Terney R, McLain LG.
Am J Dis Child. 1990 Jan;144(1):99-103.
Department of Sociology, Loyola University, Chicago, Ill.

The use of anabolic steroids by athletes has been a frequent topic in many recent reports. While much has been written in the lay literature, there is little in the scientific literature documenting the actual use of steroids, particularly in adolescents.

We describe the results of a survey of 2113 high school students. The survey was designed to elicit information about students' general knowledge about anabolic steroids, awareness of the risks and side effects, and the incidence of use of anabolic steroids.

Ninety-four (4.4%) of 2113 students admitted using anabolic steroids. Broken down by sex, 67 (6.5%) of 1028 males and 27 (2.5%) of 1085 females were users of steroids. Athletes had a higher use of steroids (79 [5.5%] of 1436 subjects) than nonathletes (15 [2.4%] of 636 subjects).

These data suggest that we have another serious, as yet unappreciated drug problem in our adolescents.

Comment in: The use of anabolic steroids. [Am J Dis Child. 1990]

PMID:
2294728
[PubMed - indexed for MEDLINE]

Melia P, Pipe A, Greenberg L.
Clin J Sport Med. 1996 Jan;6(1):9-14.
Canadian Centre for Drug-free Sport, Gloucester, Ontario, Canada.

OBJECTIVE:
To assess the prevalence of use of anabolic-androgenic steroids and other presumed performance-enhancing drugs and the associated knowledge, attitudes, and behavior of school-aged Canadians.

DESIGN:
A national survey was conducted using a self-report questionnaire distributed randomly to schools within each of five Canadian regions.

SETTING:
Canada.

SUBJECTS:
The subjects were 16,119 Canadian students, in the sixth grade and above, from 107 schools drawn randomly from five Canadian regions.

MAIN OUTCOME MEASUREMENTS:
The number of students reporting the use of anabolic-androgenic steroids and other performance-enhancing drugs in the year before the survey, the nature of such drug-taking activities, and the attitudes underlying the decision to take anabolic-androgenic steroids.

RESULTS:
More than 83,000 young Canadians (2.8% of the respondents) are estimated to have used anabolic-androgenic steroids in the year before the survey. Of those taking such drugs, 29.4% reported that they injected them; of the latter group, 29.2% reported sharing needles in the course of injecting anabolic-androgenic steroids. Significant numbers of respondents reported using other substances (caffeine, 27%; extra protein, 27%; alcohol, 8.6%; painkillers, 9%; stimulants, 3.1%; "doping methods," 2.3%; beta-blockers, 1%) in attempts to improve sport performance.

CONCLUSIONS:
The use of anabolic-androgenic steroids is more widespread than may have been assumed and is often accompanied by high-risk needle-sharing. Anabolic-androgenic steroid use is often intended to alter body build as opposed to accentuating sport performance. Many young Canadians use a variety of other substances in attempts to improve sport performance. Drugtaking of this kind represents a special challenge for educators, health professionals, and sport authorities.

PMID:
8925377
[PubMed - indexed for MEDLINE]

The Use of Dietary Supplements in Fitness Practitioners : A Cross-Sectional Observation Study / Massimiliano Mazzilli, Filippo Macaluso, Stefano Zambelli, Pietro Picerno, Enzo Iuliano. - (Environmental Research and Public Health 18 (2021) 9 (9 May); 5005)

• PMID: 34065071
• PMCID: PMC8125933
• DOI: 10.3390/ijerph18095005

Abstract

This study was aimed at evaluating the prevalence of use of dietary supplements (DSs) among gym users and gym instructors involved in body shaping-oriented fitness training. Furthermore, this study aimed to verify whether differences existed in the prevalence and in the types of DSs used in both gym users and gym instructors involved in body shaping-oriented fitness competitions vs. those not involved in fitness competitions. A survey was distributed to 316 participants, composed of 89 gym instructors and 227 gym users of both genders aged 27.3 ± 7.7. Among these participants, 52 were involved in competitions and 248 were not, while 16 participants did not specify either way. The results showed a high prevalence in the use of DSs in the population considered, with 85.4% of the participants declaring they used DSs, with high heterogeneity in the numbers and in the combinations used. No differences were found between gym instructors and gym users, or between participants involved and those not involved in competitions. The results indicate that DSs are widely used by persons involved in body shaping-oriented fitness training. The results also suggest that the majority of the participants decided individually which DSs to use.

