Jay R. Hoffman and Nicholas A. Ratamess
The College of New Jersey, Ewing, NJ, USA
Received: 10 February 2006 / Accepted: 09 March 2006 / Published (online): 01 June 2006

For the past 50 years anabolic steroids have been at the forefront of the controversy surrounding performance enhancing drugs. For almost half of this time no attempt was made by sports governing
bodies to control its use, and only recently have all of the major sports governing bodies in North America agreed to ban from competition and punish athletes who test positive for anabolic steroids. These punitive measures were developed with the primary concern for promotion of fair play and eliminating potential
health risks associated with androgenic-anabolic steroids. Yet, controversy exists whether these testing programs deter anabolic steroid use. Although the scope of this paper does not focus on the effectiveness of testing, or the issue of fair play, it is of interest to understand why many athletes underestimate the health
risks associated from these drugs. What creates further curiosity is the seemingly well-publicized health hazards that the medical community has depicted concerning anabolic steroid abuse. Is there something that the athletes know, or are they simply naïve regarding the dangers? The focus of this review is to
provide a brief history of anabolic steroid use in North America, the prevalence of its use in both athletic and recreational populations and its efficacy. Primary discussion will focus on health issues associated with anabolic steroid use with an examination of the contrasting views held between the medical community and the athletes that are using these ergogenic drugs. Existing data suggest that in certain circumstances the medical risk associated with anabolic steroid use may have been somewhat exaggerated,
possibly to dissuade use in athletes.

http://www.jssm.org

ABSTRACT
Introduction: Athletes from the Balkan have lost on the last two Olympic Games 5 medals and 5 athletes have been doping positive on out of competition testing, which represents 36% doping positive of all athletes in Sidney 2000 and 24% in Athens 2004.

Objectives: The aim of this study is to examine attitudes and experience of medical doctors from Balkan Countries in doping in sport.

Materials and methods: A total of 219 medical doctors from Bulgaria, Greece, Romania, Serbia and Turkey fulfilled the questionnaire related to doping control procedure, athletes’ rights and responsibilities, their training in doping prevention and willingness to have more education.

Results: During the period of 12 months, 80% doctors have been asked for information about doping agents, 25% of them have been contacted by athletes for the prescription of doping agents, 14% of doctors think that they should assist athletes who want to use doping so that athletes can use doping safely and in 27% of the doctors have treated athletes who are using doping due to medical problems. They believe that education is the most effective method to fight against doping and they believe that the least effective method is two years ban. They indicated adolescents and children as a first group which needs to be targeted in a doping prevention, professional athletes as a second and amateur athletes as a third one.

Conclusion: Hypothesis that athletes are not informed about doping agents because of poor knowledge of medical doctors about this issue is confirmed. This study suggests that medical doctors from Balkan region recognize doping as a real public health problem, and the need for its prevention. Our study stresses the need for prompt education and adequate training of medical doctors in this domain.

Medication Information and Supply Behaviours in Elite and Developing Athletes / Danae Perry, Bronte Librizzi, Lily Ngu, Michael Ricciardello, Amy Street, Rhonda Clifford, Carmel Goodman, Peter Peeling, Sandra M. Salter. - (Journal of Science and Medicine in Sport (2020, 16 January)).
- PMID: 32044233.
- DOI: 10.1016/j.jsams.2019.12.026

Abstract

Objectives
To investigate the behaviours of elite and developing athletes in obtaining medications and medication information, and to identify the role of pharmacists in athlete care.

Design
Cross-sectional survey.

Methods
An electronic, 39-item questionnaire was developed, piloted and distributed to elite and developing athletes aged 18 years and above at a state-based sporting institute. Quantitative data was analysed using descriptive statistics and free text comments were analysed using an inductive reasoning approach.

