Don't Confuse Me with the Facts: Doctors Have Their Own Opinions on Steroids!

http://www.mesomorphosis.com/articles/allen/doctors.htm

by Brent Allen, MS, MBA

This was a difficult article for me to write. My intent is not to accuse the medical community, as a whole, of grossly misleading the general public about the effects of anabolic steroids. This is mainly because there are now a growing number of doctors that are approaching the problem in an appropriate way. That approach being, the honest and balanced reporting of steroids.

However, I feel with magazines such as Meso-Rx, I have an opportunity to make an impression on how this problem is handled. The primary problem being the abuse of anabolic steroids among athletes and adolescence.

But what happened in the past, as outlined in this article, does directly need to be addressed, if for no other reason than to make sure we don't make the same mistake twice. The primary mistake being, it is not acceptable to lie for the right reasons and if you don’t know the answer, do the research.

I originally preferred not to include the names of those most at fault or their word-for-word quotes. But I soon realized the believability of this article would have been greatly compromised. My intention is not a personal attack. This was actually the last way I wanted to structure this article. I also want to say I will be perfectly willing to work with any of the individuals I mention in this article, as long as honest reporting is the basis of their strategy to curb the current steroid epidemic.

I feel the medical community has a very difficult job with the steroid problem. In some ways they are in a no win situation. No matter how they approach the problem, they will be open for criticism. Neither they or I will stop the current non-medical steroid use, but in a best case scenario, we can "only" hope to slow it down!

I will approach this article by first explaining the doctors’ point-of-view. Second, I will give a brief history of what happened since the late-50's in the United States. Third, I will present quotes from several highly visible steroid experts. One past, two present, as well as some statements made by NFL officials, the Surgeon General, and compare their statements with other more objective experts as well as my findings. Fourth, I will explain what happened when Linn Goldberg did a study of the use of steroid scare tactics and adolescents, which had interesting results! Fifth, I will examine one of the leading steroid gurus. And, finally, I will give an overview as to what I feel contributes to the lack of communication between steroid-using athletes and the medical community.

Doctors' point-of-view

I truly understand a doctor's point-of-view, which I feel everybody needs to look at the constraints they have when presented the steroid topic, especially at the beginning of the epidemic. First, doctors are traditionally very conservative on anything they say. The last thing they wanted to do was say steroids worked, if they actually didn't or say steroids are not that harmful if they actually are. Second, if the American Medical Association or the American College of Sports Medicine takes an official stand on a topic, very few will go against it. It has been "politically correct" (especially in the past) to exaggerate the side-effects and either down play how much they work or just flat out deny they work. Third, if you are practicing with a group of other doctors, you don't want so say something that is unpopular with them or all doctors in general. This could lead to that doctor being "black-listed" and possibly affecting their income. I've gone through several very similar courses doctors have to take in medical school and believe me; they earn every penny they make. Fourth, doctors as well as myself want to stop drug abuse. And finally, the wild card, most doctors don't like knowing something. Perhaps it's society’s expectations of doctors, but I think most doctors do not want to admit they - JUST DON'T KNOW SOMETHING! I, for one, very much admire those doctors that do possess the ability to admit they don't know something.

The problem is a good percentage of doctors have overzealously tried to stop steroid abuse. I feel many doctors think by admitting that steroids work, they are promoting steroid use. In addition, I feel many rationalize that the "ends justifies the means." And being in almost a demi-god type position, they possibly feel they could sweep this under the rug before anything had time to develop. So they will basically say whatever they have to in order to accomplish their goal.

Brief History

After John Ziegler made Dianabol, soon doctors could see the potential for a problem. So they first started to state they didn't enhance performance, without (proper) medical studies to support their claim. Second, when the athletes experienced for themselves the sometimes phenomenal performance gains, doctors then tried to exaggerate the side effects. And again without proper medical studies to support their claims! What the doctors were using was literally a handful of isolated medical emergency case studies with persons who happened to be using steroids. These are NOT proper medical studies to base claims.

