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The question of whether steroids should be banned from society

Despite the high prevalence of PED use in the United States and in many other countries, most media attention regarding PED use has focused on elite athletes and the illicit competitive advantage they gain from PEDs. Neither the medical community nor policymakers appreciate that most PED users are not competitive athletes, but rather nonathlete weightlifters sometimes referred to as recreational bodybuilders 12.

Indeed, many nonathlete weightlifters are not focused on performance per se, but are primarily focused on personal appearance, in that they simply want to look leaner and more muscular. Therefore, more strictly, these agents might be referred to as performance-enhancing and body-image—enhancing drugs, although we will use the abbreviation PED for the sake of brevity throughout this manuscript.

Moreover, there is widespread misperception that PED use is safe or that the adverse effects are manageable, when in fact the adverse health effects of PED use remain understudied and underappreciated.

  1. Historically, the term AAS reflected the view that androgenic and anabolic effects of androgens could be dissociated and that, in comparison with testosterone, some androgens were more anabolic than androgenic. We supplemented this by searching the bibliographies of major review articles published in these content areas.
  2. Another reason to involve psychiatric consultation in professional sports stems from recent reports that antidepressant drugs have been implicated as performance-enhancement agents. Psychiatrists who work with professional athletes will be faced with unique challenges that must be identified, acknowledged, and acted upon in agreement within the sport to ensure the integrity of the profession.
  3. To do so, not only must the physiologic and psychotropic properties of each drug be considered, but also the individual characteristics of each sport and, more important, the individual biology of each athlete. Masking drugs reduce the ability to detect a banned substance.
  4. The expert panel conducted its deliberations regarding the scientific statement content through multiple teleconferences, written correspondence, and a face-to-face meeting. Another reason to involve psychiatric consultation in professional sports stems from recent reports that antidepressant drugs have been implicated as performance-enhancement agents.
  5. Enhancing Performance or Restoring Normative Function?

Similarly, at a national policy level, the limited resources allocated to this problem focus primarily on the detection and deterrence of athletes using PEDs to gain a competitive advantage, and not on the health concerns associated with PED use by both athletes and nonathlete weightlifters.

With at least 3 million PED users in the U. This scientific statement aims to synthesize the available information on the medical consequences of PED use among nonathlete weightlifters, identify gaps in our knowledge, and focus the attention of the medical community and policymakers on PED use among nonathlete weightlifters as an important public health problem.

Clearly, this issue deserves substantially greater investigation of its prevalence, medical consequences, mechanisms, prevention, and treatment than it has received to date.

Because androgenic-anabolic steroids AASs are the most frequently used class of PEDs among athletes and nonathlete weightlifters, this review has devoted greater space and attention to the health consequences of AAS.

Definitions PEDs are pharmacologic agents that athletes and nonathlete weightlifters use to enhance performance. The term doping refers to the use of PEDs in competitive sports. For the purpose of this statement, we define nonathlete weightlifters as individuals whose goal is to become leaner and more muscular, often simply for personal appearance, and not to participate in formal sports competitions.

There are several categories of PEDs that are currently popular among nonathlete weightlifters and athletes. Lean mass builders, the most frequently used PEDs, are generally promyogenic anabolic drugs that increase muscle mass or reduce fat mass.

By far the most prevalent illicit drugs in this category are AASs, which are the primary focus of this report. Historically, the term AAS reflected the view that androgenic and anabolic effects of androgens could be dissociated and that, in comparison with testosterone, some androgens were more anabolic than androgenic. In the 1980s, Dr Jean D. Wilson 3citing the the question of whether steroids should be banned from society of the androgen receptor, suggested that androgenic and anabolic activity of androgens could not be dissociated.

Therefore, he and others have argued that the term AAS is a misnomer and should be abandoned 4. However, a large body of data emerged in the late 1990s that revealed that the selectivity of androgen receptor signaling could be mediated at multiple levels of the steroid hormone interactome that encompasses in addition to the androgen receptor an interacting web of chaperone proteins, a repertoire of 300 or so coactivators and corepressors, elements of the chromatin, effector proteins, and transcription factors that bind specific regions of the androgen-responsive genes 5— 9.

These landmark discoveries have reinstated the view that multiple levels of the androgen receptor interactome contribute to tissue-specific actions of the androgen receptor ligands, and can be targeted to achieve the desired tissue specificity. Indeed, a number of SARMs have achieved relative differentiation of androgenic and anabolic activity, being preferentially more potent in the muscle than in the prostate 5— 91213.

Several publications have described the mechanistic basis of tissue specificity 5— 13.

Performance-Enhancing Drugs: Where Should the Line be Drawn and by Whom?

This growing body of literature suggests that despite the singularity of the androgen receptor protein, tissue selectivity of ligand action can be achieved.

Therefore, we decided to use the term AAS for this statement. Another reason for retaining the use of the term AAS is that this term is widely used and understood by the media, lay public, and policymakers. Similarly, some nonathlete weightlifters use the hormone insulin for its potential anabolic effects 15.

Clenbuterol and other illegal stimulants, such as amphetamine, and some hormones, such as thyroid hormones, also have thermogenic fat-burning properties that make them popular among nonathlete weightlifters.

I. Introduction

For example, some competitive bodybuilders use diuretics eg, furosemide and thiazides to improve muscle definition onstage. Some boxers or wrestlers use diuretics to reduce body weight so they can compete in a lower weight class.

Diuretics may also dilute the urine, which can reduce the concentration of the PED below the limit of detection. Blood boosters erythropoietins, other erythropoiesis-stimulating agents [ESAs], and transfusions increase endurance in events such as cycling, long-distance running, and skiing.

Athletes also may combine AASs and erythropoietins to train harder and recover faster. Masking drugs reduce the ability to detect a banned substance.

For instance, epitestosterone can mask the detection of testosterone use. And tranquilizers benzodiazepines and opiates reduce anxiety in events that require steady nerves such as archeryand opiates can mask pain during competition.

The World Anti-Doping Agency WADAan international agency that oversees the implementation of the antidoping policies in all sports worldwide, maintains a list of substances drugs, supplements, etc, that are banned from use in all sports at all times, banned from use during competition, or banned in specific sports 16. WADA also publishes the doping violation thresholds for banned substances.

The chair selected a 6-member expert panel approved by The Endocrine Society with expertise in the use and health consequences of PEDs. The expert panel conducted its deliberations regarding the scientific statement content through multiple teleconferences, written correspondence, and a face-to-face meeting. All panelists volunteered their time to prepare this Scientific Statement without any financial remuneration.

Three librarians associated with the writing team created search sets for the major categories and topics that the writing group prepared.

Introduction

Figure 1 provides an example of how these sets were combined for each category of PEDs. We used these terms to search the PubMed database for articles written in English or translated into English. We supplemented this by searching the bibliographies of major review articles published in these content areas.

We also added to the reference list any additional references that were known to the members of the writing group but did not appear in this search. The expert panel reviewed and synthesized evidence in their areas of expertise and prepared the Scientific Statement. We incorporated their comments into the final version.