Results
A total of 98 responses were analysed. Ninety (n = 90/98, 91.84%) participants obtained medications in the six months prior to survey completion. Pharmacies were the most common source of both prescription (n = 67/69, 97.10%) and non-prescription medications (n = 64/75, 85.33%). Forty-five (n = 45/98, 45.92%) participants also attended pharmacies when they had a minor ailment. Sixty-two (n = 62/98, 63.27%) participants ‘sometimes’ consulted pharmacists for medication information. Only 11 (n = 11/98, 11.22%) knew, according to their sporting institute medication policy, that athletes were required to consult a medical practitioner before taking anti-inflammatory, pain-relieving or sleep-inducing medications. Forty (n = 40/98, 40.82%) participants believed pharmacists could play a role in their medication management.

Conclusions
Many elite and developing athletes visited pharmacies for medication supply and treatment of minor ailments. Doping regulatory agency websites were the most commonly used and trusted sources for medication information, although some athletes believed pharmacists could also contribute to their medication management. Future research should consider whether pharmacists are ready for a role in sports pharmacy.

Medicinal Use of Testosterone and Related Steroids Revisited /  Jan Tauchen, Michal Jurášek, Lukáš Huml, Silvie Rimpelová. - (Molecules 26 (2021) 4 (15 February); p. 1-20)

• PMID: 33672087
• PMCID: PMC7919692
• DOI: 10.3390/molecules26041032

Abstract

Testosterone derivatives and related compounds (such as anabolic-androgenic steroids-AAS) are frequently misused by athletes (both professional and amateur) wishing to promote muscle development and strength or to cover AAS misuse. Even though these agents are vastly regarded as abusive material, they have important pharmacological activities that cannot be easily replaced by other drugs and have therapeutic potential in a range of conditions (e.g., wasting syndromes, severe burns, muscle and bone injuries, anemia, hereditary angioedema). Testosterone and related steroids have been in some countries treated as controlled substances, which may affect the availability of these agents for patients who need them for therapeutic reasons in a given country. Although these agents are currently regarded as rather older generation drugs and their use may lead to serious side-effects, they still have medicinal value as androgenic, anabolic, and even anti-androgenic agents. This review summarizes and revisits the medicinal use of compounds based on the structure and biological activity of testosterone, with examples of specific compounds. Additionally, some of the newer androgenic-anabolic compounds are discussed such as selective androgen receptor modulators, the efficacy/adverse-effect profiles of which have not been sufficiently established and which may pose a greater risk than conventional androgenic-anabolic agents.

Medicine and science in the fight against doping in sport / D.H. Catlin, K.D. Fitch, A. Ljungqvist. – (Journal of Internal Medicine (2008) 264 (Aug) : p. 99-114)

• DOI: 10.1111/j.1365-2796.2008.01993.x.

Content:

- Introduction

• The IOC medical commission era
• The WADA era

- Detection of doping substances and methods

• Stimulants detection by gas chromatography Anabolic steroid detection by ummunoassay
• Gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry
• Detection of testosterone and other endogenous steroids
• Isotope-ratio mass spectrometry
• Erythropoietins
• Flow cytometry to detect blood doping
• Human growth hormone
• Profiling of blood or urine: longitudinal testing, passports and volunteer programs
• Dietary supplements
• Designer anabolic androgenic steroids
• Rapidly deployed proactive methods

- Doping controls at Olympic games
- Therapeutic use of prohibited substances
- Conclusions

The fight against doping in sports commenced as a result of the death of a Danish cyclist during the Rome Olympic Games in 1960. The International Olympic Committee (IOC) established a Medical Commission (IOC-MC) which had the task of designing a strategy to combat the misuse of drugs in Olympic Sport. Some International Sport Federations (IF) and National Sports Federations followed suit, but progress was modest until the world's best male sprinter was found doped with anabolic steroids at the Olympic Games in Seoul in 1988. Further progress was made following the cessation of the cold war in 1989 and in 1999 public authorities around the world joined the Olympic Movement in a unique partnership by creating WADA, the 'World Anti-Doping Agency'. The troubled history of the anti-doping fight from the 1960s until today is reviewed. In particular, the development of detection methods for an ever increasing number of drugs that can be used to dope is described, as are the measures that have been taken to protect the health of the athletes, including those who may need banned substances for medical reasons.

