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This research has highlighted problems with previous AAS literature as there is a lack of research into the long-term side effects of AAS use. Keywords: anabolic androgenic steroids, AAS, adverse effects, athletes, doping, performance enhancing, Ben Johnson, Marion jones, lance Armstrong. Since their first appearance on the sporting scene in the s, 1 , 2 Anabolic Androgenic Steroids AAS have often been the performance enhancing drug of choice for athletes in a variety of disciplines and remain one of the most controversial topics in sport today.

AAS are synthetic derivatives of the male sex hormone testosterone and display both anabolic and androgenic effects upon the body. Anabolic effects refer to the tissue binding effect of these hormones while androgenic refers to the development of masculine characteristics. As a result of this, many attempts have been made to synthesis a steroid that has purely anabolic effects but this has not been achieved to date. It will consider what steroids are, the reasons for use, how they are used along with the physiological and psychological effects of their use.

The limitation of this review is its reliance upon previously published literature and data. In the case of data provided on the extent of AAS usage, this is expected to be lower than the actual value.

This is a result of difficulty in the studies used for this review in determining the exact extent to which AAS are used as people are reluctant to admit usage. Figure 1 Basic chemical structure of a steroid. By definition, this classes vitamin D, cholesterol and oestrogen as steroids, along with the better known testosterone, all of which are produced naturally by the body. The two main types are corticosteroids and AAS and the two should not be confused.

Corticosteroids are synthetic versions of hormones produced naturally in the adrenal grands and are anti-inflamitaries. They are used to treat medical conditions such as asthma and arthuritus and have no muscle building ability. They are used mainly to treat anemia, muscular dystrophy and can also be used as part of a replacement therapy, usually for older men who have lost the ability to produce their own testosterone.

In these cases, AAS are prescribed in a physiological dose approximately mg a week. As AAS are fat-soluble, they are able to diffuse across the cell membrane into the cytoplasm of a cell. This results in an increase in protein synthesis, Figure 2 the effects of which are dependent on the type of cells the AAS has bound to.

For example, in muscle cells, the size of the muscle will increase and in bone cells, the size of the bone will increase. Along with this, the body produces a hormone called glucocorticoid which reduces inflammation but is also catabolic, meaning that it breaks down muscle tissue. It is believed that, when taken in doses exceeding the physiological dose, AAS effect the hormone levels in the body by not only increasing the levels of testosterone but also by decreasing the levels of glucocorticoid.

This results in accelerated muscle repair along with the blockage of muscle wasting effects of glucocorticoid allowing the muscles to become bigger and stronger.

Figure 2 Mechanism of AAS action. As mentioned previously, AAS are synthetic derivatives of the male sex hormone testosterone 1 and are classified according to their route of administration, either orally or by injection. It should be noted here that injectable AAS are always injected intramuscularly and never intravenously as this could result in the development of an oil embolism, which can prove fatal, along with large variations in the levels of AAS present in the body.

The numbers refer to carbon atoms. Oral AAS are the starting point for many users and are popular for their convenience of use.

However, as the full dose of the oral AAS passes directly to liver, frequent use can result in liver toxicity which is why they are often used in cycles as will be discussed later in this review. Table 1 Examples of commonly abused oral and injectable AAS. Steroids are listed in the form of: generic name common trade name. Oral steroids have an effect upon the body much more quickly than their injectable counterparts, however the active duration is much shorter as a result of their short half-lives and so the drug has to be taken on a more regular bases.

In contrast, injectable steroids have a much greater half-life than oral steroids as the drug is stored in the fat deposits in the body. This makes them more stable than oral steroids and easier to maintain but this consequently means that their detection times are much greater.

Table 2 Examples of the difference in half-lives and detection times of both oral and injectable steroids.

The focus of this review is the use of AAS in the sport industry however this does not mean that AAS are restricted to the sport industry. This is due mainly to the presence of the World Anti-Doping Agency WADA and their associated anti-doping policies which serve as a deterrent for many athletes.

The World Anti-Doping Code a document that harmonises anti-doping policies in a variety of sports bodies worldwide, including the Olympic movement, and abides by five International Standards to ensure consistency. These five International Standards are: testing, laboratories, Therapeutic Use Exemptions, the List of Prohibited Substances and Methods, and the protection of privacy and personal information.

In order to gain optimal results from AAS their use must be combined with a carefully planned and managed diet, exercise program and appropriate rest periods. An example of this is Equipoise which is obtainable in 50 or mm vials as oppose to the regular quantities of 1, 2, 5 or 10mm vials.

Winstrol-V is another example of an AAS intended for use by veterinarians use large animals such as horses and cattle. Oral steroids are simply swallowed whereas the injectable steroids are injected intramuscularly. The three main sits that are suitable for intramuscular injection are the gluteus maximus, quadriceps and the triceps.

Some injectable steroid users believe that spot-site injections result in more localised muscle growth, however, the risk of injecting spot-sites increase as the muscle groups become smaller and closer to nerves and veins.

Figure 5 Location of front a and back b spot-site injections. Injectable steroid users face an increased risk of infection. For example, one AAS such as Anadrol may have the primary role of increasing mass and may be used in conjunction with Winstrol which has the primary function of strength.

