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Introduction
It can be seen throughout the history of sports that there have always been ways of enhancing an athletes performance. Some ways may be natural, but the one that brings the most controversy is the use of performance-enhancing drugs. These performance enhancement drugs are used by primarily athletes and bodybuilders to increase their muscle size and strength as well as their appearance and performance in events (1). The main type of performance enhancement drug is anabolic-androgenic steroids (2). The history of individuals using performance enhancement drugs can be traced back to nearly a century ago in 1939 when Germany was designing anabolic-androgenic steroids to help treat medical conditions such as depression and cryptorchidism. It has even been speculated that during World War 2 that the Nazis used these anabolic-androgenic steroids and gave them to their soldiers to enhance their performance and aggressiveness in battle (3). Use of anabolic-androgenic steroids then began to be used and abused by Olympic athletes until they were eventually banned in 1976. Even though they were banned, some athletes still continue to use them to this day and risk getting caught using the illegal substances. It is also not uncommon for these athletes to use multiple performance-enhancing drugs at the same time such as amphetamines and diuretics. An athlete may use a diuretic drug for the purpose of covering up the use of another performance-enhancing drug. The way that the diuretic does this is by diluting the urine of the athlete and some can even change the pH of the urine and only allow certain aspects of drugs to leave the body (4). Diuretics were eventually banned by the International Olympic Committee and the World Antidoping Agency and they continue to annually update the list of banned substances (4). With this list being annually updated and performance-enhancing drugs being harder to detect through a test, the ethical question must be asked about whether or not athletes should be allowed to use performance-enhancing drugs or not.
Just like any other argument, there are two sides and both sides will be addressed in this paper. The majority of this argument lies in the social and ethical issues of allowing athletes to use these drugs. One of the ethical issues is whether or not the spirit of sport would be violated by allowing athletes to use these performance-enhancing drugs. The spirit of sport can be defined as the values of ethics, the health of the players, and equality for all players (5). One side sees that performance enhancement drugs would make sports an unequal playing ground and would completely change the dynamics of sports as we see them today. From this point of view, it would turn sports into a competition of who has the better technology and substances to enhance their players and not necessarily a competition of who is more physical naturally (6). On the other side of this argument, the argument made is that performance-enhancing drugs are allowed in other professions and they are not nearly as criticized as much as professional athletes who get caught using performance-enhancing drugs. It has been seen that there have been musicians who will use beta-blockers to decrease their heart rate and blood pressure to control their performance anxiety and stage fright (6).
It has been mentioned earlier that these performance enhancement drugs can drastically increase the strength and endurance of an athlete as well as other advantages. These advantages need to be compared with the short-term and long-term effects on the physical and mental health of the individuals who choose to take these performance enhancement drugs. The majority of the short-term health effects of using anabolic-androgenic steroids for example are reversible, but the same cannot be said about the long-term effects (7). Some of the mental health aspects that can also be associated with performance enhancement drugs such as behavioral changes. The Dark Triad has been associated with athletes who choose to use these drugs. The Dark Triad consists of the personality traits of Machiavellianism, psychopathy, and narcissism and will be discussed later on in the paper (8). There are plans to implement a better support system for health issues that are associated with performance enhancement drugs and these will be addressed later as well. Although there are side effects seen that could be potentially detrimental to an individuals health, there is a side to the argument that sees the risk of performance-enhancing drugs as equivalent to any other risk that comes when participating in sports. Players are always at risk for injuring themselves in sports whether they are minor or major injuries, so it is important to take into account that the risks of short-term and long-term health effects of the athletes will not go away by not allowing performance enhancement drugs into sports.
Biology/Scientific Background:
Anabolic-androgenic steroids (AAS) are hormones that consist of testosterone and other derivatives. All AAS have both anabolic and androgenic effects on the body (Kanayama, 2017). Anabolism is when nitrogen is retained in lean body mass through protein synthesis and there is a decrease in protein breakdown. Androgenism is the physical changes in the body which primarily consist of secondary male characteristics (Osta, 2016). The anabolic effects include an increase in muscle growth and fat loss and the androgenic effects include deepening of the voice and increases other secondary male characteristics such as facial hair (Kanayama, 2017). The steroids are able to do this because the testosterone is an androgen and has different ways of effecting the body. One way is testosterone will bind to androgen receptors in target tissues and will work on producing androgenic effects such as secondary male characteristics and libido. The second step in how these drugs work is that then the testosterone will be reduced to 5 ±- dihydrotestosterone and will act on the androgen receptor. Another way that testosterone may act on the body is that it may be changed to an estradiol and have more estrogenic effects such as retaining water, increase in breast tissue size, and increasing body fat deposition (Osta, 2016). Besides testosterone, there are three other active compounds that are found in AASs which are nandrolone, boldenone, and trenbolone (Osta, 2016).
