Page 112 - Journal of Special Operations Medicine - Fall 2015

The side-effects of anabolic use have been exaggerated. nonusers in specific athlete populations, 25,26 but more
With proper dosing and cycling, many of these side- studies are needed.
effects can be avoided.
An increased risk for precursors to heart disease such
The argument that side-effects are exaggerated reflects as dyslipidemia and hypertension is well documented,
the lack of data regarding both short- and long-term ef- in addition to the insidious development of cardiac dys-
fects of the supraphysiologic doses often used by those function. However, these are silent effects that do little
9
seeking performance enhancement. Because of the vari- to dissuade the user from androgen abuse. The more
ety of agents used, dosage, frequency, and duration of overt side-effects such as acne, gynecomastia, or testicu-
use, it is difficult to pool different studies to summarize lar atrophy are more likely to be issues for the user, as
risk data. Doses used by athletes are often multiple times they are readily apparent. It is interesting to note that
higher than doses used in clinical trials. Early studies 100% of androgen users who responded to an online
in the 1970s used protocols with varying dose ranges survey reported side-effects : 96% of those with side-
12
slightly above physiologic replacement doses (100mg to effects were taking other medications to counter the ef-
500mg testosterone equivalent per week). 19–21 Prospec- fects. Clearly, androgen use is not without side-effects,
tive studies conducted in the past two decades used dos- but further delineation of short- and long-term effects
ages that were supraphysiologic in the range of 600mg of when used by young healthy men is needed. However,
testosterone per week. 22,23 Internet studies and searches trying to dissuade illicit use of androgen by mention-
of public websites and discussion boards conducted by ing side-effects is unlikely to be a worthwhile counter-
this article’s authors revealed variability in dosing, but measure. The data suggest that users are aware of the
common themes suggested dose levels well over 600mg side-effects but prefer to mitigate side-effects rather than
per week. One survey found that more than 50% of discontinue use. 12
24
users reported dose ranges above 1,000mg per week.
12
In this same survey, 96% of users reported use of other
drugs either as adjuncts to anabolic use or to counter Special Forces are not like professional athletes. The
side-effects. Polypharmacy is very common among us- price of our competition is life or death. Is it unethi-
ers and the cumulative risk is virtually unexplored in cal to use a known performance enhancer in this
the medical literature. Adverse effects associated with circumstance?
androgen abuse are listed in Table 2. It is important to The enhanced Soldier is a topic that raises much ethical
acknowledge that the link between androgen use and debate. 27.27 Research to find techniques, equipment, and
many side-effects lacks scientific rigor, and research is substances to alter human behavior and physiology to
sorely needed to explore the effects of androgens based improve battlefield survivability and lethality is ongo-
on patterns used by athletes. Several studies have sug- ing. Enhancements must be considered in terms of in-
gested higher mortality rates for androgen users than for
dividual and collective effects while carefully weighing
Table 2 Side Effects of Androgen Abuse risk versus benefit. Although androgen use can affect
System Signs/Symptoms performance in terms or body composition, strength,
Cardiovascular Increased LDL and power, evidence supporting a benefit of androgen
use on the multidimensional requirements of military
Decreased HDL
Sudden cardiac death performance is insufficient. The complexity of tasks
Increased thrombogenesis performed by SOF in both physical and mental dimen-
Hormonal Gynecomastia sions cannot be simplified down to a one repetition max
Testicular atrophy or correlate of body composition, the main outcomes
Azoospermia measures of androgen effects on performance. Further
Male pattern baldness research is needed to explore the effects of androgens
Clitoral hypertrophy on global, military unique performance parameters.
Liver Peliosis hepatis* Given the known medical complications discussed here
Cancer* earlier and the lack of relevant performance data, the
Hepatic dysfunction* weight of current evidence does not present a favorable
Skin Acne risk:benefit profile.
Oily hair and skin
Skin abscess from IM injections
Musculoskeletal Tendon injury Roid rage—Aggressiveness, anger, and hostility as a re-
Joint stress sult of steroid use may be a benefit in military operations.
Notes: List items in bold type indicate acute effects that are more ap- Data on the psychological and behavioral effects of
parent to the user. *Most of these effects are associated with oral 17a-
alkylated steroids. HDL, high-density lipoprotein; IM, intramuscular; androgens are mixed. None of the studies exploring
LDL, low-density lipoprotein. physiologic replacement doses have shown an increase

100 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015