We're talking about anabolic steroids, growth hormone, erythropoietin (EPO), narcotics, stimulants, among others. Every year the World Anti-Doping Agency (WADA) publishes an extensive list of illicit doping agents banned from top-level sport, some of which are controlled drugs or criminally punishable recreational substances. The word doping comes from the Dutch doop, which described a ritual of the Zulu warriors before battle. They drank an alcoholic mixture which they believed would give them vigor and strength in war. The word was later imported by the British to describe illegal practices in horse racing to improve the animals' performance. From there to what it means today was a short step. The first official definition of doping dates back to 1963, "...the use of substances or physiological mediators, not normally present in the human body, introduced as an external aid to enhance athletic performance in competition".
Man has always sought various strategies to improve performance, in sport and beyond. Athletes in classical times, the beginnings of the Olympic Games in Greece, resorted to products that they believed would boost their performance. I'm talking about infusions of various herbs, but also the ingestion of sheep and ox testicles to "absorb the virility" of these animals. Ancient Indian texts also tell us about the recommendation to ingest testicles to treat impotence. It's interesting to note that although they knew nothing about testosterone, they already associated testicles with virility, muscle mass and athletic performance. This was actually observable at the time by the lack of testicles in eunuchs, castrated men who in ancient times served as harem guards and important advisors to the regency.
In Greece, Rome and China, pre-pubertal boys were castrated, either voluntarily or forced by their families as a way of escaping poverty and hunger. Eunuchs were a prestigious class who lived in close proximity to the nobility. Boys who turned out to be tall but fat men, with very weak muscles, an effeminate voice and no sexual appetite or way of consummating it. In fact, eunuchs are the ultimate expression of "masculinity" in a patriarchal society. Who better to guard the Emperor's harem than someone whose sexual organs have been removed? They arose out of jealousy and fear of betrayal, but they were men with a great capacity for strategic and calculating thinking. Often the virile, competitive and impetuous behavior that testosterone favors leads to bad results and wrong decisions. The eunuchs did not suffer from this problem.
The Holy See also took advantage of castration to fill the lines in the Church choir in the 16th century. Since women were not allowed to take part, reaching the highest notes of a soprano was practically impossible with a man's thickened and elongated vocal cords. Thus the Castratipre-pubertal castrated boys, with a voice that reached tones that only women could, with a unique "power".
Little progress was made on the role of the testicles and their secretions until 1889, when anatomist Charles-Édouard Brown-Séquard, a professor at Harvard, administered himself a testicular extract from dogs and oxen which he called the "elixir of rejuvenation". He reported in the renowned The Lancet and various medical conferences, an increase in vigor and well-being, but it was only temporary. Of course, his peers made fun of him and tried to ridicule his work. After all, he was injecting himself with a dog testicle extract. Until then, nothing was known about the presence of androgens in the testicles, and even less about their effects on men. Brown-Sequard was a prestigious anatomist with more than 500 published articles to his name. He became obsessed with the lack of productivity and loss of skills as he got older, searching endlessly for a "cure" for the loss of vitality. The "elixir of rejuvenation", which he took regularly. We could say that he was the father of hormone replacement therapy and "anti-aging".
It wasn't until 1931 that androsterone, a derivative of testosterone, was isolated from a sample of police urine. Then, in 1935, it was testosterone's turn. It was first isolated from an ox testicular stratum by Ernst Laqueur, who founded the Organon company next to a slaughterhouse, now a subsidiary of Merck. It took hundreds of kilos of testicles supplied by the slaughterhouse. That same year, Adolf Butenandt of Schering and Leopold Ruzicka of Ciba, two pharmaceutical companies, chemically synthesized testosterone from cholesterol. This work would later win them the Nobel Prize in 1937.
The chemical synthesis of testosterone allowed its effects on humans to be studied more rigorously. Gains in lean mass and increased aggressiveness were noticed early on. Other effects were described and characterized by their anabolic nature, in increasing lean mass and bone, or androgenic, related to male sexual and behavioural characteristics. These effects are still subject to study and debate today, particularly their implications for the development and behavior of men and women.
The therapeutic applications of testosterone were obvious. Not only in the treatment of hypogonadism and delayed puberty in young adolescents, but also in cases of cachexia, kidney patients, burns, among others. Situations in which there was an interest in isolating the anabolic effects of testosterone and reducing its androgenic impact, which in these cases would manifest as a collateral. They wanted to gain lean mass without hair or acne. Testosterone-derived drugs then appeared, anabolic steroids, with a lower ratio of androgenic/anabolic activity. This ratio is still used today to characterize these drugs and is measured by the ratio between the percentage increase in volume of the prostate, an androgenic tissue, and skeletal muscle in mice.
