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[Definitie:] "An ergogenic aid is any substance or phenomenon that enhances performance."
(Wilmore and Costill) 
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0 3 - 1 2 - 2 0 0 5 Anabolic Steroids: An Ethnographic Approach
Paul Goldstein For the most part, the illegal use of anabolic steroids is related to the nature of athletic competition. Many team and individual sports require that participants be at a continuous peak performance. Anabolic steroids affect tissue development and produce muscle mass which may temporarily improve athletic performance. But the dangers of steroids are well documented. Users may become quite aggressive and prone to violent behavior Continued use has been linked with tissue and organ damage, as well as various cancers. In the following [article] Paul J. Goldstein describes patterns of illicit anabolic steroid use. His research was based on observations and interviews with individuals who frequent fitness centers in New York City. Addressing the reasons for using steroids, Goldstein describes the physical and psychological effects of these drugs. He raises the concern that needle sharing among steroid users is a method of HIV transmission and discusses the potentially lethal effects of combining steroids with other drugs. The intent of this [article] is to make two sorts of contributions. The first is conceptual-to provide a sociological framework and a substance-abuse perspective from which the emergent social problem of anabolic steroid misuse may be viewed. The second contribution is to present some preliminary empirical findings from participant observation research that was done in health clubs and gyms in the New York City area. As part of this effort, interviews were conducted with bodybuilders, personal trainers (PTs), and gym staff. The poor quality of available data on the use and effects of anabolic steroids and their frequent contradictory nature is consistently bemoaned. There is clearly a need to advance beyond anecdotes, rumors, and locker-room gossip. Yet, it is important to realize that reports of such "gossip" provide an insight into the manner in which users perceive anabolic steroids, their motivations for use, and both their functional and dysfunctional experiences with these substances. The approach employed herein is part of a methodological tradition common to the study of drug abuse. it focuses on understanding users' interpretations of the etiology and meaning of drug abuse within their own sociocultural environment. This tradition, with its roots in phenomenology, is usually called qualitative methodology, or ethnography. Its primary focus is on users' perceptions of meaning and the contexts of initiation and sustaining of drug-abusing behavior (McBride and Clayton 1985). Data about the nature and scope of anabolic steroid use are difficult to collect and becoming more so, owing to recent upgrading of penalties for both steroid possession and sale. The Anti-Drug Abuse Act of 1988 upgraded federal penalties in this area. Some states had preceded the federal government in this regard, e.g., California; others have followed suit since the federal legislation; others are considering doing so. For example, Georgia has recently upgraded penalties for steroid trafficking to a third-degree felony status. This has reportedly made steroid users and traffickers in that state more reluctant to talk to researchers. According to one social scientist who had been interviewing high school and college steroid users, mainly football players, many participants in competitive athletics will no longer discuss their steroid experiences with outsiders, because they are afraid of being turned in (John R. Fuller, personal communication, January 1989). The key informants, or "guides," who have been introducing me into various health clubs and gyms in New York City and Long Island all cautioned me against publicly declaring any special interest in steroids. I was told that everybody would just "clam up" if they learned that was my primary interest. I have been presenting myself simply as a sociologist interested in the workout and fitness world. There are three principal areas in which information about steroid use and distribution must be generated: epidemiology, distribution, and consequences. Epidemiology Some sources provide a rough indication of the extent of steroid use. The Mayo Clinic estimated more than 1 million regular steroid users in America (Couzens 1988). It has been suggested that as many as 96 percent of professional football players may have taken steroids Oacobson 1988; Schuckit 1988). It has also been suggested that between 80 and 99 percent of male bodybuilders have taken steroids (Schuckit 1988; Hecht 1984; Lee 1985). There has been talk of increasing steroid use among female bodybuilders, as the trend in that sport has moved away from the goal of obtaining a "dancer's physique" towards increasing muscularity (Lee 1985). Buckley and colleagues (1988) found that 6.6 percent of a national sample of 12th-grade males reported using or having used anabolic steroids. Other scattered high-school level, epidemiological information includes an unscientific survey by Miami's South Plantation High School student newspaper in 1986. It sampled 200 of the school's 2,000 pupils. Sixty-five percent knew someone who was taking steroids (Miami Herald 1988). This sort of statistic is important, because other research in the substance-abuse field has shown that having drug using peers is one of the best predictors of drug use. Eleven percent of high-school football players in Arkansas were reported to be using anabolic steroids (Herrmann 1988). Thirty-eight percent of high-school football players surveyed in Portland, Oregon, knew where to get steroids (Charlier 1988). Many individuals who are informed about the high-school scene stress the importance of the steroid issue. Fred Rozelle, Executive Secretary of the Florida High School Activities Association, stated that "We face a lot of problems, but we feel that the number-one concern is steroids" (Phillips and Lohrer 1989, p. 4D). Don Leggett, a Food and Drug Administration (FDA) official, said, "Bulging muscles are in. Guys want to look good at the beach. High-school kids think steroids may enhance their ability to get an athletic scholarship, play professional sports, or win the girl of their heart. Steroid use in this country has spread down to general people" (Penn 1988, p. Al). Leggett A Philadelphia physical therapist who works with athletes stated, "People think the cocaine issue is big. It's not as big as anabolic steroids. Among kids, it's epidemic" (Charlier 1988, p. A20). Within the context of epidemiology, substance abuse researchers have tended to emphasize the concepts of a drug-using "career" or a "natural history" of drug use. Such careers, or natural histories, may be conceptualized as having three steps: 1. Initial stage of exploration. 