In order to use anabolic-androgenic steroids, testosterone first has to be isolated. This was first discovered in 1935 by Dutch and German chemists. By discovering how to do this, the intention of these chemists was to use these anabolic-androgenic steroids to treat medical conditions such as the dropping of testosterone levels in middle-aged men (Kanayama,2017). Once it was discovered that these drugs could be used to increase muscle size and strength and help with other athletic activities, they started to be used and abused by athletes in order to achieve an advantage over their competition. An infamous example of this was seen by the German Democratic Republic (GDR) during the Cold-War era. The entire country had a program set in place in which their Olympic athletes would be given AAS to increase their performance in the Olympics. Even though the use of AAS was banned by the Olympics in 1967, the GDR was able to evade detection by using various techniques to pass the urine tests that the Olympic committee had in place to test for the use of AAS. These techniques included having the athletes stop taking the drugs within a certain time frame before the test date was scheduled to take place (Kanayama, 2017). The GDR was able to achieve 150 gold medals between 1960 and 1990 before the information of this program was released due to the fall of the Soviet Union. It was also found that a majority of their athletes were females and they were suffering from substantial and even in some cases irreversible masculine characteristics due to the androgenic effects of AAS (Kanayama, 2017). Some of the effects that are experienced by female users include their voices deepening, decrease in breast size, acne, more body hair, and an increase in the size of the clitoris (Bird, 2015).
Although these changes were seen in females from the GDR, the majority of side effects of using AAS is seen in males due to the fact that majority of AAS users are male. Some of the other side effects seen by taking AAS include acne, hair loss, and urinary tract infections due to the prostate enlargement are due to the androgenic effects of AAS. The more serious side effects are seen in long-term and heavy users of AAS. Normally, AAS are taken either orally or injected during 4-12 week periods known as cycles. Heavy users are known to use a technique known as the mass building-stacks which is when the user will take testosterone and other drugs that will maximize their muscular and strength capacity. This will then lead into a cycle known as the cutting cycle which is where drugs with a larger dose of androgens will be taken for body definition. This cutting cycle will then be followed by a post-cycle therapy which includes drugs with anti-estrogens to restart androgen production in the users testicles (Osta, 2017). When going through these cycles, the kidneys are significantly impacted. Chronic use of AAS has been linked to renal failure. This could be due to the fact that diuretics are being used by athletes and bodybuilders along with AAS to help increase performance and as a masking agent.
Diuretics have been banned in sports both competitively and noncompetitively since 1988. One of the reasons why they have been banned is due to the fact that users can use diuretics due to the fact that these drugs have the ability to remove water from the body. This can allow athletes such as boxers or any other sport that uses weight classes to fluctuate between weight classes due to the ability of these drugs having the capability to cause rapid weight loss. The main reason why these drugs have been banned is due to the fact that diuretics can be used as a masking agent for other drugs such as AAS, which is why they are used in unison with these drugs (4). The diuretics will increase the volume of the users urine and will dilute the concentration of other substances that could be detected in the urine, making it harder to determine a positive test result (4).
A study at Columbia University that was conducted on ten bodybuilders who used AAS for many years and it was found that there was proteins leaking into the urine and there was a significant decrease in kidney function in these individuals. In 90% of the subjects being tested, it was found that they all had scarring on the kidneys that is usually seen when the kidney is overworked. The scarring seen was worse than what is seen in morbidly obese patients. The researchers conducting the study believe that when these athletes and bodybuilders are extremely increasing their muscle mass and size that it is causing their kidneys to increase their filtration rates. These increased rates put more stress on the kidneys which leads to the scarring and failure (https://www.sciencedaily.com/releases/2009/10/091029141202.htm). On top of the renal issues seen in AAS users, the main health concerns are involved with the heart and the hearts activity.
Testosterone is a prevalent ligand of androgen receptors in skeletal and cardiac tissue. With the prevalent use of AAS, it will cause harmful effects on the body such as cardiac toxicity (3). There have been studies to test to see how the prolonged use of AAS could cause cardiac toxicity. It has been seen that when someone takes AAS, it will cause changes in their lipid metabolism such as increases in low-density lipoprotein (LDL) levels and decreases in high-density lipoprotein (HDL) levels. This is due to the AAS increasing hepatic triglyceride lipase activity, which causes the LDLs to be made and the HDLs to be broken down (3). These changes are however reversible, but the risk of cardiac disease is three times more likely to occur when someone uses AAS. AAS has also been found to cause heart attacks in young patients who have never had any trace of coronary heart disease. This is due to AAS use causing coronary vessel reactivity. Once the AAS is in the body and the bloodstream, it will lower the production of cyclic guanosine monophosphate and does this by inhibiting geranyl transferase. This will work with the increased levels of LDL, not allowing nitric acid in the body to activate guanylyl transferase. This will in turn cause damage to the vascular endothelium in the heart (3). Another aspect of the body that AAS will have an effect on is the gonads and reproduction in the users.
Androgen is involved in the development of male reproductive organs such as the epididymis, vas deferens, seminal vesicles, prostate, and penis, and is necessary for puberty to take place as well. There is also a high amount of testosterone that is needed for spermatogenesis to take place (Osta, 2016). When an AAS user takes these drugs though, it will reduce the concentrations of gonadotrophic hormone, luteinizing hormone, and follicle-stimulating hormones due to the AAS preventing the hypothalamic-pituitary-testicular axis in the body (Bird, 2015). Another substance that is reduced in this process is globulin, which acts as a sex hormone- binder. These reductions in hormones will result in other changes such as smaller testicle size and altered sperm production and characteristics such as lower sperm counts, and altered motility and morphology (Bird, 2015). Most of these side effects seem to be reversible in users once they stop taking AAS after 4-12 months, but these results can lead to infertility in chronic users of AAS (Osta, 2016). AAS use has also been associated with mental health issues and this could be due to the physiological changes that happen to the brain with chronic AAS use (Bird, 2015).
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