Steroids

'Roid rage

Experts voice their fear steroid publicity will prompt more teens to experiment.

By LISA GREENE and DAVE SCHEIBER
Published February 21, 2005

[Times illustration: Amanda Raymond, Don Morris and Rossie Newson]

Dr. Eric E. Coris listens to Jose Canseco's claims about rampant steroid abuse in baseball and wonders how it will affect young athletes.

Not how many will hear about the controversy and stay away from the illegal drugs. But how many will start taking them.

"While you'd think that would be a deterrent, some kids will take that as an incentive," said Coris, team doctor at USF and director of its sports medicine division.

Many young athletes see the fame, the money, the broken records.

Not the torn ligaments, the stunted growth, the heart attacks.

Frustrated doctors say they often feel they're fighting a losing battle against steroids. Steroid use among teenagers more than doubled from 1991 to 2003, according to a survey by the federal Centers for Disease Control and Prevention.

About 6 percent of high school students said in 2003 they had used steroids, the survey found. And use was highest among younger teens.

"If you see Barry Bonds hitting home runs all over the place, that's not exactly great from the role model perspective for these kids," said Dr. Walter Taylor, director of the sports medicine training program at the Mayo Clinic in Jacksonville.

Bonds is one of several baseball players Canseco said in his recently released book has knowingly taken steroids, although Bonds has denied it.

It's tempting for high school coaches to turn a blind eye, said Dr. Nicholas A. DiNubile, orthopedic consultant to the Philadelphia 76ers.

"It creates the perfect football player," he said. "They're bigger. They're stronger. They're faster, and they're more aggressive. They're angrier. They're hitting harder. They recover quicker from injuries or from workouts or from games. ... (Coaches) tend to want to look the other way."

The message doctors try to get across: Yes, steroids do what's promised. They build bigger, stronger muscles. They accelerate recovery and make it possible to work out more often.

But that extra power comes at a terrible cost.

The side effects of steroids can disfigure and, eventually, kill. They can even hurt athletic performance - the reason for taking them in the first place.

"The downsides are really tremendous," Coris said. "It's particularly troubling when kids abuse steroids."

Anabolic steroids, the type used by athletes, are synthetic versions of the hormone testosterone. They can be taken as pills, injected or rubbed on in a gel or cream.

Steroids work by binding to receptors in the cells of muscle fibers. Once there, they signal the cell to produce more protein. That makes muscle cells bigger and, usually, stronger.

They also promote muscle healing, said Dr. Linn Goldberg, an expert on steroids, professor of medicine and head of the division of health promotion and sports medicine at Oregon Health and Science University.

"Some endurance athletes use it because they can train harder," Goldberg said. "You can train more frequently. You can lift almost every day. You can sprint every day instead of every other day. You break down protein when you do that stuff. This way, you accumulate more protein."

But most athletes use steroids for strength - power hitters, linebackers and discus throwers - rather than agility - infielders, receivers and marathoners.

There are limits to what steroids can do. Athletes who want results need to work out, Taylor said.

"You can't just be a couch potato and take steroids," he said.

Nor can the drugs deliver skill, said steroids expert Charles E. Yesalis, professor of health policy and administration, exercise and sport science at Penn State.

"You can't take some Sluggo out of the gym who's built like Godzilla," but lacks hand-eye coordination, Yesalis said. "He'll strike out every time. But you take a guy who has that God-given gift, and you make him bigger and stronger.

"Now he can wait on the ball longer because he can snap through the ball quicker. When he hits a grounder, it'll have more velocity on it. So it is less likely one of the infielders will cut it off before it goes through.

"The line drive that went to the warning track will now carry (over) the fence for a homer. And the home run will now be a home run that (reporters) write about, you know, a 500-footer."

The disadvantage is steroids also increase the risk of serious tendon and ligament injuries, which can bench athletes for several weeks at a time and end careers early. Doctors believe steroids actually weaken the tendons and ligaments, Coris said.

They also are put under more stress because the muscles they're attached to grow so fast.

(Tendons and ligaments are) not being built up as much as the muscles are," Coris said. "You get people who tear muscles off their bones."

For young athletes, there's another problem. Higher levels of testosterone send a signal to the bones that it's time to stop growing. As a result, plates close at the ends of the bone, where growth occurs. Once the plates close, they're closed for good.

Hormones don't just affect muscles or sexual development, but nearly every organ of the body. And because steroids are hormones, their influence is wide-ranging.

