Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone. According to surveys and media reports, the legal and illegal use of these drugs is gaining popularity. Testosterone restores sex drive and boosts muscle mass, making it central to 2 of society's rising preoccupations: perfecting the male body and sustaining the male libido. The anabolic effects of AAS have been questioned for decades, but recent scientific investigation of supraphysiologic doses supports the efficacy of these regimens. Testosterone has potent anabolic effects on the musculoskeletal system, including an increase in lean body mass, a dose-related hypertrophy of muscle fibers, and an increase in muscle strength. For athletes requiring speed and strength and men desiring a cosmetic muscle makeover, illegal steroids are a powerful lure, despite the risk of subjective side effects. Recent clinical studies have discovered novel therapeutic uses for physiologic doses of AAS, without any significant adverse effects in the short term. In the wake of important scientific advances during the past decade, the positive and negative effects of AAS warrant reevaluation. Guidelines for the clinical evaluation of AAS users will be presented for sports medicine practitioners.

This survey reveals several trends in the nonmedical use of AAS. Nearly four out of five AAS users are nonathletes who take these drugs for cosmetic reasons. AAS users in this sample are taking larger doses than previously recorded, with more than half of the respondents using a weekly AAS dose in excess of 1000 mg. The majority of steroid users self-administer AAS by intramuscular injection, and approximately 1 in 10 users report hazardous injection techniques. Polypharmacy is practiced by more than 95% of AAS users, with one in four users taking growth hormone and insulin. Nearly 100% of AAS users reported subjective side effects.

Objective-To identify unsupervised anabolic steroid regimens used by athletes. Methods-100 athletes attending four gymnasia were surveyed using an anonymous self administered questionnaire. Results-Anabolic steroid doses ranged from 250 to 3200 mg per week and users combined different drugs to achieve these doses. Injectable and oral preparations were used in cycles lasting four to 12 weeks. Eighty six per cent of users admitted to the regular use of drugs other than steroids for various reasons, including additional anabolic effects, the minimisation of steroid related side effects, and withdrawal symptoms. Acne, striae, and gynaecomastia were the most commonly reported subjective side effects.Conclusions-Multiple steroids are combined in megadoses and self administered in a cyclical fashion. Polypharmacy is practised by over 80% of steroid users. Skeletal muscle hypertrophy along with acne, striae, and gynaecomastia are frequent physical signs associated with steroid use. (BrJ Sports Med 1997;31:54-58) Keywords: anabolic steroids; drug regimens; polypharmacy; physical signs. ResultsThe first 100 completed questionnaires were entered into the study. All responders were male and the age range is shown in table 1. Thirty three per cent were competitive bodybuilders and 67% recreational athletes. Twenty one per cent of the group had been using steroids for less than one year and represent "new" users. Sixty four per cent admitted a committed steroid use of between one and five years, and the remaining 15% had been using steroids for six to 12 years (table 2). A weekly steroid dosage of less than 500 mg was used by 50% of the athletes in this sample, while 38%

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The primary aims of this report are to provide a review of current literature pertaining to fitness and healthrelated outcomes following spinal cord injury (SCI), to identify the common and relevant fitness assessment techniques, to describe key evidence-based intervention strategies for improving health-related components of fitness among persons with SCI and to identify emerging and future trends in health-related fitness programming for rehabilitation and research. SCI results in a partial or total loss of neural signal transmission at and below the level of injury, characterized by motor and sensory loss. About 250,000-400,000 individuals have a SCI in the USA with approximately 12,000 new injuries occurring annually. The loss of somatic and autonomic control results in a reduction of physical activity and blunted cardiovascular response to exercise. The consequences of this reduction in physical activity are significant physical deconditioning, altered body composition, and development of detrimental metabolic profiles leading to poorer health outcomes in this population. Over the past decade, much attention has been devoted to understanding the relationship between exercise participation, physical activity, and physical fitness and their impact on health-related outcomes following SCI. Physical fitness interventions are of great importance to the SCI consumer and clinicians whose goals are to halt the deconditioning process, increase functional capacity, and decrease secondary health complications associated with chronic SCI. Exercise risk evaluation and individualized fitness assessments for body composition, muscular strength/endurance, and cardiorespiratory fitness should precede implementation of exercise interventions. Current evidence indicates that both electrically stimulated and volitional exercise strategies have the potential to improve components of fitness, reduce the risk of secondary health complications, and positively impact overall health for those with chronic physical disability. However, given the complexity of SCI with respect to level and severity of injury, a clear consensus on the optimal frequency, duration, and intensity of exercise needed to ensure lasting effects on health-related outcomes has yet to be determined. In addition, as is the case in non-injured populations, consideration should be given to both diet and exercise, not exercise alone, when considering the optimal strategy for improving body composition and cardiovascular health for persons with SCI.