When the ACSM came out with their official stand stating that steroids did not enhance athletic performance, it appears all respect from the athletic community was lost. Eight years later in 1984, the ACSM revised its position stand, but it did little good. Partly because there were still a number of doctors (mainly Bob Goldman) that were still "vocally" exaggerating the side effects and claiming steroids didn't work or at best only made very minimal improvements.

Past Anti-Steroid Activist - Dr. Allan Ryan

If any one person is the focal point of this whole fiasco, it is Allan Ryan. He "adamantly" stated that steroids didn't work. That "any" strength gains were purely psychological and "any" muscle size gains were purely from water retention. I believe (or want to believe) he really thought steroids didn't work and that he was a stubborn old man that didn't objectively look at scientific data while also considering anecdotal reports. But he was correct in the fact that he could foresee that potential for the widespread non-medically supervised use of steroids, we have today. In a valiant effort, he felt he was stopping the problem, when in reality, he only made matters much worse in the long run. Here are some of the key statements he made:

In the 1978 article titled "Anabolic Steroids: The Myth Dies Hard" published in The Physician and Sportsmedicine. Allan was not satisfied with the original 1977 ACSM stand he had a major influence in forming. He suggested changes to even further claims steroids do not work. Below is the original statement with Ryan's proposed changes as follows: Those words he wanted to omit are in italics with a line through it and those words he wanted to insert are underlined in [brackets].

"The administration of anabolic-androgenic steroids to healthy humans below the age of 50 in medically approved therapeutic [any] dose often does not [consistently] of itself bring about any significant improvement in strength, aerobic endurance, lean body mass, or body weight."

This is a perfect example of Allan's attitude. Even though almost all the studies were performed with medical doses, he still wanted to change the statement to any dose! Allan, then in the same article, tried to apply pressure to the scientific community about this issue by saying:

"Myths in sport die hard. Pussyfooting by scientific bodies doesn't help kill them."

In 1981, only three years before the ACSM would reverse their stand on steroids, Allan wrote the following article titled, "Anabolic Steroids are Fool's Gold" in the Federation Proceedings:

" ... in spite of claims made by some of the investigators that the use of anabolic steroids by male athletes in conjunction with progressive weight resistance training will afford a greater increase in lean muscle bulk and greater strength than by weight resistance training alone, there is, in fact, no substantial evidence that this is so."

In other words, DON'T CONFUSE ME WITH THE FACTS, I have my own opinion. As you can see, I name this article in honor of Allan Ryan--who I call the father of the politically correct steroid movement.

Present Anti-Steroid Activist - Bob Goldman

Bob Goldman picked up almost exactly where Allan Ryan left off. Bob first appeared in the national spotlight in 1984 with his book, Death in the Locker Room, the same year that the ACSM reversed their stand on steroids. His stand on steroids, however, has been consistent from that time to present. I am only giving Bob the most space in this article only because he is by far the most vocal and most published.

For a further explanation of who Bob is, I will take information directly from his "About the Authors" section of his book, Death in the Locker Room II, published in 1992:

"Bob is recognized as one of the world's authorities on anabolic androgenic steroids, ... His first version of Death in the Locker Room/Steroids and Sports received wide international acclaim as a hardcover best seller. The softcover trade back editions were also a sellout, as well as all foreign translated editions. The new updated version of Death is poised to be an even greater success. ... He has also authored over 400 health and fitness articles and is the publisher of several sports medicine journals, The Professional's Journal of Sports Fitness, and The National Academy of Sports Medicine Journal of Certified Personal Fitness Trainers, with the largest circulation of its' category in the world. ... Dr. Goldman has appeared on over 500 radio and television shows such as Good Morning America, ABC Wide World of Sports, and numerous NBC, ABC, CBS, and CNN National news broadcast. He appears almost daily on ESPN daytime health shows, and is medical advisor and media personality for a number of other cable network series. He has given Keynote lectures all over the world on sport drug use, and high tech sports training techniques. ... After completing his medical and surgical training in Chicago, and a 3 year sports medicine fellowship, he went on to a second doctorate in androgen steroid chemistry. Dr. Goldman also founded the American Academy of Sports Medicine which is the fastest growing sports medicine organization in the world today, ... Dr. Goldman has been chief physician and surgeon for the International Federation of Body Builders since 1983, and is Chairman of all steroid drug control, and sports medicine for all 139 countries of the federation. Dr. Goldman serves on the Board of Directors for many medical and sports federations, and is medical advisor/editor for over two dozen different publications and media syndicates. ... His future plans are to explore sport-science clinical research, and continue as a medical educator, author and lecturer."

