BRITISH MEDICAL JOURNAL 31 -MAY 1975 473 which found no effect on athletic performance studied untrained men and used androstenolonel0 or stanozolol.'4 To avoid the pitfalls suggested by Ariel and Saville's' finding that placebo produced significant improvements in performance, each of our athletes acted as his own control.We found more side effects than others have reported; in particular acne has never been reported under these conditions though it is a recognized complication of androgen therapy, nor have we seen reports of "urethritis." The occasional high SGPT levels were unassociated with symptoms or signs and might have reflected enzyme induction rather than liver damage.' 8 Anecdotal Lore.-We have heard of doses of up to 300 mg/day being taken for months or even years, but the consensus of opinion is that huge doses are no more useful than the moderate doses we used. As might be expected from nitrogen balance studies'7 the effect of anabolic steroids seems to wane after about six weeks in spite of continuing treatment. The gains are usually maintained for some weeks after stopping the drug, but then follows a period of relative weakness which may last for several weeks. On steroids athletes generally become less susceptible to fatigue, which allows longer, more frequent, and harder training sessions. Injuries to muscles, tendons, and ligaments occur less often in weight training, and when they do occur they heal more quickly than usual. These two features might provide a clue to the mechanism of these drugs. Among side effects of steroids we have heard of jaundice, hypertension, urethritis, gastrointestinal haemorrhage, increased and decreased libido, and oligospermia. Inevitably many of the correlations implied by these anecdotes are incidental. Acne and headache are so widely mentioned as to confirm our own findings.Such anecdotal data are of little strict value, but we cannot mount the very large trial needed to test them objectively. Highly trained dedicated athletes are rare and few are interested in co-operating in such studies; this is especially true in Britain where top-class athletic training is unrewarding and often lonely, requiring of its practitioners a large degree of obsession.
ETHICAL CONSIDERATIONSThe taking of anabolic steroids by athletes, and thus our trial, may be criticized on the grounds that (a) these drugs give a competitor an unfair advantage over opponents not taking them; and (b) it is wrong to give a drug to a healthy person. On the other hand, anabolic steroids are reputed to be taken by almost all international heavy athletes, and if this is so then not to take them is to submit to an unfair disadvantage. We also felt iustified in proceeding with our trial because the athletes would have obtained and taken the drugs even if we had not condoned it (some already had), and in that case it were better they did so under medical supervision.Nevertheless, neither of these arguments detracts from the force of the ethical objections posed. It is wrong that athletes should be su...
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