On Steroids, HGH, and Amphetamines: An Interview with Gary Gaffney of Steroid Nation

In a day and age when it's easy to posture as an expert on a wide range of topics, it's nice to know that there are people out there who really know what they're talking about.

When it comes to steroids, Gary Gaffney, MD, is your man. Gaffney, a professor at the University of Iowa and the author of Steroid Nation (a blog I recommend you add to your favorites and check on a frequent basis) answered my questions about the effect of steroids and what they mean to the world of sports.

Due to length, I'll break this interview into two parts, with the second installment coming tonight or tomorrow morning.

By way of introduction, tell me about how you became interested in steroids. How do you incorporate this "hobby" with your job as a professor?

As a lifelong sports fan and subscriber to Sports Illustrated, I couldn't help but note the stories leaking out of that fine publication. Later, when I attended college, I began to train with weights. Although it was difficult to exercise regularly in medical school, I became more serious about weight training in residency at Johns Hopkins in Baltimore. I made connections there with other physicians and amateur athletes who maintained the same interest in PEDs and athletic performance. For instance, my friend and I called up Robert Kerr for his take on HGH; Kerr was the California physician who claimed he doped a massive number of Olympic champions.

One of my specialty areas is psychopharmacology. There is incredible similarity between the study of drugs used for behavior problems and drugs used for performance enhancement.
I integrate an interest in PEDs professionally, so it is more than a hobby. I am analyzing data on high school steroid use. I recently published a review of gene doping in sports. I have ongoing discussions about research projects looking at aspects of PED use.

The blog is a way of keeping a database on steroids and PEDs, getting some information out there, and of exercising my constitutional right to be a wise guy.

Briefly, can you explain the differences between amphetamines, human growth hormone, and anabolic steroids? How does each help an athlete improve his performance on the field?

This substances you mentioned are but some of the performance enhancing drugs used by athletes. The differences between these drugs would be encyclopedic; however I can discuss the short version.

Amphetamines, also known as 'stimulants' (although I prefer 'analeptics') structurally affect the neurotransmitter 'monoamine' family of receptors. I prescribe these every day for the treatment of ADHD. Not only do these drugs increase attention and concentration, but they can -- at certain dosages -- combat fatigue and enhance motor coordination. Side effects include anorexia, insomnia, and -- at high doses -- psychosis.

Amphetamines are an FDA Schedule 2 substance, which means I need a federal DEA license to prescribe the drugs; they are fastidiously controlled by the government because of the high abuse potential. Amphetamines are detected in urine for several days after their use.

Human growth hormone (HGH) is a peptide hormone produced by the pituitary gland which is intimately involved with growth and metabolism. Once in incredibly short supply because the substance came from cadavers in Scandinavia, HGH is now abundant because the hormone can be produced in mass quantities by biotechnology.

HGH is involved in the growth of children, the regulation of protein and carbohydrate metabolism, and in the regeneration and repair of tissues. Studies indicate HGH may also increase muscle mass, improve tissue healing, and carry out several other metabolic actions. The data on HGH increasing strength and power is somewhat ambiguous; there is evidence HGH -- as a drug -- needs to be augmented with anabolic steroids, thyroid hormone, and insulin.

HGH appeared, at one time, to be an ideal anabolic drug: high gain, no pain. However, over the years HGH has found to cause sinister side effects. HGH can cause havoc with blood glucose and insulin regulation. HGH causes internal organ (kidney for instance ) growth. In a particularly dangerous side effect, HGH can cause enlargement of the heart; it is suspected that many former users of HGH now suffer from cardiac problems.

Although patients with HGH tumors demonstrate acromegaly -- growth of skull, jaw, hands and feet -- I can find little evidence HGH as a PED causes this side effect (ie, Barry Bonds' head did not grow from HGH). There is evidence HGH increases cancer cell multiplication in the lab.

Anabolic-androgenic steroids are the 800 pound gorilla of PEDs. These bioactive steroid compounds that are synthesized in the body from a cholesterol base form the foundation of maleness in species. Testosterone, as the basic male anabolic hormone, promotes muscle growth, bone growth, and regulates metabolism. Testosterone also produces androgenic (or masculine) physiological effects: deepening of the voice, male hair patterns, acne, and development of reproduction organs, and aggressiveness.

All of the anabolic steroids produce those physiological effects to some degree. Androgenic steroids enhance muscle size, muscle strength, power, and explosiveness, as well as increase behavioral aggressiveness. Other adaptive physiological effects that enhance athletic performance may be more controversial, such as improved recovery from injury, reduced fatigue, or increased red blood cell numbers, but the key effects remain the enhancement of muscle strength and power and increase of aggressiveness.

The side effects of the anabolic-androgenic steroids follow from their physiological role, and from the fact that no drug produces pure effects. In males, the side effects include acne, baldness, testicular shrinkage, muscle and tendon stiffness, and some damage to internal organs. The estrogen effect of these drugs causes gynecomastia (development of breast tissue). There appears to be significant problems with the heart and liver in steroid abusers. And lastly, behavioral aggressiveness is a much debated, but real effect of the drugs.

In women, these drugs wreak havoc. The AAS masculinize women producing large muscles, deep voices, body hair, and large genitals. There is recent evidence the drugs are associated with birth defects. There is a reason these drugs are DEA scheduled and controlled substances.

Can you get a pretty good sense just from looking who may or may not be on each, or is that a game you stay away from?

Now would be a good time to discuss 'stacking'. Stacking occurs when athletes use different drugs in sequence to maximize their effects. For instance, an athlete might use testosterone, nandrolone, HGH, insulin and thyroid hormone for several weeks, later tapering the steroids to avoid detection, then adding an anti-estrogen or a masking agent. As you can image, stacking not only produces synergistic anabolic effects, but also potentates sinister deleterious side effects.

Since athletes who use anabolic steroids are drug cheats, utilizing an entire illicit underground pharmacy for the drugs, they tend to use other drugs too -- like narcotics, benzodiazepines, diuretics, and alcohol. If you look at the evidence of recent high profile cases, you will see someone like Chris Benoit was found to have anabolic steroids, narcotics, benzodiazepines, and alcohol in his system. It is extremely likely this mixture of potent drugs produces very dangerous behavioral and physiological side effects.

The 'sight test' is often used, but probably often wrong when looking at juicers. It may be that a rigorous routine of weight training, exercise, and diet can produce remarkable results in gifted athletes. However, rapid gain of muscles, rapid loss of fat, acne, edema (puffiness of the skin), and out-of-character aggressiveness produce questions about athletes. Certain athletes who appear to defy gravity as they age, also raise eyebrows.

Part Two now available above or by clicking here