As you can see he is a very accomplished man, with a lot of influence with the media. However, think of the impact a "distorted" message would have with a person of this influence! After reading this section, you will realize who made "scare tactics" politically correct!

For the purpose of this section, I am taking most quotes form either Death in the Locker Room II or from the National Academy of Sports Medicine Position Paper, which he is president, founder, and publisher.

HDL-Cholesterol

From - NASM Position Paper published in Death in the Locker Room II (1992)

"High Density Lipoproteins (HDL-C) that aid the body in removing cholesterol, and are important to cardiac longevity, are drastically reduced with the use of androgens. A normal level of 50 [mg/dl] is commonly dropped to as low as 5 [mg/dl] with steroid ingesting athletes."

First off, he "only" referenced five studies. Second, "none" of the studies included athletes. To help explain what's going on, HDL's are the "good" cholesterol which help fight the plaque that builds up inside the vessels. The fewer HDL's you have at a given time the potentially faster plaque can build.

His first value of 50 mg/dl is actually very accurate. In my compilation of 258 HDL-cholesterol blood tests on athletes "off" steroids, the average value was 48 mg/dl. However, of all individual HDL values of athletes on steroids, I only found ONE value at or below 5 mg/dl out of 46. This is approximately 2% of my sample of personal and medical studies. In defense of Bob, steroids do significantly reduce HDL-cholesterol. From a sample of 256 HDL blood tests of athletes "on" steroids, the average value was 26 mg/dl. That is approximately a 50% reduction in the "good" cholesterol. But obviously the facts, if Bob had taken the time to find them, were not good enough!

Blood Pressure

From - NASM Position Paper published in Death in the Locker Room II (1992)

"Blood pressure elevates significantly when an individual takes anabolic steroids due to the retained fluid, and increased blood volume."

Again only "one" of four studies he referenced in this statement included athletes. A blood pressure increase is possible but usually does not significantly change. In an objective book on steroids, written by Charles Yesalis, Anabolic Steroids in Sports and Exercise, published only one year after Bob's Death in the Locker Room II, Charles stated... "Hypertension is perhaps one of the most exaggerated claims of androgen associated health risks."

Fertility

From - interview in the Tennessean (1992)

"Sometimes the [fertility] damage is reversible, sometimes, especially with extended use, it is not."

Again, as per Charles Yesalis' book, he stated... "No cases of irreversible infertility as a result of androgen administration have ever been reliably documented." Again you can't make claims from speculation.

Strength Gains

From - Death in the Locker Room II (1992)

"Consequently, scientific, controlled studies have not found data to objectively support numerous so called 'phenomenal gains' that some individuals claim, yet athletes the world over have fallen for the wild stories told by some drug proponents of putting on pounds of muscle in almost no time and unreal performance gains."

Now compare this to an objective book titled, Fundamentals of Human Performance, written by George Brooks & Thomas Fahey. It was required reading by Dr. Mike Bobo at Texas Tech University, while I was working on my Master's degree in Sports Health... "The gains made by athletes in uncontrolled observation have been more impressive. Weight gains of 30 or 40 lbs., coupled with 30% increases in strength, are not unusual. Such case studies lack credibility because of the absence of scientific controls. It would be foolish, however, to completely disregard such observations because the 'subjects' have been highly trained and motivated athletes."

I feel reasonably confident that Bob would tell you I'm lying to you about me gaining almost 30% strength in my squat lift in only nine weeks on Dianabol®. All things being equal, I would actually prefer Bob was right, but he is not and that's the problem!

