POSITION STATEMENT POSITION STAND ON ANDROGEN AND HUMAN GROWTH HORMONE USE 1 2,3 4 4,5 JAY R. HOFFMAN, WILLIAM J. KRAEMER, SHALENDER BHASIN, THOMAS STORER, 1 6 7 8,9 NICHOLAS A. RATAMESS, G. GREGORY HAFF, DARRYN S. WILLOUGHBY, AND ALAN D. ROGOL 1Department of Health and Exercise Science, The College of New Jersey, Ewing, New Jersey 08628; 2Department of Kinesiology; 3Department of Physiology and Neurobiology, The University of Connecticut, Storrs, Connecticut 06269; 4Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston Medical Center, Boston, MA; 5Department of Kinesiology, Division of Health Sciences, El Camino College, Torrance California; 6Division of Exercise Physiology, Department of Human Performance and Applied Exercise Sciences, West Virginia University, Morgantown, West Virginia 26508; 7Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas 76798; 8Department of Pediatrics, University of Virginia, Charlottesville, Virginia; and 9Department of Pediatrics, Riley Hospital, Indiana University School of Medicine, Indianapolis, Indiana ABSTRACT the most effective anabolic form of exercise, and over the past Hoffman, JR, Kraemer, WJ, Bhasin, S, Storer, T, Ratamess, NA, 20 years, the research base for resistance exercise has just Haff, GG, Willoughby, DS, and Rogol, AD. Position stand on started to develop to a significant volume of work to help in the Androgen and human growth hormone use. J Strength Cond decision-making process in program design (187,248,305). Res 23(5): S1–S59, 2009—Perceived yet often misunderstood The interface with nutritional strategies has been less studied, demands of a sport, overt benefits of anabolic drugs, and the yet may yield even greater benefits to the individual athlete in inability to be offered any effective alternatives has fueled their attempt to train naturally. Nevertheless, these are the 2 anabolic drug abuse despite any consequences. Motivational domains that require the most attention when trying to optimize interactions with many situational demands including the desire the physical adaptations to exercise training without drug use. for improved body image, sport performance, physical function, Recent surveys indicate that the prevalence of androgen use and body size influence and fuel such negative decisions. among adolescents has decreased over the past 10–15 years Positive countermeasures to deter the abuse of anabolic drugs (154,159,246,253,370,441,493). The decrease in androgen are complex and yet unclear. Furthermore, anabolic drugs work use among these students may be attributed to several factors and the optimized training and nutritional programs needed to related to education and viable alternatives (i.e., sport supple- cut into the magnitude of improvement mediated by drug abuse ments) to substitute for illegal drug use. Although success has require more work, dedication, and preparation on the part of been achieved in using peer pressure to educate high school both athletes and coaches alike. Few shortcuts are available athletes on behaviors designed to reduce the intent to use to the athlete who desires to train naturally. Historically, the androgens (206), it has not had the far-reaching effect desired. NSCA has placed an emphasis on education to help athletes, It would appear that using the people who have the greatest coaches, and strength and conditioning professionals become influence on adolescents (coaches and teachers) be the more knowledgeable, highly skilled, and technically trained in primary focus of the educational program. It becomes imperative their approach to exercise program design and implementation. that coaches provide realistic training goals for their athletes and Optimizing nutritional strategies are a vital interface to help understand the difference between normal physiological cope with exercise and sport demands (516–518). In addition, adaptation to training or that is pharmaceutically enhanced. research-based supplements will also have to be acknowl- Only through a stringent coaching certification program will edged as a strategic set of tools (e.g., protein supplements academic institutions be ensured that coaches that they hire will before and after resistance exercise workout) that can be used have the minimal knowledge to provide support to their athletes in conjunction with optimized nutrition to allow more effective in helping them make the correct choices regarding sport adaptation and recovery from exercise. Resistance exercise is supplements and performance-enhancing drugs. Address correspondence to Jay R. Hoffman, [email protected]. The NSCA rejects the use of androgens and hGH or any performance-enhancing drugs on the basis of ethics, the ideals 23(Supplement 5)/S1–S59 of fair play