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Androgen Abuse by Athletes

Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas Dallas, Texas 75235

Correspondence: Address requests for reprints to: Jean D. Wilson, M.D., Department of Internal Medicine, The University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75235.

Abstract

Introduction: ANDROGEN abuse by athletes constitutes only a portion of the problem of androgen misuse by the general population (1) and only a minor aspect of the doping of athletes with drugs presumed to enhance athletic ability (2, 3). Indeed, of the drugs banned by the International Olympic Committee, steroids account only for about 15% (4). This particular form of drug abuse stems from the convergence of several separate misconceptions. The first was the recognition that the administration of androgens to hypogonadal males causes an increase in nitrogen retention and an increase in muscle mass and lean body weight (5). It followed that the differences in muscle mass between men and women are largely due to differences in testosterone levels, and it was assumed that the administration of androgens in supraphysiological amounts to normal men would do even more than the normal amount. The second misconception was that the anabolic (muscle promoting) and androgenic (virilizing) actions of the hormone are exerted by different mechanisms and that pure anabolic agents could be devised that would be devoid of or have minimal androgenic effects (6, 7). In fact, androgenic and anabolic effects are not due to different actions of the hormone but result from interaction of the hormone with the same receptor molecule in different tissues (1). In men with normal levels of plasma androgens the androgen receptor in most tissues appears either to be saturated or downregulated. Thus, it has not been possible to separate the two types of actions at the pharmacological or physiological levels, and in normal men any anabolic actions obtained from exogenous androgens are inevitably limited in scope. The third misconception, at least in the United States, stemmed from international competitiveness in sports. According to a widely accepted account, John B. Ziegler, a physician for the US weight lifting team, was told by a Russian team physician at the 1954 world weight lifting championship in Vienna that some members of the Russian team used androgens (8–10). Ziegler assumed that androgens would enhance athletic performance, and he began to experiment in American weight lifters with the various agents that had been developed as candidates for pure anabolic steroids (8). He subsequently concluded that the effects of androgens are purely psychological (9, 10).

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