ONE OF the great ironies of modern sport is that a group of drugs originally developed to treat emaciated prisoners of war and frail geriatric patients the anabolic-androgenic steroids-has become the controversial "breakfast of champions" for some of the world's biggest, strongest athletes.
Steroids. Perhaps no single word in international sports inspires so much fear and loathing, mystery and distrust.
After nearly two decades of spotty and inconclusive research, the American medical community remains sharply divided, and mostly undecided, about the value of anabolic steroids-synthetic derivatives of the male hormone testoterone-in promoting lean muscle mass and strength.
But almost unanimously, the athletes who use them are convinced that they "work," generating not only bulk as a result of increased fluid retention but also strength and improved performance, at least in weight events.
Therefore, the use of steroids is becoming increasingly widespread, despite documented side effects ranging from unpleasant to dangerous and almost complete absence of research into the possible long-term ill effects of the massive dosages routinely used by athletes.
Most alarming to physicians is the growing use of steroids by women, even though adverse reactions in females can be more severe and irreversible, and by young athletes, despite the likelihood that they can cause serious and irreversible growth disturbances in individuals who have not matured physically or sexually.
Steroids are probably the most widely used of the so-called "ergogenic" (strength-promoting) substances banned by the International Olympic Committee and other sports governing bodies.
The consensus is that in certain sports-notably the throwing events (hammer, discus, javelin, shot put), weightlifting, bodybuilding and wrestling-most of the top men use steroids in quantities ranging from modest to mind-blowing.
A great number of football players-chiefly in college, increasingly in high school, sometimes in the professional ranks-also use them, most often inconjunction with weight-training programs.
Steroid use also is increasing among pole vaulters, high jumpers, sprinters, cyclists, swimmers and athletes in various other sports who are trying to build strength.
"Every top-flight track man in the U.S. takes them," said Naval Academy track coach Al Cantello. "No one can convince me they don't. The marginal athlete can't compete without them, and the great athlete can't win a gold medal without them."
"How far down does the epidemic go? In colleges, I'd say steroids are widespread at the IC4A level and among any terms or individuals who think they are in contention for league titles . . .
"For any event that requires an explosion-running, jumping or throwing-steroids are mandatory. You're just giving away too much without them because the other guy is using them."
Adds Gideon Ariel of the University of Massachusetts, a respected authority on exercise physiology and chairman of biomechanical research for the U.S. Olympic Committee: "I know that practically all the American Olympic team qualifiers in many events-weight events, jumping, sprint-use steroids. 'If you don't use them, you don't make the finals.' That's the common belief."
Aggravating the situation is the fact that it is much more costly and complicated to test athletes for use of steroids than it is for stimulants.
The mass spectrometry and gas chromotography tests currently used can cost $400 to $500 apiece. Athletes also know that they can avoid detection by "going off" the drugs a week or two before testing, without sacrificing much of the presumed benefit.
Others shift from synthetic steroids to whole testosterone, produced chemically or obtained naturally from bulls, about three weeks before testing. Current tests are qualitative rather than quantative, and cannot distinguish between the testosterone produced naturally by the male athlete and that taken orally or by injection.
Moreover, some athletes have found ways of flushing remaining traces of synthetic steroids out of their systems before testing by using diuretics. Some Americans suspect Soviet weightlifting gold medalist Vassily Alexeyev of having done this in the 1976 Olympics at Montreal.
While few active athletes will acknowledge their own steroid use publicly, for fear of being disqualified from competition, many privately confirm their impression that use of the drugs is almost universal among world-class men, increasing among women, and filtering down to younger athletes in weight events.
The anabolic steroids used most commonly by American athletes are Dianabol (generic name: methandrostenelone), Winstrol (stabozalol), Maxibolin (ethyl estrenol), Durabolin (nandrolone phenpropionate), and Deca-Durabolin (nandrolone decanote).
All of these, and others manufactured abroad, are synthetic derivations of testosterone, which has properties that are both anabolic (tissue-building) and androgenic (masculinizing, in the sense of developing secondary male sex characteristics).
The synthetic steroids preferred by athletes attempt to emphasize the anabolic properties-primarily the synthesis of protein into muscle mass, and the production of nitrogen-retention by muscles-while minimizing the masculinizing effects, such as growth of body hair, deepening of the voice, enlargement of the penis in males and the clitoris in females.
However, as the pharmaceutical companies that manufacture the drugs acknowledge in their literature, "complete disassociation of anabolic and androgenic effects has not been achieved."
Moreover, a variety of adverse reactions have been documented even in the relatively small therapeutic doses (2 to 5 milligrams per day) recommended for the treatment of enfeebled patients.
In the massive doses regularly taken by athletes (10 to 500 milligrams per day, or prolonged periods), other side effects have been reported and far more serious long-range ones are feared.
Among the possible adverse reactions to anabolic steroids listed in the Physician's Desk Reference are, for both males and females, nausea, fullness, loss of appetite, vomiting, burning of the tongue, increased or decreased libido, acne (especially in females and prepubertal males), jaundice and various liver disfunctions. In cases of long-term therapy, there have been a few reports of liver tumors.
