1. ( AB ) USE HORMONES PERFORMANCE-ENHANCING ( AB ) USE OF HORMONES Dr, Hossein Zaeri Assistant Professor of Pediatric Endocrinology & Metabolism

2. Hormones Common Hormonal drugs for (AB)Use Anabolic Steroids Growth Hormone

3. Anabolic Steroids Anabolic-Androgenic Steroids (AASs): Chemically modified analogues of testosterone First isolated in 1935 AASs have been modified many times to maximize the anabolic effects and to minimize the androgenic effects These analogues are degraded much more slowly than endogenous testosterone is, resulting in a higher prolonged concentration of the analogue

4. Anabolic Steroids Various AASs: (1) Endogenous androgens ( Androstenedione, DHEA) (2) 17β-esters of testosterone (Cypionate, Enanthate, Heptylate, Propionate, Undecanoate) (3) 17α-alkyl derivatives of testosterone (Methyltestosterone, Fluoxymesterone, Oxandrolone, Stanozol) (4) 19-nortestosterone (nandrolone); (5) 17β-esters of 19-nortestosterone (Decanoate, Phenpropionate) (6) 19-norandrostenedione and 19-norandrostenediol; tetrahydrogestrinone

5. Anabolic Steroids Various AASs: More than 100 different AASs have been developed most of them being used illegally synthesized in clandestine laboratories commercialized without medical prescription or safety controls

6. Anabolic-Androgenic Steroids 50 AASs have been used in sport for more than 50 years. most common Use among weight lifters and heavy throwers almost all types of athletes whose event requires explosive strength, including football players, swimmers, and track and field athletes, have been known to use steroids. In 1991, there were more than 1 million AAS users in the US Current estimates indicate that there are as many as 3 million AAS users in the US 2.7% to 2.9% of young American adults have taken an AAS at least once in their lives. 2/3 of AAS users are noncompetitive recreational body builders or nonathletes who use these drugs for cosmetic purposes rather than to enhance sports performance

7. Anabolic-Androgenic Steroids Anabolic & Androgenic Effect : Promote tissue growth Promote masculinization Enhance lean body mass Improve sport performance increased fat-free mass, decreased total body fat Decrease in the percentage of body fat located in the gluteal, femoral, and triceps regions in women The effects of anabolic steroids on lipolysis and skeletal muscle mass are potentiated by caloric restriction and mechanical loading

8. Anabolic-Androgenic Steroids Growth of Skeletal Muscle; Size & Strength AASs Effect on Growth of Skeletal Muscle; Size & Strength Women and Children : Stimulating growth of skeletal muscles in subjects with low circulating testosterone Men: o Previous Studies; little evidence for effect of supraphysiologic doses of testosterone or synthetic AAS on muscle size or strength in healthy men o Recent Reviews; timing of doses dietary factors administration of AAS can consistently result in significant increases in strength if male athletes satisfy certain criteria, including the timing of doses and dietary factors

9. Anabolic-Androgenic Steroids Growth of Skeletal Muscle; Size & Strength AASs Effect on Growth of Skeletal Muscle; Size & Strength Women and Children : Stimulating growth of skeletal muscles in subjects with low circulating testosterone Men: o Bhasin and colleagues [150] demonstrated that the administration of supraphysiologic doses of testosterone in combination with exercise in male weight lifters induces a greater increase in muscle size and strength compared with exercise alone or testosterone treatment alone o Conclusion fat-free mass, muscle size, strengthpower dose-dependent testosterone concentrations. [154] increases in fat-free mass, muscle size, strength, and power are highly dose-dependent and correlated with serum testosterone concentrations. [154]

10. Anabolic-Androgenic Steroids Growth of Skeletal Muscle; Size & Strength AASs Effect on Growth of Skeletal Muscle; Size & Strength Women and Children : Stimulating growth of skeletal muscles in subjects with low circulating testosterone Men: The anabolic effect of testosterone is dose dependent, and significant increases in muscle size and strength occur only with doses of 300 mg per week and higher

11. Anabolic-Androgenic Steroids Growth of Skeletal Muscle; Size & Strength AASs Effect on Growth of Skeletal Muscle; Size & Strength Women; body fat distribution effects of anabolic steroids on body fat distribution in young adult females: As Seen in 2 groups; o Women undergoing gender reassignment o Women athletes ingesting high doses of androgens results: Shift of body fat from a gynoid to an android distribution Decrease of subcutaneous body fat in the abdomen, hip and thigh regions

12. Anabolic-Androgenic Steroids another AASs Effects; exercise tolerance improve exercise tolerance adaptability of muscle to overload adaptability of muscle to overload by protecting against muscle fiber damage protein synthesis during recovery increasing the rate of protein synthesis during recovery

13. Anabolic-Androgenic Steroids Types AASs The Types of AASs used by athletes ; In a survey conducted in Great Britain: male Testosterone or Nandrolone: drugs of choice in the majority of male anabolic steroid users women women preferred oxandrolone, stanozolol, and methandienone Testing by International Olympic Committee laboratories in 1993; most commonly detected steroids were: Testosterone (32.5%) Nandrolone (23.9%) Stanozolol (11.4%) Metandienone (10.7%) Methenolone preparations (7.7%) A recent study suggested that the drugs methyltestosterone and norethandrolone were those most commonly used by athletes

14. Anabolic-Androgenic Steroids Doses AASs The Doses of AASs used by athletes ; is often thought to exceed 10 to 40 times the recommended therapeutic dose In a survey of 100 male AAS users: Testosterone the drug dosages ranged from 250 mg to 3200 mg per week of Testosterone or its equivalent. [162] 50 % of the AAS users in this sample reported using a weekly dose of at least 500 mg. stacking To achieve these supraphysiologic doses, 88% of AAS users in this sample combined two or more different types of AAS—a process known as stacking.

