Gym and Tonic: a Profile of 100 Male Steroid Users Br J Sports Med: First Published As 10.1136/Bjsm.31.1.54 on 1 March 1997
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54 BrJ Sports Med 1997;31:54-58 Gym and tonic: a profile of 100 male steroid users Br J Sports Med: first published as 10.1136/bjsm.31.1.54 on 1 March 1997. Downloaded from Nick A Evans Abstract Table 1 Age distribution ofsteroid users Objective-To identify unsupervised ana- bolic steroid regimens used by athletes. Age (years) % ofsteroid users Methods-100 athletes attending four 16-19 10 were an 20-24 27 gymnasia surveyed using anony- 25-29 36 mous self administered questionnaire. 30-34 14 Results-Anabolic steroid doses ranged 35-39 10 40+ 3 from 250 to 3200 mg per week and users Total 100 combined different drugs to achieve these doses. Injectable and oral preparations were used in cycles lasting four to 12 population. A questionnaire was designed with weeks. Eighty six per cent of users admit- a simple, easy to answer format, to obtain spe- ted to the regular use of drugs other than cific information from users of anabolic steroids for various reasons, including steroids (fig 1). A cover note accompanied each additional anabolic effects, the minimisa- item providing additional information and tion of steroid related side effects, and assuring confidentiality and anonymity. Ques- withdrawal symptoms. Acne, striae, and tionnaires were distributed to four privately gynaecomastia were the most commonly owned gymnasia in three neighbouring coun- reported subjective side effects. ties, namely South Glamorgan, Mid Glamor- Conclusions-Multiple steroids are com- gan, and Gwent. Permission was granted in bined in megadoses and self administered each case from the gymnasium proprietor. in a cyclical fashion. Polypharmacy is Respondents were requested to seal completed practised by over 80% of steroid users. forms in an envelope before depositing them in Skeletal muscle hypertrophy along with a collection box at the gymnasium reception acne, striae, and gynaecomastia are fre- area. The questionnaires were left for 14 days quent physical signs associated with ster- in each institution. It was evident at this stage oid use. that the self administered questionnaire would (BrJ Sports Med 1997;31:54-58) produce a self selected group and a degree of bias. This should not, however, affect the main http://bjsm.bmj.com/ Keywords: anabolic steroids; drug regimens; polyphar- objectives of the study. macy; physical signs. Anabolic/androgenic steroids can promote Results increases in muscular size and strength when The first 100 completed questionnaires were combined with the appropriate training and entered into the study. All responders were male and the age range is shown in table 1. diet.1-3 Their use for this purpose is deemed on October 2, 2021 by guest. Protected copyright. unjustified by the medical profession because Thirty three per cent were competitive body- of numerous adverse effects. Despite this builders and 67% recreational athletes. Twenty advice, athletes in sports where size and one per cent of the group had been using ster- strength are paramount continue to use oids for less than one year and represent "new" steroids, seeking a competitive edge. Indeed, users. Sixty four per cent admitted a commit- up to 35% of athletes attending weight training ted steroid use of between one and five years, gymnasia in the United Kingdom use anabolic and the remaining 15% had been using steroids,4 and 4% of males at a British college steroids for six to 12 years (table 2). A weekly oftechnology admitted using these drugs.5 The steroid dosage of less than 500 mg was used by increasing number of published case reports 50% of the athletes in this sample, while 38% also suggests that steroid users often present to used between 500 and 1000 mg per week, and as a source the remaining 12% took in excess of 1000 mg Department of medical practitioners. However, of Trauma and reference, documentation of these unsuper- weekly. Combinations of different anabolic Orthopaedics, Cardiff vised steroid regimens is poor. This study pro- steroids were taken to achieve such doses by Royal Infirmary, vides a profile of 100 steroid users, revealing Newport Road, Cardiff the drugs and dosages currently being used in Table 2 Duration ofsteroid use CF2 lSZ, United the United Kingdom. Subjective side effects, Kingdom and asso- Duration (years) % of users N A Evans, specialist withdrawal symptoms, physical signs ciated with steroid use are also identified. < 1 21 registrar 1-2 13 2-3 26 Correspondence to: 3-4 15 Mr N A Evans. Methods 4-5 10 > 5 15 Accepted for publication Athletes currently using weight training gym- Total 100 15 October 1996 nasia in South Wales were chosen as the target Male steroid users 55 Table 3 List ofanaboliclandrogenic steroids used (proprietary names in brackets) the athletes in this sample. The most popular agents were intramuscular nandrolone deca- Anabolic steroids Androgenic testosterone esters noate (84%), testosterone esters (75%), and Br J Sports Med: first published as 10.1136/bjsm.31.1.54 on 1 March 1997. Downloaded