2. Continuing stage, in which use is regular, and the identity of the user is established. 3. Cessation from use (usually preceded by growing ambivalence towards regular use and unsuccessful attempts at detachment). Exploration Stage Steroid use may be viewed as a search for a competitive edge in athletics. Many athletes have a win-at-any-cost mentality. Of course, this mentality is common to areas other than athletics. The rhetoric in these other areas is remarkably similar to the steroid rhetoric. For example, I recently received a brochure for a February 1989 conference on "Achieving Excellence." The conference included seminars in financial planning, organization, innovation, and leadership skills. One of the presenters was Nancy K. Austin, author of the 1985 publication, A Passion for Excellence: The Leadership Difference. The brochure announced her presentation as follows: Nancy K. Austin highlights how "winners"--even those in mundane, decaying, battered, or regulated environments--create and sustain their competitive edge. They don't just do a percent or two better than the rest, they do hundreds of percentage points better.... This presentation will highlight those who have achieved extraordinary results under fire and how they succeeded, while others faded away. I suspect that, if a pill or an injectable were available that was touted to guarantee such a competitive edge in business, or in grant writing, it would be used eagerly. Steroids function in this fashion with regard to athletics and body development. Of course ' what happens is similar to the arms race. Those with early access to an innovation do have an edge. Soon, however, the "have nots" catch up. In the case of steroids, the word now is that everybody is doing it and competitive steroid users no longer have an edge; they must use just to stay even with their rivals. There can be no question that there has been in escalation of muscularity in those areas in which muscularity is important. Professional athletes are bigger and stronger now than they ever were. The old cinema muscle men, like Victor Mature, look fairly puny compared to modern titans like Arnold Schwarzenegger. Charles Atlas, in his famous advertisements of three decades ago, looks like a pretty ordinary guy today. Competitive bodybuilders claim that persons who won major titles 10, or even 5 years ago, would have little chance against today's competitors. One bodybuilder claimed that today "the only way you can make even the beginnings of an amateur is by taking steroids." The use of performance enhancers in athletic competitions are neither new nor limited to steroids. Participants in 6-day bicycle races in 1879 were alleged to have prepared as follows: the French used a mixture made from a caffeine base; the Belgians ate sugar cubes dipped in ether; others drank alcohol cordials; and sprinters used nitroglycerine (STASH 1978). In 1886, a British cyclist died from using a drug containing ephedrine, a stimulant alleged to mask fatigue and remove physiological restraints intended to prevent overexertion (STASH 1978). In remarks to the January 1984 meeting of the FDA Endocrinologic and Metabolic Drugs Advisory Committee, Thomas Murray of the Hastings Center noted that performance enhancers were popular at the turn of the century. Vin Muriani, a widely used mixture of coca leaf extract and wine, was advertised as the wine for athletes. It was reportedly used by French cyclists and by a champion lacrosse team in Peru (Hecht 1984). A variety of other substances or techniques are employed by athletes who try to give themselves an edge on the competition. These include special dietary regimens, vitamins, bicarbonate loading (for short events), caffeine loading (for long events), and such psychological techniques as hypnosis. Some gyms sell a wide variety of products to their clientele. A blender will mix up an Aminofuel or Carbofuel drink for $2. or an extra $1, a banana will be added. Fruit punch-like concoctions that are billed as being rich in amino acids are sold for $2. In speaking with gym regulars, it becomes clear that some persons lack the sophistication to discriminate between such products and steroids. For young high-school athletes, getting big and strong enough to compete on the collegiate level may be vital for their future. Don Reynolds, chairman of the drug-abuse committee of Florida High School Activities Association, stated, "I think there is a lot more steroid use than we think there is. High schools is where it's at. That's where the competition for college scholarships begins" (Phillips and Lohrer 1989, p. 4D). Parents may contribute to this pressure to obtain athletic scholarships. Steroid use should also be viewed in the context of the search for substances that increase feelings and appearances of strength. Steroid research has been likened to the search for a "superman formula" (Schuckit 1988). Stories of great strength have intrigued our imaginations for centuries. We have television series like "The Bionic Man"; comic book superheroes like Superman and the Hulk; biblical supermen like Samson; legendary strongmen like Hercules; that staple of carnivals, the sideshow strong man; professional wrestlers; a long list of male movie stars, such as Victor Mature, Steve Reeves, and Arnold Schwarzenegger, whose muscular bodies were their main attraction for the ticket buying public. Weight-lifting competitions are popular Olympic events. Body building contests attract large audiences and are frequently shown on cable television. Children watching Saturday morning cartoon shows aspire to the impossible-to-achieve muscularity of superheroes, such as He-Man. Popeye's spinach-eating produces the great strength that allows him to vanquish his comical opponents. Clearly, there is something about muscular development and great strength that taps into something very basic to the male mentality. Sexual attractiveness is part of this. Young boys want to impress the girls with their muscles. One young man that I spoke to in a gym remarked that it is tough for high-school kids when a muscular guy takes their girl away. Some boys feel that they cannot compete with a guy who has a great body. It is a real incentive for them to try to develop their own bodies as fast as possible. Steroids present the promise that such aspirations can be achieved through chemistry in health clubs and gyms, I have observed the frustration felt by those who