The chemical synthesis of testosterone and the first anabolic steroids took place in Hitler's Germany. Some reports suggest that they were tested and used in World War II by the Nazi army as a way of increasing the aggressiveness and physical power of their soldiers. The propaganda spoke of a übermanA kind of exemplary superman of the Aryan race, with attributes that we could attribute to anabolic steroids. In any case, there is no factual evidence to prove the deliberate and state-promoted use of anabolic steroids in Nazi soldiers. It may be nothing more than a myth that originated with Wade in his 1972 article in the magazine Science.
Anabolic steroids and doping in sport
The first author to suggest that testosterone and its derivatives could have a positive impact on athletic performance was Paul de Kruif in 1945 in his book "The Male Hormone".
"... it would be interesting to see the productive power of an industry or professional group of athletes who systematically tried to load themselves with testosterone"
Paul de Kruif was a microbiologist who gave a detailed account of his experience with the continued use of testosterone. He felt younger, stronger and more virile, similar to what Brown-Sequard had described decades earlier. The Male Hormone" is an account and essay on the effects of hormone replacement therapy. But in fact, although historically the idea of doping in sport is attributed to de Kruif, as early as 1939 the doctor Ove Bøje was writing ironically, not referring specifically to the newly discovered testosterone:
"In sports in which animals take part, the use of stimulants was so common that some countries introduced legislation to ban it, based on the cruelty to these animals. Similar attention should be paid to humans taking part in sporting events"
The Soviet Union is thought to have pioneered the use of anabolic steroids in its athletes, with reports dating back to the early 50s. Despite rumors of the use of testosterone in preparation for the 1936 Berlin Olympics by the Germans, but without documented proof. The Russians dominated the weightlifting championships and nobody could convince Bob Hoffman, an American coach, that this hegemony was due to better training methodologies. The Russians won seven medals at the 1952 Olympic Games in Vienna alone. In 1954, during the World Championships, the American team doctor, John Ziegler, also an amateur weightlifting athlete, took one of the Soviet coaches to a local tavern to "fraternize". After getting him drunk, he made the expected confession. The Russian athletes were being "enhanced" with testosterone and other substances that the coach couldn't describe.
The revelation changed Ziegler's life, and he experimented with testosterone himself and devoted himself to pharmacology. A few years later he synthesized methandrostenalone, a patent he sold to Ciba and which appeared on the market under the name Dianabol (1955) in the form of small pink hexagonal tablets. Dianabol became popular and its use widespread among athletes, along with other anabolic steroids that had already been created by that time. One of Ziegler's colleagues, Alvin Roy, was hired by the San Diego Chargers and provided the athletes with bowls of Dianabol tablets at mealtimes. The results were remarkable. Stronger, more aggressive players. The practice soon spread to other teams in an uncontrolled way.
Some players began to report hitherto unknown side effects, with an emphasis on testicular atrophy. The size of the testicles reduced significantly and this frightened them. The dramatic effect of anabolic steroids was leading to abuse by highly competitive athletes with obsessive personalities. Ziegler's protocols with 5-10 mg of Dianabol a day were dropped, and high doses of 50-60 mg became normal. Ziegler later became a fierce opponent of the use of anabolic steroids in sport, when he was primarily responsible for their introduction in the USA.
High-level athletes are a particular population in which the desire to win at all costs easily leads to behavior that puts their health at risk. In the 1980s, Bob Goldman anonymously questioned a group of elite athletes with a simple question - "If I gave you a pill that would make you win every competition of the year, but kill you the next year, would you take it?". Some 50% answered yes, that they would be willing to pay the highest price for glory and a place in history. The same question was later asked of 120 amateur sportsmen in Australia, and only one answered in the affirmative.
Authentic mass doping programs of athletes have been made public over the years, both institutional and governmental. After the reunification of Germany in 1990, former athlete Brigitte Berendonk and Professor Werner Franke obtained secret scientific documents that revealed a state-sponsored doping program (GDR), which included doctoral theses and detailed doping protocols for athletes, and for evading anti-doping controls. Thousands of athletes were "treated" with anabolic steroids, with an emphasis on women and teenagers. Around 9,000 according to reports. GDR athletes did particularly well between 1972 and 1990 in international events, and it later became clear why. In 1976 alone, the women's swimming team won 11 medals out of a possible 13. In an authoritarian regime like that of the GDR, the athletes had no choice and some later confessed how the "offer" was made to them. Either you take it, or you die.