in competition, and concerns for the athlete’s health. Journal of Strength and Conditioning Research Ó 2009 National Strength and Conditioning Association The NSCA has based this position stand on a critical analysis of VOLUME 23 | SUPPLEMENT 5 | AUGUST 2009 | S1 Androgen and Human Growth Hormone Use the scientific literature evaluating the effects of androgens and 10. Combined administration of hGH and resistance exercise human growth hormone on human physiology and perfor- training is associated with minimal gains in lean body mance. The use of anabolic drugs to enhance athletic mass, muscle size, and maximal voluntary strength in men performance has become a major concern for professional compared with resistance exercise alone. sport organizations, sport governing bodies, and the federal 11. Human growth hormone is approved for the therapy of government. It is the belief of the NSCA that through education children and adolescents with growth hormone de- ficiency, Turner syndrome, small for gestational age with and research we can mitigate the abuse of androgens and hGH failure to catch-up to the normal growth curves, chronic by athletes. Due to the diversity of testosterone-related drugs kidney disease, Prader-Willi syndrome, idiopathic short and molecules, the term androgens is believed to be a more stature, Noonan syndrome, and SHOX gene deletion. For appropriate term for anabolic steroids. adults, hGH is approved for the treatment of GH deficiency, AIDS/HIV with muscle wasting, and short 1. Androgen administration in a concentration-dependent bowel syndrome. manner increases lean body mass, muscle mass, and 12. The magnitude and frequency of adverse events associ- maximal voluntary strength in men. However, the upper ated with hGH use are clearly dose related. Potential concentration for maximum effects remains unknown. adverse events include suppression of the hypothalamic- 2. Combined administration of androgens and resistance pituitary GH/IGF-1 axis, water retention, edema, in- exercise training is associated with greater gains in lean creased intracranial pressure, joint and muscle aches, and body mass, muscle size, and maximal voluntary strength in those of needle injection (hepatitis and HIV/AIDS). men than either intervention alone. These should be the same in women as well as in men. 3. Testosterone therapy is approved only for the treatment 13. Continued effort should be made to educate athletes, of hypogonadism in adolescent and adult men. However, coaches, parents, physicians, and athletic trainers along the anabolic applications of androgens and selective AR with the general public on androgen and hGH use and modulators are being explored for the functional limitations abuse. Educational programs should focus on potential associated with aging and some types of chronic illness. medical risks of these illegal performance-enhancing 4. The magnitude and frequency of adverse effects among drugs use, optimizing training programs and concurrent androgen users have not been systematically studied. nutritional strategies to enhance physiological adaptation Potential adverse effects of androgen use in men include and performance. In addition, educating coaches on suppression of the hypothalamic-pituitary-gonadal axis, setting realistic training goals and expectations for their mood and behavior disorders, increased risk of cardiovascular athletes will help reduce the pressures to use illegal PED disease, hepatic dysfunction with oral androgens, insulin and assist in potentially identifying potential users of resistance, glucose intolerance, acne, gynecomastia, and illegal PED. withdrawal after discontinuation. In addition, the polyphar- 14. The NSCA supports and promotes additional research macy of many androgen users (psychoactive and accessory funding to be directed toward effective educational drugs) may have serious adverse effects of their own. programs, documentation of both acute and long-term 5. The adverse effects of androgen administration in women adverse effects of androgen and hGH abuse, strategies for are similar to those noted in men. In addition, women optimizing athletic performance through training and using androgens may also experience virilizing side effects nutritional interventions, strategies to help athletes such as enlargement of the clitoris, deepening of the voice, discontinue androgen and hGH use, and strategies for hirsutism, and changes in body habitus. These changes the detection of abuse of androgens and hGH. may not be reversible on cessation of androgen use. 6. In pre- and peripubertal children, androgen use may lead to he use of androgens by athletes has received a lot of virilization, premature epiphyseal closure, and resultant attention