are working out intensely, yet who are not achieving substantial results. This frustration is intense for persons who are working out next to someone who is enjoying good results, i.e., getting bigger and stronger much more rapidly than they are. Such frustrated persons become targets of pushers who offer a short cut to physical development. Pushers may compliment persons on their successful workout regimen but stress that, if the person continues to work out at such a pace, it may take 5 or 6 more years of struggle and pain before the person will look that certain way. of course, there is a way to get there a lot sooner. That way is, of course, the use of anabolic steroids. Successful bodybuilders, especially competitors, are usually approached in a different fashion. Pushers of steroids may begin their sales pitch to successful bodybuilders by saying such things as the following: 1. "You're looking good, but you look unfinished. You need something in order to get that finished look." 2. "You look good enough to enter a competition. But you don't look good enough to win. You'll need something else for that." However, a former steroid user and PT who has worked with adolescents cautions against attributing most steroid use to competitive bodybuilders or other athletes: Forget that! I think the majority of people who use steroids don't have any idea of going into a contest. Let's not go in a direction that these steroids are being used by bodybuilders who aspire to be Mr. Universe. That's baloney. Steroids are being used mostly by men and women and young kids just for their ego. ... I see the kids using it today. it just blows my mind. They are using at a young age for one reason only, for their egos. Whether to get dates, whether to be part of a gang.... The peer pressure is enormous for strength. If you're not a rock singer, you damn well better be a muscle man. ... once bodybuilding hits you, it doesn't matter. Once the idea of strength and size, and feeling good about yourself and being admired and looked at , hits you, you could be from anywhere. Users also describe a euphoric state produced by steroids. One user said, "The anabolics make you feel good mentally They are a high." Continuing Stage For whatever reasons people begin steroid use, it appears that the addictive nature of the substance, the habituating effect of the workout routine itself, and the feelings of muscularity and strength that arise, create a syndrome of continued and habitual use. Addiction is a difficult concept to operationalize. Previous research with heroin users indicated that individuals who are typically classified as heroin addicts, in fact, have patterns of use that contain many peaks and valleys, and days of non-use are frequently intermixed with days of use (Johnson - et al. 1985). In other words, operational definitions of addiction, especially those employing a medical model, may be of limited value in predicting actual behavior of substance users in their environments over time. The classic behavioral definition of addiction was that advanced by Alfred Lindesmith (1947). Essentially, he argued that persons might begin using a drug for a variety of reasons, usually involving positive feelings produced by the drug. Individuals might continue to use the drug for this reason. However, real addiction sets in when the individual experiences negative feelings, such as pain or dysphoria in the absence of the drug, attributes these negative sensations to the lack of the drug, and begins to administer the drug to ward off the negative sensations, rather than attempting to achieve a positive feeling. A variety of knowledgeable sources, including Robert Voy, have argued that in addiction syndrome exists with regard to anabolic steroids (Jacobson 1988; Schuckit 1988). Craig Whitehead, who directed the drug-rehabilitation unit of the HaightAshbury Clinic, stated, "The dependence many people develop on steroids is classic" (Cowart 1987a, p. 427). The addiction syndrome that has been described to me by habitual steroid users harmonizes well with Lindesmith's definition. Users claim that steroids function to anesthetize the body. Steroids enable the user to work out intensely, without feeling pain. However, when the user stops taking steroids, muscles and joints (especially) become very sore. Old injuries or strains that were not even noticed before begin to be very painful. The ex-user cannot work out anywhere near the level that he or she did while taking steroids. It is just too painful now. Indeed, common everyday physical tasks may become difficult and painful. Psychological feelings of depression set in. if the user returns to steroids, the pain disappears. The depression disappears. One's body feels good again. One can return to one's workout regimen. A PT whom I interviewed described some manifestations of this addictive state of mind: I hear it all the time. I heard it just yesterday ...three guys ... I asked them how they're doing. They said, "Well, good. I just got back from skiing. I can't wait to get back on the stuff." That's all you hear. And another guy, "How you been?" "Good, doing all right, you know, maintaining, but in 2 weeks I got all my stuff together now, I'm going back on the stuff." These are not competitive bodybuilders. These are just gym guys who are printers and going to school. A steroid user described to me the manner in which steroids affect the psychology of users and function to perpetuate use: If you never use [steroids], you use your natural inclination to drive forward. Whatever may have been your driving force, whether it was to show your father that you can succeed in life, or whether it was being insecure and needing to have assurance from the world that you can be somebody.... if you have that burning up so hard in you, then you can make it with that. But once you get on the steroids, you'll lose that ability to call upon self. It then controls you, and you actually lose the ability to ever do that again. There's a part of you that goes and never comes back... if you do it for one little 12-week cycle, and you can manage to get off it, and you say, "This was not for me," God bless you. But if you're stuck on that stuff for a year, you're hooked for life. You're no longer a virgin ... you're finished. You forget a lot of the innocence that you had. Or a lot of the natural drive that is in there. 