Keywords: body shaping; dietary supplements; exercise; food supplements; gyms; physical fitness.

The use of legislation in relation to controlling the production, movement, importation, distribution and supply of performance enhancing drugs in sport (PEDS) / Barrie Houlihan and Borja García. - Institute of Sport and Leisure Policy School of Sport, Exercise and Health Sciences Loughborough University: Loughborough, 2012

The revised World Anti-Doping Code which entered into force on 2009 marked an important development in the fight against doping in sport. Among the many changes introduced one of the most significant was the expansion of the scope of anti-doping activity beyond the use of substances by athletes to incorporate a concern to address issues associated with the production, movement, importation, distribution and supply of performance-enhancing drugs. Such a broadening of the remit of anti-doping activity not only involves National Anti-Doping Organisations (NADO's) in a series of relationships with other non-sport anti-drugs organisations, but also involves the introduction of new laws and/or amendments to existing legislation.
UNESCO States Parties to the International Convention against Doping in Sport have adopted a variety of responses to the implementation of the revised Code and particularly to the requirements of Article 8 of the UNESCO Convention which notes that ‘States Parties shall, where appropriate, adopt measures to restrict the availability of prohibited substances and methods in order to restrict their use in sport by athletes, unless the use is based upon a therapeutic use exemption. These include measures against trafficking to athletes and, to this end, measures to control production, movement, importation, distribution and sale.’

Tsitsimpikou C, Chrisostomou N, Papalexis P, Tsarouhas K, Tsatsakis A, Jamurtas A.
Int J Sport Nutr Exerc Metab. 2011 Oct;21(5):377-84

Although the use of nutritional supplements by professional athletes and the benefits thereof have been extensively studied, information on recreational athletes' use of supplements is limited. This study investigated the consumption of nutritional supplements, source of information and supply of supplements, and level of awareness with regard to the relevant legislation among individuals who undertake regular exercise in Athens, Greece. A closed-ended, anonymous questionnaire was answered by 329 subjects (180 men, 149 women), age 30.6 ± 12.1 yr, from 11 randomly selected gym centers. Preparations declared as anabolic agents by the users were submitted to a gas chromatographic analyzer coupled to a mass spectrometric detector. Consumption of nutritional supplements was reported by 41% of the study population, with proteins/amino acids and vitamins being the most popular. Age (r = .456, p = .035), sex (χ2 = 14.1, df = 1, p < .001), level of education (χ2 = 14.1, df = 3, p < .001), and profession (χ2 = 11.4, df = 4, p = .022) were associated with the subjects' decision to consume nutritional supplements. Most (67.1%) purchased products from health food stores. Only 17.1% had consulted a physician or nutritionist, and one third were aware of the relevant legislation. Two preparations were detected containing synthetic anabolic steroids not stated on the label. In conclusion, use of nutritional supplements was common among recreational athletes in Athens, Greece. A low level of awareness and low involvement of health care professionals as sources of information and supply were observed.

The use of RNA-based 5'-aminolevulinate synthase 2 biomarkers in dried blood spots to detect recombinant human erythropoietin microdoses / Francesco Loria, Holly D, Cox, Sven C. Voss, Angela Rocca, Geoffrey D. Miller, Nathan Townsend, Costas Georgakopoulos, Daniel Eichner, Tiia Kuuranne, Nicolas Leuenberger. - (Drug Testing and Analysis (2021) 3 July)