It should be noted that the use of anabolic steroids was not initially prohibited. In fact, until the 60s they were seen more as "food supplements" than drugs, a view that only began to change in the 70s. They were formally banned by the International Olympic Committee's medical commission, and anti-doping control was instituted in 1976 after a series of positives in random samples from athletes after the ban. Retrospective studies carried out in 1972 suggest that 78% of runners were using or had used anabolic steroids.
The first list of banned drugs in sport came from the International Olympic Committee's Medical Commission in 1967, for the 1968 games. But it didn't include anabolic steroids, simply because there was no technology to detect them at the time. Only in 1973 did this become possible, but curiously not for testosterone. There was no way of detecting it or distinguishing it from what was produced naturally in the body. This only happened in 1983 when Manfred Donike developed a method that assessed the T/E ratio in urine and which was implemented at the Pan American Games in Venezuela. The T/E ratio measures the relationship between testosterone and epitestosterone, two very similar isomeric molecules that differ only in the position of an -OH group on the same carbon, and which are produced in the body in a 1:1 ratio. Changes to this ratio indicate exogenous administration, and 6:1 was established as the cut-off value for a doping positive. The mere announcement of the test's implementation caused dozens of athletes to suddenly fall ill and not take part in the 1983 Pan American Games. A virus that spread with the news.
Despite the ban on doping in sport and the morality of it, we all know that it's a reality. It is estimated that between 30% and 50% of athletes have used illegal substances at some point in their career. In 2003, in an interview with Sports Illustrated, pitcher David Wells said he estimated the prevalence of doping in Major League Baseball at 25-40%. A figure that Jose Conseco raises to 80% in his book Juiced. The point isn't to use. It's getting caught.
Anti-doping control is not infallible and scandals such as that of the Russian Federation in 2015 were to be expected. A state program that came to light after complaints from dissatisfied, but by no means innocent, athletes. Grigory Rodchenkov was director of the Russian anti-doping control laboratory, accredited by WADA and one of the most advanced in the world with state-of-the-art equipment. Today he lives in exile in the US under the witness protection program after revealing how Russia for years deceived an entire control system that was considered to be unreliable, not to say inviolable. With exchanges of urine samples taken by corrupt officials, "surprise" checks that were announced two months in advance, and positive tests not reported according to protocol, or simply erased from history.
The Russian Federation's massive doping program reached its peak at the 2014 Winter Olympics in Sochi, Russia. After the debacle in Vancouver, Putin wasn't going to pass up the opportunity to show off the power of his athletes on his own turf by sponsoring one of sport's biggest ever scams. Putin himself is an athlete and sports fanatic. With the help of agents from the FSB, heir to the KGB, dozens of urine samples from doped athletes were exchanged for clean urine collected earlier. The collection containers were deemed inviolable after being sealed by the WADA official. And here comes the FSB, which found a way to open them and replace the contents overnight. Nobody noticed, and it was all done under the noses of International Olympic Committee officials. The Games went so well that historians say it boosted national pride to internally legitimize the invasion of Crimea that same year. It's all ours.
When the scandal came to light the following year, the Russian authorities tried to wash their hands of it. Blaming Rodchenkov and other minor figures who became a risk to the state for what they knew and the evidence they gathered. Rodchenkov managed to flee to the US with evidence of Operation Sochi Resultat as they called it, but the head of the Russian anti-doping agency, RUSADA, was not so lucky. Both he and his predecessor died mysteriously within weeks, in good Soviet style. There was no explanation for a sudden heart attack in a man in his 50s, with no history of illness and who was only given a proforma autopsy that closed the case there. Things that happen in those parts.
The Balco case in 2002 in the USA, which led to the sanctioning of elite athletes such as Marion Jones e Tim Montgomery. An athletics coach, who later turned out to have been Marion Jones' coach, sent a syringe containing an unknown substance to the US anti-doping body, identified as tetrahydrogestrinone (THG). An anabolic steroid that was undetectable until then, synthesized by Patrick Arnold, a chemist employed by Vitor Conte's Balco. The novelty of the substance and the typical route of administration, buccal or transdermal, prevented detection until the syringe was sent to Don Catlin, director of the credited laboratory in Los Angels. It wasn't until 2007 Marion Jones confessed to using doping, in a very emotional interview, and was jailed for six months. Not for the use, but for perjury in lying to investigators.
