Contemporary issues in sports

What are anabolic-androgenic steroids (AAS) in specific Oxandrolone and how do they physiologically affect an athlete.

Only a small percentage of people can make it to the level of being classified a professional athlete. The excessive psychological and physiological demands are not easy to live up to as strains, pressure and requirements are constantly placed on the individual.

Injuries are an athlete’s worst nightmare, they cause set backs and can ruin an athletes form when they are at the best of their ability. Since athletes are required to train and compete to the best of their abilities, they are constantly looking for ways to recover quicker, train harder and perform better while staying within the limits of the anti-doping association. Athletes will utilise any form of product or physical aid such as isotonic drinks, supplements, ‘light’ footwear or clothing to help gain an edge, no matter how small, over their opponents. They will adopt any form of aid that can help their bodies cope and get through the demands placed on them by their chosen sport.

With sport being at an all time competitive high, with all the media hype, fame and money thrown into the sport, athletes are training harder and longer in order to be one step ahead of their opponents and even their own team mates. With every one striving to be the best, athletes may resort to using substances to help improve their athletic ability and performance, walking on the fine line of what is acceptable within the ethics of sport.

For years it has been well know that the use of illegal performance enhancing substances especially anabolic – androgenic steroids (AAS) is highly frowned upon, with most athletes who are caught using such substances to be given hefty bans. Although closely watched and constantly being tested, athletes still risk their careers by using banned substances. It is something, which the average individual would think idiotic but when asked, Lance Armstrong stated, “Competitive sports can be cutthroat. Fans, coaches, and sponsors have high expectations for athletes, and hold in high regards records and never – been – done – before, seemingly superhuman feats”. With this in mind, it can be understandable to see how athletes can cave under pressure and resort to using illegal substances as an aid to help develop their athletic ability.

A drug known as oxandrolone is one, which has been used by athletes for decades to help increase athletic performance while having minimal negative side effects (Fox etal, Albanese et at, 1962). Oxadrolone, a drug released to the public 1964, is a synthetic androgenic steroid (Jeschke MG, 2007, Geronadache etal, 1967), which is mainly used for medical purposes to treat individuals who have suffered from severe weight loss due to illness, surgery or trauma. It is a synthetic compound, which aids in maintaining the masculine features of the human body (Sriram 1st ed). Oxandrolone helps a process referred to as anabolism, which can be used to help with weight management and also helps develop the physiology of an individual (Frank etal, 1997).

Oxandrolone is an AAS mainly used in power sports to help reduce visceral and abdominal fat. A major advantage of oxandrolone is its ability to develop muscle mass and strength without causing water retention. It also does not aromatise at any particular dose and does not prevent the natural production of testosterone in the body. In comparison to norethandrolone, fluoxymesteron, methAndriol and methyltestosterone, oxandrolone holds the lowest sulfobromophthalein retention, which makes it a more attractive AAS for athletes in sports with weight categories such as boxing, karate, power lifting and so on (Rhonda etal, 2004). Nitric oxide levels have also seen to be improved, which is important as this helps to promote muscle cell volume and displacement of fluid between muscles cells, which have a positive effect on protein synthesis (Nygard etal, 1997).

Structurally oxandrolone is derived from testosterone, but possessed a different chemical configuration (Rhonda etal, 2004). The 4-3-oxo-group common in many AASs is absent in oxandrolone. “A oxygen atom is placed instead of the methylene group at the second position and lacks a 4- ene function in the phenatherne nucleus” (Kuhn etal, 2002, Rhonda etal, 2004). “Oxandrolone is part of the alkyl group attached at the C17 – a position of the steroid nucleus which allows the AAS to be formulated as an oral preparation” (Rhonda etal, 2004),

Since oxandrolone has a positive effect on muscle development and can be induced orally, it is no surprise to see that it is preferred amongst patients suffering from medical cases such as sever weight loss to HIV, severe burns, osteoporosis and so on. A study on the effects of oxandrolone on severely burned patients, was conducted by Hart, etal (2001). It was hypothesised that oxandrolone may be able to reverse catabolism in cachectic critically ill paediatric burn patients. Fourteen severely burned children were enrolled for a five-month period in a prospective cohort analytic study. All patients underwent excision and skin grafting and received similar clinical care. Five to seven days after admission the subjects were studied, then again on week post oxandrolone treatment (0.1mg/kg by mouth twice daily). Muscle protein kinetics were taken from venous blood and femoral arterial samples and biopsies of the vastus lateralis muscle were taken during stable isotope infusion. Through testing, the findings suggested the effectiveness of oxandrolone in delaying protein catabolism in cachectic, critically injured children.