'Cause this stuff gives you a new level of aggression and power that you can't achieve on your own by thinking it out on your own anymore. You just can't. You try! Like you're lifting a dumbbell, and you give up. "I ain't going to do it. I'm leaving." But you go to the gym when you're on that stuff, and everything is going good, and your levels are real built up high.... You take that weight, 40 pounds heavier, and you do it. Screaming! Crazy joy.' Ecstasy! It is like having an orgasm. It's better. You don't have any idea what it's like.... It's total orgasm. Oneness. It is like a one-cell creature reproducing itself It's just incredible.... The fire, the escalation of joy and excitement, the conquering of it. And it's nowhere near as exciting when you're off the stuff as when you're on it. You just feel so good that you just want to buy 20 bottles more. That's the way it is. It's crazy. Some users say that feelings of power become so associated with steroid use that persons begin to use steroids for social situations in which they feel insecure. For example, adolescents may take steroids before going to a party because they feel nervous, and the steroids give them a sense of being able to handle the situation. In this case, the drugs address basic feelings of inadequacy. One user stated, "You get to believe in the drugs so much that if you need a crutch you will take a few extra pills." Several factors appear inextricably linked in a steroid addiction syndrome. For example, steroid users find it almost impossible to analytically separate the drug from the workout itself. They say that one would just not exist without the other. Without the drug, there would be no workout. Without the workout, there would be no need for the drug. It should be noted that persons who do not use steroids, yet who are also committed to working out frequently talk about the addictive nature of a workout regimen. But serious steroid use and habitual working out seem to dissolve into a unitary lifestyle. One user vividly described this reality: You get into the vicious cycle of doing more and more and more and doing new sophisticated stuff... Then, once you're on the stuff, you feel differently. See, you're on it and all of a sudden you're making the gains .... And you're strong. And you have no pains like you had before. You're very euphoric. You kind of feel indestructible. And nothing matters. They can steal your car. You know, so what? if you caught the guy, you would kill him. But if you didn't, all right, the car's gone. As long as the gym is open.... Don't steal your food. Don't steal your steroids. But you can take my car, my wife, take anything you want. That's really how you become. And you don't know it. You're in this fog. The gym culture itself tends to perpetuate steroid use. The gym culture is very competitive. Bodybuilders are always comparing themselves to other gym regulars or to the proverbial "new guy," as to who is biggest and strongest. Persons who are getting bigger and stronger may feel puny and weak because a gym buddy is progressing faster than they-lifting more weight or adding more lean muscle. Girls hanging around the gym gravitate towards the biggest, strongest guys. Friends exert pressure to get back on "the stuff." The grapevine is filled with gossip about who is selling what. Special "deals" may be offered. The peer pressure to continue steroid use is strong. Cessation From Use Steroid users that I have talked with tend to cease their use for one of two reasons. Most younger persons seem to "mature out" when they reach an age at which career, marriage, and all the trappings of conventional lifestyles become more highly valued than a macho image of great strength and size. Older, long-term steroid users tend to quit only when their health is seriously threatened. A long-term steroid user who had been a highly successful competitive bodybuilder claimed to have almost died from liver problems about 3 years ago: After I got sick I had to come off it, or I never would have come off it. I would never have come off of steroids if I didn't get sick. Never! I'd still be using it today and trying to compete at 40. But I was forced. I almost died. So, you choose between that and living. You find out living is not so bad. Distribution Until recently, black-market sale of steroids was estimated at more than $100 million per year Couzens 1988; Penn 1988; Kahler 1989). However, this estimate was recently upgraded to between $300 and $400 million per year by Leslie Southvick, Deputy Assistant Attorney General (1990). It has been estimated that more than half the steroids smuggled into the United States are counterfeit, frequently bearing the names of reputable manufacturers. Most supplies are alleged to come from Mexico (Penn 1988; Kahler 1989). These counterfeits are often produced in crude, unsanitary laboratories and are of dubious purity. Counterfeit steroids are also being manufactured in this country, in makeshift laboratories that are springing up around the United States. My own sources in gyms in the New York City area have suggested that as much as 80 percent of the steroids that they encounter are counterfeit. One clandestine laboratory, Fountain Valley Research Laboratories, Inc., located 35 miles south of Los Angeles, was shut down recently. It produced hat were labeled as East German steroids. The labels read: Eigentum Der DDR-Versenden Getetzlich Verboten-"Property of GDR, export prohibited." The steroids fetched $180 per bottle. "East German steroids are rated the best," said a California lawman. "Their athletes have the reputation of being better, bigger, and stronger" (Penn 1988, p. 20). The Department of justice has recently expressed an interest in the use and trafficking of steroids. Assistant Attorney General John Bolton stated the following: Not only are we concerned with the risks associated with the unprescribed use of legitimate steroids [by adolescents], risks such as upsetting the hormonal balance and stunting growth, but of equal or greater concern is the unauthorized use of illegitimate steroids which have no FDA approval and are made under less than sanitary conditions. We think it's a very dangerous problem.... You will see a lot more prosecutions. Prosecution of steroid cases is a priority for the civil division. (Kahler 1989, p. 29) Justice officials have reportedly obtained federal convictions or guilty pleas against 60 steroid traffickers in the 2-1/2 years preceding October 1988. About 120 more persons face charges (Penn 1988). In December 1988, former British Olympic medalist David Jenkins was sentenced to 7 years in prison, followed by 5 years probation, and was fined $75,000 for his role in arranging for a Tijuana plant, Laboratorios Milano de Mexico, to produce anabolic steroids and smuggle them across the border for distribution in the United States (Kahler 1989). There are indications that traditional drug traffickers are involved in steroid distribution. There are also indications that they are conducting their business in