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A Bulked-Up Body of Knowledge

As researchers look more closely at the steroid dosages used by athletes, they are ever closer to determining the risks


Former baseball star Ken Caminiti's recent statement that "at least half" of major league players are using steroids was barely out of his mouth before he retracted it.

Too late; by that time the debate was in full swing on radio talk shows, in Internet chat rooms and grocery store lines. Depending on your point of view, athletes who dope themselves are either hard-nosed competitors or big-time cheaters. The drugs either add home runs or merely shorten careers. And steroid use itself is either a harmless form of sports medicine--or a deadly gamble.

In part, the dispute expresses simple personal bias about performance enhancers that are illegal, except to treat disease. Yet experts say it also reflects the controversial, and still incomplete, science of anabolic steroids themselves, the dozens of substances now bought and sold illicitly on the black market.

"You have to understand that up until about 10 years ago, many in the medical research community still doubted that these drugs had any effect on muscle," said Dr. Shalender Bhasin, an endocrinologist at Charles Drew University in Los Angeles. "We were studying doses of the drugs that were much lower than what athletes were actually taking."

That has changed. In recent years, researchers have begun to study higher doses of anabolic steroids, and piece together a clearer picture of what they do to the body. Anabolic steroids mimic the action of testosterone, which is produced naturally by male testes and, to a lesser extent, by female adrenal glands. Levels of the hormone first surge in boys after age 8, triggering many of the physical changes that occur during puberty--deepening voice, increase in lean muscle mass, acne and physical growth. By adulthood, a man produces about 50 milligrams of the crucial hormone a week; a woman, about a tenth of that amount. Men whose bodies produce abnormally low amounts of testosterone--a condition called hypogonadism, often due to chronic disease, such as AIDS--can suffer depression, sexual malaise, fatigue and shrinkage of their gonads. In recent years, doctors have begun treating these patients with anabolic steroids, usually giving them what are called replacement doses, of about 100 milligrams a week.

Weightlifters and other athletes in search of an edge may take anywhere from 250 milligrams to more than 3,000 milligrams a week, and most are delighted with the change in their physique, trainers say. For example, combining doses of 600 milligrams a week with regular workouts increases muscle size by about 8%, on average, and strength by 10% to 15%, in just a couple of months, according to recent research by Bhasin. "For a competitive athlete, that is a huge gain," he said. Bhasin has also demonstrated that, as a rule, the higher the steroid dose, the bigger and stronger the athlete becomes.

There is a physical cost to steroid use, however, and this is where the scientific debate begins.

In adolescents, doctors all agree that the drugs are dangerous. Not only can doses of steroids cause very visible problems--hair loss, severe acne--but they often interfere with the body's own hormone-driven development. In effect, taking steroids tricks an adolescent body into thinking it's older, doctors say. The result: stunted growth. The rate of steroid use at high schools increased about 50% in the 1990s, with about 3% of students reporting they'd used the drugs in 1999, compared with 2% in 1991, government statistics show. "Some of these guys are stacking several steroids, and mixing them with ephedrine and all sorts of other things," said Dr. Gary Green, a professor of sports medicine at UCLA. "There really is no safe level of use, as far as I'm concerned."

When it comes to adults, however, the science is cloudier and medical opinions vary. Doses of 1,000 milligrams a week or higher are considered risky; yet those in the 500-milligram range may not be, some doctors say. "I'm not convinced the drugs are all that dangerous," said Dr. Paul D. Thompson, a cardiologist at Hartford (Conn.) Hospital, who has studied steroid use in older men and athletes. "I'm willing to be wrong on this. But I think we need to be very careful speculating about serious effects. We just don't have the data yet."

Dr. Nick Evans, an orthopedic surgeon in Los Angeles who has studied steroid use, agrees. In a 1997 survey of 100 experienced weightlifters, Evans found that two out of three steroid users reported some noticeable health problem. Some of the problems, such as acne and shrunken testicles, resolve themselves after users quit the drugs; others, such as stretch marks around the muscles and enlarged breasts, can be permanent. "These are the changes [steroid users] perceive on their own," he said. "They don't know what's happening to their liver and kidney function, or their endocrine system."

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