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 theproblem of androgen misuse by the general population (1) andonly a minor aspect of the doping of athletes with drugs presumedto enhance athletic ability (2, 3). Indeed, of the drugs bannedby the International Olympic Committee, steroids account onlyfor about 15% (4). This particular form of drug abuse stemsfrom the convergence of several separate misconceptions. Thefirst was the recognition that the administration of androgensto hypogonadal males causes an increase in nitrogen retentionand an increase in muscle mass and lean body weight (5). Itfollowed that the differences in muscle mass between men andwomen are largely due to differences in testosterone levels,and it was assumed that the administration of androgens in supraphysiologicalamounts 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 exertedby different mechanisms and that pure anabolic agents couldbe devised that would be devoid of or have minimal androgeniceffects (6, 7). In fact, androgenic and anabolic effects arenot due to different actions of the hormone but result frominteraction of the hormone with the same receptor molecule indifferent tissues (1). In men with normal levels of plasma androgensthe androgen receptor in most tissues appears either to be saturatedor downregulated. Thus, it has not been possible to separatethe two types of actions at the pharmacological or physiologicallevels, and in normal men any anabolic actions obtained fromexogenous androgens are inevitably limited in scope. The thirdmisconception, at least in the United States, stemmed from internationalcompetitiveness 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 weightlifting championship in Vienna that some members of the Russianteam used androgens (8–10). Ziegler assumed that androgenswould enhance athletic performance, and he began to experimentin American weight lifters with the various agents that hadbeen developed as candidates for pure anabolic steroids (8).He subsequently concluded that the effects of androgens arepurely psychological (9, 10).
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