Performance-Enhancing Drugs: Steroids, Hormones, and Supplements

John Perritano

S E R I E S C O N S U L TA N T SARA BECKER, Ph.D. Brown University School of Public Health/Warren Alpert Medical School


Performance-Enhancing Drugs: Steroids, Hormones, and Supplements


Alcohol and Tobacco

Causes of Drug Use

Drug Use and Mental Health

Drug Use and the Family

Drug Use and the Law

Hallucinogens: Ecstasy, LSD, and Ketamine

Intervention and Recovery

Marijuana and Synthetics

Opioids: Heroin, OxyContin, and Painkillers

Over-the-Counter Drugs

Performance-Enhancing Drugs: Steroids, Hormones, and Supplements

Prescription Drugs

Stimulants: Meth, Cocaine, and Amphetamines


Performance-Enhancing Drugs: Steroids, Hormones, and Supplements John Perritano

S E R I E S C O N S U L TA N T SARA BECKER, Ph.D. Brown University School of Public Health Warren Alpert Medical School


Mason Crest 450 Parkway Drive, Suite D Broomall, PA 19008 www.masoncrest.com

© 2017 by Mason Crest, an imprint of National Highlights, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, taping, or any information storage and retrieval system, without permission from the publisher. MTM Publishing, Inc.

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Designer: Annemarie Redmond Copyeditor: Peter Jaskowiak Editorial Assistant: Andrea St. Aubin Series ISBN: 978-1-4222-3598-0

Hardback ISBN: 978-1-4222-3609-3 E-Book ISBN: 978-1-4222-8253-3 Library of Congress Cataloging-in-Publication Data Names: Perritano, John, author. Title: Performance-enhancing drugs : steroids, hormones, and supplements / by    John Perritano. Description: Mason Crest : Broomall, PA, [2017] | Series: Drug addiction and    recovery | Includes bibliiographical references and index. Identifiers: LCCN 2016003955| ISBN 9781422236093 (hardback) | ISBN    9781422235980 (series) | ISBN 9781422282533 (ebook) Subjects: LCSH: Doping in sports—Juvenile literature. | Athletes—Drug use—Juvenile literature. | Anabolic steroids—Health aspects—Juvenile literature. | Hormones— Physiological effect—Juvenile literature. | Somatotropin—Health aspects—Juvenile literature. Classification: LCC RC1230 .P4784 2017 | DDC 362.29/088/796—dc23

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Series Introduction . . . . . . . . . . . . . . . . . . 7 Chapter One: What Are Performance-Enhancing Drugs? . . . . . 11 Chapter Two: Steroids . . . . . . . . . . . . . . . . 25 Chapter Three: HGH and Other Hormones . . . . . . . . . . 39 Chapter Four: Sports Supplements . . . . . . . . . . . . 49 Further Reading . . . . . . . . . . . . . . . . . . 58 Educational Videos . . . . . . . . . . . . . . . . . 59 Series Glossary . . . . . . . . . . . . . . . . . . . 60 Index . . . . . . . . . . . . . . . . . . . . . . 61 About the Author . . . . . . . . . . . . . . . . . . 64 About the Advisor . . . . . . . . . . . . . . . . . . 64 Photo Credits . . . . . . . . . . . . . . . . . . . 64 Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there. Educational Videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text. Examples include news coverage, moments in history, speeches, iconic sports moments and much more! Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout the series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field. Words to Understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text, while building vocabulary skills.

Key Icons to Look for:


Many adolescents in the United States will experiment with alcohol or other drugs by time they finish high school. According to a 2014 study funded by the National Institute on Drug Abuse, about 27 percent of 8th graders have tried alcohol, 20 percent have tried drugs, and 13 percent have tried cigarettes. By 12th grade, these rates more than double: 66 percent of 12th graders have tried alcohol, 50 percent have tried drugs, and 35 percent have tried cigarettes. Adolescents who use substances experience an increased risk of a wide range of negative consequences, including physical injury, family conflict, school truancy, legal problems, and sexually transmitted diseases. Higher rates of substance use are also associated with the leading causes of death in this age group: accidents, suicide, and violent crime. Relative to adults, adolescents who experiment with alcohol or other drugs progress more quickly to a full-blown substance use disorder and have more co-occurring mental health problems. The National Survey on Drug Use and Health (NSDUH) estimated that in 2015 about 1.3 million adolescents between the ages of 12 and 17 (5 percent of adolescents in the United States) met the medical criteria for a substance use disorder. Unfortunately, the vast majority of these IF YOU NEED HELP NOW . . . SAMHSA’s National Helpline provides referrals for mental-health or substance-use counseling. 1-800-662-HELP (4357) or https://findtreatment.samhsa.gov SAMHSA’s National Suicide Prevention Lifeline provides crisis counseling by phone or online, 24-hours-a-day and 7 days a week. 1-800-273-TALK (8255) or http://www.suicidepreventionlifeline.org


