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This article may require cleanup to meet Wikipedia's quality standards. Please improve this article if you can. The talk page may contain suggestions. (August 2009) This article may require copy editing for grammar, style, cohesion, tone, or spelling. You can assist by editing it. (January 2009) The examples and perspective in this article deal primarily with USA and do not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page. (January 2009) The neutrality of this introduction is disputed. Please see the discussion on the talk page. Please do not remove this message until the dispute is resolved. (January 2009) This article contains weasel words, vague phrasing that often accompanies biased or unverifiable information. Such statements should be clarified or removed. (February 2010) Since their discovery anabolic steroids (AAS) have been widely used as an ergogenic aid to improve performance in sports, to improve one's physical appearance or in self-medication for injury recovery or as an anti-aging aid. Use of anabolic steroids for purposes other than treating medical conditions has been controversial. Over time, major sports organizations have increasingly moved to stem AAS use, and were successful in lobbying to have their use and possession criminalized.[citation needed] This has triggered an arms race between users and testing laboratories, resulting in a wide range of health concerns for users. In the general population, legislation in many countries now restricts and criminalizes AAS possession and trade. A political countercurrent has formed in some of these countries. Contents 1 History 2 Protocols 2.1 Steroid cycle 2.2 Steroid stack 2.3 Minimization of side effects 3 Prevalence and user profiles 3.1 General population 3.2 Sports 3.3 Celebrity controversies 4 Doping 5 Legal status and politics 5.1 United States 5.1.1 Movement for decriminalization 5.2 United Kingdom 6 Economics and law enforcement 6.1 Illegal trade 6.2 Production 6.3 Distribution 7 See also 8 References // History Performance enhancing substances have been used for thousands of years in traditional medicine by societies around the world, with the aim of promoting vitality and strength.[1] In particular, the use of gonadal hormones pre-dates their identification and isolation: medical use of testicle extract began in the late 19th century while its effects on strength were still being studied.[2] In 1889, the 72-year-old British neurologist Charles-Édouard Brown-Séquard injected himself with an extract of dog and guinea pig testicles, and reported at a scientific meeting that these injections had led to a variety of beneficial effects, but almost all experts, including some of Brown-Sequard's contemporaries, have agreed that these positive effects were induced by the power of suggestion.[3] In 2002 a study reproducing Brown-Séquard's method determined that the amount of testosterone obtained was too low to have any clinical effect.[4] Testosterone, the most active anabolic-androgenic steroid produced by the testes, was first isolated in 1935 and chemically synthesized later in the same year. Synthetic derivatives of testosterone quickly followed, and by the end of the following decade both testosterone and its derivatives were applied with varying degrees of success for a number of medical conditions. It was not until the 1950s, however, that athletes began to discover that AAS could greatly increase their muscularity. According to John Ziegler the first confirmed use of an AAS in an international competition was, at the weightlifting championships in Vienna in 1954, when the Russians weightlifters are said to have used testosterone.[5] Throughout the 1960s and even into the 1970s, AAS use was confined largely to the elite levels of sport. While in the Eastern bloc programs of training went as far as forcing some athletes to take AAS,[citation needed] in the United States sports physicians, including John Ziegler, and medical texts were still widely proclaiming that AAS were ineffective in helping athletes gain muscle, but acknowledged the usefulness of AAS for debilitated patients. The package insert for Dianabol, an AAS of choice at the time, stated unequivocally "anabolic steroids do not enhance athletic ability."[5] Despite these warnings, by the mid 1960s use of AAS quickly spread into competition bodybuilding, and later to track and field events such as the shot put, and other sports where performance depended on muscle strength or speed of recovery during training.[6] At the end of the decade, Science published a study on the effects of Dianabol on athletes. This open label study, conducted by J.P. O'Shea and coworkers at Oregon State University, confirmed the muscle building effects of AAS on athletes that followed a high protein diet.[7] Two years later O'Shea successfully replicated the results in a double blind design.[5][8] At the beginning of 1970s, sporting bodies including the IOC and NCAA declared the use of AAS unethical, but with no effective means of testing athletes, the issue remained academic.[5] Protocols This section needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (January 2009) Steroid cycle The longer the body's endogenous supply of testosterone is suppressed, the harder it will be for their hypothalamus/pituitary/testicular axis (HPTA) to recover. More serious health risks are associated with longer cycles, such as testicular atrophy, gynecomastia, heart problems, liver diseases, and in extreme cases, permanent suppression of the HPTA, necessitating permanent testosterone replacement therapy.