Tuesday, June 13, 2006

A Primer: Steroids and HGH for non-medical students

by Alan Eliot

I am about to start my last year of med school. I often take that fact for granted when it comes to the more science-related aspects of the game. I get the body. I've studied its functions, delved into its details, and wrapped my head around its most intricate processes for three years. At a base level, one does this to pass. At a higher level, one does this to ultimately be a better clinician. But regardless of motive, the student leaves the four-year physician-making factory armed to the teeth with information, a vast soup of names and catch phrases and mneumonics, ready to diagnose and to treat.

Doctors are made, not born. There is no magic. Healing, sure. Art, of course. But no magic. To the average person, the body is something resembling a black box- food go in, poop comes out; meds go in, I feel better; I'm scheduled for surgery- two hours later, problem is solved and I have a scar. My car is a black box to me. A chinese manuscript is a black box to 80 percent of the world's population. But given enough time, pretty much anyone can learn to hone their skills at looking at a black box and pulling out relevant information. In that sense, we are all potential doctors, or mechanics, or translators of foreign languages. Claims of magic notwithstanding.

I cannot escape the doctor in me. I've gone too far. I see the world too differently. Everyone is a potential patient, and most variations in people explainable in terms of science- did I just hear you cough? Talk to me, tell me, when did it start? Let's look for rashes, signs of acute infection, a marker to tell me more, ...The kid in first grade who wore a patch over one of her eyeglass lenses for two months? Treatment for strabismus. My ex with the inconsistent periods? I have four explanations, all plausible. Now if only I could track her down to get some labwork done, we could move forward with the case...

And then there's baseball. Men with the "magic" ability to hit a round ball with a round bat (or to make other men miss the round ball with their round bat). Human men. Men who seem larger than life, but who in reality are as tied to the laws of medicine and nature as the rest of us. Patients, really. That player might have heart, but he's also got lungs, kidneys, a liver and a spleen. He gets colds. He needs vaccinations. He enjoys the occasional morning shit. Just like us, really. Or rather, just like us, only better at baseball. Or, they're just like me, only less adept with a stethoscope. Same difference.

No magic. Just science.

It is a shame to me, the sorta-doctor trapped in a baseball fan's body, that the terms of recent events are left so vague to the general population. He cheated. He took steroids. Steroids are bad. Steroids ruin your body, shrink your nuts (show video of inflated basketball deflating in locker room for effect), increase your risk for injury. Or how about they are all on growth hormone now that MLB is testing for steroids.

These are statements that are supposed to elicit shock and anger. And they do. But what I don't understand is how an issue as relevant to baseball in 2006 as performance-enhancing drugs can have its major terms left so undefined, and ultimately most likely misunderstood.

So without further ado, some science behind the "steroids go in, muscles come out":

Steroids: What's a steroid?
If steroids are evil, why did my doctor just prescribe them to my 5-year-old with asthma?

Steroids are hormones naturally produced by the human body. In simple terms, there are three main steroids that a male baseball player would be concerned with: cortisol, aldosterone and testosterone (androgen). All steroids have a similar structure, but very different functions. Cortisol and aldosterone are made in the adrenal glands (also where you get "adrenaline" from), as is a testosterone precursor. Testosterone is also made in the testes.

As an example, imagine the three Steroid brothers: Al (aldosterone) is always stressed, Andrew (androgen/testosterone) is macho and horny, and Cory (cortisol) is the pudgy peacemaker. As brothers, they all look alike, and are all classified as "Steroids", but act in completely different ways. Al's stress comes from aldosterone's role in the body as a hormone to increase blood pressure- consequently, some blood pressure meds work by blocking Al's role at the kidney.

Cory's peacemaking comes from cortisol's natural anti-inflammatory properties- a lot of cortisol will decrease swelling as well as suppress the immune system. Willis Reed's heroic stand at game seven of the 1970 NBA finals was made possible by this type of steroid (cortisol-related), injected into his knee to reduce swelling. It is also what is inhaled as long-term therapy for asthma patients- to reduce inflammation in the lungs. This type of steroid is the type referred to when transplant patients need to be on lifelong-steroids- in that case, to prevent the body from attacking the new tissue by suppressing its immune system. Unlike a performance-enhancing steroid, this steroid in excess will actually cause muscle wasting on the arms and legs, and will make you obese.

The last Steroid brother, the macho one (testosterone), is the one getting all of the press. In fact, to avoid confusion, rather than call this class "steroids" as is common in the media, this class should be referred to as "testosterone-related performance enhancers". That's all they are.

Andrew is macho and muscular because of testosterone's effects. Imagine puberty- Muscle and body growth. Body hair growth. Zits. Sexual desire. In fact, players take testosterone just for the muscle mass effect, but cannot avoid its other appearance altering effects (bacne). In fact, baldness too is a result of testosterone overdose, as testosterone is converted to another hormone (another steroid!) that naturally causes hair loss.