Medicolegal aspects of doping in football / T. Graf-Baumann. - (British Journal of Sports Medicine 40 (2006) Supplement 1 (July); p. i55-i57)

• PMID: 16799105
• PMCID: PMC2657503
• DOI: 10.1136/bjsm.2006.027979

Abstract

This article describes the historical background of the medicolegal aspects of doping in sports and especially in football. The definitions of legal terms are explained and the procedure of individual case management as part of FIFA's approach to doping is presented. Finally, three medicolegal problems awaiting urgent solution are outlined: firstly, the difficulties in decision making arising from the decrease of the T/E ratio from 6 to 4; secondly, the therapeutic application of alpha-reductase inhibitors for male pattern baldness in the face of the classification of finasteride as a forbidden masking agent; and lastly, the increasing use of recreational drugs and its social and legal implications in positive cases.

Melanotan II injection resulting in systemic toxicity and rhabdomyolysis / Nelson ME, Bryant SM, Aks SE
Clin Toxicol (Phila). 2012 Dec;50(10):1169-73

INTRODUCTION:
Melanotan products are currently purchased over the Internet and are designed to induce melanogenesis to create sunless tanning as well are used as sexual stimulants. We report a novel case of systemic toxicity with sympathomimetic excess and rhabdomyolysis after use of Melanotan II.

CASE REPORT:
A 39 year-old Caucasian male injected subcutaneously 6 mg of Melanotan II purchased over the Internet in an attempt to darken his skin during wintertime. This dose was six times the recommended starting dose per the patient. In the emergency department two hours post injection, he complained of diffuse body aches, sweating, and a sensation of anxiety. Vital signs included BP 151/85 mmHg, HR 130 bpm that peaked at 146 bpm, and temperature of 97.8°F. Physical exam demonstrated a restless and anxious appearing male with mydriasis, diaphoresis, tachycardia, and diffuse muscle tremors. Pertinent laboratory values were creatinine 2.25 mg/dL, CPK 1760 IU/L, troponin 0.23 ng/mL, WBC 19.1 k/μL. Urinalysis demonstrated 3 + blood with red cell casts but 0-2 RBC/hpf. Qualitative urine drug screen was negative for metabolites of cocaine and amphetamines but positive for opiates. The patient received benzodiazepines for agitation and anxiety and had improvement in his symptoms. He was admitted to the ICU and during hospitalization his CPK elevated to 17773 IU/L 12 hours later. He continued to receive intravenous fluids with sodium bicarbonate for rhabdomyolysis and his CPK decreased to 2622 IU/L with improvement of creatinine to 1.23 mg/dL upon discharge from the ICU after 3 days. The substance, which he injected, was analyzed via mass spectrometry and was confirmed to be Melanotan II when compared with an industry purchased standard sample.

DISCUSSION:
Melanotan products are purchased via the Internet and have three main formulations (Melanotan I, Melanotan II, and bremelanotide). Melanotan I increases melanogenesis and eumelanin content to produce sunless tanning. Melanotan II also increases skin pigmentation but also produces spontaneous penile erections and sexual stimulation. Bremelanotide is a variation of Melanotan II that is specifically designed for sexual stimulation. This unique case highlights the potential of systemic toxicity with sympathomimetic excess, rhabdomyolysis, and renal dysfunction from Melanotan II use.

CONCLUSION:
Melanotan II use resulted in systemic toxicity including apparent sympathomimetic symptoms, rhabdomyolysis, and renal dysfunction.

