The merciless rigor of modern competitive sports, especially at the international level, the glory of victory, and the growing social and economical rewards of sporting success (in no way any longer related to reality) increasingly forces athletes to improve their performance by any means available.

--Statement by the Medical Commission of the International Olympic Committee, 1972

In their drive to excel, athletes have always searched for something special to give them competitive advantage. Starting in the 1960s, weightlifters and bodybuilders began to think that they had found the magic something in the form of anabolic steroids. By the 1970s, these drugs already had become established as an integral feature of the high-technology scene of competitive sports--a fact attested to by the International Olympic Committee, which eventually included them on their list of banned doping substances. However, widespread use of anabolic steroids continues today, despite official bans and a lot of recent bad press.

Just what are these anabolic steroids? Do they provide a real physiological advantage for some of the athletes who use them? And if the answer is yes, do they present an ethical dilemma by violating the concept of fair play?

First synthesized in the 1950s, anabolic steroids are drugs that mimic the male sex hormone testosterone. By binding to specific receptor sites on muscle cells and various other tissues, testosterone greatly contributes to the male secondary sex characteristics and to the gender differences in muscle mass and strength that begin to develop at the onset of puberty. Testosterone's androgenic, or masculinizing, effects can be minimized by synthetically manipulating the chemical structure of the steroid so that its anabolic (protein-building) activity is emphasized for purposes of promoting muscular growth.

Anabolic steroids were first introduced by pharmaceutical companies for the treatment of patients who were deficient in natural androgens, or who had muscle-wasting diseases. They have a role in treating metastatic cancer, osteoporosis in postmenopausal women, and some types of anemia. Athletes who use them to increase muscle mass and strength often take a progressively increasing dose in both oral and injectable form (a method called stacking) far in excess of the clinical therapeutic dose. In months prior to competition, they gradually decrease the dose to reduce chances of detection.

Although testimonials to the effectiveness of anabolic steroids abound, it is far from clear whether using them actually leads to improved athletic performance. For example, normal healthy men who take these drugs without training show no gains in muscle size or strength. Some of the weight gain that occurs has been shown to be due to retained body fluid rather than to performance-related bulk. In fact, studies have not shown conclusively that anabolic steroids increase lean muscle bulk and strength any more than simple weight-resistance training alone. To confound the problem, improvements in performance may occur not simply because of increased muscle mass but because the anabolic steroids act via the central nervous system to make athletes more aggressive and fatigue-resistant, and thus able to engage in traditional training regimens for longer periods of time.

Whether or not anabolic steroids exert a positive influence on performance, the side effects associated with heavy, prolonged use are well documented. These include hypertension, acne, edema, and damage to the liver, heart and adrenal glands. Psychiatric symptoms can include hallucinations, paranoid delusions, and manic episodes. Users may also be predisposed to violent, antisocial behavior.

In men, anabolic steroids can cause infertility, impotence, atrophy of the testes, premature balding, and enlargement of the breasts (gynecomastia). Women can develop excessive body and facial hair, male-pattern balding, menstrual irregularities, and deepening of the voice. While not verified, it has been speculated that excessively rapid aging in women may be related to steroid use. In children and adolescents, steroids can produce premature closing of the epiphyses (bone plates), leading to stunted or retarded growth.

Particularly troublesome is the fact that use of anabolic steroids is no longer restricted to athletes. In a recent study, approximately 500,000 American high school students admitted to using or having used anabolic steroids. Improved athletic performance was the most common reason cited, but a large percentage of the students stated that they simply wanted to improve the appearance of their bodies. Regrettably, for some adolescents at least, the promise of merely looking like a powerful athlete is incentive enough to cause them to experiment with drugs that may endanger their health.

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