the traditional ways of drug traffickers. The following account appeared in the Wall Street Journal: According to criminal charges filed in San Diego last year, when a man in Phoenix reneged on a steroid deal, his supplier sent an emissary named Leonard T. Swirda. Mr. Swirda took along an accomplice carrying a 12-inch club, a double-edged knife and leather gloves weighted with metal, says the indictment, which accuses Mr. Swirda of beating and cutting the dealer. In a separate action, Mr. Swirda last May was indicted for cocaine trafficking in Spokane, Washington. (Penn 1988, p. Al, A20) The underground world of steroid use and trafficking is prone to the same sorts of hustles and scams that we are more used to hearing about with regard to street drugs, such as cocaine or heroin. One common hustle concerns the difference in price between generic and name-brand steroids. Brand names, of course, fetch a higher price. Inexperienced users are frequently sold generic steroids, but are charged brand-name prices. A former steroid user, speaking of the great prevalence of bogus steroids, recalled a product called Bolasterone: Bolasterone. it swept the country. They made millions. Millions, these California guys. All it was, was vegetable oil, a little bit of testosterone, and liquid aspirin. And they called it Bolasterone. And they hyped it up so much. It was selling for $250 to $275 a bottle. You would do anything to get this stuff. [They said] "Mr. Olympia used it! Secretly." I tell you, Madison Avenue could not have come up with a better campaign to sell this stuff... if you had a bottle of it, I mean you could sell it for anything.... [It was hyped] through the grapevine. Underground. The network is incredible. From gym to gym to gym.... They'll say, "Did you see M.? He put on 15 pounds in a week." "What the hell is he using?" 'Don't say anything. He's using Bolasterone" "wow. What the hell is it? Can you get it?" "Yeah, I can." It is difficult to estimate actual costs to users because of a wide variability in patterns of use. Serious long-term users may spend as much as $200 to $400 per week on steroids and the accompanying pharmacopoeia. Since such users may go on cycles of steroid use lasting 12 to 14 weeks, each cycle can cost in the thousands of dollars. Users are generally afraid of being caught short in the middle of a cycle, and like to have all the drugs that they will be using in hand before they start their cycle. Cycles generally begin with a few pills of this kind, a few pills of that kind during the first week; gradually the number and strength of pills is increased; then injectibles are introduced into the Cycle. As the weeks go by, the number of pills and shots increase, until a plateau is reached; for example, about the ninth week of a 14-week cycle. Then users come back down the same way they went up. Younger, or less experienced or committed users, will use considerably less. Some persons may be long-term users, but take only one injection per week. Adolescents may go on shorter cycles, perhaps only 6 weeks. Some adolescents will only use when they have the money to do so. These youngsters may take a very few pills or shots on an irregular basis. As with most drug use, a primary way of supporting one's own steroid use is trafficking in the substance. Also, since many users do not use that much, they are able to support their steroid use by working, getting money from women, stealing from their parents, or engaging in petty theft. Competitive athletes may be supplied by coaches, promoters, or other interested parties. Steroid use may also be supported by male friends. Older or wealthier homosexuals are frequently interested in the company of young, male bodybuilders. These homosexual liaisons may involve sexual activity or remain at the friendship level. Older bodybuilders report that this phenomenon was more common prior to the advent of AIDS than it is today. Male bodybuilders may obtain employment for which their muscularity especially qualifies them. Some examples of these sorts of jobs include bouncers, male dancers in such clubs as Chippendales, and models. PTs One of the hallmarks of the sociological approach is a focus on social structure and social roles. David Matza summarized the sociological approach nicely in a discussion of delinquency: The distinguishing feature of sociological theory, in contrast to formulations stressing personality, lies in the prominence of the social situation. Sociology brings to the foreground the social circumstances that form the backdrop for personality theory. (Matza 1964, p. 17) In doing ethnographic research in health clubs and gyms, I was struck by a particular social role the PT. PTs enjoy a high status in the "workout" world. They are the cognoscenti, the knowledgeable insiders, the gurus. They instruct their clients in a wide variety of areas, including workout techniques, diet, nutritional supplements, and sometimes in the use of steroids. PTs typically work with a heterogeneous clientele that may include overweight housewives, professional football players, competitive bodybuilders, adolescents who want to look better, and simple gym habitués. Most clients do not appear interested in ascertaining potential PTs' educational or professional credentials; they are more concerned with how PTs look. If a PT has a title, e.g., Mr. America, that seems to carry the most weight with potential clients. The title is proof of the PT's ability to condition a body; it is a real status thing to be able to say that Mr. America is one's PT. Additional status is held by PTs with ties to professional athletics. It enhances clients' status to be able to say that their PT trains football players. It is also fun to feel like an insider, e.g., to get some gossip about sports celebrities. Individuals become PTs for a variety of reasons. The basic reason is, of course, money. PTs tend to be young men and women beginning a career in the fitness business, young athletically oriented persons who reject a 9-to-5 office existence, or older athletes who are retired from competition and who may have few marketable job skills. Health clubs pay very low wages. At one health club that I visited, the fitness director, who had 3 years experience, a bachelor's degree, and some credits towards a masters degree, made $ 19,000 per year. There is a need to supplement salary by taking on private clients, who will pay about $25 per hour. Bartering is not uncommon among PTs. For example, one young female PT that I spoke with has a client who is a psychiatrist. They exchange hours of physical training for hours of therapy. PTs' income may be erratic. Clients go in and out of phases of life dedicated to working