Steroids: Jekyll and Hyde

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Mark McGuire will probably be remembered as much for his use of the "dietary supplement" androstenedione (Andro) as he will for the seventy home runs he hit in 1998. While you can debate whether one had anything to do with the other, in my opinion one thing is clear: the use of the term "dietary supplement" to describe the anabolic steroid he took should be criminal, just like selling Andro itself is now. Dietary supplement. Talk about a euphemism. This would almost be funny if these drugs weren't so dangerous.

There is nothing dietary or supplemental about Andro. Unless, that is, you believe that anything you add to your normal diet is "supplemental." According to this generous definition, a bowling shoe would be a dietary supplement, assuming you could swallow it. And you would be better off with the shoe. Andro is a serious and possibly very harmful drug, not a vitamin pill. More on this later.

The recent congressional hearings on steroids in baseball have brought considerable attention to the problem. And also much confusion, no doubt because most people don't have any idea what "steroid" really means. If you say the word to a hundred people and ask for a one-word response you will probably hear most of the following: sex, hormones, asthma, arthritis, and, of course, muscles. So, how can one word mean so many different things? In order to answer this you first have to know what a steroid is.

Defining Steroids

Steroids are chemicals (either man-made or naturally occurring) that have in common a distinctive structure that looks like this:

In the picture, each sphere represents one atom of carbon. Three six-membered rings of carbon atoms are fused to a five-membered ring (five- and six-membered carbon rings are both very common in nature). Other atoms (usually carbon and oxygen) are attached to this scaffold in different places on the molecule. This is what differentiates one steroid from another. But all steroids have this same basic framework. If a molecule looks like this, it's a steroid. If it doesn't, it's not. Thus, the definition of steroid is strictly a function of chemical structure. And in case you're wondering, Andro fits this structure perfectly.

So, are they good or bad for you? The answer is both. Small changes in the structure of the molecule (i.e. the number and/or position of other atoms) can make all the difference in the world. This is why some steroids are essential while others are terrible. For simplicity, they can be roughly grouped into four broad categories: cholesterol, the sex hormones, anti-inflammatory (a.k.a. adrenal) steroids, and anabolic (muscle-building) steroids.

Steroid Varieties

1. Cholesterol is a steroid that is an essential component of all animal cells. Without it there would be no animal life. It is obtained either by diet or by biosynthesis in your liver, with the biosynthetic route accounting for about 80% of the total cholesterol in humans. Cholesterol is an example of a steroid that is not a hormone. (Hormones are chemical messengers -- substances secreted from a gland in one part of the body that trigger a response in a different location. They may or may not be steroids. Examples of hormones that are not steroids are insulin and adrenaline.)

2. All of the male and female sex hormones are steroids. Although this is a very complicated subject, the chief female hormones are estrogens and for males, testosterone (an androgen). Chemically, the two are almost identical in structure and are both made in the body from cholesterol.

3. Anti-inflammatory steroids are man-made relatives of naturally occurring hormone cortisol. Cortisol (a.k.a. hydrocortisone) and its close chemical cousin cortisone are powerful drugs with a role in regulating a wide variety of body functions. Although these are very potent anti-inflammatory agents (for asthma, allergy, and arthritis), they must be used carefully because they weaken the immune system and can cause diabetes and loss of bone minerals. This class is sometimes also referred to as the adrenal steroids or "corticosteroids".

4. Anabolic (muscle-building) steroids -- are what come to mind when people hear the word steroid. These are synthetic derivatives of testosterone and have been in existence since about 1930, when scientists discovered that they built muscles in lab animals. The same held true for humans, and by about 1950 these drugs were being used by bodybuilders. There are now over a hundred of them in existence. Most of these are illegal in the U.S., although some can be obtained by prescription for a few specific conditions. But until recently you could buy Andro in your drug or health food stores. This is just plain nuts.

These drugs are bad news. They cause heart attacks, strokes, liver cancer, psychological problems, testicular atrophy, and breast development in men. Their use in teenagers is alarming. They have turned baseball into a joke, turned the Olympics into a pharmacology contest, and killed many young professional wrestlers.

Jurisdictional Dispute

I believe this is the worst example of unscrupulous companies using the term "dietary supplement" to escape FDA jurisdiction that applies to other drugs. Taking advantage of a 1994 law that weakened the FDA's authority over "supplements," companies have been exploiting the scientific ignorance and gullibility of the American public to sell their garbage. Banking on the fact that the terms "natural" and "supplemental" somehow will convey safety, these companies have suckered many medically naive people into buying them, when in fact, neither "natural" nor "supplement" ensure anything of the sort. In fact, selling over the counter use of anabolic steroids is probably comparable in risk to doing the same with prednisone (a powerful anti-inflammatory steroid). At least in the case of the prednisone, one could argue that you're treating a condition, as opposed to building muscles for purposes of vanity or to compete in sports.

But Andro is now banned, so everything is OK, right? Not exactly. Go to your supermarket, and next to the vitamins you'll find DHEA. It, like Andro, is a sex hormone (both are converted to testosterone in the body). And the two are almost identical in structure and function. It's like buying Andro all over again. Unbelievable. "Food supplement"? I don't think so.

Fortunately, as one supplement after another is found to be harmful/not useful (e.g. ephedra), I believe our laws will change, putting an end to this farce.

(Author's note: also see the April 17 New York Times story about DHEA escaping the steroid ban.)

Dr. Bloom, who resides in Nyack, NY, is an organic chemist. He has worked in the pharmaceutical industry for about twenty years.