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Performance-Enhancing Drugs and Sexual Health

It’s not hard to miss stories about “doping” – using performance-enhancing drugs or PEDs – in the news these days.

In July, several athletes were suspended from competition in the London Olympics after failing drug tests. And 16-year-old Chinese swimmer Ye Shiwen sparked controversy after her stunning victory in the 400-meter individual medley. (The swimmer has denied using PEDs and, according to The Guardian, was deemed “clean” by Colin Moynihan, chairman of the British Olympic Association.)

This month, Major League Baseball suspended San Francisco Giants left-fielder Melky Cabrera for 50 games after he tested positive for testosterone use. And Lance Armstrong was stripped of his seven Tour titles after he declined to contest a case against him for blood doping

We often associate PEDs with famous athletes. But such drug use isn’t confined to the sports world. Some of our own patients may be using them, including men, women, and teenagers.

PEDs have a wide range of side effects and health risks, from acne to heart problems. Today, we’re going to talk about how one type of PED – anabolic steroids - affects sexual health.

What are Anabolic Steroids?

Anabolic steroids, sometimes called anabolic-androgenic steroids, are based on the male sex hormone testosterone or a synthetic form of it. Testosterone is important for building muscles and for the development of male sex characteristics, such as a deeper voice.

These drugs are sometimes prescribed for conditions stemming from testosterone deficiency, such as delayed puberty. They may also be prescribed to people who have lost significant muscle mass from diseases like AIDS and cancer.

However, some people take anabolic steroids to enhance their physical appearance or build strength and performance. Some find that the added aggression brought on by anabolic steroids gives them a competitive edge.

The Mayo Clinic explains, “Besides making muscles bigger, anabolic steroids may help athletes recover from a hard workout more quickly by reducing the muscle damage that occurs during the session. This enables athletes to work out harder and more frequently without overtraining.”

Anabolic steroids can be taken orally or by injecting them into the muscles. They may also come in the form of a gel or cream applied to the skin.

Sexual Problems Caused By Anabolic Steroids

Anabolic steroids are associated with a number of sexual problems. In men, common issues are:

  •  Testicular atrophy - a shrinking of the testicles
  • Gynecomastia - the development of noticeable breasts
  • Reduced sperm count or infertility
  • Enlargement of the prostate gland
  • Decrease in natural testosterone production
  • Erectile dysfunction
  • Common issues for women include:
  • Enlargement of the clitoris
  • Changes in menstrual cycle
  • Hormonal issues

Anabolic steroids have also been linked to:

  • Elevated blood sugar, which may lead to diabetes and, in turn, erectile dysfunction.
  • Increased aggression (“roid rage”) or depression, which may affect personal relationships, including intimate ones.
  • Risk of HIV and hepatitis transmission, if users inject the drugs.
  • Increased cholesterol, which may interfere with blood flow to the genitals. In men, this increases risk for erectile dysfunction
  • Changes in body appearance, such as breast development in men or facial hair in women. This may lower one’s sexual self-confidence.

Other Risks With Anabolic Steroids

Other risks associated with anabolic steroids are:

  • Dosage. Anabolic steroid users often take 10 to 100 times more than what is safely prescribed by doctors for medical uses.
  • “Stacking.” Some users use anabolic steroids in conjunction with other performance-enhancing drugs or dietary supplements in a risky process called “stacking” because they think they’ll achieve better effects.
  • Black market. Because anabolic steroids are only available by prescription in the United States, many users buy them on the black market. As such, there is no guarantee of the drugs’ safety, purity, or accurate labeling.
  • “Designer drugs.” These types of synthetic anabolic steroids are designed to help users pass drug tests, as they are undetectable. Unlike prescription anabolic steroids, these drugs are not approved for medical use. They are also not approved by the U.S. Food and Drug Administration (FDA).
  • Illegality. Non-prescription steroid use and production is illegal in the United States. Most major sports organizations prohibit them. Users may find themselves in legal trouble and/or banned from playing sports.

Are Your Patients Using Anabolic Steroids?

If you suspect one of your patients is abusing anabolic steroids (for example, if you see a patient with unusually large muscles), ask about it. While patients may not volunteer this information, it’s helpful to remind them that their honesty helps you help them. Reassure them of confidentiality and provide a trusting environment.

If they reveal anabolic steroid abuse – or any drug abuse – to you, don’t be judgmental. Calmly discuss the situation, the repercussions of continued use, and referrals to a drug treatment program, as appropriate.

Resources

BBC News
Heald, Claire
“London 2012 Olympics: Q & A on Drug Testing”
(July 31, 2012)
http://www.bbc.co.uk/news/uk-19066937

The Guardian
Addley, Esther
Ye Shiwen calmly takes another gold as drug claim storm rages around her
(July 31, 2012) 
http://www.guardian.co.uk/sport/2012/jul/31/ye-shiwen-200m-medley-gold

Mail Online
Moroccan, Belarusian and Colombian athletes suspended after failing drugs tests
(August 4, 2012)
http://www.dailymail.co.uk/sport/olympics/article-2183573/London-2012-Olympics-Three -athletes-suspended-failed-drugs-tests.html

Mayo Clinic
Performance-enhancing drugs: Know the risks
(December 23, 2010)
http://www.mayoclinic.com/health/performance-enhancing-drugs/HQ01105

McKesson Health Solutions / RelayClinical Education (accessed via Agawam Public Library databases
Rouzier, Pierre.
“Anabolic steroids.”
RelayClinical Education. Vol. 2011.
McKesson Health Solutions LLC, 2011. 
Health Reference Center Academic
Web. 21 August 2012. 

MLB.com
Haft, Chris “Melky banned 50 games for testosterone use
(August 15, 2012)
http://mlb.mlb.com/news/article.jsp?ymd=20120815&content_id=36734312&vkey=news_mlb&c_id=mlb

National Institute on Drug Abuse 
DrugFacts: Anabolic Steroids
(Last updated: July 2012)
http://www.drugabuse.gov/publications/drugfacts/anabolic-steroids

NSW Health
Anabolic Steroids – Let’s Get the Facts Right
(1999, 2002)
http://www.druginfo.nsw.gov.au/__data/page/1228/anabolic-steroids_handout.pdf

Philly.com
Hecht, Mitchell Ask Dr. H: Harm steroids, other drugs can do to athletes
(August 7, 2012)
http://articles.philly.com/2012-08-07/news/33066120_1_cranberry-juice-urinary-tract-infections-creatine

WebMD
Steroid Abuse
(Last updated: June 30, 2011)
http://men.webmd.com/guide/anabolic-steroid-abuse-topic-overview

Photo


Syringe
flickr user Andres Rueda, cc-by
http://www.flickr.com/photos/andresrueda/2983149263/