out. Clients are usually fairly wealthy and may do lots of traveling. They may go south during the winter, cutting substantially into a PT's income. PTs may recruit and see clients at a number of different health clubs or gyms. They may spend some mornings at this gym; some afternoons at that gym; some evenings at yet another. They may also go to client's homes. Their network of contacts tends to be far-reaching. There appears to be a growing professionalization of the fitness field, exemplified by the growth of degree programs in physical education, biomechanics, exercise physiology, and so on. New young holders of professional certifications are in conflict with older fitness and bodybuilding trainers whose knowledge is experiential rather than learned from books. Older PTs used their own bodies as their laboratories, experimenting with various workout routines, nutritional programs, and drugs, including steroids. The success of particular regimens was subjectively determined and also objectively determined in terms of looks, performance, and titles achieved. I have observed conflict in health clubs between younger credentialed PTs and older non-credentialed PTs. They argue over which pieces of equipment to install and what sort of training regimens are appropriate to use. They are in competition for clients, scarce jobs, and the acceptance of their point of view, as to how the subject matter in their field should be taught. The situation may be viewed, from the standpoint of occupational sociology, as a case of developing professionalism, which poses interesting sociology-of-knowledge issues, regarding experiential vs. academic knowledge. The prevalence of PTs is difficult to estimate. Most trainers that I spoke with were reluctant to make any quantitative estimates. The best "guesstimates" that I was able to obtain were that there are about 1,000 PTs in New York's Nassau County going to persons' homes, and about 1,500 working in clubs. The American College of Sports Medicine certifies trainers, but it appears that most trainers work without certification; and, hence, it would be difficult to ascertain how many PTs there actually are. For comparative purposes, there are approximately 1,200 Aerobics and Fitness Association of America (AFAA) - certified aerobics instructors teaching on Long Island, which includes Nassau and Suffolk counties, according to Peg Jordan, editor of American Fitness magazine. However, about 50 percent of all Long Island instructors have had no professional training at all. That percentage is better than the national average, in which only an estimated 17,000 of 100,000 aerobic instructors are AFAA-certified (Hancock 1989). PTs play an interesting role with regard to steroid use and distribution. Some may be users themselves. PTs may be motivated to use steroids, because they feel a need to look perfect. Their ability to secure and maintain clients may depend on how good they look, how good their clients perceive them as looking, and how they perceive themselves as looking. More important, PTs, as bodybuilding gurus, have a strong influence on their clients. This influence may be exerted to encourage or discourage steroid use. Experienced PTs, because of their wide networks of contacts, may be pressured by clients to supply them with steroids. PTs may be financially motivated to supply steroids to clients that ask for them. In addition to the profit to be made from selling steroids, PTs are primarily concerned with maintaining clientele. if they do not supply steroids to a client that requests them, the client may find another PT that will supply steroids. The original PT then loses a client. One PT remarked that, for this reason, he will not train bodybuilders anymore: It just got to be too nuts. What with you trying to please everybody. Who wants this, who wants that, and you're watching everybody self-destruct. I couldn't take it. When you train bodybuilders, that one-to-one trainer will certainly be looked upon as the guru of many things. And certainly, it affords the trainer an opportunity to make a lot of money. But it isn't the one-to-one trainer who is the source of distribution of the stuff. Really. it occurs, and it happens, but he isn't the main. He doesn't get into it to do that. Older PTs, especially those who are or have been steroid users themselves, express horror at the naivety with which many young persons approach the use steroids. Many PTs feel a responsibility to coach the young person in the proper use of these substances to minimize the potential health consequences. A 57-year-old man who claimed to have taken one shot of decadurabolin per week, "forever," say that the kids today were worrying him: [They are] ... using so much stuff. I walk into the gym and they're all 17 years old, and they all look like pus heads .... They are all puffed out with water. And they have very little muscle. Because they are just throwing crap into their bodies. They have no idea.... And who knows what they are doing to their insides.... They're stupid by taking the steroids so wrong. A PT remarked that everyone is different, and the steriod users must be medically monitored, both while on cycles and when between cycles: Blood tests ... white-cell counts. we're looking to see liver, kidney problems. We are looking to see pancreatic and pituitary problems. We want to see their testosterone levels, estrogen levels, nitrogen levels. We want to see their blood-sugar level, thyroid, adrenal, and, if they have normalized, they can go back on them. If it's 4 weeks, they can go back on them. If it is 4 months, they have to keep taking the test until they're normal. If not, no sense going back on it again. The body won't react. They just You do need a healthy body to keep getting worse. You do need a healthy body to keep this stuff working to the maximum. Additional factors mentioned as important were levels of minerals, such as calcium and magnesium. Steroids are calcium-depleting. [Huh? Corticosteroïden, maar androgenen niet - red.] With regards to steroids currently being used, I am told that the trend today is towards veterinary steroids. one user described this trend in the following way: Veterinary drugs are cheaper, they come in much larger quantities, and they're much better.... They're more anabolic. The androgenic ones tend to build fat, hold water.... Race horses are the biggest users of anabolic steroids. They cannot breed a horse that's full of water and fat. Every tiny micro-ounce must be muscle, or he's not going to win a race. He cannot carry any extra weight. So, if you have ever seen a race horse up close, it's built like the greatest bodybuilders of the world. They are ripped to the bone. And they