General Side-Effects

From - Death in the Locker Room II (1992)

"Anabolic steroids bestow few benefits, and none worth the terrible risks of taking them. Anabolic steroids should be reserved for very sick, debilitated persons and administered by qualified physicians, who constantly monitor the progress of their patients and watch for the development of side-effects."

The best way to compare this is with the World Health Organization. This is an agency established in 1948 by the United Nations with a mission of improving the health of the world's people and preventing or controlling communicable diseases. It is the most important health organization in the world. Here are the results of a 1990 study in which they tested the use of an anabolic-androgenic steroid as a possible male contraceptive. They stated... "... weekly [200 mg] injections of testosterone enanthate, ... can maintain safe, stable, effective, and reversible contraception for at least 12 months."

I run into people that are or have received steroid therapy from a physician for conditions I definitely would not classify as "very sick" or "debilitated."

Depression

From - Death in the Locker Room II (1992)

"Even more devastating is the severe depression that occurs when steroid administration is ceased."

In a review of literature, I found six group studies examining depression of steroid-using athletes. However, the individual results varied greatly to say the least, from 100% to only 2% of the subjects, experiencing depression, with the average being 30%. In an anonymous questionnaire study I performed, 9 or 32% of 28 subjects, listed depression as a side-effect of their post-use of steroids, which is consistent with the overall average. One unique aspect of my study was, I had the steroid users classify if the depression was "major" depression or "minor" depression. Of those 9, 3 steroid users classified their depression as "major," while the other 6 classified it as "minor." Although "major" depression does indeed occur, as is demonstrated with this study, making a blank statement from 11% (3 of 28) of a population, is stretching it a bit.

Cancer/Diseases

From - Interview in the Tennessean (1985)

"Right now there are several hundred athletes in this country who are walking around with liver cancer [from their steroid use] and don't know it."

This statement is almost ten years old and there have only been three cases in the medical literature describing fatal or near fatal liver tumors or cancer, one of which was reported by Bob. This is not to say there has been more case. But again this is far short of several hundred in one point in time, not to mention over a ten year period.

From - Interview in the Berksire Eagle (1989)

"The scary part is, here we have the finest product of this country - our young, aggressive people - and in the next five to 10 years, we're going to have an entire patient population develop diseases [from steroid use] they never should have had."

Athletes in this country have been taking steroids since the late-50's and I have yet to find evidence that "an entire patient population" are experiencing any type of catastrophic steroid-related health problems. Again I want to stress that there are going to be a few individuals that will develop conditions either directly or indirectly related to their steroid use.

Steroid Drug-Testing

From - Death in the Locker Room II (1992)

"Oral steroid medications remain detectable for two to four weeks or more."

"I am very much in favor of drug-testing because it is an excellent deterrent... "

There have been a number of documented examples of athletes taking oral steroids up to 10 days before competition and testing negative (steroid-free). As far as the present state of drug testing being an excellent deterrent, I believe it is about as effective as President Clinton being asked to tell the truth "under oath," even with potentially being charged with the felonious offense of perjury. And ironically, a felon cannot be President! Well back to the main point, it’s just not going to happen!

Bob's Attitude

From - Interview in the New Haven Register (1989)

"Anyone who tells you he's been using steroid for several years and doesn't know anybody who's had a problem, well, they're either lying or deaf or dumb or probably both. They're in a heavy state of denial, without a doubt."

This is one of the main problems. Most potential steroid users who start asking questions about side-effects, especially before the steroid laws, find that users very seldom regret using them. I've found that approximately 9 in 10 steroid users do not regret using steroids not only in a study I performed (3 out of 28) but in another study performed by Jay Silvester which produced the same results (2 in 22)! So altogether 5 of 50 or 10% regretted using steroids. In Silvester's study, published in the Journal of Strength and Conditioning Research, he stated, "Asked about suspicions regarding long-term physical or psychological problems caused by earlier anabolic-androgenic steroid use, 19 [of 22] subjects felt there were no long-term physical health problems and 20 [of 22] believed there were no long-term psychological problems.

