With the opening of the 2018 Winter Olympics on Friday, there has been a lot of discussion about a “clean” competition. This refers to the use of performance-enhancing drugs, previously stimulants and now more typically anabolic steroids, to facilitate athletic performance. While steroid use has been banned from the Olympics since 1975, it is commonly believed that many athletes use them during training, if not during the actual competitions. A large number of Russian athletes have been banned from past Olympics for using performance-enhancing substances, although a number of these bans were recently lifted.
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There is a long history of athletes using performance-enhancing drugs. In the 19th century, French long-distance cyclists used wine combined with coca leaves (the origin of cocaine) to increase energy and endurance. In the 1960s, there was substantial use of stimulants, particularly by cyclists, and in 1960 a Danish cyclist crashed and died during the Olympic competition. His autopsy revealed traces of amphetamines. The first list of banned substances at the Olympics was released in 1967 and the first drug tests for Olympic athletes occurred in 1968.
More common than stimulant use is the use of anabolic steroids. These medications were first approved by the Food and Drug Administration in 1958. Their effect is to increase production of male sex hormones, particularly testosterone. These medications have two effects: increasing muscle mass (anabolic effects) and increasing the salience of male sexual characteristics such as facial hair (androgenic effects). These effects are found in both male and female steroid users. Steroids can be administered orally or by injection, and self-injection of any drug has potentially serious consequences of infection, including hepatitis or HIV.
There are several reasons why steroid use can be appealing to athletes. Steroids are well known to increase the muscle mass response to exercise and to facilitate healing of injuries. When used by relatively older athletes (age 35 and above), levels of performance may be consistent with those seen in younger players. Energy levels and endurance are also increased under the influence of steroids. As a result, steroid use may be appealing to people who are seeking a competitive edge or to maintain athletic performance past what would be retirement age.
Despite the performance benefits of steroids, most medical professionals agree that the side effects and consequences of steroid use offset benefits for athletic performance. While there are relatively few immediate deaths from steroids, there are predictable physical responses that lead to long-term risk of serious consequences. Testicular atrophy and baldness are common consequences of steroid use in males, while in females several changes associated with masculinization occur. These include deepening voice, increase in body hair and decrease in scalp hair. These changes can be permanent. More importantly, steroid use increases levels of low density lipoprotein (bad cholesterol) while decreasing levels of good cholesterol. These are significant risk factors for heart attack and stroke and have occurred in steroid users under age 30.
There are several psychiatric consequences of steroid use. While taking steroids, users can be prone to irritability and verbal and physical aggression. Referred to as “roid rage,” users can behave erratically and unpredictably. When trying to stop steroid use, it is common to see the development of serious depression. This can last for over a year after stopping steroids and has been reported to be associated with thinking about suicide or suicidal behavior. Also, one study at a drug abuse treatment center found that 10 percent of patients who were referred for opiate addiction had started taking steroids before any other drug. They said they began using opiates to counteract steroid side effects like insomnia, anxiety, and irritability.
Most steroids are obtained through diversion from pharmacies, although there are regular reports of bodybuilders who work closely with physicians to get prescriptions. In addition to steroidal substances, there are testosterone precursors that are converted to testosterone in the body. Some of these substances were banned in 2004, but there are constant new developments to avoid the detection of these substances through testing. The safety of the substances is not known, but it would be logical to assume that taking large doses of precursors could have the same risks.
Steroid use is an ongoing issue in athletics, both professional and amateur. There are several medical and psychiatric risks of these drugs, and the fact that their use is largely illegal leads to use without the medical supervision that would be provided if they were used for their intended purposes.
Philip D. Harvey, Ph.D., is director of the division of Psychology in the Department of Psychiatry and Behavioral Sciences at the University of Miami Health System.