This particular study was extremely useful as it observed a group of people with the same illness and could determine possible risk factors for the group of subject. Since the fourteen subjects were broken up into two groups of seven, this helped determine the actual effects of oxandrolone on the treatment of burn victims. Seven patients were treated with oxandrolone while the other seven served as time controls. Although the sample size was not a significant amount, and not randomly selected, it still gave insight to the possible benefits of the use of oxandrolone in the treatment of youth burn victims.

A supporting study by Murphy, etal (2004) agrees with the findings of Hart, by looking into the use of long – term oxadrolone use in severely burned children. The purpose of this randomised control study was to determine whether the use of oxandrolone for one-year post burn could reverse muscle and bone catabolism in hyper metabolic pediatric burn patients. Children with burns greater than 40% of their total body surface area were selected into a randomised controlled trial to receive long – term oxandrolone treatment. Like the study by Hart, all subjects were given 0.1mg/kg and serum hepatic transaminases were measured along with lean body mass (LBM), bone mineral content (BMC) and bone mineral density (BMD) by use of and dual energy x – ray absorptiometry. Murphy found that with the use of oxandrolone, at six, nine and twelve months LBM was significantly improved and BMC and BMD scores at twelve months were significantly better too. Liver transaminases were unaffected.

This study may prove to be more beneficial than Hart (2004) as it is set out over a longer period of time and due to the nature of the study being a randomised controlled study, it limits the potential for any biases since subjects are placed unsystematically in placebo groups and protocol groups.

These studies are important as they show us that in unhealthy individuals were there is rapid catabolism, oxandrolone can have significant effects on rebuilding and reversing the effects. This being said, if the drug were to be abused and used in healthy athletic individuals, there can be significant improvements in athletic ability and physiological development. If incorporated with a properly formatted training regime, athletes may be able to see an increase in athletic ability, which may not have been achievable without the help of oxandrolone. The fact that it is not very easily traceable can also temp athletes into using the drug.

It positive characteristics may help athletes who are looking to take performance-enhancing lean towards oxandrolone, as it does not convert to oestrogen so female tissue will not develop, does not affect the natural production of testosterone and causes very minimal damage (if abused of) to the liver and kidneys. This is ideal for athletes who are looking to develop their athletic ability but limit the negative effects that can be caused by using other AAS. Since oxadrolone promotes protein synthesis, it would mainly be used to promote lean muscle gains. Physiological changes that may come about with the use of oxandrolone would be, improved nitrogen utilisation and positive nitrogen balance due to the reversal of catabolism. AAS have been seen to increase the concentration of plasma amino acids, due to a preservation method brought about through the kidneys (Hausmann etal, 1990). Even if an individual is untrained, AAS may be able to help with the regulation of fatty acid oxidation in the liver and fast twitch muscle mitochondria (Kliener etal, 1991). Glucose levels may be changed, causing and increase in serum insulin, although exercise can help in the decrease of serum insulin in the blood (Kersey etal, 2012, Meriggiola etal, 2002). It is suggested that athletes concluding an AAS cycle have been reported to have lower serum testosterone concentrations, which return to normal within a few weeks after finishing the AAS phase (Hartgens etal, 2004, Alen etal, 1985).

It was found by Hoffman in 2006, that the use of orally induced AAS had a significant affect on the decrease of free and total serum testosterone levels, while AAS induced through injection had an increase on free and total serum testosterone levels. Although unproven, suggestions have been made that serum testosterone levels may have an effect on the users physiological frame of mind leading them to possibly be more aggressive in behaviour (Bahrke etal, 1990).
As with any drug, there are guidelines and prescriptions on how to safely use the substance. Since oxandrolone would mainly be associated with weight gain, the average person associated with severe weight loss would be prescribed 2.5 to 10 mg orally two to four times daily. Dosages can range between 2.5 to 20 mg per day depending on the severity of the case (Chung etal, 2007).

To reach the elite status in sport, it may seem that at some point athletes may have to contemplate whether or not they are to go down to road of using banned substances to take ability that one step further. It may seem that it is impossible to be successful in professional sport without some kind of ‘help’. The only question it seems, that may arise when taking performance enhancing substances is, when is enough, enough. Just like anything else, too much of one thing can have detrimental effects and when dealing with the human body, sometimes these effects cant be irreversible.