Oral and transdermal administration reduces the presence of long-lasting secondary metabolites, detected for periods of more than 6 months. At the Sochi Games, Rodchenkov developed a cocktail of anabolic steroids solubilized in whisky, which the athletes took during the competition. Methenolone, oxandrolone and trenbolone solubilized in Chivas Regal, which they called "Duchess" and which allowed them to recover more quickly between events. Pre-competition doping was common and widespread, but during the event it was a novelty due to the risks of detection. The Russian athletes were at ease at home. In the preparation phase it is only necessary to have a thorough knowledge of the life span of substances and to carry out tests before the competition to guarantee a negative. And be warned in advance of any surprise checks that might be carried out by corrupt WADA officials. Nowadays, the biological passport has made life a little more difficult for athletes, but there's nothing you can't get around with a good "witch doctor" as they are nicknamed.
Of the almost 200,000 samples analyzed by WADA every year, around 2% contain banned substances. Of these 2%, 45% are anabolic steroids. These figures obviously underestimate a dark reality in sport. A world where appearing is more important than being, and where politics rules. Nobody wants positives. It's not good for business. Whether we like it or not, doping is part of sport. As Pierre de Coubertin himself said, the "father" of the Olympic movement, only amateur athletes compete, in his "clean" vision of sport. When other interests come into play, particularly financial ones or the reputation of a state, cheating opens up.
Although doping is widespread in sport, bodybuilders are the most vulnerable. poster-boys and scapegoats for the use of anabolic steroids. The studies tell us of a prevalence of 55%, similar to that found in powerlifters but which may be underestimated. Their use is clearly evident in the level of muscle mass and fat they show at certain times of the year, also the result of massive doses and the combination of various drugs. The first reports of recreational use for aesthetic purposes date back to Venice Beach, California, in the 1950s, the Mecca and cradle of bodybuilding. In addition to testosterone, other drugs such as Dianabol were already available that were believed to have more interesting potential for aesthetic purposes. As William Taylor, a historian of medicine, put it, "on the beaches of Southern California the bodybuilders they wore T-shirts that said, 'Dianabol, the breakfast of champions'". Just like that.
Arnold Schwarzenegger is, or was, probably the most famous bodybuilder in history and one who marked an era. He has admitted to having used "small amounts" of Dianabol in his time, which doesn't take away from what he has achieved. Despite the euphemism "small", admitting to the use of anabolic steroids by "role-models" is a must. Making it clear that this is a body that is virtually unattainable in a natural way kills false expectations, disappointments and failures in the search for something that is unattainable. Nothing good comes from believing that a bodybuilder's body is possible just by eating chicken, rice and training every day. The great fitness lie. Not everything is possible with effort and dedication alone.
The evolution of athletes' physiques is clear over the decades, and the difference cannot be explained by better training methods, more commitment or genetics. Steve Reeves' physique marked the 1950s, and the difference compared to the athletes of the late 1960s and 1970s is abysmal. Arnold Schwarzenegger dominated the 70s, with a physique incomparably more muscular and defined than Reeves. But the 1990s saw another leap forward, marked by Dorian Yates, perhaps the first great bodybuilding "monster". He admitted to using testosterone doses of around 1000 mg a week, nandrolone and Dianabol, as well as growth hormone. And in the following decade came Ronnie Coleman and Jay Cutler, two giants who set an inhuman standard for the sport. In retirement, Coleman is very weak and Cutler insists on what it takes to maintain the size he had in competition. It's not healthy. In the last decade we've been living through the "Fitness Revolution". The IFBB has put an end to women's bodybuilding and categories like Bikini Fitness and Wellness are gaining fans. For men, athletes in Men's Physique are popping up like mushrooms in the woods. More balanced standards, but they still don't give up the massive use of drugs.
Leaving the controversy in the air, even in Portugal it is impossible for a natural athlete to reach the podium in a Men's Physique competition or any other current category. The level is high, and the use of anabolic steroids and other drugs is irresistible to athletes. In women, although doping is common, it is possible to be competitive without drugs, although this is very rare. Use is normalized and those who compete know what they're getting into. I don't make value judgments about the use of anabolic steroids in competitive fitness and the decision is exclusively a personal one. This sport is based on drugs, and anyone who says otherwise is being hypocritical.
The insurgents have created natural bodybuilding, with federations allegedly testing athletes for the presence of doping agents. The IFBB itself (International Federation of Bodybuilding) has already tried, and the dream of making bodybuilding an Olympic sport will lead him to try again, but it won't go well. In natural bodybuilding, being clean doesn't mean you haven't used banned substances. It just means that you test negative on the day of the competition, with no surprise tests during the preparation phase. This would happen under the auspices of WADA. Now, guaranteeing a negative using doping in preparation is easy and follows protocols that have been optimized for decades in other sports. By knowing the life span of each substance in the body, diluting the secondary metabolites in the urine, testing beforehand, or changing the urine when the officials don't see it in the bottle, you can use drugs in preparation without getting caught in the test. Athletes have been doing this for decades, in a huge variety of sports.