When pro- and anti-drug information sit side-by-side online, it can be hard for kids to separate fact from fiction.

adolescents did not receive treatment. Less than 10 percent of those with a diagnosis received specialty care, leaving 1.2 million adolescents with an unmet need for treatment. The NSDUH asked the 1.2 million adolescents with untreated substance use disorders why they didn’t receive specialty care. Over 95 percent said that they didn’t think they needed it. The other 5 percent reported challenges finding quality treatment that was covered by their insurance. Very few treatment providers and agencies offer substance use treatment designed to meet the specific needs of adolescents. Meanwhile, numerous insurance plans have “opted out” of providing coverage for addiction treatment, while others have placed restrictions on what is covered. Stigma about substance use is another serious problem. We don’t call a person with an eating disorder a “food abuser,” but we use terms like “drug abuser” to describe individuals with substance use disorders. Even treatment providers often unintentionally use judgmental words, such as describing urine screen results as either “clean” or “dirty.” Underlying this language is the idea that a substance use disorder is some kind of moral failing or character flaw, and that people with these disorders deserve blame or punishment for their struggles.


And punish we do. A 2010 report by CASA Columbia found that in the United States, 65 percent of the 2.3 million people in prisons and jails met medical criteria for a substance use disorder, while another 20 percent had histories of substance use disorders, committed their crimes while under the influence of alcohol or drugs, or committed a substance-related crime. Many of these inmates spend decades in prison, but only 11 percent of them receive any treatment during their incarceration. Our society invests significantly more money in punishing individuals with substance use disorders than we do in treating them. At a basic level, the ways our society approaches drugs and alcohol— declaring a “war on drugs,” for example, or telling kids to “Just Say No!”— reflect a misunderstanding about the nature of addiction. The reality is that addiction is a disease that affects all types of people—parents and children, rich and poor, young and old. Substance use disorders stem from a complex interplay of genes, biology, and the environment, much like most physical and mental illnesses. The way we talk about recovery, using phrases like “kick the habit” or “breaking free,” also misses the mark. Substance use disorders are chronic, insidious, and debilitating illnesses. Fortunately, there are a number of effective treatments for substance use disorders. For many patients, however, the road is long and hard. Individuals recovering from substance use disorders can experience horrible withdrawal symptoms, and many will continue to struggle with cravings for alcohol or drugs. It can be a daily struggle to cope with these cravings and stay abstinent. A popular saying at Alcoholics Anonymous (AA) meetings is “one day at a time,” because every day of recovery should be respected and celebrated. There are a lot of incorrect stereotypes about individuals with substance use disorders, and there is a lot of false information about the substances, too. If you do an Internet search on the term “marijuana,” for instance, two top hits are a web page by the National Institute on Drug Abuse and a page operated by Weedmaps, a medical and recreational


marijuana dispensary. One of these pages publishes scientific information and one publishes pro-marijuana articles. Both pages have a high-quality, professional appearance. If you had never heard of either organization, it would be hard to know which to trust. It can be really difficult for the average person, much less the average teenager, to navigate these waters. The topics covered in this series were specifically selected to be relevant to teenagers. About half of the volumes cover the types of drugs that they are most likely to hear about or to come in contact with. The other half cover important issues related to alcohol and other drug use (which we refer to as “drug use” in the titles for simplicity). These books cover topics such as the causes of drug use, the influence of drug use on the family, drug use and the legal system, drug use and mental health, and treatment options. Many teens will either have personal experience with these issues or will know someone who does. This series was written to help young people get the facts about common drugs, substance use disorders, substance-related problems, and recovery. Accurate information can help adolescents to make better decisions. Students who are educated can help each other to better understand the risks and consequences of drug use. Facts also go a long way to reducing the stigma associated with substance use. We tend to fear or avoid things that we don’t understand. Knowing the facts can make it easier to support each other. For students who know someone struggling with a substance use disorder, these books can also help them know what to expect. If they are worried about someone, or even about themselves, these books can help to provide some answers and a place to start.

