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Performance-enhancing drugs: Are they a risk to your health?

Most serious athletes will tell you that the competitive drive to win can be fierce. Besides the satisfaction of personal accomplishment, athletes often pursue dreams of a medal for their country, a college scholarship or a place on a professional team. In such an environment, the use of performance-enhancing drugs has become increasingly common.

For some athletes, winning at all costs includes taking performance-enhancing drugs. Some may appear to achieve physical gains from such drugs, but at what cost? The long-term effects of performance-enhancing drugs haven't been rigorously studied. And short-term benefits are tempered by many risks.

Take the time to learn about the benefits, risks and many unknowns regarding so-called performance-enhancing drugs. You may decide that the benefits aren't worth the risks.

Anabolic-androgenic steroids

What are they?
Some athletes take a form of steroids — known as anabolic-androgenic steroids — to increase their muscle mass and strength. The main anabolic-androgenic steroid hormone produced by your body is testosterone.

Testosterone has two main effects on your body:

• Anabolic effects promote muscle building.
• Androgenic effects are responsible for male traits, such as facial hair and a deeper voice.

Some athletes take straight testosterone to boost their performance. Frequently, the anabolic-androgenic steroids that athletes use are synthetic modifications of testosterone. These hormones have approved medical uses, though improving athletic performance is not one of them. They can be taken as pills, injections or topical treatments. Common anabolic-androgenic steroids include:

• Methyltestosterone (Android)
• Oxandrolone (Oxandrin)
• Oxymetholone (Anadrol)

Why are these drugs so appealing to athletes? Besides making muscles bigger, anabolic-androgenic steroids may help athletes recover from a hard workout more quickly by reducing the amount of muscle damage that occurs during the session. In addition, some athletes may like the aggressive feelings they get when they take the drugs.

Designer steroids
A particularly dangerous class of anabolic-androgenic steroids has emerged since 2002. These so-called "designer" drugs are synthetic steroids that have been illicitly created to be undetectable in current drug tests. They are made specifically for athletes and have no approved medical use. Because of this, they haven't been tested or approved by the Food and Drug Administration (FDA) and represent a particular health threat to athletes. 

Designer steroids include:

• Tetrahydrogestrinone (THG)
• Desoxymethyltestosterone (Madol)
• Norbolethone (Genabol)

Risks
Many athletes take anabolic-androgenic steroids at doses that are much higher than those prescribed for medical reasons, and most of what is known about the drugs' effects on athletes comes from observing these users. It is impossible for researchers to design studies that would accurately test the effects of large doses of steroids on athletes, because giving test participants such high doses would be unethical. This means that the effects of taking anabolic-androgenic steroids at very high doses haven't been well studied.

Anabolic-androgenic steroids come with serious physical side effects as well.

Men may develop:

• Prominent breasts
• Baldness
• Shrunken testicles
• Infertility

Women may develop:

• A deeper voice
• An enlarged clitoris
• Increased body hair
• Baldness

Both men and women might experience:

• Severe acne
• Liver abnormalities and tumors
• Increased low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol)
• Decreased high-density lipoprotein (HDL) cholesterol (the "good" cholesterol)
• Aggressive behaviors, rage or violence
• Psychiatric disorders, such as depression
• Drug dependence
• Infections or diseases such as HIV or hepatitis if you're injecting the drugs
• Inhibited growth and development, and risk of future health problems if you're a teenager

Taking anabolic-androgenic steroids to enhance athletic performance, besides being prohibited by most sports organizations, is illegal. In the past 20 years, more effective law enforcement in the United States has pushed much of the illegal steroid industry into the black market. This poses additional health risks because the drugs either are made in other countries and smuggled in or are made in clandestine labs in the United States. Either way, they aren't subject to government safety standards and could be impure or mislabeled.

Diuretics

What are they?
Diuretics are drugs that change your body's natural balance of fluids and salts (electrolytes) and can lead to dehydration. This loss of water can decrease an athlete's weight, helping him or her to compete in a lighter weight class, which many athletes prefer. Diuretics may also help athletes pass drug tests by diluting their urine.

Some of the most common diuretics include:

• Acetazolamide (Diamox)
• Spironolactone (Aldactone)
• Furosemide (Lasix)

Risks
If diuretics are taken at a dose that is higher than the medically recommended dose, the adverse effects may be significant. These include:

• Dehydration
• Muscle cramps
• Exhaustion
• Dizziness
• Potassium deficiency
• Heart arrhythmias
• Drop in blood pressure
• Death

Creatine

What is it?
Many athletes take nutritional supplements instead of or in addition to performance-enhancing drugs. Supplements are available over-the-counter as powders or pills.