• PMID: 34216436
• DOI: 10.1002/dta.3123

Abstract

The hematological module of the Athlete Biological Passport (ABP) is used for indirect detection of blood manipulations; however, the use of this method to detect doping, such as with microdoses of recombinant human erythropoietin (rhEPO), is problematic. For this reason, the sensitivity of ABP must be enhanced by implementing novel biomarkers. Here, we show that 5'-aminolevulinate synthase 2 (ALAS2) mRNAs are useful transcriptomic biomarkers to improve the indirect detection of rhEPO microdosing. Moreover, the sensitivity was sufficient to distinguish rhEPO administration from exposure to hypoxic conditions. Levels of mRNAs encoding carbonate anhydrase 1 (CA1) and solute carrier family 4 member 1 (SLC4A1) RNA, as well as the linear (L) and linear + circular (LC) forms of ALAS2 mRNA, were monitored for 16 days after rhEPO microdosing and during exposure to hypoxic conditions. ALAS2 mRNAs increased by 300% compared with the baseline values after rhEPO microdosing. Moreover, ALAS2 mRNAs were not significantly increased under hypoxic conditions. By contrast, CA1 mRNA was increased after both rhEPO microdosing and hypoxia, whereas SLC4A1 mRNA did not significantly increase under either condition. Furthermore, the analyses described here were performed using dried blood spots (DBSs), which provide advantages in terms of the sample collection, transport, and storage logistics. This study demonstrates that ALAS2 mRNA levels are sensitive and specific transcriptomic biomarkers for the detection of rhEPO microdosing using the hematological module of the ABP, and this method is compatible with the use of DBSs for anti-doping analyses.

The Value of the Dark Side : An Insight into the Risks and Benefits of Engaging in Health-compromising Practices from the Perspective of Competitive Bodybuilders / Anne Probert, Sarah Leberman. - (European Sport Management Quarterly 9 (2009) 4 (20 November); p. 353-373)

• Issue: The Dark Side of Sport 
• DOI: 10.1080/16184740903331838

Abstract

Phenomenological accounts of competitive bodybuilders have emphasized positive experiences, whilst critical and clinical perspectives have predominantly portrayed the sport as unhealthy and detrimental to participants. This article provides insights from competitive bodybuilders in New Zealand relating to their health-compromising and risky experiences within the sport. Interviews with thirty-two competitive bodybuilders were undertaken, highlighting their conscious decisions to engage in health-compromising practices and also their vulnerabilities. Stories of steroid use, the extremes of dieting, eating disorders and obsessive behaviour are provided. The research confirms that there is a dark side to competitive bodybuilding, but there are also pleasures and value associated with these encounters. These can prove meaningful to personal and athletic identity and enable participants to test their boundaries and internal strengths—experiences that may contribute to personal growth, therapy and a sense of “self-affirmation”.

The very high premature mortality rate among active professional wrestlers is primarily due to cardiovascular disease / C.W. Herman, A.S. Conlon, M. Rubenfire, A.R. Burghardt, S.J. McGregor. – (Public Library of Science one 9 (2014) 11 (5 November) : p. 1-7).
doi: 10.1371/journal.pone.0109945. eCollection 2014

Content:

- Introduction
- Methods
• Ethics Statement
• Calculations of Mortality Rates
• Survival Analysis
- Results
• Survival Estimates
- Discussion
- Conclusion
- References

PURPOSE:
Recently, much media attention has been given to the premature deaths in professional wrestlers. Since no formal studies exist that have statistically examined the probability of premature mortality in professional wrestlers, we determined survival estimates for active wresters over the past quarter century to establish the factors contributing to the premature mortality of these individuals.
METHODS:
Data including cause of death was obtained from public records and wrestling publications in wrestlers who were active between January 1, 1985 and December 31, 2011. 557 males were considered consistently active wrestlers during this time period. 2007 published mortality rates from the Center for Disease Control were used to compare the general population to the wrestlers by age, BMI, time period, and cause of death. Survival estimates and Cox hazard regression models were fit to determine incident premature deaths and factors associated with lower survival. Cumulative incidence function (CIF) estimates given years wrestled was obtained using a competing risks model for cause of death.
RESULTS:
The mortality for all wrestlers over the 26-year study period was.007 deaths/total person-years or 708 per 100,000 per year, and 16% of deaths occurred below age 50 years. Among wrestlers, the leading cause of deaths based on CIF was cardiovascular-related (38%). For cardiovascular-related deaths, drug overdose-related deaths and cancer deaths, wrestler mortality rates were respectively 15.1, 122.7 and 6.4 times greater than those of males in the general population. Survival estimates from hazard models indicated that BMI is significantly associated with the hazard of death from total time wrestling (p<0.0001).
CONCLUSION:
Professional wrestlers are more likely to die prematurely from cardiovascular disease compared to the general population and morbidly obese wrestlers are especially at risk. Results from this study may be useful for professional wrestlers, as well as wellness policy and medical care implementation.