One question that arises is the morality of outlawing doping in sport in general, when we all know that it is an unavoidable reality and will continue to be so. Athletes are faced with the "prisoner's dilemma". The potential advantages outweigh the risk of being caught, since only a small percentage are caught. And they know it. Doping is almost irresistible for top-level athletes who make sport their life. If drugs were legalized, there would be less hypocrisy, but the message would be very perverse. Athletes are role models for society. If cheating were allowed, it would mean distorting competition and assuming that anything goes. Winning at any cost, legitimizing the option of putting one's health at risk.
It is estimated that high-competition athletes account for only around 20-30% of anabolic steroid users. Their use is also common among police forces and military operatives. Prevalence studies of military personnel in the USA indicate figures of between 1.5 and 2.5%, but an anonymous 2009 survey of operatives before their departure for the Middle East reveals an increase to 50%. In absolute terms, the use of anabolic steroids is mainly for purely recreational and aesthetic purposes. In the fitness milieu. The effects can be dramatic on body composition, strength, sense of well-being, energy, libido, but with risks that are also recognized and well characterized.
Prevalence of use
It's difficult to estimate the prevalence of anabolic steroid use among fitness enthusiasts, or even in the general population. Studies with Western populations that we could compare to Portugal, such as the USA or Sweden, tell us of an overall prevalence of 1-5% in men. In women, the prevalence is lower, although growing. Among gym-goers and exercisers, the prevalence rises to around 10-20%. Around 20% of gym-goers have taken some kind of anabolic steroid at some point in their lives. The most common drugs that stand out are testosterone and oxandrolone (Anavar), a substance that is widely regarded as less harmful. In Brazil, the prevalence of use among gym-goers is higher, a country where the use of doping substances has become widespread, and has even been normalized with ethically questionable medical approval.
The Brazilian reality is different from the Portuguese one. One example that illustrates this well was a prescription for a manipulated product from a Brazilian nutrologist that came into my hands. A patient told me he was taking a multivitamin to increase his vigor and strength. Among a long list of vitamins and minerals, there was "5 mg of oxandrolone" as if it were a natural and minor compound. In the same vein, we started importing testosterone replacement therapy (TRT) without any clinical indication. It's worrying to see how men in their 20s and 30s think they need testosterone replacement therapy (TRT) without any evidence of hormonal axis dysfunction. But masked by alleged benefits to their health and well-being, what they really want is to enjoy the effects of testosterone on their body composition. "Gardening" with a doctor's prescription, and with less moral burden. Let's call a spade a spade. It's not therapy at all, nor is 250 mg of testosterone enanthate a week a replacement dose.
The role of doctors
What we've discussed brings us to a more complex issue, which is the medical position on this phenomenon. Should those who want to use anabolic steroids for aesthetic purposes be able to enjoy medical supervision so that they can do so with the least possible risk? A serious doctor cannot condone the recreational use of anabolic steroids. The risks are not outweighed by any clinical benefit, nor is there any therapeutic indication for their prescription. To a greater or lesser degree, if someone wants to put their health at risk without a clinical benefit, they must do so at their own risk. Anabolic steroids are drugs, and like all drugs they carry risks. This is the only position that seems to me to fit the ethical code of a doctor who, by prescribing anabolic steroids for recreational purposes, is guilty of misconduct. Without a therapeutic or preventive benefit, anabolic steroids cannot and should not be prescribed.
It's quite another thing for clinicians to pass moral judgment on those who come to them for treatment of sequelae. It's revolting and unworthy of the profession. Time and time again I have come across people who have felt humiliated in the doctor's surgery, and some of them have even left with a refusal of post-cycle treatment. It's true that the vast majority of doctors, including endocrinology specialists, don't know what to do in these cases. Ignorance frightens them and leads to a defensive attitude. But the doctor's role is to treat, not to judge. Not even to give an opinion on whether the person has done right or wrong. A disapproving and judgmental attitude only alienates and feeds the shame that these patients feel about going to the doctor. It makes room for other, less competent people to take the place that should be reserved for them.
Users of anabolic steroids don't credit doctors with knowledge of the subject, opting instead to get information from trainers, bodybuilders and the internet itself. A survey in the USA shows that 56% of users have never revealed their use of anabolic steroids to their doctor for fear of judgment, distrust of their technical ability, or fear of legal repercussions. And of those who have reported their use, 55% say they have felt discriminated against and disrespected. This is very worrying data and there is an urgent need to change this attitude on the part of the medical community, guaranteeing adequate training for these professionals on anabolic steroids.
