For the Very Ill, Steroids Can Offer Hope

HOLCOMB B. NOBLE- NY Times, 04/20/99

Experts who study the effects of synthetic anabolic steroids are encouraged, for two distinctly different reasons, that two new trials of their use show a benefit for two groups of very sick people. One reason is the possible long-term benefits for the patients. But the other is that the trials may serve as a reminder of whom the drugs were not intended for: healthy people who use them in ways that can destroy their health.

The trials, reported last week, found that taking anabolic steroids helped kidney dialysis patients and people with H.I.V. regain some of the weight they had been losing uncontrollably as a result of their illnesses.

Dr. Gary Wadler, an anabolic-steroid authority at New York University Medical Center, points out that the first widespread use of the drug came after World War II for people who were wasting away from illnesses or injuries suffered in the war or in concentration camps.

It was for these people, the very sick, that steroids were developed, he said, not for healthy athletes seeking build bigger muscles to improve their athletic performance. These include baseball's new home-run king, Mark McGwire, who says he regularly takes androstenedione, a precursor steroid that quickly becomes anabolic once taken into the body. Professional baseball, unlike other athletic organizations, has not banned this substance. Medical experts say athletes frequently take anabolic steroids in doses high enough to have dangerous consequences, with some users known to have taken 10 to 100 times the recommended dosage.

These steroids are synthesized from human testosterone, the hormone responsible for male characteristics like increased muscle tissue, facial hair and a deep voice. Testosterone's effect as a muscle builder was discovered more than 100 years ago by the French physician Charles-Edouard Brown-Séquard, who in 1889 injected animal extracts into a dog and then into himself. At the time, he hypothesized that added testosterone would be good for human health.

"Brown-Séquard overinterpreted what was happening, but he turned out to be onto something, as history has shown," Dr. Wadler said. The synthetic forms of testosterone were designed to replace the body's normal supply of the hormone, which can be depleted by disease, and to help the patient regain strength, Dr. Wadler said in "Drugs and the Athlete" (Oxford Press), regarded as the definitive textbook on the subject.

Dr. Peter Goldberg, a consulting physician for the United States Olympic Committee, expressed similar concern about the expanding use of steroids, especially among teen-agers. Adolescent females are now the fastest growing group of users. With a colleague, Dr. Diane Elliot, Dr. Goldberg recently completed a program for 3,200 athletes in 31 high schools in Oregon and Washington among whom steroid use was reduced by a reported 50 percent.

In the clinical trials of anabolic steroids for kidney-dialysis and H.I.V. patients, low doses were used to reverse previously uncontrollable weight loss, which has been associated with a sharply reduced life spans among these groups. The patients, in the two separate studies reported last week in The Journal of the American Medical Association, were given the steroids in conjunction with exercise programs.

Both groups of patients increased muscle mass significantly more than a group given a placebo, and increased their abilities to do more exercise faster while becoming less fatigued. More studies are needed to determine how much and for how long steroids can be safely used, both doctors who directed the studies said. But they pointed out that the doses used by the athletes were much higher.

Weighing medical uses against the uses to enhance athletic performance, those who take steroids must ask: what is a safe dose and when does a dose become dangerous? The second question is being urgently studied at a number of major institutions.

In the meantime, Dr. Wadler said, all science really knows on the subject is this: It has been found safe to increase the amount of testosterone or testosterone substitute to the normal level among sick people whose supply has become depleted. But at some level above this, the substitutes can have disastrous results.

The list of problems doctors cite is very long: liver tumors, uncontrollably violent behavior, elevated cholesterol, enlarged veins in the liver that cause fatal bleeding, permanent stunting of growth in adolescents and blood clotting that leads to premature stroke and heart attacks.

The list of less serious but nevertheless undesirable effects is also long and includes large breasts in men and beards in women.

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