New Trends in Steroids and Image Enhancing Drugs

by William Llewellyn (Liverpool John Moores University, 2014)
“If I had an hour to solve a problem, I'd spend 55
minutes thinking about the problem, and 5 minutes
thinking about solutions.”
― Albert Einstein
All AAS are based on TESTOSTERONE
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Anabolic: muscle, bone, red blood cell production
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Androgenic: masculinization, fertility, libido
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Estrogenic: anabolic, metabolic effects
1931 – testosterone synthesized
1934 – first steroid for hypogonadism (Proviron,
Schering Germany)
 1935, 1936 – testosterone esters,
Methyltestosterone
 1940’s – AAS in common medical use
 1950’s – “Research Decade”
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Manipulate anabolic/androgenic/estrogenic effects
alter bioavailability
Injection
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Testosterone Esters
Nandrolone Esters
Methenolone
Boldenone
Trenbolone
Oral
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Methandrostenolone
Oxymetholone
Oxandrolone
Stanozolol
Mesterolone
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Hypogonadism
Osteoporosis
Anemia
Anti-Wasting
Tissue Healing/Injuries and Burns
Breast Cancer
Cardiovascular
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Cholesterol (reduced HDL/LDL ratio)
Ventricular hypertrophy
Blood pressure
Increased prothrombin time
Reproductive
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Infertility
Sexual dysfunction
Hypogonadism/testicular atrophy (men)
Menstrual irregularities (women)
Liver Toxicity (Orals)
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Liver dysfunction
Liver cancer
Cosmetic
Acne
 Hair loss (androgenetic alopecia)
 Gynecomastia
 Water or fat retention
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Psychological
Depression
 Aggression
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Virilization (women)
Body/facial hair growth
 Clitoral enlargement
 Vocal change
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Not Supported
Suicide
“Roid Rage”
 other cancers
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Ability to build muscle becomes
widely known
 AAS use spreads throughout
sports/bodybuilding
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Hospitals flooded with toxicity cases
Major sporting events
Competitors dying on the field
Turning point for AAS prohibition
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Doping scandals
Media speculation
Public “Fix steroid problem!!!”
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Drug Enforcement Agency (DEA)
Department of Health and Human Services
American Medical Association (AMA)
Various Experts
All opposed U.S. steroid criminalization
“The other potential loss of credibility is we are
telling people that they are going to be dropping
over dead and the athletes are looking at the
longtime user and not seeing people dropping
like flies. Now, increased death, probability of
death, or morbidity could be taking place, but
people are apparently not dropping like flies.”
- Dr. Charles Yesalis
AAS are Acutely Very Safe Drugs
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No overdose
No physical addiction
Non-toxic, primarily
Exceedingly rare to have a life-threatening reaction
Most short-term side effects are cosmetic or temporary
Health Risk Primary With Long-Term Abuse
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Increased risk of CVD/heart attack/stroke
Hypogonadism
24 AAS related deaths in 16 years (1996-2012)
Department of Forensic Medicine (DOFM)
All men, mean age early 30’s
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Accidental drug toxicity 54.2% (13)
Combined accidental drug toxicity/CVD 8.3% (2)
Suicide 16.7% (4)
Homicide 12.5% (3)
Accident 4.2% (1)
Undetermined 4.2% (1)
J Forensic Sci, 2014. doi: 10.1111/1556-4029.12424
In only ONE CASE was AAS found alone
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Opioids 37.5%
Psychostimulants 66.7%
Benzodiazepines 45.8%
(9)
(16)
(11)
Steroid Deaths = OTHER DRUGS
Cardiac pathology was diagnosed in 47.8% of Cases
More than 20 years, fighting AAS abuse with
prohibition policies
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Prevent diversion of pharmaceuticals
Prohibit physicians from prescribing (non-medical)
Ban the importation of AAS
Criminalize use/possession
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1. Drastically Cut Supply of Pharmaceuticals
Portion of Market
10%
.
Legitimate
Illegitimate
90%
Raw material trade, mainly from China. UK major hub.
Converting powder into product
Converting powder into product
12 AAS Samples from 3 Internet Dealers
None matched the label. Underdosed, overdosed, substitute ingredients.
Contaminants included:
 Arsenic
 Tin
 Lead
 Prednisone (corticosteroid)
 Betamethasone (corticosteroid)
 Diethylstilbestrol (synthetic estrogen)
 Benzyl chloride (alkylating agent, precursor chemical)
 FurFural (industral processing)
24 samples sent in for analysis
6 samples (25%) contained bacteria.
Other contaminants included:
 BHT (food preservative)
 Bis (2-ethyl hexyl) phthalate (plasticizer)
 Paraffin (kerosene)
 Amines & Carboline (organic/synthesis)
 Fatty Acids
Underground ANABOLICS, 2010
35 year old bodybuilder carrying assortment of supplements,
steroids, other drugs, two unlabeled vials admitted to the
hospital.
 Symptoms of liver dysfunction.
 Progressed to signs of heavy metals poisoning.
 33x safe level of arsenic present. Patient died.
Analysis of vials yielded an unlabeled bottle with very high arsenic level, no
AAS.
J Clin Endocrinol Metab. 2013 Dec;98(12):4613-8
2. Prohibition prevents prescribing (nonmedical)
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No physician oversight or advice
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Minimal focus on health markers/blood testing
.
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Higher Doses
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Longer Cycles (bridging, cruising)
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Spot Injections
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More Injections
3. Prohibition = Market Free-For-All
Much higher concentrations
Unapproved AAS
Blends/multi-component
AAS (“pre-stacked”)
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4. Effect of Prohibition Unknown
2014 meta-analysis puts usage rate at:
 3.3 % global lifetime prevalence rate
 6.4 % for men
 1.5 % for women
.
Prohibition has decimated AAS supply
Placed users at high risk of drug mislabeling,
contamination, infection
 Diminished access to medical advice/blood work
 Unknown effect on AAS prevalence, though usage
rates are higher today than pre-prohibition
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Is this a recipe for reduced public harm?
“No problem can be solved from the same level of
consciousness that created it.”
― Albert Einstein
1. Quantify Risk of AAS Misuse
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Researchers and clinicians need to work
together to collect and analyze data
Short-term risks
Long-term risks
Athletes vs. Bodybuilders
2. Quantify Black Market Risk
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Heavy metals
Bacterial/microbial contamination
Dosage/drug mislabeling
Other substance contamination
3. Evaluate New Equipment
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Syringe filters
Sterile vials
Can remove all bacteria from a solution
Limitations: Cannot remove other drugs,
pyrogens, or
heavy metals.
4. Address Abuse vs. Self Medication
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Many men 35+ suffer from hypogonadism (low
testosterone)
Clinical symptoms: loss of libido, reduced
energy, loss of muscle mass, increased adiposity,
osteoporosis, and depression.
HRT shows consistent improvements in CVD,
diabetes, metabolic syndrome, and cancer risk.
Some needle exchange users should be referred
for medical treatment.
5. Allocation of Resources
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AAS users should not take away resources
from narcotic interventions
AAS = separate issue = new resources
6. Staffing: Weightlifter/Former AAS User
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Beyond standard BBV interventions
Connect with users; better acceptance of
drug-related advice
7. Rethink Policies
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Ease restriction on imports
Recovery agenda?
Allow personal-use. Never criminalize.
Allow physicians to Rx and monitor
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Liposuction deaths: 1 every 5,000 procedures