Page 4 The Consumer's Medical Journal HeaMi Review

Testes to Testy:A Look at

Anabolic SteroidsBy Christa M. Gutzier

Today, the word, "steroid" connotes ideas of illegal activity, toxicself-destruction, and testosterone-fueled competition. The frenziedpower and eruptible behavior exercised by people on steroids has notalways been the primary focus, nor was this aggressive combination theintention for the first incidents of chemically synthesized testosteroneusage. In the 19th century, scientific and biological interests piqued dur-ing the investigation into what features were truly demonstrative ofmale identity. It is speculated that the question posed was, "What reallymade a man a man?" To find answers, scientists isolated the testes ofvarious male birds and erroneously hypothesized that displacing theseorgans in their abdomens or other locations throughout the body wouldaffect the male sexual reproductive system.

Their findings suggested that the anabolic functions of testoseronecould serve many purposes including prolonged and elevated states ofphysical and mental prowess. To be anabolic means to take simple sub-stances and make them more complex. Testosterone is not harmful dis-cretely, but when compounded with synthetic matter, the hormones takeon a life of their own. These discoveries were invaluable to scientistswho undertook the synthesization of testosterone, which later producedan extract that would come to be known as the first anabolic steroid. Totrace the history of steroids from the initial intended usages to its mod-em appeal requires a look at the historical, physiological, and culturalaspects of these controversial hormones.

As a synthetic derivative of testosterone, steriods' multifacetedeffects have both legitimate and illegal subtexts. Because the steroids inquestion are known to be anabolic, they refer to complex substancesmade from simpler ones as opposed to catabolic substances that are bro-ken down from their complex origins. Natural anabolism, taking placein all humans, activates cell growth and promotes overall muscle andbone enhancement by way of protein creation and other systematicswelling agents cued by cell division. Unnaturally generated anabolismimparted by illegal steroid use tends to give way to a host of unwantedeffects often overlooked by exiting or potential steroid users. Participat-ing in the process of anabolism, steroidal use of testosterone synthesizessimple compounds into more complex ones. Our naturally processedtcsosterone is essentially drowning in extraneous amounts of its ownkind at the receptor site when steroids are injected, thereby causingextremely hazardous side efFects and the likelihood of an overdose.

A choice to engage in illegal steroid use translates to a choice in sab-otaging the natural testosterone mechanics in one's body. Anabolicsteroids not only affect growth, baldness, impotence, and susceptibilityto disease, but the desired outcomes of usage may derail from hyper-activity muscle and bone strength to out of control fits of aggression andhostility. Most steroid users do so to maximize body weight regimensand increase muscle development, but the long-term and side effects ofhabitual use can prove to be addictive and deadly. Steroids have beenknown to cause erratic behavior that matches sociopathic tendencies asboth mind and body are affected by hormone injections of this magni-tude. Using steroids in cycles is a common tactic, which throws the stateof the user's mental and physical systems into a chaotic world of highsand lows. Because steroids target the hormone receptors responsible forincreased and rapid physical activity, their potency can be alarming andaddictive. Enter the illegalization of anabolic steroids.

While the isolation of testosterone was initially done in the earlytwentieth century to better understand the physiological mechanisms ofchange in male sexual development, the anabolistic tendencies ofsteroidal use, such as the directed enhancement of both sexual and phys-ical endurance, was not considered until chemically synthetic com-pounds were pulled into the experiment. Not until 1938's Federal Food,Drug, and Cosmetic Act (F.F.D.C.) was passed did the Food and DrugAdministration (F.D.A.) revise the fn-st Act passed in 1906 by implent-ing new systems of control over illegal sale, possession, and consump-tion of "adulterated" substances.

Included in these revisions was a direct claim that "adulterated" sub-stances are those that "consist in whole or in part of any filthy, putrid,or decomposed substance." (Federal Food, Drug, and Cosmetic Act,Sec. 501. [21 u s e 351]) This legislation did little to dissuade Olympic

"This is the defensive tacide, Aivin ingram ... He's eightfeet, five inches taii... He weighs five hundred and eightythree pounds ... His major is genetic engineering. "

competitors from engaging in illegal steroid use to bolster individualand national success in the mid 1900's. Prompted to overhaul regula-tions prohibiting this illegal and unethical behavior, the InternationalOlympic Council and other major athletic organizations worldwideworked to enact new policies and investigations to both detect and stopanabolic steroid use in the 197O's. While their efforts put illegal steroiduse front and center, trainers and athletes alike continued to misuse,administer, and distribute steroids. To date, suspensions, jail time, andpublic scrutiny have not discretely or collectively proved to be power-ful enough deterrents for illegal and unhealthy steroid use.