"There are receptors in just about every tissue," Goldberg said. "They're also in the brain, the skin, the hair follicles, the liver. They're very powerful hormones."

In the brain, steroids can affect other chemicals, such as serotonin and dopamine, leading to depression or impulsive behavior.

Steroids also can make users more aggressive. That might boost an athlete's confidence and will to win. But it also might send him into a hormone-fueled violent "roid rage."

Because the heart is a muscle, steroids can increase its size and thickness.

"Sometimes, we worry about sudden death," Taylor said.

Steroids can raise blood pressure and LDL ("bad" cholesterol) and lower HDL ("good" cholesterol). They can build up in the liver, leading to chronic disease, liver cancers and rare cysts filled with blood. Doctors aren't sure why these form, Goldberg said, "but they can rupture, and you can die."

As sex hormones, steroids have different effects on men and women. In men, testicles can shrink while breasts grow. Women can develop facial hair and deeper voices while their breasts shrink.

It's hard to know how frequently these side effects occur, doctors said, because athletes don't admit they're users, making studies difficult to conduct.

"Just try to sign up a bunch of people to say, "Hey, I use illegal drugs, so I want to participate,"' Taylor said.

Common sense says the worst side effects are rare, said William Kraemer, professor of exercise physiology at the University of Connecticut and a fellow with the American College of Sports Medicine.

"I'm not supporting steroids," he said. "The reason you haven't been able to scare people away ... (is that) people haven't been dropping over (dead) from steroid use."

A few high-profile athletes have died or suffered serious illness. Among them: former NFL All-Pro defensive end Lyle Alzado, who died in 1992 at age 43. The cause was officially complications from brain cancer, but Alzado blamed his condition on the anabolic steroids he took continually starting in college in 1969.

Steve Courson, a former offensive lineman for the Steelers and Bucs, used steroids so frequently, he was placed on a list for a heart transplant. Courson, however, recovered through a special diet and exercise program and today speaks on the danger of steroids.

There just haven't been enough studies to know how many athletes have died early because of steroids, DiNubile said. And there's no way to know who will be affected.

"Not everybody responds to drugs or medications in the same way, and what you might get away with might severely damage my liver or my heart or give me cancer," he said. "There's no safe way to take these drugs. They're medications, and you see everybody so panicky about (pain relievers) Vioxx and Celebrex now. To me, that's M&M's compared to steroids."

Scientists have examined the effects in small studies of animals and people taking lower doses of anabolic steroids for medical reasons, such as osteoporosis or low testosterone levels.

Goldberg said doctors noticed steroids seem to have a greater effect on traits a user already possesses. A muscular athlete is more likely to see dramatic muscle growth. Someone with anger problems is more likely to fall prey to roid rage.

Users try to maximize muscle growth and minimize side effects by "stacking" and "pyramiding." They use more than one steroid at a time, increase doses for 6-12 weeks then decrease them.

"Stacking and pyramiding have not been scientifically shown to decrease their toxic effects," Coris said. "That's just a common cultural perception within the abusing community."

Some studies indicate steroids are addictive, Goldberg said. Rats who take steroids will keep pressing a bar that delivers more.

But the mental hook might be stronger than the physical one. Doctors often cite a survey in which aspiring Olympians were asked whether they would take a drug that would guarantee victory if they knew they would not be caught. Almost all said yes, reported Sports Illustrated .

Then the question changed: Would they take the drug knowing they would win all competitions for five years then die from the side effects? More than half still said yes.

"You take a 17-year-old. He sees Barry Bonds. He's ... 40," Goldberg said. "That's more than a lifetime from now. One guy told me, "I'm 21 years old; 40 is an old man. I don't care if I'm dead then."'

Still, Goldberg believes youngsters can be turned away from steroids. He runs two federally funded programs that aim to not just scare them, but create networks of youngsters who know the risks so they discourage others. The programs also offers an alternative, teaching teens how to eat and train to get stronger.

But sometimes, knowledge comes too late.

Goldberg was interviewed on CNN a few years ago and asked about 1996 National League MVP Ken Caminiti, who not only admitted to using steroids, but said he had no regrets.

Caminiti, who also admitted to taking cocaine, might feel that way now, Goldberg said then. But ask him again in 10 years.

Nobody got the chance.

On Oct.10, 2004, the three-time All-Star third baseman, age 41, died of a heart attack.

[Last modified February 21, 2005, 10:11:03]