And there you have it- your classic muscular baseball player who is balding and has bacne.
Mark McGwire once noted how his new drug, androstenedione, not only helped him bulk up but would also make girlfriends very happy with their boyfriends. Andro naturally is converted eventually to testosterone-like compounds in the body. Big Mac was probably referring to a boyfriend's increase in libido and sexual performance- with the unsaid hope that the female in question wouldn't mind her boyfriend's new zit-covered face and new bald spot. Or shrunken testicles.

So steroids are not really banned after all...
Correct. Just testosterone-related ones, aka testosterone-related performance enhancers, aka anabolic steroids.

And every person naturally makes steroids...

So how can MLB test for them if people are naturally full of them?
What does an "undetectable steroid" mean?
Anabolic steroids are generally synthetically made compounds meant to mimic testosterone's effect in the body. They are not naturally made by the body, and their presence indicates that they have come from a source outside the body. It is helpful to think of them as "testosterone plus"- you essentially start off with what amounts to a testosterone molecule in the lab and add a side chain or two to it (or take one off). Sometimes this is done to change the potency of testosterone as a muscle builder. Other times this is done to mask the compound. This is a weakness of current testing- you can only find exactly what you are looking for. There are nearly infinite ways to manipulate the molecule slightly without changing its effects. It is then "undetectable", until MLB hears about it, adds it to the banned list, and the lab makes another small change and makes the new compound "undetectable". An equivalent analogy would be Andrew, the cunning brother, is being sought after by police. He draws a moustache on his face, and passes undetected- until a new bulletin is released with a picture of Andrew with moustache. So he puts a ring on his index finger. And is undetected. Then police update. So he changes his t-shirt from green to white. And is undetected. And it goes on.

So what is human growth hormone (HGH) and how is it a performance enhancer?
Imagine puberty again. There was the accompanying growth spurt at the time as well. This was due to the brain (specifically, the pituitary gland) making and releasing growth hormone. Your bones got longer, and you got taller. Growth hormone also caused your soft tissues, including muscles, to grow.

HGH is a synthetic growth hormone made specifically for children with a rare disorder in which they don't make enough growth hormone. It is illegally used, however, by baseball players, due to its effects in increasing muscle mass. Hence, it is another "performance enhancer".

w would I spot an HGH user?
Of course, as is the case with someone using a testosterone-related performance enhancer, a dramatically increased bulk over a very short time would be a tip off.

Additionally, you'd see other classic signs. Excess growth hormone causes a condition called acromegaly, usually caused by a pituitary tumor. Since bones are already fused by adult age, HGH in an adult won't cause bone lengthening as it does in a child. But enough of it will cause an acquired acromegaly- where the bones of the hands and feet all enlarge and widen, and where the cranium and bones of the face actually increase in size. This may cause a jaw-squaring, or jaw-protrustion, and for spaces for form between teeth. Of course, HGH will cause other enlargement, to internal organs such as the heart, which can eventually be lethal.

Typical HGH abuser? Player with history of sudden increased muscle mass, who's head seems to have grown in recent years (perhaps like a certain very prolific home run hitter who plays in California). In fact, there is a certain very famous actor who was once a bodybuilder, and who has admitted to using performance enhancing drugs, including HGH and steroids, whose classic teeth spacing and square jaw may be a result of his HGH use. Think of a very "clutch" lefty batter in the AL with a gap in his teeth and whose head also seems to have grown since he was called up.

Speculation? Of course. But what part of this terrible scandal isn't? As a player- you may escape detection by MLB authorities, but you can never escape the suspicion of an educated fan. And as a fan- as long as you base it in science, you may be able to prove it to yourself- cause we may never be able to prove it any other way.

Finally, this all comes to a head as Jason Grimsley was recently found to be in possession of HGH in his home. He has apparently cooperated with authorities, and named names in a now published affidavit at TheSmokingGun.com. The names have been blacked out, but they will eventually become public- possibly shedding light on a hidden epidemic of HGH use in the MLB, especially with new steroid testing, and players still looking for an "undetectable edge".
We marvel at how a not-so-bulky non-hitter who wasn't even good was using performance enhancers, and who openly admitted to how rampant their use was in the majors. And it makes us look at the heroes of our generation and wonder, "who else?"

Science. Not magic. Performance enhancers such as steroids and HGH were used for years by baseball players looking for an edge, with a magical "inject here, grow there" approach. Players who fell for the allure of the quick gains were almost certainly not thinking of long-term consequences of their actions, whether to their bodies, or to the game itself- ruined in both cases. But what's dictated by reality and science is that you can't grow muscle in isolation using these drugs. There are always side effects- whether physical, like the balding, acne-prone star, or the bulked-up player with the new hat size, or spiritual.

What has become increasingly clear is that a lot of men sold their souls to performance enhancing drugs for an edge. Their collective lack of ethics is incredibly disheartening, as the game and its integrity now stand trial for the sins of its finest, as well as its mediocre. As a fan, you hope that the issue is being blown out of proportion by an overzealous media, that in fact the problem was very small and involved a small minority of players. The evidence is increasingly showing a very different picture, thought, which is scary- because very little evidence has thus far been presented. You wonder, with the coming weeks and evidence and accusations only set to increase, how nasty that final picture will ultimately be.

Alan Eliot's column, "The Stories We Tell", appears alternate Tuesdays


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