Performance Enhancement Flashcards
What is the specific type of steroid being discussed when talking about performance enhancing drugs?
particularly sex hormones: testosterone, other androgens, LH, hGC
all androgens are chemically related to testosterone
What are the primary actions of androgens?
anabolic- stimulates the protein synthesis
androgenic- stimulates the production of male secondary sex characteristics
What are SARMS? What are the clinically indicated for?
selective androgen receptor modulators that activate androgen receptor in either muscle or bone and aim to avoid other effects
they can be used to increase lean body mass in elderly men and post menopausal women with no difference in adverse side effects v. placebo
Contrast the types of AAS (A and B).
Type A- long acting injectable
Type B- short acting PO, risk to liver
not alkylation is performed to slow liver inactivation because very little testosterone is absorbed orally (associated with hepatic side effects)
What are THG and DMT?
“designer” steroids created to avoids drug testing, they are longer acting, more expensive and are “easier” on the liver
What are potential therapeutic uses of androgen therapies?
refractory anemia, hereditary angioedema, replacement in hypogonadism, muscle wasting in HIV infection, improve bone mineral density, severe burns, sports injury healing
What are common practices and formulations regarding anabolic steroids?
stacking- many use two or more simultaneously
often use din 6-12 week cycles because of side effects
doses are often 10-100 times the usual therapeutic doses
veterinary grade or drugs manufactured in other countries frequently used
What are some of the adverse effects of anabolic steroids?
liver: cholestasis, pelisses hepatic, tumors
gonads: testicular atrophy, infertility and gynecomastia, virilization (not irreversible) in women, hirsutism, amenorrhea, increased libido
psychological: increased aggression, irritability, addiction, depression with withdrawal
skin: acne, male pattern baldness
CV: increased BP, total cholesterol, risk of CAD, cardiomyopthy and decreased HDL
hematologic: prothrombotic state, arterial occlusion
Other: decreased IgA levels, more self-reported injuries, early closure of growth plates is used early
What are some of the most successful interventions for preventing steroid use?
repeated sessions with peers and coaching regarding risk, honest of physicians
What are the effects of DHEA and androstenedione?
has less efficacy on increasing strength with similar side effects (may have more estrogenic side effects)
What are classic signs that a patient is a user of AAS?
increase in lean body mass, worsening of acne, rap weight gain, moodiness and puffy face (facial edema); note that AAS drug screening is not available to most practitioners but it may be helpful to test proxies like lipid profile (very low HDL), liver function panel and FSH/LH (suppressed)
most primary care docs should refer to AODA specialist for care, it is important to taper use and treat depression
What is the mechanism of GH in improving performance?
stimulates IGF-1, increases lean body mass (unclear effect on strength)
adverse effects- acromegaly
What is the mechanism by which EPO improves performance? Describe regimen and adverse effects
increases production of red blood cells
new EPO substances have increasing long half-lives and do not need to be dosed as frequently (like continuous erythropoietin receptor activator)
can cause hyper viscosity and thromboses, blood born infection possible since is administered IV or subQ
How is EPO abuse detected?
electrophoresis (direct)
indirect- measure of Hct, Retics etc.
Best methods are biologic or molecular passports (serial testing of blood levels)