From - Death in the Locker Room II (1992)

"Now that I've finished my research, I'm no longer open-minded."

It strongly appears Bob was not open-minded going into his research. And I do want to say it may appear I do not like Bob, which is not true. I only dislike his behavior on this topic. If Bob was to change his stand, I would be the first one to join him in helping to fight steroid abuse!
__________________

NFL Follies

Forest Tennent was at one time in charge of the NFL's drug-testing program. This statement even takes the normal exaggeration of doctors on steroids to an entirely new level.

"Young athletes who take heavy doses of anabolic steroids for 60 to 90 days should expect to die in their 30's or 40's."

Pete Rozelle, form NFL commissioner stated in 1985:

"We're developing test for steroids. We might even come up with it this year."

I feel one of Steven Seagal's lines in the movie Under Siege is an appropriate comment to both of these two quotes... "What kind of babbling bull---- is this!"

The statement made by Forrest Tennant is ridiculous. There is absolutely NO medical research to support his claim. However, this statement was also made by an official of the Food & Drug Administration. The thing is I expect children to make statements as unsupported as this, not a doctor in charge of the drug-testing for a sports organization that grosses approximately $5 billion a year!

As far as Pete Rozelle, the first steroid test was made in 1973 and used in 1974. A much improved version was devised in 1983 which caused the 1983 Pan American Games scandal.

C. Everett KoopPast Surgeon General and Founder of Drkoop.com, C. Everett Koop, M.D.

In a message through the Department of Health and Human Services, C. Everett Koop had this to say about steroids while he was surgeon general:

"A number of studies have been done on just how well the anabolic steroids work at building muscle, and their ability to do that remains in doubt. However, there's no doubt about the number of side effects and adverse reactions that can occur from the drugs. The list is long, running from acne, cancer, kidney disease and sexual problems to stunted growth for younger children. Needless to say, some of the reactions can be fatal."

This quote is consistent with Dr. Koop’s bias, and uninformed attitude towards medicine. If anything, he should have stated there is there is a considerable amount of evidence that steroids enhance muscular growth and strength and due to the limited research, the long-term side-effects of steroids presently remain in "doubt."

Frederick C. HatfieldPresent Steroid Expert - Fred Hatfield

This is from Fred's book , Hardcore Bodybuilding: A Scientific Approach, he discusses "Mythic Concepts About Drugs":

"Myth Two:

Without Steroids, I Can't Make the Same Gains

"Have you tried applying integrative science yet? Don't know it until you've tried it! It may take more discipline and time, [to make the same gains with steroids], but it most certainly can be done."

Steroids raise genetic potential while supplements and training only get you closer to your ultimate "natural" potential.

Present Steroid Counselor/Researcher - Neil Carolan

Neil Carolan, a steroid counselor at Bryland Hospital in Buffalo, had this to say in a November 18, 1993 edition of ABC News Primetime Live:

"You're just not going to be able to have children long-term [if you use steroids]. You're going to develop liver cancer long-term, you're going to develop testicular cancer, prostate cancer long-term."

None of these conditions have been proven to have a scientific causal relationship to anabolic steroid use in athletes!

Why Scare Tactics Don't Work

I commend Linn Goldberg and his coworkers for his study "Anabolic Steroid Education and Adolescents: Do Scare Tactics Work?" The purpose of this study was to compare adolescent athletes' opinions or level of agreement with the type of information received. The concluded that:

"... 'scare tactics' - using a negative teaching model - failed to increase student athletes' belief of any possible untoward consequences of anabolic steroids."

In order for an education program to be effective, it must have a "balanced" presentation on the positive and negative effects of steroids as well as alternatives to steroids, such as the best knowledge available on nutrition and weightlifting programs.

Dan DuchaineSteroid Activist - Dan Duchaine

Dan Duchaine is to steroids, as Timothy Leary was to LSD. Dan was a very "pro" steroid activist in the 80's. He has appeared on such television programs as 60 Minutes, The Ron Reagan Show, 20/20, Geraldo, ESPN, and Now It Can Be Told. He is the author of the Underground Steroid Handbook series, which first appeared in print in 1982. He has been convicted of steroid charges twice. Of the quotes I use below, all come from the Underground Steroid Handbook II.