Oxandrolone is said to be an AAS which contains very few or close to no side effects. This being said, with all AAS, when not taken in the responsible/ recommended dosage, complication may arise. In rare cases, oxandrolone can lead to liver poisoning, or damage. Although highly uncommon, if abused of, oxandrolone can cause side effects which may consist of abdominal pain, dark coloured urine, unusual fatigue, nausea or vomiting, yellowing of the skin and light coloured stool. These are all early warning signs of liver damage. More serious side effects can lead to damage to the immune system, were the immune system will become weakened and not be able to efficiently produce antibodies to fight of viruses and elevated blood pressure, particularly individuals with hypertension (Grace etal, 2003).

Gynecomastia, is also a condition that can be developed through AAS abuse. Due to the increased conversion of testosterone to estradiol by the enzyme aromatase (Bahrke etal, 2004) although relatively uncommon with the use of oxandrolone, if doses are severely exceeded, slight variations of this condition may occur.

Abuse of AAS may also cause an increase in LDL cholesterol and a decrease in HDL cholesterol, which can have a severe effect on cholesterol levels (Cohen etal, 1996, Vanberg, 2010) leading to coronary artery diseased. Through the changes of LDL and HDL a common and serious side effect from abuse of AAS is cardiovascular disease. “Chronic abuse can result in different patterns of pathologic alterations, which are dependant on type, dose, frequency and mode of use” (Riezzo etal, 2011). In extreme cases, with the abnormalities that are formed around the cardiac muscle such as myocardial hypertrophy, arrhythmias and ventricular relaxation (Vanberg, 2010), sudden death can be a consequential result of AAS abuse.

The world of a professional athlete is a world with very high, highs and very low, lows. There is not much that can be left to error as small mistakes and can mean the difference between winning and losing and being successful or unsuccessful. Athletes will constantly try to push the boundaries of what their bodies can do and sometimes and extra aid whether illegal or not may be what is needed to take them that step further in their chosen sport. With new methods of beating doping tests are constantly being discovered, athletes may look to use illegal substances such as oxandrolone if they feel the risk with worth the reward.

The incentives of having the title professional athlete are some like no other. Fame, fortune and popularity are amongst the few incentives, which come with the ‘professional’ title. The world of a professional athlete is a highly competitive one and does not leave much room for error. The incentives to be the best are incredibly high and most athletes know that sometimes-natural ability and talent are just not good enough. CJ Nitkowski, a pitcher for several different major league baseball teams from 1996 to 2005 states in an interview with CNN, "Really it’s a trade-off between the short term and the long term. In other words, some of the incentives that are in place make it worth in the short term to get involved with using performance enhancing drugs without looking too much to what might happen down the line.” With the amount of money, fame and pride that is involved in sport, it is no surprise that athletes will resort to using performing enhancing substances when under pressure, to help achieve the goals set out.

References

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References: Franke WW, Berendonk B., 1997. Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic Government. Clin Chem., 43:1262–1279. David W Fox M, Minot AS, Liddle GW, 1962. Oxandrolone: potent anabolic steroid of novel chemical configuration. J Clin Endocrinol metab, 22: 921–924. Albanese A, Lorenze E, Orto L, 1962. Nutritional and metabolic effects of some new steroids. N Y State J Med, 62: 1607–1616. Gerondache CN, Dowling WJ, Pincus G., 1967 Kuhn CM, 2002. Anabolic steroids. Recent Prog Horm Res, 57: 411–434. Hausmann, D.F., Nutz, V., Rommelsheim, K., Caspari, R., Mosebach, K.O., 1990 ESPN, 2013. Oprah: Lance Armstrong confesses, January 16. Available at: [Date accessed] Kleiner, S.M., 1991 Alen, M., Reinila, M., Reijo, V., 1985. Response of serum hormones to androgen administration in power athletes. Medicine and Science in Sports Exercise, 17(3): 354-359. Hartgens, Fred; Kuipers, Harm, 2004 Bahrke, M.S., Yesalis, C.E., Wright, J.E, 1990 Hoffman JR, Ratamess NA, 2006 Grace F. Sculthorpe N, Bker J, Davies B, 2003. Blood pressure and rate pressure produce response in males using high – dose anabolic androgenic steroids (AAS). J sci med sport, Sep; 6(3):307–312 Cohen LI, Hartford CG, Rogers G.G., 1996 Bahrke M.S. 2004. Abuse of anabolic androgenic steroids and related substances in sport and exercise. Curr Opin Pharmol., Dec 4; 4(6):614–620. Nyga°rd O, Nordrehaug JE, Refsum H, 1997 Chung T, Kellehert S, Liu PY, 2007. Effects of testosterone and nandrolone on cardiac function: a randomized, placebo-controlled study. Clin Endocrinol, Feb; 66(2): 235–245.