose related in other words, effects depend on how much you take. All, or almost all, side effects are reversed when you stop. Side effects can be divided into the serious and the minor. The major ones are related to the cardiovascular system, and include high blood pressure and unhealthy levels of cholesterol. Prolonged use can cause liver damage and ultimately increase the risk of liver cancer.
The minor side effects are slightly different for men and women. Both sexes can experience acne but men also experience hair loss, enlarged breast tissue, their testicles shrink and sperm production is reduced. Women may experience deepening of the voice, clitoral size increase, increase in body hair and disruption of the menstrual cycle.
The legal status of anabolic steroids varies from country to country: some have stricter controls over their use than others. In the US anabolic steroids are listed as Schedule III under the Controlled Substances Act, which makes their possession a federal crime punishable by up to seven years in prison. In South Africa legislation provides for a 10-year sentence for those in possession of steroids, but there is no enforcement mechanism.
Not all experiences are negative. Chuck Palahniuk, author of Fight Club, which was made into a film with Brad Pitt, has written about his foray in the world of roids.
Hanging with friends who were weightlifters, Palahniuk decided after a while to “jump off the cliff” as well. Although only a dabbler in weightlifting, he describes the effect of roids as generally positive. Despite dire warnings in the package insert, his side effects were minimal for the month he took the drugs.
He developed a raging priapism (painful, stiff penis) for the first two weeks but that resolved itself; he noticed that his testicles had shrunk and tried not to worry about it. But there are positive effects: “People squinted at me and asked what was different. My arms got bigger but not that much. More than the size, the feeling was enough. I stood straight, my shoulders squared … Your eyes are popped open and alert. The way women look good when they are pregnant, glowing and soft and so much more female — Anadrol makes you look and feel that much more male.”
The effect on training, whether psychological in origin, was even more dramatic: “Weightlifting gets better than sex —”
Most users employ two methods to minimise side effects; one is to exercise more to reduce the hypertensive and cardiac risks. The other is to use what is referred to in the literature as “cycling”, or coming off them for predetermined periods to allow the body to recover. Cynics might say that when rugby coaches talk about their players “needing rest” or a “conditioning programme” what they are actually referring to is the cycling phenomenon.
So where does this leave the question of anabolic steroid use? If the athlete’s health is paramount we are all collectively guilty of the purest hypocrisy: we are entertained by, for example, the Nadia Comaneci type of gymnast and acrobat. Yet the price such an athlete pays is well known — eating disorders, sometimes life-threatening, are almost universal, as well as a middle age of pain and disability from osteoarthritis in worn-out and damaged joints. So clearly the protection of athletes is not the reason for the outlawing of roids.
What about the question of unfair competition — if some athletes are users and some are not, surely this is unfair? But is it equally unfair if some athletes train at altitude or train harder and longer than others? Or even more crudely, is it unfair if athletes have different capacities?
But this debate is largely academic — if every professional cyclist in the world uses anabolic steroids then we need to acknowledge and accept that. To pretend to outlaw it is simply to place the athlete in the position of hiding and denying his steroid use.
Perhaps the need is for free and open disclosure about what the athlete is taking and a safety officer or committee to advise the athlete what breaks she needs to take and how the dose can be tailored to individual needs. Then we’ll have free and open competition in international sport where a sportsman’s health is the major concern.
Besides, as the cynical athlete mentioned above said: “And, if Chuck Palahniuk enjoyed taking them, that’s good enough for me to have a crack too —”
Elvis Jack is a physician and freelance journalist