HDL-cholesterol

"Although there is an argument about whether steroids truly lower HDL levels the research showing that serum cholesterol can increase while using steroids cannot be dismissed."

Without exception [perhaps there is a study or two I missed] in every medical study testing steroid-using athletes, HDL-cholesterol was significantly lower relative to non steroid-using athletes or other control groups. As far as total-cholesterol, I found that occasionally studies would demonstrate a significant increase.

The thing that bothered me about Dan, at least in the past, was his very "pro" attitude as is evident by this statement, which he now laughs about:

"... A few side effects can occur, however, it may elongate your chin, feet and hands. Diabetes in teen-agers is possible ... Massive increases in weight over such a short time can, of course, give you heart problems. We have heard of a powerlifter getting a heart attack while on GH [growth hormone]. GH use is the biggest gamble that an athlete can take, as the side effects are irreversible. Even with all that, we LOVE the stuff."

I feel Dan is very close on most of his information or at least that which I can check relative to what limited scientific research we have available on the subject. However, there is a lot of his information that has no science to support it. And in my conversations with Dan, we both agreed knowledge on steroid side-effects, as of now, is more of an "art" than a "science." So the Dan Duchaine's and the Mauro DiPasquale's are going to know more than the MD's and the PhD’s, until the MD’s and PhD’s are able to do some serious research on the subject.

An Overview

I feel "every" objective steroid expert will agree that a good percentage of doctors in the past decades have downplayed how well steroids have worked and exaggerated the side-effects. But I feel there are some other factors that have contributed to the distorted information about steroid side-effects between the medical community and steroid-using athletes.

First, I feel a doctor’s "baseline" gauge of side-effects is different than that of a steroid-using athlete. Doctors tend to be more sensitive about the magnitude of the side-effects. Perhaps it's a conditioned response from past malpractice suits. Athletes, on the other hand, have to go through so much discomfort and pain in perfecting their respective sports. Possibly because of this, I feel athletes build a high pain threshold or become desensitized. Because of this, I feel athletes, on average, view "many" or "all" of the side-effects of steroids as either "minor" or "acceptable," with Duchaine's last quote as evidence of this attitude. In addition, most steroid users do not get blood work performed, so they simply may not be aware of any harm.

Second, I feel athletes have been influenced to a certain extent with the exaggerated stories doctors have told in the past. I know I've heard stories about lifters being on their death beds' because of steroids and ten years later they are still alive and well! I've seen this exact same situation happen to me. If you are a good lifter, the easiest way for other lifters to justify your good lifts is from the "huge" quantities of steroids you take. Due to the rumors spread by one lifter, he had everybody in one gym believing I was taking 10 times what I actually took and that I was going to die before the age of 30. I didn't learn this till years later and upon reflection, I kind of wondered why everyone always treated me so nice at that gym! Well, I'm now 39 and still kicking.

Last, there are the steroid "gurus" who I feel are "pretty much" on the money with everything they say. But, I have noticed, especially before the steroid laws, making people feel "too" at ease with using steroids, which is still a drug and must be respected as a drug! Bottom line, doctors and PhD’s know less than the "gurus" and it will remain that way until some serious money is available for research on steroids and more doctors are willing to be more objective in that research!

Good read.

yes good read bro thanks

Good read. I wish steroids would get the respect and understanding they deserve. If you asked 100 women if they thought breast implants were dangerous most would say no, where as if you asked 100 non using people if steroids were dangerous they would almost all say yes. Not to mention all the other cosmetic crap women get away with that involves invasive surgery.

It would be nice if we could get to a point in the future where guys could go on medically supervised cycles and maintain a certain level of respect. I cant tell anyone what I do because I'd be categorized with heroin addicts.

Good read none the less. Id like to send it around, too bad that would be a dead give away :puff