Figure 6 Adaptions of AAS cycles for beginners, intermediate and advanced users 27 along with an adaptation of an advanced AAS cycle for female users. As mentioned previously, many users believe that stacking AAS can allow optimal results to be obtained. To promote the natural production of testosterone during an off-cycle as this is often suppressed during the on-cycle. Table 3 Adaption of drugs commonly used in conjunction with AAS and their proposed reason for use. These effects are outlined in Table 4 and all differ in severity.

Particularly on the back but also on the face. Cystic types can leave permanent scarring. Effects observed in both sexes. Can cause skin puffiness and causes increase in blood pressure and increased strain on the kidneys. Male-pattern baldness is observed in both sexes with prolonged use and is often sped up with the use of AAS. The increased growth of facial hair is also observed which is unwanted in female users.

The development of abnormal breast tissue in male users due to an imbalance in the ratio of oestrogen to testosterone. Gynaecomastia is permanent and is treated with surgery.

These effects are reversed when AAS use stops. It has also been reported that AAS use can cause prostate enlargement which causes problems urinating as well as users experiencing an increased libido.

Increased libidos, disruptions to the menstrual cycle, and clitoral enlargement have all been reported by female AAS users along with breast atrophy. This increases the risk of atherosclerosis fatty deposits that disrupt blood flow inside arteries and can lead to a heart attack or stroke depending on where the blood flow is disrupted. AAS use has been associated with liver tumours and peliosis hepatis formation of blood-filled cysts on the liver and has been observed in both sexes particularly with the use of oral steroids.

Particularly a problem with AAS use in adolescents. Sex hormones are responsible for triggering bone growth and abnormally high levels can result in the bones stopping to grow prematurely. AAS use is known to bring on psychological changes such as increased aggressiveness and feelings of power and indestructability. Some users are described to have a Dr. Jekyll and Mr. Hyde personality. It is not an offence under the MDA to possess AAS if they are intended for personal use and are in a medicinal form.

This could suggest that people are dealing in AAS as they are importing quantities that are much greater than those required for personal use. The desire to succeed and the feeling of euphoria that comes hand in hand with victory is the driving force of many athletes and to some, this is worth virtually any sacrifice. Not only is the use of performance enhancing drugs in general, not specifically AAS, unfair but it creates an uneven playing field that make it impossible for some to compete on.

The use of AAS can have a serious impact, not just on the health of the athlete as mentioned previously, but the repercussions of being caught abusing AAS can result in a ban from competing and even having any medals or titles won as a result stripped. The use of AAS was initially confined to the power disciplines such as the throwing events javelin, discus, shot-put and hammer along with weightlifting and body building but their use soon spread to other disciplines where an increase in size, speed or strength would be advantageous.

The observation that the testes were vital for masculinisation can be dated back as far as the fifteenth century BC. However, it was not until that the crystalline testosterone was isolated and it is from this that the whole concept of AAS stems. In reality, however, the use of substances to give an athlete an advantage over an opponent can be dated back as far as to the ancient Greeks.

It was not until after the Second World War that the use of drugs in sport became wide-spread. Used the ground rear hooves of the Abyssinian ass as they believed it enhanced their performance.

Amphetamine used to counter fatigue among soldiers and pilots. Testosterone used to increase aggressiveness and strength of German soldiers. East Germany introduces a secret national system for hormone doping for athletes of both sexes with methandrostenolone and state-manufactured oral-turinabal.

Ben Johnson became the first Olympic gold medal winner in track and field to be stripped of his medal after testing positive for stanozolol. Lance Armstrong stripped of all seven tour de france titles won from and given a lifetime ban by the international cycling union. Table 6 Adaption of an overview of the key points in the history of the development and use of peds in Sport. In the early s there were rumours of hormonal experiments taking place by the Soviet Union to enhance the performance of their athletes.

However, in at the Seoul Olympics something happened that exposed the problem of AAS use to the general public world-wide. He was quick to establish a promising track career and became a known athlete after he won a bronze medal at the Los Angeles Olympics. Ben Johnson immediately became a national hero, but this all changed three days later when it was announced that he had tested positive for stanozolol, an AAS banned by the IOC. This resulted in Lewis been promoted to first place, retaining his title, and Linford Christie was promoted to the silver medal position.

This included Lewis who, it emerged, had tested positive for stimulants during the U. Johnson has since admitted to using AAS since 51 , 53 , 54 having been encouraged to do so by his coach, Charlie Francis. Figure 9 Ben Johnson at the Commonwealth games. Although he refuses to place any blame on Francis, 52 Johnson recalls: "Charlie said over a few conversations, that you only cheat if you're the only one doing it.

This means if the other guys are doing it, and you start doing the same thing, it's not cheating". He believes that some corporate force did not want him the win the race and so paid for him to be framed by spiking a drink he drank sometime before the race with stanozolol, an AAS that he claims he has never used. I wouldn't be that dumb to take anything so close to an Olympic final. And the amount of steroids found in my system could have killed a normal man.