In males, testicular atrophy, reduced sperm count and feminization of the breasts can also result. All are apparently reversible.
In females, growth of facial hair, male pattern baldness, deepening of the voice and clitoral enlargement have been reported, and these adverse effects are generally not reversible even after use of the drug is discontinued. Menstrual irregularities also have been reported.
Use of steroids by young persons whose long bone growth is incomplete can result in closure of the epiphyses (the end parts of long bones) and irreversible stunting of growth.
While many athletes have taken anabolic steroids in moderate doses and experienced few if any of these adverse effects, some have encountered them and others.
According to empirical data gathered by researchers, coaches and athletes who have interviewed steroid users, few have encountered shrinkage of the testicles or reduction of sex drive, although some have experienced a decrease in ejaculate the reduced sperm count. There have been no reported cases of sterility.
But a number of athletes have encountered dangerously high blood pressure, especially when they have not done a good deal of endurance running as part of their training. This is undoubtedly due at least in part to fluid retention by their bodies, which also accounts for the development of a puffy "moon face" in heavy users. Many have developed liver disfunction.
Athletes on steroids frequently undergo personality changes as well, particularly increased nervousness and agressiveness.
According to Dr. Ariel, even modest steroid intake "makes you more nervous, short-tempered. You react to things hyperquickly and sometimes irrationally. There are often muscular twitches and cramps.
"I took steroids just for the hell of it, and within six weeks I had those symptoms," Ariel says. "I also broke all my old personal weightlifting records six years after I had given up lifting. At age 34, I bench-pressed 425 pounds-almost 50 pounds more than in my prime . . . very depressing for someone who is an enemy of steroids."
Athletes who routinely take large doses of steroids-as much as 500 milligrams of Dianabol a day at the peak of their training, or 3,000 milligrams of an injectable plus 1,000 milligrams of tablets a week-have experienced physical sluggishness along with mental aggression.
This is apparently due to two simulataneous phenomena. Because the liver is unable to dispose of metabolites formed as waste products, these clog the biliary capillaries around the liver, producing lethargy. At the same time, the intake of synthetic steroids inhibits the body's natural production of testosterone and other chemicals, including adrenaline. The adrenal cortex stops functioning normally, leaving the body without its natural stimulant.
In order to overcome this loginess, to "get through the valleys in training," athletes take various stimulants-usually amphetamines or ephedrine, sometimes Ritalin (a psychostimulant). In some cases they then need sedatives of other "downers" to ease them from their chemically-induced "highs".
"A lot of side effects of the steroid doses athletes take have yet to be delineated," said one physician who has treated a number of steroid-using athletes.
"There's some concern that steroids might increase cholesterol in the bloodstream and induce some sort of long-term arterial sclerosis or degenerative changes within the blood vessels themselves, but this is all very highly speculative at this point, without any definite data on it.
"The chemical structure of testosterone and its derivatives is very similar to that of cholesterol, and the people who take very high doses of steroids show some of the same manifestations of heart disease as people with high cholesterol levels. They also almost invariably have liver problems. Some doctors feel they run a high risk of developing cancers, but that too is purely speculative."
One frightening and thought-provoking theory put forward by Dr. Ariel, regarded by many as a "theoretical wizard" in his field, is that steroids could speed up the aging process.
"Aging is little more than the inability of DNA and RNA (the "lifebuilding" amino acid chains) to replicate as they once did. Protein can only duplicate itself so many times, and then you start to get old.
"Steroids speed up the replication process. Who knows that one year of chronological time using steroids is equal to in biological time? Two years? Three year? Who knows?"
Much of the research that led to the development of anabolic steroids was conducted in the 1930s, and the drugs started coming into regular use in sports in the 1960s.
"Many Olympic athletes of my generations wish they had never heard of anabolic steroids. We were just told, 'Here, take these pills. They'll make you bigger and stronger," said Naval Academy coach Cantello, a javelin thrower in the 1960 Olympics at Rome.
"What I've seen of steroids in 20 years terrifies me. No one can really prove that it's related to steroids, but as a group, those of use who were in the first wave of users have had a lot of tension, depression, emotional problems . . .
"You can't tamper with your own chemistry and not pay a price. I believe that using steroids affected my personality. I don't believe I'm the same person I would have been. A lot of people have told me so, too."
By modern standards, Cantello would have been considered a tiny user, yet he is convinced the drug left permanent effects. "I just think it changed me . . . maybe took away some mental sharpness. I just don't think I'm as smart," said the coach who, ironically, is known for his quick-wittedness.
"The Olympic track men of the '60s, those of us who were the first guinea pigs for anabolic steroids, have kept an eye on each other. We're waiting to see if we drop dead at 40," said Dr. Jay Silvester, three-time Olympic medalist in the discus, now a teacher at Brigham Young University, where he has published papers on the effects of steroids.
"Just 10 years ago, if you took 10 milligrams of Dianabol a day, that was considered a standard dose. That is the maximum that has ever been used in a controlled experiment, and then for perhaps six weeks on and six weeks off.