are very muscular and thick. So, that has certainly seeped its way down ... in the list 20 years. And a lot of the drugs they are using now are the veterinary drugs. The Winstrol-V, land others].... They come in these huge 50-cc bottles. I don't think the veterinarians are selling them to bodybuilders. I think they're a lot more sensible than that. But it is filtering down through the veterinary market. I think maybe the distributors or the salesmen have found the market. Consequences Some experienced steroid users place much of the responsibility for the current problem on pharmaceutical companies and suggest that the nature and scope of health consequences are likely to increase in the future. A long-term steroid user stated the following: Athletes that used them in the late forties, they ... used it very sparingly, so anybody who developed a tumor here or there, it had to be very scarce. Then the fifties came, and some synthetics came in to being used. Then the sixties came, and a little more research got involved in it. Around the late sixties or early seventies, the drug companies realized there was a hell of a market here for the stuff. So, they threw some dollars into research. Now, the steroids are so sophisticated and are getting even more sophisticated. The old ones are not even available anymore. They got a whole new line.... The more powerful ones weren't being used, certainly not as often as today. Now, in the eighties, and going into the nineties, they are using anabolics that ... work so fast, they are so powerful ... I don't think the body has caught up with the dosage or the science of it all.... And not as many people were using it as they are today, because the sport [bodybuilding] was not as popular in the past as it is today.... So, 20 years from now, you're going to see a whole bunch of people dying. But you are going to have to wait 20 years. There is a long list of health consequences that have been associated with the use of anabolic steroids. Unfortunately, good clinical documentation and elaboration, obtained through rigorously controlled experimental studies, is lacking in most areas. However, the list of commonly discussed health consequences of steroid use includes liver problems (tumors, peliosis hepatis), kidney problems, hypertension, psychiatric problems (depression, aggression), sexual problems in males (testicular atrophy, decreased sperm production, gynecomastia), sexual problems in females (menstrual irregularities, shrinkage of breast tissue, hypertrophy of the clitoris, facial hair, deepened voice), acne, physical injuries, cholesterol difficulties, cardiovascular problems, stunted growth in adolescents, male pattern baldness, fetal damage, gallstones, and so on. Since most of these topics are covered by other chapters in this volume, I chose to focus my discussion of health consequences on only two areas that are of traditional interest to drug-abuse researchers: (1) interactions between steroids and other drugs and (2) needle sharing. Steroids and Other Drugs In the area of health consequences, the National Institute on Drug Abuse (NIDA) should have a special interest in interaction effects between steroids and other drugs of abuse. In this regard, experienced steroid-using bodybuilders hold a taken-forgranted prohibition against using cocaine while on a steroid cycle. They claim that there is a great danger of heart attacks if the two substances are mixed. One user stated that whenever he reads of a young athlete dying suddenly of a heart attack, he immediately suspects an interaction between steroids and cocaine. Amphetamines may be used to help drive the workout regimen. Long-term steroid users report that, as the years go by, steroids lose their ability to provide the driving force for the workout routine. At this point, "speed" may come to be used. Under the influence of speed, bodybuilders report going "nuts," working out until totally exhausted, and then "failing out." No one that I have spoken with reported any specific interactions between alcohol and steroids. In fact, most of the bodybuilders who shared their experiences with me were very moderate drinkers or abstainers. Interestingly, one person observed that, in his opinion, persons who have great tolerance to alcohol tend to have a great tolerance to steroids: Those who get drunkon a beer really get a lot of side effects real quick on steroids. Migraine headaches, bloody noses, deep acne-tremendous scarring of the face. It is funny.... Experienced steroid users also report using a wide variety of other drugs along with steroids. The primary purpose of these other drugs is to cope with the side effects of the steroids. For example, in order to prevent or retard the spread of acne, antibiotics are used. Nolvadex is medicine used in the treatment of breast cancer. It is an antiestrogen. Bodybuilders may use Nolvadex during steroid cycles to keep their estrogen levels down. When coming off a steroid cycle, human chorionic gonadotropin (HCG) and Clomid are used. HCG is a polypeptide hormone produced by the human placenta. It is derived from the urine of pregnant women. The use of exogenous hormones (steroids) tends to depress the body's natural hormone production. Heavy steroid users wish to return to normal levels of testosterone as quickly as possible when they come off a steroid cycle. They claim the body is usually sluggish and just takes too long to return to normal hormonal activity. HCG is reportedly used to simulate an estrogen buildup in the male which "shocks" the system into a more rapid recovery. [Onzin - red.] Clomid, a female fertility drug, is alleged to perform the same trickery. Teslac and Halotestin are also reported to accomplish this result. [Laat je niks wijsmaken - red.] Long-term steroid users claim that there is a right way to do steroids which involves full knowledge of pharmacological "chain reactions." The above discussion has just presented a few of the substances that are commonly employed by anabolic steroid users who were interviewed in the New York City area. Some of these users maintain amazing pharmacopeias. There are two contrary health-consequence aspects of this multiple-drug use. The first relates to the utility and dangers of this wide range of drugs being used by the most pharmacologically sophisticated steroid users. The other health-consequence aspect refers to the fact that many users are not sophisticated; they are not aware of potentially damaging side effects or the means for circumventing them. Many young men can barely afford the steroids that they are using. They see the purchase of these other substances as a low-priority item in an already strained budget. A sophisticated PT stated