from Nandrolone decanoate (Deca-Durabolin) Testosterone cypionate oral methandrostenolone (68%). Eighty five Stanozolol (Winstrol) Testosterone propionate (Virormone) per cent used both parenteral and oral Methandrostenolone (Dianabol) Testosterone blend (Sustanon 250) Methenolone (Primobolan) Testosterone heptylate (Theramex) preparations, 1 1% used solely injectable prepa- Trenbolone (Parabolan) Testosterone enanthate (Testaviron) rations, and 4% used tablets only. Most self Oxandrolone (Anavar) Testosterone undecanoate (Andriol) administered intramuscular were Oxymetholone (Anapolon) injections Drostanolone (Masteron) sited in the gluteal region, but the thigh and Boldenone (Equipoise)* deltoid were also used. * Drugs other than anabolic steroids used by Veterinary steroid. this group are given in table 4. The frequency Table 4 Polypharmacy: drugs other than anabolic steroids of subjective side effects resulting from steroid used by athletes use is shown in table 5; only 12% denied any adverse symptoms. Less frequently reported Drug % of users side effects included dyspepsia, exacerbation of Clenbutarol 70 asthma, and tendon rupture. Eighty eight per Ephedrine 57 Human chorionic gonadotrophin 49 cent of users admitted withdrawal symptoms Tamoxifen 45 on cessation of steroid administration, with a Growth hormone 12 reduction in muscle size and strength reported Diuretics 22 Nalbuphine (Nubain) 6 by 72%, and reduced libido by 33%. Insulin 2 The exact population size could not be Thyroid hormone 2 determined accurately as attendance figures for Aminoglutethimide (Orimeten) 3 Esiclene 5 the two week period in each gymnasium were None 14 not recorded. Discussion Table 5 Subjective side effects associated with steroid use Two broad groups of testosterone derivatives are used by athletes: anabolic agents are Symptom % ofusers synthesised with reduced androgenic activity, Acne 54 whereas testosterone esters retain their full Gynaecomastia 34 androgenic effect (table 3). Scientific studies Striae 34 have attributed gains in muscle size and Testicular atrophy 40 None 1 2 strength to anabolic steroids, provided they are used in conjunction with an appropriate train- ing programme and a high protein diet.' 3 Even the majority of users (88%). The lowest in the absence of such clinical data, 50 years of recorded weekly dose was 250 mg and the steroid use by athletes would imply a positive highest was 3200 mg. The duration of steroid benefit.6 The anabolic action of these drugs is http://bjsm.bmj.com/ administration (steroid cycle) was reported as mediated in two ways. An anticatabolic effect is follows: 4-6 weeks (28%), 8-10 weeks (39%), achieved by minimising the catabolic action of 12 weeks (33%). Forty eight per cent of the corticosteroids released during stress (athletic sample stated that their annual steroid use was activity). The second action is the maintenance less than six months, while the other 52% used ofpositive nitrogen balance by improving utili- steroids for more than six months each year. sation of ingested protein. Anabolic steroids Three athletes admitted continuous steroid use also have motivating effects, inducing a state of on October 2, 2021 by guest. Protected copyright. for 52 weeks of the year. Table 3 is a complete euphoria and diminished fatigue, thereby list of the anabolic/androgenic steroids used by enhancing training capabilities.2 Figure 1 Gymnasium user questionnaire Please tick, delete or write answers where appropriate. AGE MALE/FEMALE DO YOU COMPETE? HAVE YOU EVER USED ANABOLIC STEROIDS? Yes No WHEN DID YOU FIRST START USING THEM? WHICH STEROIDS DO YOU NORMALLY USE/PREFER? Dianabol Deca Testosterone Winstrol Others DO YOU USE: Tablets Jabs/Injections HOW MANY WEEKS DO YOU STAY "ON" STEROIDS? HOW MANY WEEKS DO YOU TAKE "OFF"? HOW OFTEN DO YOU USE STEROIDS EACH YEAR? GIVE AN EXAMPLE OF YOUR TYPICAL COURSE/STACK: jabs of every jabs of every tabs of every WHERE DO YOU INJECT? Buttock Thigh Shoulder Other DO YOU GET ANY OF THE FOLLOWING? "Gyno" _ Stretch marks Acne spots Testicle shrinkage WHAT HAPPENS WHEN YOU COME OFF STEROIDS? Lose size Lose strength _ Reduced sex drive Other WHICH OTHER DRUGS HAVE YOU USED? Ephedrine Clenbutarol Growth hormone Insulin HCG Tamoxifen Diuretics Thyroid Nubain Others 56 Evans Table 6 Examples ofdrug regimens administered by new and veteran steroid-use,rs, and a users report using techniques such as loading typical precontest protocol. Approximate cost on the black market is provided in £ sterling doses and pyramidal dose tapering. Longer for Br J Sports Med: first published as 10.1136/bjsm.31.1.54 on 1 March 1997. Downloaded from New user Dianabol 25 mg/d PO £40 acting agents, example Sustanon (a mixture Nandrolone decanoate 100 mg/week IM oftestosterone propionate 30 mg, phenylpropi- 4 weeks onate 60 mg, isocaproate 60 mg, and dec- Sustanon 250 mg/week IM £140 anoate 100 mg), used in the initial weeks, are Veteran user Nandrolone decanoate 200 mg/week IM 4 weeks substituted by shorter acting drugs mid-cycle Testosterone propionate 300 mg/week IM to prevent continued steroid action during the Stanozolol 150 mg/week IM off-cycle.