Page 114 - Journal of Special Operations Medicine - Fall 2015
P. 114
of natural testosterone production during use can result the scope of the issue and further defining the potential
in low endogenous testosterone production when the benefits balanced against the short- and long-term risks
athlete cycles off exogenous androgen, which may con- will be critical. We should discourage passive skepticism
fer a catabolism state. 46 and aggressively test our theories in a scientific manner
to dispel myths and help define best practices.
Military providers just don’t get it, so I will seek private
care to ensure someone listens when I think I need a Disclosures
medication.
The authors have nothing to disclose.
Hormone replacement therapy (HRT) in men has seen
an explosion in availability in recent years. An in-depth The opinions and assertions contained within are the
discussion of HRT is far outside the scope of this article, private views of the authors and are not to be construed
but the screening tools for HRT include a broad array as official views of USUHS or the DoD.
of nonspecific symptoms. It is concerning to note that
androgen prescriptions in military treatment facilities References
(MTFs) have markedly increased in recent years, with
the greatest increase seen in 35- to 44-year-olds. Inter- 1. Tattersall RB. Charles-Edouard Brown-Sequard: double-hy-
47
estingly, the rate of increase in hypogonadal dysfunction phenated neurologist and forgotten father of endocrinology.
Diabet Med. 1994;11:728–731.
diagnosis did not have the commensurate increase ex- 2. Freeman ER, Bloom DA, McGuire EJ. A brief history of tes-
pected with the higher prescription rate. Recognition tosterone. J Urol. 2001;165:371–373.
47
of primary disorders that can lead to secondary hypo- 3. Hoberman JM, Yesalis CE. The history of synthetic testoster-
gonadism and mimics of hypogonadism is critical when one. Sci Am. 1995;272:76–81.
caring for the service member. The unique stressors of 4. Dotson JL, Brown RT. The history of the development of an-
the SOF environment must be considered when explor- abolic-androgenic steroids. Pediatr Clin of North Am. 2007;
54(4):761–769.
ing symptoms of hypogonadism, as the symptoms may 5. Wade N. Anabolic steroids: doctors denounce them, but ath-
in fact reflect another disorder. Thoughtful investigation letes aren’t listening. science (New York, N.Y.). 1972;176:
by a provider who understands the unique factors rel- 1399–1403.
evant to SOF and the potential sequelae of treating hy- 6. Fair JD. Isometrics or steroids? exploring new frontiers of
strength in the early 1960s. J Sport Hist. 1993;20:1–24.
pogonadism as a primary and not a secondary disorder 7. Yesalis CE, Anderson WA, Buckley WE, Wright JE. Incidence
is critical. Currently, the military medical community is of the nonmedical use of anabolic-androgenic steroids. NIDA
developing clinical practice guidelines to assist provid- Res Monogr. 1990;102:97–112.
ers in the complex care pathway to diagnose hypogo- 8. Todd T. Anabolic steroids: the gremlins of sport. J Sport Hist.
nadism (see summary of proceedings from April 2015 1987;14:87–107.
symposium on androgen use that follows this article). 9. Hoffman JR, Kraemer WJ, Bhasin S, et al. Position stand on
androgen and human growth hormone use. J Strength Cond
Future efforts to establish a multidisciplinary approach Res. 2009;23(5 Suppl):S1–S59.
to the care of secondary hypogonadism are desirable. 10. Evans NA. Gym and tonic: a profile of 100 male steroid users.
It is important to recognize that prescription androgen Br J Sports Med. Mar 1997;31:54–58.
use represents only a small portion of users. Studies sug- 11. Hoffman JR, Faigenbaum AD, Ratamess NA, et al. Nutri-
gest almost 90% of users obtain androgens through il- tional supplementation and anabolic steroid use in adoles-
cents. Med Sci Sports Exer. 2008;40:15–24.
licit sources. The segregation of SOF from the medical 12. Parkinson AB, Evans NA. Anabolic androgenic steroids: a
12
community in regard to androgen use makes it challeng- survey of 500 users. Med Sci Sports Exer 2006;38:644–651.
ing to ensure users or potential users are appropriately 13. Bucher J. Soldiering with substance: substance and steroid use
educated to make informed choices. Highlighting the among military personnel. J Drug Edu. 2012;42:267–292.
alternatives to androgens for achieving performance 14. Balas FM. 2011 Health Related Behaviors Survey of Active
Duty Military Personnel.
gains is important in mitigating inappropriate androgen 15. Johnson AE. Findings of recent surveys on dietary supple-
use. SOF are well poised to capitalize on existing human ments use by military personnel and the general population.
performance programs to optimize training load, nutri- In: Greenwood MRC, Oria M, eds. Use of Dietary Supple-
tion, sleep, and psychological wellness to effect optimal ments by Military Personnel. Washington, DC: National
Academies Press; 2008:414–415.
hormone balance. 16. Hughes J, Shelton B, Hughes T. Suspected dietary supple-
ment injuries in special operations soldiers. J Spec Oper Med.
2010;10(3):14–24.
Conclusions 17. Kao TC, Deuster PA, Burnett D, Stephens M. Health behav-
Androgen use outside of legitimate replacement for pri- iors associated with use of body building, weight loss, and
mary hypogonadism is occurring across the military, and performance enhancing supplements. Ann Epidemiol. 2012;
22:331–339.
specifically SOF communities. To properly care for indi- 18. Knapik JJ, Steelman RA, Hoedebecke SS, et al. A system-
viduals who are using or considering use, understand atic review and meta-analysis on the prevalence of dietary
102 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015