Some people question the illegality of steroids for those not engagedin competitive sport, because testosterone supplements, if usage is mon-itored and controlled, can have legitimate purposes. Doctors and scien-tists fielding these inquiries simply maintain that the vitamins, diet, andexercise that supplant the effects of steroids have been deemed healthi-er and less likely to result in addictive dependence. As we know, contin-ued steroid overindulgence still plagues our country's most belovedsports heroes and competitions. Perhaps more distressing is the frequen-cy with which the adolescent and teenage population use steroids beforetheir bodies have a chance to output the natural doses of tesosterone thatattribute to healthy and timely physical and sexual development.

The potential for long-term hazardous effects, as well as abusiveaddiction, has been rampant in younger users in recent years. Their apti-tude for decreased levels of self-control and cavalier attitudes about thelikelihood of extended use and its effects contributes to youthful steroidabuse. That is why advocacy and awareness groups are on the rise toeducate both parents and coaches of young athletes and the target usersthemselves of the risks involved in using and abusing steroids. TheNational Institute on Drug Abuse (N.I.D.A.), the Association AgainstSteroid Abuse, and Athletes Targeting Healthy Exercise & NutritionAlternatives (A.T.H.E.N.A.) are just a few organizations active in pre-venting steroid abuse in teens. By distributing reference material on theharsh reality of steroid use, organizing leadership workshops for kids,parents, and coaches, and offering concrete alternatives to the "juice,"or "pumpers," as they are often called, awareness and prevention arealso on the rise.

Before the effects of steroid ingestion became a desired and danger-ous habit for sports-related success and to achieve other weight, muscle,and stamina goals, steroids were simply the result of an experimentinvolving the male organs of birds. The testes of birds that were isolat-ed and studied led to the discovery of testosterone, the powerhousebehind those metabolic and physiological changes that take place inmembers of the male sex. More clinical studies at the turn of the twen-tieth century exposed testosterone as an androgen, the generic term forthe hormone compounds directly related to male sex organ and charac-teristic development.

Today, we know that testosterone is a naturally produced hormonein both men and women, although male production is said to be nearly50 times greater than in its female counterpart. Increased testosteronelevels in males are naturally affected by a thirst for power or status, thepresence of female pheromes, and sleep in the rapid eye movement(REM) stage. Conversely, testosterone levels are naturally decreased bydepressive episodes, vitamin deficiencies and aging. If you mix in thehyperactive effects of illegal anabolic steroid injection, the results can

Continued on page 7

Healik Review The Consumer's Medical Journal Page 7

Genetics May Affect TestingFor Drugs in Athletes

A genetic peculiarity could help devious athletes beat drug tests andcould unfairly ruin players who are honest. The genetic variation affectsan enzyme that processes testosterone. Although testosterone is primar-ily known as a male sex hormone, it is made in the body by both menand women.

To differentiate between naturally present hormone and synthetictestosterone from steroid use, drug tests measure a ratio of two chemi-cals found in urine. One chemical, epitestosterone glucuronide (EG), ismade at a constant level in the body, regardless of testosterone levels.The other chemical, testosterone glucuronide (TG), is a by-product oftestosterone. Testosterone abuse is usually assessed by the urinarytestosterone/epitestosterone (T/E) ratio. Levels above 4.0 are consid-ered suspicious.

The large variation in TG excretion and its strong association witha deletion polymorphism in the uridine diphospho-glucuronosyl trans-ferase (UGT) 2B17 gene challenge the accuracy of the T/E ratio test.The enzyme UGT2BI7 adds a chemical to testosterone to prepare it forsecretion in the urine. Scientists in Sweden found that some peoplecompletely lack the gene that produces UGT2BI7, and this differencecan affect results of doping tests.

About 15 percent of 145 healthy male volunteers lacked the enzymeentirely; 52 percent of the men had one copy of the gene, and one-thirdof the men had two copies. Some of the men were selected to get a sin-gle injection of testosterone. The researchers monitored production ofTG in the men's urine for 15 days after the injection. About 40 percentof the subjects who lacked the enzyme never secreted enough TG toraise suspicions in the standard test even after their hormone injection.

As Anders Rane, M.D., Ph.D., of the Karolinska Institute in Stock-holm, explains, there is a chance that many such individuals haveescaped detection. On the other hand, 14 percent of people with twocopies of the gene made so much TG that the current test would identi-fy them as cheaters even before they received a testosterone injection.

No one actually knows whether there have been false-positive orfalse-negative results among the winners of various games, but it couldhave happened, Dr. Rane believes.

About two-thirds of the East Asians in the study lacked the enzyme,and fewer than 10 percent of the Swedish participants lacked it. Variousethnic groups may use different enzymes to process testosterone, saysGlenn Cunningham, M.D., an endocrinologist at Baylor College ofMedicine in Houston, Texas.