the following: These kids, of course, don't know anything about this.... I get the reaction from them like I have two heads. Some of them don't want to listen to it. They say, " I'm just taking my 'tes' or my Dianabol 'cause my friend is taking them." But anybody who is serious about going on them ... and who is really interested in his health and going on a couple of cycles, will have to absorb this. Needle Sharing Persons using injectable steroids are prone to all the health hazards common to needle users of any substance. This includes diseases associated with bacterial infections caused by injections with non-sterile equipment. This practice may lead to localized infection problems, such as abscesses and cellulitis, or systemic problems, such as endocarditis, hepatitis, and AIDS. A competitive bodybuilder reported that a number of his colleagues had problems when they were first learning how to inject themselves: A lot of people don't know how to do it. They do it eventually, because they feet they have to. Or they get a friend who learned from a friend who learned from a sister who is a nurse. That's generally how it works. And you learn how to put it in a muscle. A lot of guys have come to me that they hit a vein and they are black or blue.... You hit too much in the same site and you get tumors all the time. A lot of bodybuilders had to get those cut out.... Actually, you get huge fibroid lumps that develop from hitting the same sites. Harold Connally, an Olympic gold medalist in the hammer throw, testified to the following before a 'U.S. Senate Committee in 1973: It was not unusual in 1968 to see athletes with their own medical kits, practically a doctor's, in which they would have syringes and all their various drugs.... I know any number of athletes on the '68 Olympic team who had so much scar tissue and so many puncture holes on their backsides that it was difficult to find a fresh spot to give them a new shot. (Hecht 1984, p. 14) All competitive athletes that I have spoken with denied using dirty needles or sharing needles. As one person stated, "The guy who's selling you the needles wants you to buy 100 needles. He don't want to sell you two needles." However, in some inner-city gyms, I did get reports that heterosexual lovers, perhaps spouses, who are working out together will sometimes share needles. It's part of the "we do everything else together, so why not this" feeling. A young woman told me that such couples decide which muscles they will work on that day, inject into that muscle, sharing the needle, and then go and do their workout. A 1984 letter to the editor of The New England Journal of Medicine from six physicians at Nassau Hospital in New York described a case of AIDS in a bodybuilder using anabolic steroids. This was a 37 year-old white male who denied any history of homosexual activity. He did admit to injecting cocaine intravenously on one occasion approximately 6 months prior to hospital admission. During the 4 years before admission, the patient had injected anabolic steroids intramuscularly on a weekly basis. The needles were often shared with other bodybuilders at various gyms. The physicians state that their experience with this patient indicates that intramuscular injection of anabolic steroids through shared needles may serve as a mode for dissemination of the AIDS virus. "Because this practice appears to be common among many athletes ... persons at risk must be warned" (Sklarek et al. 1984, P. 1701). A recent issue of Sports Illustrated featured a story on Benji Ramirez, a 17-year-old boy from Ashtabula, Ohio, who was alleged to have died from steroid-related heart problems. While there appears to be some question as to both the cause of death in this case and the nature and extent of Ramirez's actual involvement with steroids, the story does contain the following account: Another of Ramirez's classmates ... says that on two occasions last summer he purchased steroids from Ramirez and used them in his company. In both instances, Ramirez injected the classmate in the buttock and then injected himself. (Telander and Noden 1989, p. 78) It is not clear from this account whether the boys shared the needle. The possibility seems to be present here and in other cases, in which naive youngsters with limited financial resources may be involved with injectable steroids. Needs for Further Research It is customary, and frequently gratuitous, to end a research paper with a statement of the need for future research. However, in the area of anabolic steroids, that need is clear and immediate. The following sorts of data are needed: 1. Good epidemiological data are needed regarding incidence and prevalence of steroid use in different populations. 2. Data are needed on the frequency and volume of steroid use in different populations, including data on concomitant use of other substances with steroids. 3. Data are needed regarding the consequences of increasing criminal penalties for use or possession of steroids. 4. Data are needed on the health consequences and other effects of long-term use of steroids. 5. Data are needed on the natural history of steroid use in different populations, including patterns of use and cessation associated with different stages of life. 6. Given the general trend in society towards drug testing, and the specific trend towards steroid testing in both amateur and professional athletics, data are needed on (a) what should be done when a steroid-problem area, e.g., high school football, is identified; and (b) what should be done when a specific steroid user is identified. 7. Data are needed on the patterns of steroid distribution, and how they are similar to or different from distribution patterns associated with other substances. Of special interest in this regard is the extent to which systemic violence may be beginning to be associated with black-market steroid sales. 8. Data are needed on the cost of steroid use, and how users support their consumption. 9. Data are needed on the extent to which counterfeit steroids have penetrated the market and the specific sorts of problems associated with these substances. 10. Data need to be generated on the extent of needle sharing among steroid users. Special attention should be paid to gay populations in this regard. 11. Data are needed on the effect of steroid use among persons with existing mental disorders. 12. The role of steroid use in sports injuries needs to be further explored. References
Buckley, W E., Yesalis, C. E., Friedl, IC E., Anderson, W A., Streit, A., and
Wrightj E. Estimated prevalence of anabolic steroid use among male high-school
seniors. JAMA 260(23):3441. 3445,1988. |
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