Medical and Nonmedical Uses of Anabolic-Androgenic Steroids

Abstract

Recent trends in the use, abuse, and diversion of steroids for nonmedical purposes illustrate a growing problem that not only imposes health risks but presents ethical dilemmas as well. Concern over the known adverse effects, the limited research into the long-term effects, and the ethics of engineering body size and performance through anabolic-androgenic steroid use has led to legislative, legal, and education responses. Increased penalties for distribution to minors and stricter controls in prescribing practices have been enacted through state legislation and federal initiatives. Government, some health professional organizations, and some sports groups have denounced the nonmedical use of anabolic-androgenic steroids and have developed materials to educate their members, other professionals, athletes, educators, and the public at large. (JAMA. 1990;264:2923-2927 ANABOLIC-androgenic steroids (AAS) are synthetic derivatives of tes¬ tosterone, most of which were devel¬ oped in the 1950s in attempts to sepa¬ rate the hormone's masculinizing (androgenic) and skeletal muscle-building (anabolic) effects. There are no steroids at present that have purely anabolic ef¬ fects. These drugs are not to be con¬ fused with the adrenal corticosteroids. Administration may be oral or parenteral, and parenteral injections may be in oil or water. In general, oil-based AAS have a longer biological half-life.Anabolic-androgenic steroids are prescription drugs that have legitimate medical uses. These include certain types of anemias, hereditary angioedema, certain gynecologic conditions, and protein anabolism.1 They also may have a role or be useful in conjunction with the following: constitutional delay of growth, an adjunct to growth hor¬ mone therapy, and osteoporosis. Medi¬ cal indications are estimated to account for fewer than 3 million prescriptions per year in the United States.2 NONMEDICAL USE OF ANABOLIC STEROIDS Anabolic-androgenic steroids are most frequently used to aid in body building and/or to provide skeletal mus¬ cle enlargement or increased strength by persons in good health. Their use for these reasons has been condemned on the basis of ethics (fair play) Football League, the US Olympic Com¬ mittee, and the International Olympic Committee.3,4 These organizations also condemn their use because of the known adverse effects, the lack ofdata regard¬ ing long-term gains in size and strength, and the unknown long-term damage to health.Historically, use was opposed by medical organizations and sports groups on the grounds that these sub¬ stances were ineffective. Recent re¬ search, however, shows that increases in skeletal muscle mass and strength are observed in users who already are train¬ ing with weights and who continue in¬ tensive training while maintaining highprotein, high-calorie diets. Those not adhering to such a training and diet reg¬ imen do not consistently report im¬ proved performance.56 The wide dis¬ semination of initial reports of AAS ineffectiveness, coupled with subse¬ quent announcements of researc...