I tested positive for stanozolol but I was using other steroids". Rapists and murderers get sent to prison, but even they get out eventually. I know what I did was wrong. Rules are rules. But the rules should be the same for all. Marion Jones displayed talent at an early stage. Her family moved numerous times during her teenage years to enable her to compete in prominent teams and she was competing on an international level at the age of Jones became the golden girl of athletics overnight.

It was not until that allegations that Jones had used prohibited substances were made by her ex-husband, C. In an era of sport where PED use is becoming ever more prevalent, it is hard to believe that any athlete who wants to remain clean would take any substance given to them without knowing for certain its identity. Coupling this with the fact that she has knowingly associated herself with people who have previously been involved in drug scandals further enhances the belief that it was her intention to dope all along.

Lance Armstrong, like many athletes, showed talent at a young age. Olympic cycling development team. He underwent surgery to remove the malignant testicle but it was revealed that the cancer had spread to his lungs, lymph nodes, abdomen and brain. Armstrong underwent surgery later that month to remove two cancerous lesions from his brain. He also won a bronze medal at the Sydney Olympics. Having achieved this, Armstrong then announced his retirement from cycling but later returned in , placing third in the Tour de France that year.

However, this return was short lived as he announced his retirement yet again in February , under a cloud of allegations of PED use 20 Figure Figure 13 Lance Armstrong after winning his seventh Tour de France title. Lance Armstrong after winning his seventh Tour de France title. Also in , Armstrong finally admitted to the use of testosterone, EPO and blood doping in the mids and said that they contributed to all seven of his Tour de France titles in an interview with Oprah Winfrey.

Armstrong remains proud of his seven yellow jerseys, all of which are displayed on the walls of the cycling shop he owns in Austin, Texas. He believes that the era in which they were won was one in which doping was a common practice among professional cyclists.

Ullrich admitted to the use of EPO throughout his career a few months after Armstrong confessed to Oprah. Many people believe that the winners titles for the seven years in which Armstrong won should be awarded to someone else, however, there is speculation as to just how far down the ranking you would have to go to reach a rider that you were sure had not used PEDs. In interviews he has openly admitted that he is happy to be made an example of if it will eventually lead to his forgiveness and earning back some trust.

Yet it is hard to truly believe his remorse when, for years, he has point blank denied any allegations of PED use. He has said that he would not necessarily change the decisions he made, only the way in which he treated others involved.

And to top it all off, he would do it again. Athletes are, in a sense, addicted to winning and will do anything within their power to ensure that they are victorious and appear to pay little attention to the consequence if they get caught.

This literature review confirms that the objectives, to provide an overview of AAS and their use and impact within the sports industry, have been established and information detailing the basic chemical structure and nomenclature of an AAS molecule have provided a basic background of the drugs along with the mechanism in which they work. The different types of AAS, namely oral and injectable, have been discussed and it has been highlighted how modifications to the basic structure of an AAS molecule determines the most effective route of administration.

The advantages and disadvantages of oral and injectable AAS are shown with regard to the speeds at which they have an effect upon the body, their detection times and the adverse side effects that they have upon the body.

It is clear from the research conducted during this review that the speed of effect and the detection times are the two factors that are the most important to an AAS user, especially when you factor in the possibility of drugs testing. This turns AAS use into a complex equation for athletes whose optimal goal is to use AAS to enhance their performance but the vital component is to avoid detection.

However, little research has been conducted into the long-term effects of AAS use such as the increased risk of a heart attack or stroke which are, at present, only associated with prolonged AAS use.

It would be recommended that this is an area greatly in need of further research to establish causation. Along with this, further research in this area would allow health care professionals to provide more accurate information to AAS users and further address the medical problems caused by AAS use.

However, due to the underground nature of AAS abuse, it is understandable that this may be difficult and the reluctance of users to admit use plays a key role.

With regard to the effect that oral AAS have upon the liver, there is evidence to suggest that, to some extent, users take this into consideration. It is understood from the way in which stacks and cycles are employed that oral AAS tend to be used at the beginning of a cycle.

This is partly due to them having an effect upon the body much more quickly than injectable AAS but is mainly due to users understanding of the damage that prolonged use of oral AAS can have upon the liver.

This review has also provided an in-depth view of the use of AAS in the sports industry and highlights that, although AAS use was initially confined to the power disciplines, their power as a performance enhancer has now been realised and they are now used in just about every sport where an increase in strength, speed or size would be considered advantageous.

Furthermore, the profiles of what are considered by many to be three of the most high profile drug cheats in sporting history have been examined. The impact that this exposure has had upon the spectators of sport is one that has changed the shape of sport forever.

Many studies have documented Oxandrin's safety and effectiveness in treating HIV wasting. It is metabolized in the kidney and acts without the masculinizing side effects associated with other steroids, such as Anadrol One study showed an average weight gain of 24 pounds following 8 months of treatment.

Oxandrin is the best choice for those at the earliest stages of AIDS wasting syndrome. However, when a more aggressive treatment is necessary, Anadrol is stronger, less expensive, and more effective, but liver function must be monitored closely.