15. Anabolic-Androgenic Steroids Duration AASs The Duration of AASs use by athletes ; Most Steroid cycle lasts between 4 and 12 weeks. The time interval between steroid cycles is more variable; Regular users: allow a 4- to 6-week drug holiday Less frequent users: may remain drug free for months

16. Anabolic-Androgenic Steroids Side Effects AASs The Side Effects of AASs; because most anabolic steroids are obtained on the black market and are of dubious quality, there is potential for adverse medical events to occur independent of steroid use the majority (88% to 96%) of AAS users experience at least one minor subjective side effect, including ; acne (40% to 54%) testicular atrophy (40% to 51%), gynecomastia (10% to 34%), cutaneous striae (34%), and injection site pain (36%)

17. Anabolic-Androgenic Steroids Side Effects AASs The Side Effects of AASs;Cardiovascular; Cardiomyopathy Lipid disorders (decreased high-density lipoprotein, increased low- density lipoprotein) Increased platelet aggregation Increased hematocrit Elevated blood pressure

18. Anabolic-Androgenic Steroids Side Effects AASs The Side Effects of AASs;COSMETIC; Gynecomastia Acne Hair loss Cutaneous striae

19. Anabolic-Androgenic Steroids Side Effects AASs The Side Effects of AASs;REPRODUCTIVE-ENDOCRINE; Libido changes Subfertility In males Testicular atrophy, Impaired spermatogenesis, Erectile dysfunction Prostate diseases In females Hirsutism Breast atrophy Voice deepening Virilization (clitoromegaly) Menstrual disturbances

20. Anabolic-Androgenic Steroids Side Effects AASs The Side Effects of AASs; HEPATIC; Cholestasis Steatosis Tumors ; Hepatocellular adenoma carcinoma Hepatic angiosarcoma Cholangiocarcinoma

21. Anabolic-Androgenic Steroids Side Effects AASs The Side Effects of AASs; PSYCHOLOGICAL; Aggression Mood swings Anxiety Psychosis Irritability Dependence Withdrawal Depression

22. Anabolic-Androgenic Steroids Side Effects AASs The Side Effects of AASs; INJECTION RELATED; Infection Bruising Fibrosis Injection site pain

23. Anabolic-Androgenic Steroids Summary; AASs are chemically modified analogues of testosterone AASs act by: binding with androgen and glucocorticoid receptors exerting central and peripheral effects on neurotransmitters interacting with IGF-I or its binding proteins in the circulation and/or in the muscles Skeletal muscle is a primary target tissue for the anabolic effects of AAS The anabolic effect of testosterone is dose dependent significant increases in muscle size and strength occur only with supraphysiologic doses

24. Anabolic-Androgenic Steroids Summary; The dose of AAS used by athletes varies considerably and is often thought to exceed 10 to 40 times the recommended therapeutic dose. The side effects associated with AAS use are numerous and involve multiple organ systems.

25. Growth Hormone GH has been used as a drug of abuse in sport since the early 1980s. There are currently no proper scientific studies providing GH to be performance enhancing in normal subjects, but GH has been shown to have a very important role in regulating body composition in adult humans and in other species. it specifically diverts calories in food toward protein synthesis and away from fat synthesis Physiologic replacement therapy with recombinant GH (rhGH) in GHD adults results in significant changes in body composition with, on average, a 5-kg increase in lean body mass within the first month and a comparable loss of 5 kg of fat. [180]

26. Growth Hormone GH The mechanisms of GH acts: The mechanisms through which GH acts on exercise performance are more complex than the simple increase in lean body mass GH; stimulates erythropoiesis exerts significant cardiovascular effects increasing plasma volume and peripheral blood flow enhancing left ventricular stroke volume and cardiac output. All these factors may well contribute to; improve aerobic capacity improve aerobic capacity

27. Growth Hormone GH The mechanisms of GH acts: Evidence suggests that GH therapy alone, in the absence of some form of exercise program, may increase the lean body mass but not its functional capacity, thus indicating that training may have to be combined with GH replacement in these patients to increase physical performance

28. Growth Hormone Side Effects Side Effects; Pseudotumor Cerebri Slipped Capital Femoral Epiphysis Diabetes Mellitus Central Hypothyroidism Gynecomastia Pancreatitis Growth of nevi Behavioral changes Scoliosis and kyphosis Hypertrophy of tonsils and adenoids

29. Growth Hormone Summary: GH has been used as a drug of abuse in sport since the early 1980s there are no proper scientific studies providing GH to be performance enhancing in normal subjects. GH has a very important role in regulating body composition in adult humans. Physiologic replacement therapy with rhGH in GHD adults results in significant changes in body composition with an increase in lean body mass and a loss of fat.

30. Thank you for your attention