The WADA World Anti-Doping Code: The Road to Harmonisation / Janwillem Soek. - (International Sports Law Journal (2003) 2 : p. 2-11)

Content:
1.) Introduction
2.) Description of the doping offence (violation of the anti-doping rule)
2.1.) The definition of doping
2.2.) Description of the doping offence
3.) Out-of-competition testing
4.) Procedure after testing positive
5.) Provisional suspension
6.) Sanctions
6.1.) Sport sanctions
6.2.) Disciplinary sanctions for individuals
6.3.) Disciplinary sanctions for teams
6.4.) Remission of sentence
6.4.1.) Exceptional circumstances
6.4.2.) Cooperation in the investigation
6.5.) Reinstatement
7.) Right of the defence
8.) Proof of doping
9.) Appeals
10.) Athlete support personnel
11.) The role of the ADOs and NADOs
12.) Summary

The description of the doping offence has been laid down somewhat oddly in the WADC. No longer is the starting point the undesirable human act which is punished; instead it is the violation of anti-doping
rules. These rules describe the outcome of a human act. The way in which these matters are regulated by the WADC is neither elegant, nor transparent. The WADC provisions not only concern the athletes, but also persons from their entourage. The system providing for strict liability after a sample has tested positive in a laboratory may lead to the punishment of innocent people. The author argues in favour of the simple reversal of the burden of proof whereby the athlete is presumed guilty but is at least given the opportunity to prove his/her innocence.

The Whereabouts in the fight against doping. What about the whereabouts : necessary evil or disproportional violation of the rights of elite athletes / Jens Raes. – Ghent : Ghent University, 2012. – (Masters dissertation Ghent University)

De whereabouts in de strijd tegen doping. What about the whereabouts : noodzakelijk kwaad of disproportionele inbreuk op de rechten van de elitesporter / Jens Raes. - Gent : Univeriteit Gent, 2012. - (Masterproef opleiding Master in de rechten, Universiteit Gent, Faculteit Rechtsgeleerdheid, academiejaar 2011-2012)

Inhoud:

Hoofdstuk 1: Inleiding
Hoofdstuk 2: Juridische grondslag
2.1 Internationale context
2.2 Nationale context
Hoofdstuk 3: What about the Whereabouts
3.1 Definities
3.2 De whereabouts vanuit praktisch oogpunt
Hoofdstuk 4: Case-studies
4.1 Wickmayer-Malisse
4.2 Sporta
4.3 Buitenlandse Cases
Hoofdstuk 5: De whereabouts en het recht op privacy
5.1 Verenigbaarheid van de whereabouts met artikel 8 EVRM
5.2 Visie privacycommissie
Hoofdstuk 6: De whereabouts en het sportrecht binnen de EU
6.1 Historische achtergrond
6.2 Meca-Medina en Majcen
6.3 Guillermo Cañas
6.4 Meca-Medina en Cañas openen perspectieven in de strijd tegen de whereabouts
6.5 Richtlijn betreffende een aantal aspecten van de organisatie van de arbeidstijd
Hoofdstuk 7: Algemene conclusie en alternatieven
7.1 Schending van de rechtszekerheid omwille van de procedure
7.2 Schending legaliteitsbeginsel en proportionaliteitsbeginsel
7.3 Alternatieven
7.4 Slotwoord
Bibliografie