Athlete's steroid use is no surprise to physicians

Muscles, performance don't develop suddenly by nature, doctors say

December 03, 2004|By Jonathan Bor and Michael Stroh | Jonathan Bor and Michael Stroh,SUN STAFF

When the Yankees' Jason Giambi blossomed from a good hitter of average build into a slugger with a thick neck, bulging arms and a steel torso, it thrilled fans and made him one of the top commodores in Major League Baseball.

But doctors who observed the rapid transformation of Giambi and many other athletes weren't surprised by yesterday's disclosure that the Yanks' first baseman had turned to performance-enhancing drugs.

Such changes, they said, do not occur in nature, even among athletes who train hard and eat properly.

"His history is of a guy who has gotten bigger and bigger and bigger and he's still fairly young," Dr. William Howard, a sports medicine specialist at Union Memorial Hospital, said of the slugger, 33. "His output has increased, he's bigger than life, and he didn't used to be."

Dr. Charles Yersalis, a Penn State epidemiologist who writes extensively about athletic drug use, said Giambi is a classic case: "It's not the size of the person I look at as much as the metamorphosis that their body undergoes over a short period of time, relatively. Giambi did what thousands and thousands of athletes have done. It's called `polypharmacy,' taking multiple drugs for multiple purposes."

In testimony before a federal grand jury investigating the Bay Area Laboratory Co-Operative, a California company accused of trading in banned sports drugs, Giambi admitted he had injected human growth hormone into his gut and testosterone into his buttocks.

He also said he used two BALCO steroid concoctions known among athletes as "the cream" and "the clear."

Though there are chemical differences, all the drugs supply hormones that can enhance muscle development - and by extension, an athlete's strength and speed. But those benefits come with a host of medical risks, ranging from acne and headaches to decreased sperm count and kidney damage.

That hasn't diminished their popularity. Studies show that up to 3 million athletes in the United States alone have used anabolic steroids, generating black market sales in excess of $100 million.

Anabolic steroids are essentially synthetic variants of testosterone, a hormone primarily associated with male traits. While they're often called "performance-enhancing" drugs, scientists say the truth is more complicated. Sometimes, they say, bigger muscles don't translate into better performance.

Here is what science knows about each of the drugs Giambi said he took:

In a review in September's American Journal of Sports Medicine, Harvard University's Mininder Kocher and colleagues reported that "there is no evidence that growth hormone supplementation will lead to an increase in performance."

Despite this, they cited a recent study showing that 5 percent of 10th-graders in the United States have tried human growth hormone, which occurs naturally and is produced by the pituitary gland.

As for testosterone, Thomas Storer, a UCLA physiologist, conducted the first serious human study of the male hormone's effects on strength. "We proved what everybody in the gym already knew: that testosterone will increase muscle size and strength," he said.

In their 1996 study, Storer and his colleagues gave 10 weeks of testosterone injections to men who didn't exercise. The subjects nonetheless developed bigger triceps and quadriceps and could bench-press 20 pounds more than when they started.

"How does that translate into performance?" asked Storer. "Nobody knows."

What about "the clear" and "the cream"?

"The clear" is a custom-designed steroid that U.S. anti-doping officials have named tetrahydrogestrinone, or THG. The Food and Drug Administration says the drug is a chemical relative of two other synthetic steroids, gestrinone and trenbolone.

Gestrinone is used to treat a female gynecological condition known as endometriosis. Trenbolone is given to beef cattle to boost muscle mass. In February, the FDA warned that the effects of THG are unknown but could "pose considerable risks to health."

"The cream" is even more mysterious.

Investigators in the BALCO case say it's a mixture of testosterone and epitestosterone, a naturally produced hormone that so far has no identifiable biological function.

But epitestosterone is used as a flag in drug testing, which could be why athletes turned to it. Measuring the ratio of testosterone to epitestosterone in the body is one way to detect unnaturally high levels of testosterone. Since it contains both hormones, "the cream" might have been an attempt to mask illegal testosterone use.

While scientists don't know how many of these substances work, they do know that they can cause health problems.

Side effects from human growth hormone use include water retention, carpal tunnel syndrome and insulin resistance. Testosterone and other anabolic steroids have been linked to reduced sperm count, cardiovascular disease and sudden cardiac death.

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