[citation needed] A steroid cycle is the period in time where an individual is actively taking anabolic steroids. A cycle typically lasts 7–14 weeks.[9] Steroid stack Athletes sometimes ‘stack’ steroids by taking AAS with different androgenic:anabolic ratios simultaneously. Although this practice is anecdotally documented in bodybuilding literature, its effects in humans are poorly studied. For ethical reasons, well-controlled clinical investigations have been mostly restricted to single agent regimens.[9] Minimization of side effects Further information: AAS adverse effects and AAS mechanism of action In men, AAS administration produces a predictable, dose-dependent depression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), via the negative feedback loop of the hypothalamic-pituitary-gonadal axis (HPGA/HPTA). Thus, AAS administration can result in hypogonadism and oligospermia, leading to infertility, because both LH and FSH are required for spermatogenesis. Bodybuilding literature suggests that post-cycle treatment with chorionic gonadotropin (hCG) may speed recovery by stimulating LH production. A few medical case reports support this practice, but controlled studies are lacking. However, FSH activity—required for completion of spermatogenesis—is not precipitated by hCG. Many athletes who discontinue AAS have their sperm morphology normalize within 4 months, but some individuals required up to 1 year for normalisation of sperm morphology and motility.[9] Since AAS can be converted by the enzyme aromatase into metabolites that act like the endogenous estrogens, male users may develop gynecomastia. Unlike HPGA suppression, the occurrence of this side effect is unpredictable. In order to prevent it, many users of AAS self-administer antiestrogenic agents, typically SERMs such as tamoxifen. It is not known whether this practice is effective, nor if it poses any health risks.[9] A recent small-scale randomized control trial suggests that recombinant human growth hormone may improve symptoms of anxiety, depression as well as cardiovascular risk markers in former users of AAS.[10] Prevalence and user profiles General population It is difficult to determine what percent of the population in general have actually used anabolic steroids, but the number seems to be fairly low. Studies in the United States have shown anabolic steroid users tend to be mostly middle-class heterosexual men with a median age of about 25 who are noncompetitive bodybuilders and non-athletes and use the drugs for cosmetic purposes.[11] Another study found that non-medical use of AAS among college students was at or less than 1%.[12] According to a recent survey, 78.4% of steroid users were noncompetitive bodybuilders and non-athletes while about 13% reported unsafe injection practices such as reusing needles, sharing needles, and sharing multidose vials,[13] though a 2007 study found that sharing of needles was extremely uncommon among individuals using anabolic steroids for non-medical purposes, less than 1%.[14] Another 2007 study found that 74% of non-medical anabolic steroid users had secondary college degrees and more had completed college and less had failed to complete high school than is expected from the general populace.[14] The same study found that individuals using anabolic steroids for non-medical purposes had a higher employment rate and a higher household income than the general population.[14] Anabolic steroid users tend to research the drugs they are taking more than other controlled-substance users; however, the major sources consulted by steroid users include friends, non-medical handbooks, and fitness magazines, which can provide questionable or inaccurate information.[15] Anabolic steroid users tend to be disillusioned by the portrayal of anabolic steroids as deadly in the media and in politics.[16] According to one study, AAS users also distrust their physicians and in the sample 56% had not disclosed their AAS use to their physicians.[17] Another 2007 study had similar findings, showing that while 66% of individuals using anabolic steroids for non-medical purposes were willing to seek medical supervision for their steroid use, 58% lacked trust in their physicians, 92% felt that the medical community's knowledge of non-medical anabolic steroid use was lacking and 99% felt that the public has an exaggerated view of the side effects of anabolic steroid use.[14] A recent study has also shown that long term AAS users were more likely to have symptoms of muscle dysmorphia and also showed stronger endorsement of more conventional male roles.[18] Sports Anabolic steroids have been used by men and women in many different kinds of professional sports (cricket, track and field, weightlifting, bodybuilding, shot put, cycling, baseball, wrestling, mixed martial arts, boxing, football, etc.) to attain a competitive edge or to assist in recovery from injury. Such use is prohibited by the rules of the governing bodies of many sports. Anabolic steroid use occurs among adolescents, especially by those participating in competitive sports. It has been suggested that the prevalence of use among high-school students in the U.S. may be as high as 2.7%.[19] Male students used anabolic steroids more frequently than female students and, on average, those who participated in sports used steroids more often than those who did not. Celebrity controversies In 1992, NFL football player Lyle Alzado died from brain cancer, which he attributed to the use of anabolic steroids.