—Sara J. Becker, Ph.D., Assistant Professor (Research), Center for Alcohol and Addictions Studies, Brown University School of Public Health, Assistant Professor (Research), Department of Psychiatry and Human Behavior, Brown University Medical School



anabolic: the act of converting chemicals into life-sustaining compounds in the human body. dysmorphia: a mental illness in which you cannot stop thinking about your appearance. hemoglobin: a protein in red blood cells that is used to transport oxygen throughout the body. synthesize: to combine different chemical components into a new substance. testes: male reproductive glands that produce sperm and male sex hormones. testosterone: a hormone associated with male sex characteristics such as facial hair. transfusion: the transfer of whole blood from a healthy person into the bloodstream of another.


WHAT ARE PERFORMANCE- ENHANCING DRUGS? Perhaps no sporting event is as grueling and as body-punishing as the Tour de France, the world’s premier cycling event. The 21-stage race covers some 2,089 miles (3,360 km)—about the distance from Chicago to San Francisco—and includes treacherous mountain climbs across the Pyrenees Mountains in France and along the French Alps. Four cyclists have won the Tour five times. Only the American Lance Armstrong has won the race seven consecutive times, which he did from 1999 to 2005. It was a remarkable feat of endurance for anyone, but especially for Armstrong, who had overcome a life-and-death struggle with cancer.



Lance Armstrong riding in the Tour de France.


There was one problem with Armstrong’s accomplishments—he cheated. Armstrong was injecting himself with performance-enhancing drugs, or PEDs. In 2013, Armstrong admitted taking the male sex hormone testosterone and human growth hormone (HGH) to boost his performance. He also admitted using EPO, or erythropoietin, a hormone that increases the amount of oxygen flowing to a person’s muscles. EPO is supposed to give endurance athletes like Armstrong a competitive boost. In addition to taking these banned substances, Armstrong also admitted he had used oxygen-boosting blood transfusions . Many people had suspected that Armstrong was using PEDs. Their suspicious were confirmed by a report by the United States Anti-Doping Agency (USADA), which tests American athletes for PEDs. Armstrong, once the Superman of cycling, was stripped of his seven Tour de France victories and the Olympic bronze medal he had won at the 2000 Summer Olympic Games. He was also kicked out of cycling, becoming a pariah in the sport he once dominated. Armstrong’s dramatic fall came after years of steadfastly denying he used PEDs. Not only did Armstrong lose his medals, championships, and awards, but he also lost his reputation. Sadly, Armstrong is not alone. Thousands of professional and amateur athletes, including teenagers, use illegal steroids or other PEDs. It’s a win-at-no-cost attitude that can have dire consequences. Despite the laurels and awards, Armstrong put himself at great risk. Long-term use of PEDs can create myriad physical and psychological problems that could end in death.


Athletes take PEDs in the hopes of gaining a competitive edge. The drugs allow athletes to train harder and longer. As a result, they become faster and stronger. However, PEDs are banned by professional sports


organizations for a number of reasons. First, they give athletes an unfair advantage. Second, they are dangerous: the drugs can wreak havoc on users’ bodies and even alter how their brains work. PED users can suffer a range of lifelong problems, including infertility, heart and liver damage, difficulty managing aggression, and depression. Some have committed suicide or harmed others. However, the risks of stiff penalties for PED use in some sports have done little to curb their use. In fact, despite Armstrong’s PED legacy, PED use—also called “juicing”—is still widespread in cycling and many other sports. The constant refrain sports fans hear from athletes is that PEDs “level the playing field.” In other words, because their opponents are juicing, they have no choice but to take PEDs, too. To see this phenomenon in action, one only has to look at the 1998 Major League Baseball season, in which Mark McGwire of the St. Louis Cardinals and Sammy Sosa of the Chicago Cubs chased Roger Maris’s 37-year-old single-season home run record. McGwire slugged 70 homers that season, breaking Maris’ record by nine homers. The following year, Barry Bonds of the San Francisco Giants hit 73, besting McGwire’s total. But it wasn’t long before Sosa, McGwire, Bonds, and other top stars in baseball soon became mixed up in the greatest PED scandal in sports history. Baseball officials later conducted an inquiry into PED use, revealing that 5 percent of the 1,438 major-league players in the early 2000s had tested positive for PEDs. McGwire (who later admitted using PEDs) and Bonds (who has never admitted using them), along with other top stars, including the pitcher Roger Clemens, have been denied induction into the Baseball Hall of Fame, the highest honor in the game, due to suspicions of PED use. In addition to the physical and mental consequences, PED users take the drugs in the shadows, jeopardizing their careers, their lives, and their reputations. Yet the allure of these drugs is so powerful that many athletes have had a hard time acknowledging the negative consequences of their actions.

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