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Addiction is a legitimate concern, and Yesalis says a quarter to a half of those who use steroids solely to improve their body image exhibit signs of psychological dependence. "But in all my years of research," Yesalis continues, "I've only known three professional athletes who were clinically addicted to steroids." The distinction, he explains, is that professional athletes see steroids as little more than a tool to help them do their job--the way "an office worker views his computer." Once their playing days are over, almost all the athletes within Yesalis' purview "terminate their use of the drug."
One reason the health effects of steroids are so uncertain is a dearth of research. In the almost 65 years that anabolic steroids have been in our midst, there has not been a single epidemiological study of the effects of long-term use. Instead, Yesalis explains, concerns about extended usage are extrapolated from what's known about short-term effects. The problem is that those short-term research projects are often case studies, which Yesalis calls the "lowest life form of scientific studies." Case studies often draw conclusions from a single test subject and are especially prone to correlative errors.
"We've had thousands upon thousands [of long-term studies] done on tobacco, cocaine, you name it," Yesalis complains. "But for as much as you see and hear about anabolic steroids, they haven't even taken that step."
What about the research that has been done? At least some of it seems to yield engineered results. "The studies linking steroid use to cancer were performed by and large on geriatric patients," notes Rick Collins, attorney, former bodybuilder, and author of the book Legal Muscle, which offers an exhaustive look at anabolic steroid use under U.S. law. The hazard of such research is that side effects observed in an older patient could be the result of any number of physiological problems unrelated to steroid intake. Moreover, the elderly body is probably more susceptible to adverse reactions than the body of a competitive athlete.
Collins believes that some studies were performed with a conclusion in mind at the outset. "Their hearts were in the right place," says Collins. "Curtailing nonessential steroid use is a good and noble goal, but they undermined their efforts by exaggerating the dangers." Call it the cry-wolf effect.
For instance, it's long been dogma that use of anabolic steroids interferes with proper hepatic (liver) function and causes thickening of the heart muscle. However, a 1999 study at the University of North Texas found that it's not steroid use that causes these medical phenomena; rather, it's intense resistance training. Weight-lifting causes tissue damage, and, at high extremes, can elevate liver counts and thicken the left ventricular wall of the heart. Both disorders were observed in high-intensity weightlifters irrespective of steroid use. The researchers concluded that previous studies had "misled the medical community" into embellishing the side effects of use.
Testosterone-Fueled Panic
The cry-wolf effect may have as much to do with the boom in steroid use as anything else. Athletes were inclined to be skeptical of warnings about steroids because their own experience contradicted what critics were saying. When use of Dianabol and other anabolics began to surge in the 1960s and '70s, opponents decried them as ineffective. The message was: They don't work, so don't take the risk. But steroids did work, and users knew it. Once weightlifters, bodybuilders, and other athletes realized they were being lied to about the efficacy of steroids, they were less likely to believe warnings about health hazards, especially when the evidence backing them up was vague or anecdotal.
One of the chief drumbeaters for the steroids-don't-work movement was Bob Goldman, author of the hysterical anti-steroids polemic Death in the Locker Room. Goldman, a former competitive power-lifter turned physician and sports medicine specialist, was an early, and shrill, critic of performance pharmacology. In his 1984 expose, Goldman attributes steroids' tissue-building qualities almost entirely to the placebo effect. His agenda may have been morally sound, but his conclusions ran counter to the preponderance of scientific evidence at the time. Today, his claims are even less supportable. Goldman is working on a new edition of the book, one that he says will better crystallize current scientific thought on the subject. Of his 1984 edition and its seeming histrionics, Goldman says the book was intended "as an educational tool to warn high school students of the possible hazards of drug use, but then it became something else."
Whatever his intentions at the time, Goldman's views played well in the media, which cast the book as a sobering empirical assault on performance-enhancing drugs. Its warnings soon gained traction with lawmakers. Although the Anti-Drug Abuse Act of 1988 had already made it illegal to dispense steroids for nonmedical reasons, Congress, ostensibly out of concern over reports of increasing steroid use among high school athletes, revisited the matter in 1989.
Congressional hearings convened to determine whether steroids should become the first hormone placed on Schedule III of the Controlled
Substances Act, reserved for drugs with substantial abuse potential. Such legislation, if passed, would make possession of anabolic steroids without a prescription a federal offense punishable by up to a year in prison. Distributing steroids for use, already prohibited by the 1988 law, would be a felony punishable by up to five years in prison. What's usually forgotten about these hearings, or perhaps simply ignored, is the zeal with which many regulatory agencies, research organizations, and professional groups objected to the proposed changes.
The American Medical Association (AMA), the FDA, the National Institute on Drug Abuse, and even the Drug Enforcement Administration all opposed the reclassification. Particularly adamant was the AMA, whose spokespersons argued that steroid users did not exhibit the physical or psychological dependence necessary to justify a change in policy.
Nevertheless, Congress voted into law the 1990 Anabolic Steroids Control Act, which reclassified steroids as Schedule III controlled substances, placing them on legal par with barbiturates and narcotic painkillers such as Vicodin, just one step down from amphetamines, cocaine, and morphine. Now even first-time steroid users faced possible jail time.
Black-Market 'Raids
Prohibition naturally produced a black market, and unintended consequences followed. Besides creating yet another economic niche for the criminal underworld, the legislation scuttled any hope of using steroids as a legitimate and professionally administered performance enhancer.
Criminalization of steroids created dangers more serious than any that had prompted the ban. Once steroids became contraband, many athletes bought black-market anabolics that, unbeknownst to them, were spiked or cut with other drugs or intended solely for veterinary use. Physicians were forbidden to prescribe steroids for promoting muscle growth and thus were not able to provide steroid users with responsible, professionally informed oversight. New league policies even ban the use of steroids for recovery from injuries.
Combine the lack of medical supervision with the mind-set of the garden-variety steroid user, and you have a potentially perilous situation. "Many of those using anabolic steroids," says Penn State's Yesalis, "have the attitude that if one [dose] works, then five or 10 will work even better. That's dangerous."
Athletes who acquire steroids on the black market are loath to consult with their physician after they begin using regularly. If they do disclose their habit and ask for guidance, the physician, for fear of professional discipline or even criminal charges, may refuse to continue seeing the patient. For professional athletes, another deterrent to proper use is that all responsible doctors keep rigorously accurate records of their dealings with patients. The fear that those records might be leaked or even subpoenaed makes pro athletes even less likely to seek medical guidance.
Since many of the observed side effects of steroids--anecdotal, apocryphal, or otherwise--most likely result from excessive or improper use of the drug, one wonders: Can steroids be used for muscle building with a reasonable degree of safety? "The candid answer is yes, but with caveats," says Collins, the attorney who specializes in steroid law. "It would need to be under the strict direction of a physician and administered only after a thorough physical examination, and it would need to be taken at reasonable and responsible dosages."
It's a statement that even Goldman, once the bellwether scaremonger, says is "something I could probably agree with."
