Tuomo Karila
ACADEMIC DISSERTATION
Faculty of Medicine of the University of Helsinki
ABSTRACT
A large number of young adults abuse anabolic androgenic steroids (AAS) to enhance physical fitness and appearance. Although AAS have been banned in organized sports for nearly thirty years, their useremains one of the main health-related problems in sports today because of their availability and lowprice. According to recent statistics of the International Olympic Committee, over half of positive doping cases are due to AAS abuse. Confiscation of doping substances by Finnish customs authorities increased during the 1990s concomitantly with the lower black market prices and easier availability of AAS.
The present study elucidates the adverse effects of AAS abuse. Its focus is on the effects of massive doses of AAS when abused with or without other anabolic substances such as growth hormone (GH), human chorionic gonadotrophin (HCG) or antiestrogens under authentic conditions. Twenty-six healthy male power athletes were followed up during their self-regimen of substance abuse and during a six-month withdrawal period. None of the volunteers were competitive sports athletes subject to doping regulations, and they abused the drugs, which they had obtained from the black market, independently of this study.
The results indicate that AAS abuse is dose-dependently associated with myocardial hypertrophy and that concomitant use of GH is associated with concentric remodelling of the left ventricle (LV). Despite the similar heart size of elite endurance athletes and AAS-abusing power athletes, marked differences were present in the electrocardiographic repolarization indices. Thus, QT dispersion was greater in AAS abusers in spite of short QT intervals, in contrast to endurance athletes, who had long intervals but less QT dispersion. The heart of endurance athletes did not morphologically vary substantially from the heart of the subjects abusing AAS, but abuse of AAS resulted in hypertrophy with pathological features.
AAS abuse increases QT dispersion, as measured from a 12-lead electrocardiogram. The autonomic tone appears to inß uence QT variables more than the left ventricular mass does. Pathological hypertrophy caused by AAS abuse has been suggested to alter repolarization of the myocardium.
Our result support earlier findings of an AAS-induced decrease in serum high-density lipoprotein concentration. AAS also have an influence on the by-products of the mevalonate pathway. Signifcant increases occurred in serum ubiquinone concentration and the ubiquinone to high-density lipoprotein ratio was increased. However, serum dolichol concentration tended to decrease concomitantly with high-density lipoprotein concentration during AAS abuse. Supraphysiological doses of AAS enhance collagen synthesis, especially in soft connective tissues.
Concomitant abuse of supraphysiological doses of AAS with HCG results in altered semen density. Regardless of AAS-induced hypogonadotrophic hypogonadism, HCG maintained spermatogenesis but reduced semen quality. Both morphology and motility of semen tended to be impaired. The average semen concentration reached normal levels six months after the cessation of substance abuse, although serum testosterone levels still tended to be low, especially among those subjects with a longer history of anabolic substance abuse.
To sum up, despite the low number of subjects and relatively short follow-up, numerous adverse effects were observed, including ventricular tachycardia, transient infertility, atherogenic changes in lipoprotein profile and pathological remodelling of the myocardium. The abuse of physical fitness-enhancing substances of all forms should be considered a health risk for young males, which may result in both sudden and long-term adverse effects