The most popular supplement among athletes is probably creatine monohydrate. Creatine is a naturally occurring compound produced by your body that helps your muscles release energy.

Scientific research indicates that creatine may have some athletic benefit by producing small gains in short-term bursts of power. Its benefits include:

• Helping muscles make and circulate more adenosine triphosphate (ATP), which stores and transports energy in cells, and is used for quick, explosive bursts of activity, as in weightlifting or sprinting
• Delaying muscle fatigue

There's no evidence that creatine enhances performance in aerobic or endurance sports.

Your liver produces about 0.07 ounces (2 grams) of creatine each day. You also get creatine from the meat in your diet. Creatine is stored in your muscles, and levels are relatively easily maintained. Because your kidneys remove excess creatine, the value of supplements to someone who already has adequate muscle creatine content is questionable.

Risks
Supplements are considered food and not drugs by the FDA. This means supplement manufacturers are not required to conform to the same production safety standards as drug manufacturers do. It is common to find supplements that have been diluted or contaminated with other substances, which may inadvertently lead to a positive test for performance-enhancing drugs.

Possible side effects of creatine that can decrease athletic performance include:

• Stomach cramps
• Muscle cramps
• Nausea
• Diarrhea
• Weight gain

Weight gain is sought after by athletes who want to increase their size. But with prolonged creatine use, weight gain is more likely the result of water retention than an increase in muscle mass. Water is drawn into your muscle tissue, away from other parts of your body. This puts you at risk of dehydration.

High-dose creatine use may potentially damage your:

• Kidneys
• Liver

It appears safe for adults to use creatine at the doses recommended by manufacturers. But it's unknown what kind of effect taking creatine has over the long term, especially in teens or younger children. The American College of Sports Medicine advises against taking creatine if you're under 18 years old. However, the International Society of Sports Nutrition has concluded that creatine use for serious high school athletes can be a good alternative to illegal steroids or other harmful performance-enhancing drugs if specific criteria are met, including that the child's parents are aware of and supervising their child's creatine use.

Androstenedione

What is it?
Androstenedione (andro) is a hormone produced by the adrenal glands, ovaries and testes. It's a hormone that's normally converted to testosterone and estradiol in both men and women.

Andro is a controlled substance and its use as a performance-enhancing drug is illegal in the United States. However, andro is still sold as a nutritional supplement and manufacturers and bodybuilding magazines tout its ability to allow athletes to train harder and recover more quickly.

Scientific studies that refute these claims show that supplemental androstenedione doesn't increase testosterone and that your muscles don't get stronger with andro use.

Risks
Side effects of andro in men include:

• Acne
• Diminished sperm production
• Shrinking of the testicles
• Enlargement of the breasts

In women, side effects include:

• Acne
• Masculinization, such as deepening of the voice and male-pattern baldness

In both men and women, andro can decrease HDL cholesterol (the "good" cholesterol), which puts you at greater risk of heart attack and stroke.

Stimulants

What are they?
Some athletes use stimulants for the perceived edge they give in stimulating the central nervous system and increasing heart rate and blood pressure.

Stimulants can:

• Reduce fatigue
• Suppress appetite
• Increase alertness and aggressiveness

Common stimulants include:

• Caffeine and amphetamines (Dexedrine, Adderall)
• Cold remedies, which often contain the stimulants ephedrine or pseudoephedrine hydrochloride (Sudafed, Advil Allergy Sinus)
• Street drugs such as cocaine and methamphetamine

Risks
Although stimulants can boost physical performance and promote aggressiveness on the field, they have side effects that can impair athletic performance.

• Nervousness and irritability make it hard to concentrate on the game.
• Insomnia can prevent an athlete from getting needed sleep.
• Athletes may become psychologically addicted or develop a tolerance so that they need greater amounts to achieve the desired effect, meaning they'll take doses that are much higher than the intended medical dose.

Other side effects include:

• Heart palpitations
• Heart rhythm abnormalities
• Weight loss
• Tremors
• Mild hypertension
• Hallucinations
• Convulsions
• Heart attack and other circulatory problems

Gaining the competitive edge

Athletic performance has more to do with skill and hard work than popping a pill or downing a superdrink, says Edward Laskowski, M.D., a physical medicine and rehabilitation specialist at Mayo Clinic, Rochester, Minn., and co-director of Mayo Clinic's Sports Medicine Center. Concern is growing that young athletes will emulate sports figures who use substances of questionable value in a bid to gain a competitive edge.

"There's a danger that kids or young adults will think: 'If I want to be like that, I'll need to take something,' " Dr. Laskowski says. "There's a tendency to look for an external agent as a magic bullet, a magic pill that's going to help us perform better. The truth is, there isn't any."