[20] However, although steroids have been known to cause liver cancer,[21] there is no published evidence that anabolic steroids cause either brain cancer or the specific type of T-cell lymphoma that caused his death.[20][22] Alzado's doctors stated that anabolic steroids did not contribute to his death.[23] Arnold Schwarzenegger has admitted to using anabolic steroids during his bodybuilding career for many years before they were made illegal,[24] and in 1997 he underwent surgery to correct a defect relating to his heart. Some have assumed this was due to anabolic steroids.[25] Although anabolic steroid use can sometimes cause enlargement and thickening of the left ventricle, Schwarzenegger was born with a congenital genetic defect in which his heart had a bicuspid aortic valve; a condition that rendered his aortic valve with two cusps instead of three, which can occasionally cause problems later in life.[26] Doping See also: Use of performance-enhancing drugs in sport The use of anabolic steroids is banned by all major sporting bodies, including the International Olympic Committee, Major League Baseball, the National Football League, the National Basketball Association, the National Hockey League, WWE, ICC, ITF, FIFA, FINA, UEFA, the European Athletic Association, and the Brazilian Football Confederation. Anabolic steroids are controlled substances in many countries, including Argentina, Australia, Brazil, Canada, the Netherlands (NL), the United Kingdom (UK) and the United States (U.S.), while in other countries, such as Mexico and Thailand, they are readily available over-the-counter. Anabolic steroids are banned by all major sports bodies including the Olympics,[27] the National Basketball Association,[28] the National Hockey League,[29] as well as the National Football League.[30] The World Anti-Doping Agency (WADA) maintains the list of performance-enhancing substances used by many major sports bodies and includes all anabolic agents, which includes all anabolic steroids and precursors as well as all hormones and related substances.[31][32] Spain has passed an anti-doping law creating a national anti-doping agency.[33] Italy passed a law in 2000 where penalties range up to three years in prison if an athlete has tested positive for banned substances.[34] In 2006, Russian President Vladimir Putin signed into law ratification of the International Convention Against Doping in Sport which would encourage cooperation with WADA. Many other countries have similar legislation prohibiting anabolic steroids in sports including Denmark,[35] France,[36] the Netherlands[37] and Sweden.[38] Legal status and politics The legal status of anabolic steroids varies from country to country: some have stricter controls on their use or prescription than others though in many countries they are not illegal. In the U.S., anabolic steroids are currently listed as Schedule III controlled substances under the Controlled Substances Act, which makes the possession of such substances without a prescription a federal crime punishable by up to seven years in prison.[39] In Canada, anabolic steroids and their derivatives are part of the Controlled drugs and substances act and are Schedule IV substances, meaning that it is illegal to obtain or sell them without a prescription; however, possession is not punishable, a consequence reserved for schedule I, II or III substances. Those guilty of buying or selling anabolic steroids in Canada can be imprisoned for up to 18 months. Import and export also carry similar penalties.[40] Anabolic steroids are also illegal without prescription in Australia,[41] Argentina, Brazil and Portugal,[42] and are listed as Schedule 4 Controlled Drugs in the United Kingdom. On the other hand, anabolic steroids are readily available without a prescription in some countries such as Mexico and Thailand. United States The history of the U.S. legislation on anabolic steroids goes back to the late 1980s, when the U.S. Congress considered placing anabolic steroids under the Controlled Substances Act following the controversy over Ben Johnson's victory at the 1988 Summer Olympics in Seoul. During deliberations, the American Medical Association (AMA), Drug Enforcement Administration (DEA), Food and Drug Administration (FDA) as well as the National Institute on Drug Abuse (NIDA) all opposed listing anabolic steroids as controlled substances, citing the fact that use of these hormones does not lead to the physical or psychological dependence required for such scheduling under the Controlled Substance Act. Nevertheless, anabolic steroids were added to Schedule III of the Controlled Substances Act in the Anabolic Steroid Control Act of 1990.[43] The same act also introduced more stringent controls with higher criminal penalties for offenses involving the illegal distribution of anabolic steroids and human growth hormone. By the early 1990s, after anabolic steroids were scheduled in the U.S., several pharmaceutical companies stopped manufacturing or marketing the products in the U.S., including Ciba, Searle, Syntex and others. In the Controlled Substances Act, anabolic steroids are defined to be any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promote muscle growth. The act was amended by the Anabolic Steroid Control Act of 2004, which added prohormones to the list of controlled substances, with effect from January 20, 2005.