There is no apparent athletic advantage or disadvantage associatedwith lacking the enzyme. Dr. Rane says. He suggests combining genet-ic testing with periodic urine testing that tracks individual athletes overtime. Dr. Cunningham thinks that they have made a strong case forgenetic testing in addition to current assessments.

Because of the expense, genetic testing is not feasible for largenumbers of people. Such tests will probably be used in elite amateurand professional sports, but it is unclear whether it will be available forcollege and high school athletes.

(Source: Journal of Clinical Endocrinology and Metabolism^2008; 93:2500-2506.)

How Hormones Affect HealthContinued from page 5

Q. What is osteomalacia?A. Soft bones result from a lack of vitamin D and calcium. The full-

blown disorder, which was common before we supplemented cow'smilk with vitamin D, was rickets, vitamin D deficiency at its extreme.Rickets was pretty common in the 19th century, as was scurvy, causedby a lack of vitamin C. Scurvy was a bleeding disorder that affectedBritish sailors at sea. They called themselves "Limeys" because theywould take limes to prevent scurvy. The other common disorder wasvitamin D-dependent rickets.

Waiter Simon Newman, Jr., M.D., has been on the Clinical Facultyat Stanford University since 1982. His has been Director of the WesternOccupational and Environmental Medicine Association since January2006. He is a member of the American College of Occupational andEnvironmental Medicine, the Santa Clara County Medical Association,and the California Medical Association.

Do Women Have MoreDental Problems?

The transition from foraging to fanning has been associated witha decline in oral health, with women experiencing a more rapid anddramatic decline than men. Historically, anthropologists have attrib-uted this difference to behavioral factors such as sexual division oflabor and gender-based dietary preferences.

John R. Lukacs, Ph.D., Professor of Anthropology at the Univer-sity of Oregon, argues that the effect of dietary changes on women'soral health was intensified by the increased demands on women'sreproductive systems. These included the increase in fertility thataccompanied the rise of agriculture, with these factors thereby con-tributing to the differences in the prevalence of dental caries (cavi-ties). A comprehensive review of dental records in prehistoric andcurrent human populations reveals that women have more dentalproblems than men because of reproductive and fertility factors thatseem to be linked to female hormones.

(Source: Current Anthropology, 2008; 49:901-914.)

Topical CorticosteroidsNot Effective for Sunburn

Topical steroids do not help to improve acute sunburn when they areapplied after a person has been exposed to short-wave ultraviolet B radi-ation (UV-B), report Danish researchers.

A sunburn is an intense, delayed, transient inflammatory responsecaused by acute overexposure to ultraviolet radiation (UVR) in sunlight,primarily UV-B.

Annesofie Faurschou, M.D.. and Hans C. Wulf, M.D., from Copen-hagen conducted a randomized, double-blind trial in 20 healthy volun-teers (age range, 23 to 62 years) with Fitzpatrick skin type 1 to III toevaluate the effect of topical corticosteroids in treating acute sunburn. Aperson's skin type is often categorized according to the Fitzpatrick skintype scale and is determined genetically. Eye and hair color are alsoclassified according to these criteria.

Six areas were marked on the back of each study participant. Two ofthese areas received either a moderate-potency or high-potency corti-costeroid 30 minutes prior to UV-B exposure as a control; the remain-ing four areas were treated with either a moderate-potency or high-potency corticosteroid six hours or 23 hours after UV-B exposure.

The scientists concluded that treatment with topical moderate-potency or high-potency corticosteroids did not provide a usefuldecrease in acute sunburn reaction when it was applied six or 23 hoursafter UV exposure.

(Source: Archives of Dermatology, 2008; 144:620-624.)

Testes to Testy:A Look at Anabolic SteroidsContinued from page 4

be confounding. On the other hand, low levels of legally prescribedsteroids administered in moderation and under the guidance of a mecVical professional can benefit the body.

Organic properties of testosterone have healthful benefits, includirgthe mental alertness and physical maintenance sought by both male ado-lescents during their maturation and males in adulthood. Lawful pre-scriptions can help treat everything from minor aches and pains to breastcancer, pulmonary fibrosis (a disease characterized by an irreversiblescarring of the lungs), and pet ailments. Veterinarians have administeredappropriate doses of corticosteroids to animals for years, treating condi-tions like arthritis, infiammation, and energy deficiencies. As withhuman beings, how closely monitored the injections are by a licensedprofessional makes a difference as well as the legal status of the partic-ular drug. Like other forms of psychological and physical treatments, itis vital to the outcome of treatment to be properly assessed and moni-tored. The truth is: the abuse of steroids and other pschoactive sub-stances impairs the individual's judgment on proper administrationincluding how much, little, or often to take something. Whether the drugis legal does not matter when it comes to the abusive tendencies of theuser.

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