Hormone therapy for rejuvenation, or anti-aging as they call it, has gained popularity in recent years, although its origins date back to Brown-Séquard's experiments in 1889 with animal testicular extracts. Both he and Paul de Kruif later reported identical effects on improving well-being, vitality, work capacity, etc. Brown-Séquard was already in his 70s, in decline and unhappy. Anti-aging has emerged as a preventative therapy to mitigate the consequences of ageing, partly linked to hormonal decline. On average, a Western man sees his testosterone drop by 1.3% a year from the age of 40. Whether this is a cause or a consequence is unknown. But it is known that levels in men from non-Westernized populations do not observe the same downward trend, although they do tend to be lower. Is the decline a consequence of lifestyle or biology? Perhaps a bit of both.
Although conventional medicine doesn't take kindly to this not very evidence-based practice, the truth is that it is gaining ground. If good doctors don't occupy this space, it will be left to the "picaretas" as they say in Brazil. Perhaps it's time to look at medicine in a more preventive way, improving quality of life, and not just curing or relieving symptoms once the disease has set in. This doesn't mean prescribing hormones willy-nilly, as unfortunately I see is common practice among some professionals who have embraced anti-aging, a very financially attractive area. For the type of client who seeks them out, the value of the consultation, and commissions or benefits on the tests prescribed, which often serve no purpose. More regulation in this area is needed, but despite some doctors "cracking down" on bad practices, the profession is willing to do very little.
The typical user
We can draw up a profile of anabolic steroid users based on the information available. The most frequent age for starting use is between 22 and 30. In fact, the vast majority start using before the age of 30 (>70%), and less than 10% before the age of 18. The primary motivation is physical appearance (~80%), followed by strength gains. Many men also report problems with self-esteem and body image, and there is an association between anabolic steroids and eating disorders or body dysmorphisms such as vigorexia or reverse anorexia, as they also call it. All that size and muscle isn't enough.
We talk a lot about stereotypes of beauty in women, but it's not just women who are taught from an early age what is socially accepted and valued. Boys, too, are subtly taught from an early age to associate muscular bodies with virility, heroism, success and status. A Barbie with more realistic body proportions is demanded. But I don't see anyone complaining that Action Man, He-Man or the Ninja Turtles are too muscular. Boys are no less permeable to the influence of these stereotypes on their development as teenagers and adults. We still live in a society where men don't suffer from these things. It's a sign of weakness. But self-image disorders are associated with an increased risk of using anabolic steroids, problems that have a clear social basis. The association of a body model with status. A body that is not always the work of nature, but sometimes also "chemically enhanced".
Access to anabolic steroids
Access to anabolic steroids is easy on the black market, and they are relatively cheap, which makes access widespread. The raw material produced in India, Eastern Europe and especially China reaches Europe relatively easily. It was a party until 2008, when the Chinese government came under pressure to end the buffet of raw anabolic steroids being shipped to the West. If they wanted to join the group and organize the Olympic Games, they had to play by the rules. China tightened legislation and outlawed the export of anabolic steroids. That didn't stop, of course, but it was dealt a severe blow. The steroids arrived in raw form, an oily powder or viscous gel, as in the case of boldenone, in metallized and coded packaging to fool customs, which was unable to cope.
At its destination, it becomes the final product for intra-muscular application or oral administration in clandestine laboratories, which use pompous packaging and fictitious serial numbers to give the product credibility. But in reality, it's a powder from China that could have been converted in any cellar with minimal aseptic conditions. All that's needed is a solvent, a bactericidal agent and an oily vehicle, heat everything to solubilize it and pass it through a microfilter. The rest is packaged in sterile vials or ampoules. These steps are not always carried out rigorously, and then cases like that of actor Ângelo Rodrigues happen. An infection and septicemia, potentially lethal. These are not the effects of the drug itself, but of the unhygienic conditions in which it was handled.
Statistics show that more than 60% of users buy anabolic steroids online, with no guarantee of the product's safety or authenticity. Few use authentic pharmaceutical grade substances, and less than 15% get them on prescription. This is an ethical problem that we've already touched on, but at least it provides guarantees as to the quality of the drugs being administered. The vast majority of the products administered come from underground laboratories without any quality control.
Are anabolic steroids really effective?
There are those who undervalue the impact of anabolic steroids on physique and performance. Out of bad faith or just ignorance. Or perhaps to justify themselves. Yes, the effect is dramatic and they're not just a faster way to achieve a goal. They're a way of achieving goals that wouldn't be achieved any other way. It's not because individual X has a better physique than Y. But compared to himself, X would never have achieved naturally what he can achieve with anabolic steroids. It's as simple as that. The gains in lean mass are obvious, and although training greatly enhances them, they occur independently. These gains are accompanied by an increase in strength production capacity, greater tolerance to physical exertion and much faster recovery. These effects don't persist indefinitely, but are lost within an average of 3 months. What you gain with anabolic steroids, you lose without them if abstinence is prolonged.
