Page 113 - Journal of Special Operations Medicine - Fall 2015

in aggression and only a small percentage of those re- to military members. Research exploring the possible
ceiving supraphysiologic doses (less than 5%) have been performance benefits relevant to military operations,
associated with increased aggression. It is postulated while at the same time clearly defining the risks in young
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that androgen use may unmask rage reactions in those healthy subjects, is needed for meaningful discussion.
with preexisting psychobehavioral disorders. The tragic Alternatives to androgen use that can help close the per-
1
killings of Afghan civilians by Robert Bales, reportedly formance gap are available and efforts need to be dedi-
given anabolic steroids by a SOF member, highlighted cated to identifying further potential lower risk avenues
the concern that androgen use may precipitate rage re- of enhancement.
actions. 28–30 Of significant concern is the association be-
tween androgen use and various mood disorders such Special Forces have higher baseline testosterone levels
as mania, hypomania, or major depression, with ma- and thus when tested may not reveal an abnormal level.
jor depression being much more frequent during peri- This statement is a myth. No data suggest that SOF
ods when androgen use is discontinued. 31,32 Such mood would be expected to have testosterone levels that differ
disorders would be deleterious to SOF, especially in an from reference laboratory population norms. 36–38 More-
operational setting where decrements in mental clarity over, no evidence indicates that SOF have “high nor-
would carry extremely high stakes. Additionally, andro- mal” testosterone levels, which might lead to deviation
gen use is reported to disrupt sleep architecture and effi- from current replacement guidelines. However, SOF
ciency of sleep. The association between androgen use may be susceptible to alterations in hormone profiles
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and various behavioral health-related conditions raises due to high training volumes, nutritional deficits, and/or
the possibility that anabolic use may potentially contrib- psychological stress. Reduced testosterone and elevated
ute to PTSD. This has never been overtly explored and cortisol concentrations as a result of intense training
is a topic worthy of future research. Androgen use has coupled with energy deficit and sleep deprivation have
also been associated with a higher risk of subsequent been well documented in Ranger training. 39,40 Studies in
substance abuse. Coupling androgen use with frequent SERE training have shown an even more marked effect
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deployments and combat exposure (known risk factors on anabolic hormone balance, suggesting psychological
for substance abuse ) may further increase risk. stress as a significant variable. 41,42 It is interesting to note
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that SOF are more biologically “stress hardy” with less
variability in neurochemical and hormonal response to
By prohibiting anabolic use, the problem is being pushed stress, suggesting validity in our current selection and
underground, where Servicemembers are more likely to training methods. 41,42 This underscores the importance
use inferior products and engage in illegal behavior.
of bearing in mind nonpharmaceutical interventions
The Warrior ethos, often simplified to “what you are in when considering alterations in the anabolic hormone
the dark,” only underscores the principles that should milieu.
guide SOF when exploring the use of androgens. Cur-
rently, androgen use without a prescription for a le- Anabolic supplementation aids my recovery. The mili-
gitimate medical condition is illegal. Androgens are a tary beats up my body and anabolics help aid recovery
Schedule III drug, which means they are drugs, sub- so I can sustain the training load necessary for Special
stances, or chemicals with potential for physical and Forces.
psychological dependence. Possession is a crime, and
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partaking in the trade of anabolic steroids violates the The ability to train harder and recover more quickly is
Warrior ethos and can potentially threaten security by one reason reported for androgen use. However, a pau-
introducing the SOF member into a world of illegal city of data exists with regard to androgen effects on
activity. The Designer Anabolic Control Steroid Act recovery in the otherwise healthy athlete. Most data
(DACSA) of 2014 enhanced the ability of the Drug focus on patients with chronic diseases associated with
Enforcement Agency (DEA) to regulate possession or muscle wasting. Some studies have suggested an an-
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trafficking of steroids by taking into account the grow- drogen benefit with regard to creatine kinase returning
ing number of products on the market intentionally de- to preworkout levels and the ability to repeat a work-
signed to circumvent the current regulatory system. out sooner than non–steroid-using controls. 44,45 This ef-
fect is likely due to the ability of androgens to block the
Importantly, the performance and medical community binding of cortisol to its receptors, which would prevent
must recognize that androgen abuse will exist despite muscle breakdown and thus enhance recovery. Although
DACSA and the threat of civil penalties and stigmata this action might benefit the athlete when using andro-
of unethical behavior. Opening up a dialogue around gens, it may be deleterious when the athlete stops taking
the desire for enhanced performance is crucial to bring- androgens. This effect may reflect the upregulation of
ing androgen use into the light of day so it can be ex- cortisol receptor sites and increased cortisol production
plored from an evidence-based perspective applicable when using anabolic agents. Similarly, the suppression

Androgens and Androgen Derivatives 101