Meldonium residues in milk : A possible scenario for inadvertent doping in sports? / Sven Guddat, Christian Görgens, Tim Sobolevsky, Mario Thevis. - (Drug Testing and Analysis (2021) 26 August)

• PMID: 34448364
• DOI: 10.1002/dta.3145

Abstract

Lately, the veterinary drug Emidonol® has been discussed as a possible scenario for inadvertent doping in sports. Emidonol® is approved for use in livestock breeding, exhibiting antihypoxic and weak sedative effects. The veterinary drug rapidly dissociates into meldonium, a substance prohibited in sports, and is excreted largely in its unchanged form into urine. To investigate if residues of meldonium in edible produce may result in adverse analytical findings in sports drug testing, a pilot study was conducted with three volunteers consuming a single dose of 100 ml meldonium-spiked milk at a concentration of 500 ng/ml (Study 1), and multiple doses of 100 ml of meldonium-spiked milk (500 ng/ml) on five consecutive days (Study 2). In the single dose study, urinary meldonium concentrations peaked between 2 and 6 h post-administration with maximum values of 7.5 ng/ml, whereas maximum meldonium concentrations of 18.6 ng/ml were determined after multiple doses 4 h post-administration. All samples were analyzed using an established and validated protocol based on HILIC-HRMS/MS.

Men regret anabolic steroid use due to a lack of comprehension regarding the consequences on future fertility / J.R. Kovac, J. Scovell, R. Ramasamy, S. Rajanahally, R.M. Coward, R.P. Smith, L.I. Lipshultz. - (Andrologia 47 (2015) 8 (October); p. 872-878).
- PMID: 25220690.
- PMCID: PMC4362970.
- DOI: 10.1111/and.12340

Summary

We examined whether men with anabolic‐steroid‐induced hypogonadism (ASIH) seeking testosterone supplementation therapy (TST) regretted their decision to use anabolic‐androgenic steroids (AAS) and what their reasons were for this regret. An anonymous, prospective survey was distributed to 382 men seeking follow‐up treatment for hypogonadism. Prior AAS use was confirmed by self‐report, and men were categorised based upon whether they regretted (R) or did not regret (NR) their use of AAS. The average patient age was 40 ± 0.9 years (n = 79) and 15.2% expressed regret over AAS use. No demographic differences were identified between those who regretted AAS use (n = 12) and those who did not (n = 67). Regret was not related to ASIH diagnosis or to AAS‐related side effects like increased aggression, mood disorders, erectile dysfunction, acne, fluid retention or dyslipidemia. Those who regretted AAS use were significantly more likely to have not comprehended the negative impact on future fertility (P < 0.030). Actual fertility issues were comparable in men who regretted AAS use (16.7%) and those who did not (13%). A total of 15.2% of men regretted using AAS. A lack of awareness regarding the negative long‐term effects on fertility was the primary factor related to regret of AAS use in men with ASIH.

Men, bodywork, health and the potentiality of performance and image-enhancing drugs / Gary W. Dowsett, Duane Duncan, Andrea Waling, Steven Angelide, Gemma Nourse

• Health Sociology Review (28 December 2022), p. 1-16
• PMID: 36577038
• DOI: 10.1080/14461242.2022.2148959

Abstract

In a qualitative study on masculinity, embodiment and sexuality, we interviewed men who were recreational gym-goers about their bodywork practices in Melbourne, Australia. We also asked whether the men had used performance and image-enhancing drugs (PIEDs) as an adjunct to their bodywork practices. While none had used PIEDs, all were considering, or had considered, using them. We found that participants held varying opinions on PIED use and those who used them. The literature on PIEDs noted men's concerns with body appearance and health and focused largely on individual problematic use, but non-users were not mentioned. A second issue in the literature focused on social influences on PIED use, but again with no mention of non-users. Discussion on risk reduction as a public health response did not mention non-users either. This paper, therefore, reports on non-users' thoughts on, regular exposure to, and considerations of PIEDs and other men who use them. We propose that PIEDs might more usefully be understood as an everyday, if contradictory, consideration within most men's bodywork and health practices. We argue that PIEDs constitute a discursive practice exposing a potentiality that engages non-users also and this requires new health promotion approaches.