My 20 years in fitness have allowed me to experience a somewhat worrying paradigm shift. The motivation for using anabolic steroids hasn't changed. To maximize results and achieve an aesthetically appealing body, however subjective that may be. But not only are anabolic steroids more commonplace today, the approach has evolved to keep up with the ease with which this generation lives. Many people take them to train less and make their diet easier. And not a few only train when they're taking them. It used to be different, and I don't mean that in a nostalgic way. Anabolic steroids were seen as an "aid", and what an aid it was, allowing you to train harder and more intensely. They don't make the athlete, but they do enable them to overcome their biological limitations in recovery. And that's also how they were seen by elite athletes. Not because it was easy, but because it gave them the opportunity to excel. This doesn't invalidate the effect they can have on their own, but a bad athlete doesn't enter the circle of champions just because he's doped.
Although it is clear to those in the field that anabolic steroids have a dramatic effect on muscle mass and strength, it was only in 1996 that Bhasin made this clear to the medical and scientific community. Until then, the evidence was sparse and limited to methodologically flawed and uncontrolled studies, which led to the belief that the effects on healthy men were marginal. There was even talk of a placebo effect, or saturation of receptors by the naturally higher levels in men. This hypothesis was later refuted, and receptor saturation doesn't seem to exist.
Although the use of anabolic steroids in sport dates back to the 1950s, it wasn't until 1987 that the American College of Sports Medicine reluctantly recognized their effect on an athlete's strength and muscle mass. A year later, Canadian Ben Johnson smashed the 100m world record with the help of stanozolol (Winstrol), beating Carl Lewis, an American hero. A scandal that dominated the media and hurt American pride, and in 1990 anabolic steroids were classified as prohibited and controlled drugs. Little talked about was the fact that Carl Lewis also tested positive three times during his preparation for the games, but the result was not reported. Revelations from 2003 that fell on him after such a moralistic speech in the condemnation of Ben Johnson.
Bhasin then demonstrated almost 10 years later that supraphysiological doses, 10 times higher than those used for therapeutic purposes, but still common for doping purposes, 600 mg of testosterone enanthate per week, significantly increased lean mass and strength in young men without hypogonadism (figure). An effect that proved to be synergistic with physical exercise, but independent.
The studies show results that actually fall short of reports and observations in the field. Perhaps this is due to the relatively short duration of the cycles and the moderation of the doses used compared to common practices. Bhasin found gains of 6 kg in 10 weeks in conjunction with training, which is significant but not extraordinary for a first use of anabolic steroids, and was one of the largest results reported in clinical studies to date. More experienced athletes use higher doses and combinations of various drugs that surpass those used by Bhasin in cumulative terms. By far...
For the more skeptical who still believed that anabolic steroids only work with training, the same Bhasin later carried out another study in 2001 in which he exposed groups of men to different doses of testosterone, without any physical activity during the period they were taking it (figure). The results were unequivocal. Testosterone increases lean mass in supra-physiological doses, in a positive dose/response relationship. The more, the greater the effect. Subject closed. If there was any doubt, testosterone has a dramatic effect on lean mass, whether you train or not. Although training has a synergistic effect that greatly enhances the result.
It's also interesting to note that the effect of androgens on lean mass is differential and regionalized. Gains are much greater in the torso compared to the lower limbs. This phenomenon is explained by the distribution of androgen receptors (AR), to which testosterone and its derivatives bind, which is known not to be homogeneous throughout the body. Their density is higher in the trunk, which also explains the dimorphism that exists between men and women in terms of muscle mass. The difference is essentially in the torso and not in the legs, where lean mass does not differ substantially between the sexes. Men produce around 7 mg of testosterone a day, and women 0.05 mg. Any effect of testosterone is obviously more marked in men, and accentuates sexual dimorphism. More muscle mass in the torso and a more developed shoulder girdle. However, exposed to lower doses, women experience more noticeable effects from small variations in androgen levels. They see results with less.
The variability in the effect of testosterone, between the sexes, regionally or intra-individually, can be explained by the density of receptors, but not only that. It is true that there is a relationship between the number of androgen receptors in the muscle and the hypertrophic potential. But the action of the testosterone receptor is also conditioned by the recruitment of transcriptional activators and repressors that are differentially expressed between tissues and even individuals. And probably also by variability in the receptor itself. It's an intricate and concerted action by several players that has yet to be fully clarified. But the truth is that not everyone benefits from anabolic steroids in the same way, nor do the collateral effects manifest themselves in a predictable way.