"Now I'm seeing doses no one would believe . . . These guys are taking 20 times more steroids than what used to be considered heavy doping, for months at a time, and they honestly believe that they are running no risk."
Silvester believes they are running a grave risk. Some doctors have grimly predicted a future rash of cancers. But the state of medical knowledge on the subject remains woefully incomplete.
"The basis problem is that no one has been permitted to run the experiments that have to be run in order to answer these questions-what are the real benefits, and what are the dangers," says Dr. Reggie Edgerton, a Ph.D. exercise physiologist at UCLA who has done some of the most extensive recent studies on steroids.
With an endocrinologist at a Los Angeles hospital, Edgerton spent a year formulating a proposal for such a study. But it was turned down by the university, whose board of review thought that the problem addressed did not justify the funding required, and also balked at the "human use problem."
"My feeling is that the only way around the problem, the one we proposed, is to combine the athletic questions with studies that are now being done at several labs around the world on the use of testosterone as a male contraceptive agent," says Edgerton. "We could probably get some useful information, but so far nobody has been willing to stick his neck out."
Last year the American College of Sports Medicine, an association of experts in the field, issued a position statement on the use and abuse of anabolic-androgenic steroids, based on an exhaustive review of the world literature, which reflected the cautious conclusions most of the scientific community draws from the fragmentary and often contradictory data at hand.
The position paper made these five points:
The administration of anabolic-androgenic steroids to healthy humans below age 50 in medically approved therapeutic doses often does not of itself bring about any significant improvements in strength, aerobic endurance, lean body mass or body weight.
There is no conclusive scientific evidence that extremely large doses of anabolic-androgenic steroids either aid or hinder athletic performance.
The prolonged use of oral anabolic-androgenic steroids . . . has resulted in liver disorders in some persons. Some of these disorders are apparently reversible with the cessation of drug usage, but others are not.
The administration of anabolic-androgenic steroids to male humans may result in a decrease in testicular size and function and a decrease in sperm production. Although these effects appear to be reversible when small doses of steroids are used for short periods of time, the reversibility of the effects of large doses over extended periods of time is unclear.
Serious and continuing effort should be made to educate male and female athletes, coaches, physical educators, physicians, trainers and the general public regarding the inconsistent effects of anabolic-androgenic steroids on improvement of human physical performance and the potential dangers of taking certain forms of these substances, especially in large doses, for prolonged periods.
The College's statement reflects the inconsistency of research methods and conclusions.
The crux of the problem remains that no controlled experiments have been done, at least in the West, using the high dosages that athletes use.
Dr. Ariel, who spent five years studying the effects of steroids, characterized as "ludicrous" those experiments that concluded that steroids have no effect on body building bulk or strength.
"I believe there is no doubt that steroids increase the rate of protein synthesis," he says. "They are hormones that catalyze amino acid production. The result is more tissue production, more water retention, and more strength."
But Ariel also has done studies that dramatize a "placebo effect," in which athletes given inert pills they thought were steroids showed as much physical gain as those given real steroids.
And so the debate continues, with some physiologists convinced that steroids work, others just as certain they don't, and most undecided.
Amid the uncertainty over the effects of steroids arises a question of medical ethics: Should a doctor assume the responsibility for prescribing steroids for athletes?
One who does is Dr. Walter Jekot, a Los Angeles pediatrician and general practitioner.
Dr. Jekot, a bodybuilder and weightlifter himself, treats a number of athletes, including football players, wrestlers, bodybuilders and lifters. After a complete physical examination, he prescribes steroids if they request them, and monitors them every three months with a series of blood, liver function, cardiovascular, kidney and other tests.
"Most of the time, the patients have already heard about and know about these drugs when they come in. A lot of them have already started them and just want somebody to guide them in taking them. We're so close to Mexico, that people can just go over the border and purchase them over the counter," Dr. Jekot says.
"If the patient is already using them, fine. If he comes in and says he wants to use them, chances are he would get them on his own, anyway, so I will prescibe some low-dose steroids for him, and monitor his functions."
But Dr. Irving Dardik, chairman of the U.S. Olympic Committee's sports medicine committee and drug task force, questions physicians who try to guide athletes in steroid use.
"It's a very difficult situation. I was in West Germany last year, reviewing their sports medicine program, and this came up. Some doctors were prescribing dosages to athletes because they said they were going to use steroids, anyway, and they didn't want them to hurt themselves with overdosages. But they were admonished by the Olympic officials, who came out with a major statement saying no one should give out drugs or prescribe dosages.
"The thing that was brought out in the last meeting of our drug task force was that if a physician is in disagreement with a patient about method of treatment, and the patient decides to treat himself, it would be not only legally-but morally, from a medical point of view-totally inappropriate to assist the patient in an improper method of treatment," Dr. Dardik said.
"If you give the dosages to that athlete, you are essentially saying, 'Go ahead and do something that is wrong.' So you have to draw the line. A doctor shouldn't assist a patient that way, I think it is unethical." CAPTION: Illustrations 1 and 2, no caption