[39] Movement for decriminalization After the Anabolic Steroid Control Act of 1990 listed anabolic steroids as Schedule III controlled substances in the U.S., a small movement has arisen that is highly critical of current laws concerning anabolic steroids. On June 21, 2005, Real Sports aired a segment discussing the legality and prohibition of anabolic steroids in America.[44] The show featured Gary I. Wadler, M.D., chairman of the U.S. Anti-Doping Agency and a prominent anti-steroid activist. When pressed for scientific evidence by correspondent Armen Keteyian that anabolic steroids are as "highly fatal" as is often claimed, Wadler admitted there was no evidence. Bryant Gumbel concluded the "hoopla" concerning the dangers of anabolic steroids in the media was "all smoke and no fire".[44] The show also featured John Romano, a pro-steroid activist who writes "The Romano Factor", a pro-steroid column for bodybuilding magazine Muscular Development. United Kingdom In the United Kingdom, anabolic steroids are classified as class C drugs for their illegal abuse potential, which puts them in the same class as benzodiazepines. In 2008 a study published in the Lancet suggested that anabolic steroids are less dangerous than most other illegal substances.[45] Economics and law enforcement Illegal trade Several large buckets of tens of thousands of Anabolic steroid vials confiscated during a DEA raid In countries where anabolic steroids are illegal or controlled, the majority of steroids are obtained illegally through black market trade.[46][47] These steroids are usually manufactured in other countries, and therefore must be smuggled across international borders. Like most significant smuggling operations, organized crime is involved.[citation needed][dubious – discuss] A large stash of anabolic steroid vials confiscated during "Operation Raw Deal" undertaken by the Drug Enforcement Administration which ended in September 2007. In September 2007 the DEA wrapped up an 18-month international investigation of illicit anabolic steroid use in which 124 arrests were made and which targeted over 25 Chinese companies which produced raw materials for producing steroids and human growth hormone. The companies exported raw products to Mexico, where the consumer products were packaged. The investigation, dubbed "Operation Raw Deal," was the largest anabolic steroid operation in United States history and involved China, Mexico, Canada, Australia, Germany and Thailand among other countries. The investigation also focused on online message boards where advice was given on how to use anabolic steroids and the DEA also intercepted hundreds of thousands of e-mails. The DEA has also stated that the e-mails intercepted were compiled into a massive database of names which could lead to months or years of future arrests of steroid users.[48][49][50] Production Anabolic steroids are frequently produced in pharmaceutical laboratories, but in nations where stricter laws are present, they are also produced in small home made underground laboratories, sometimes in kitchen sinks.[49] Common problems associated with illegal drug trades, such as chemical substitutions, cutting, and diluting, affect illegal anabolic steroids as well, so that when they reach the distribution level, the quality may be compromised and the drugs may be dangerous. In the 1990s, most U.S. producers such as Ciba, Searle and Syntex stopped making and marketing anabolic steroids within the U.S. However, in many other regions, particularly Eastern Europe, they are still produced in quantity. European anabolic steroids are the source of most medical grade anabolic steroids sold illegally in North America.[citation needed] Anabolic steroids are still in wide use for veterinary purposes, and often contain the same components as those prepared for humans but without the same quality control.[51] These can also be dangerous, as they may have been produced and handled in cruder and less sterile environments.[52] Distribution In the U.S., Canada and Europe, illicit steroids are sometimes purchased just like any other illegal drug, through dealers who are able to obtain the drugs from a number of sources. Illegal anabolic steroids are sometimes sold at gyms, competitions, and through the mail, but may also be obtained through pharmacists, veterinarians, and physicians.[53] In addition, a significant number of counterfeit products are sold as anabolic steroids, particularly via mail order from websites posing as overseas pharmacies. Individuals also produce fake steroids and attempt to sell them over the Internet, causing a wide variety of health concerns.[citation needed] In the U.S., black market importation continues from Mexico, Thailand, and other countries where steroids are more easily available as they are not illegal.[54] See also Performance-enhancing drugs Muscle dysmorphia Androgen replacement therapy References ^ "A short doping history". Anti-Doping Hotline. Archived from the original on 2007-10-08. http://web.archive.org/web/20071008174029/http://www.dopingjouren.se/page.asp?page=history. Retrieved 2007-04-24.  ^ Kuhn CM (2002). "Anabolic steroids". Recent Prog. Horm. Res. 57: 411–34. doi:10.1210/rp.57.1.411. PMID 12017555. http://rphr.endojournals.org/cgi/content/full/57/1/411.  ^ Hoberman JM, Yesalis CE (1995). "The history of synthetic testosterone". Scientific American 272 (2): 76–81. doi:10.1038/scientificamerican0295-76. PMID 7817189.  ^ Cussons AJ, Bhagat CI, Fletcher SJ, Walsh JP (2002). 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