Studies evaluating the impact of testosterone administration at supra-physiological doses, and those evaluating the therapeutic effect in men with hypogonadism, also reveal a moderate trend towards absolute fat mass loss. But unlike what happens with lean mass gains, which tend to be proportional to the dose, the positive effect on fat mass loss seems to describe a U-shaped trend. At infra-physiological doses and at very high doses, there is an increase in fat mass. But despite this effect, it is in the preservation of lean mass and even gain during calorie restriction that anabolic steroids prove to be a very powerful weapon in improving body composition. Probably the most powerful of all. Much more so than growth hormone and other expensive drugs with more "selective" access. The allocation of energy for protein synthesis mobilizes reserves of adipose tissue, because building muscle is very expensive for the body.
As we can see in the figure above, there is indeed an increase in lean mass proportional to the dose. But at infra-physiological or physiological doses, these gains do not appear to be significant. Only from 125 mg per week do we start to see an increase in lean mass, which is why there is little or no effect when physiological doses are administered to healthy men with normal testosterone levels. Hence the erroneous notion that persisted in the medical community for years that anabolic steroids produced marginal effects on an individual's muscle mass. It's all a question of dose, and don't expect major effects in eugonadal men with physiological doses. We'd just be replacing what they already produce.
Each anabolic steroid has its own profile and a different impact on body composition, although the mechanisms of action are broadly similar. There is only one receptor, with a single isoform, that all anabolic steroids share. The androgen receptor (AR). What varies is affinity, recruitment of transcription co-factors and metabolization into different intermediate compounds with biological activity. An aspect that seems to be overlooked by many users who choose to combine a panoply of anabolic steroids as if there were a receptor for each one in the body. One receptor for testosterone, another for oxandrolone, another for stanozolol. That's not how it works and combining several drugs only increases the cumulative dose and potential side effects.
Anabolic steroids are usually taken cyclically. Hence the expression "cycle". John Ziegler himself recommended using his Dianabol for periods of 6 weeks and taking 5-week breaks, with doses of 5-10 mg that should be strengthened. It is believed that breaks between periods of taking the drug facilitate the recovery of the hormonal axis and reduce the risks. Two to three cycles a year are common, but the truth is that many end up taking them continuously to escape the drama of the post-cycle period. This is a phase in which there is not only drug withdrawal but also an inhibition of natural testosterone production, which explains the gradual loss of what was achieved while taking the drug. And in addition, a state of hypogonadism with all the symptoms that characterize it. Such as a depressive state, demotivation, loss of libido, among other very debilitating psychological symptoms.
Giving up anabolic steroids
Of the 45% of users who decide to stop, only 40% are successful and don't take anabolic steroids again. Nobody wants to feel like they're in the ditch when testosterone plummets. Depression, general lack of motivation, lack of concentration, lack of sexual appetite and impotence, among other debilitating symptoms. That's why some suggest a "blast and cruize" strategy, in which there is no complete cessation of use, but only a reduction in the dose and a choice of substances they consider less harmful, or in most cases a more moderate dose of testosterone. A kind of replacement therapy. An illusion, because a dose as low as 100 mg of testosterone a week inhibits the hormonal axis at 90%. There's never any recovery, and it's actually a continuous form of use.
We'll discuss the controversy surrounding addiction to anabolic steroids in more depth later. It's a controversial subject because it's not recognized as having a direct addictive effect like opiates or amphetamines. But dependence on the effect and not on the drug can be enough to promote continued use. We feel like supermen when we take it, and we don't want to lose that. The body you get from drugs can't be maintained without them either. If you want the effects, you can't stop taking them. It's a vicious cycle, not because of the drug but because of the result, which is hard to get out of. That's why the vast majority of authors have attributed the potential for addiction to anabolic steroids.
The problem of anabolic steroids is still taboo, but it continues to grow while health professionals turn their heads away. Lack of training or sensitivity to the problem, which is not seen as an addiction or a manifestation of self-esteem problems caused by a competitive society that values the physical as a mark of virility and status. To quote Matt Haig in his book "Reasons to Stay Alive", being satisfied these days with our simple existence is almost an act of rebellion. Society is constantly demanding more and better from us. A lot of work needs to be done to ensure that the issue receives the attention it deserves, and ignoring it as if it didn't exist certainly doesn't do anything. It does help to keep the phenomenon in the obscure sphere of "gurus" and gym partners, who don't always have the necessary knowledge or even the fundamental interest in each other's health.
