Anabolic steroids Introduction cause increase in muscle strength increase aggressive behavior increased erythropoiesis side effects hypertension liver tumors increased LDL decreased HDL hypercholesterolemia Intake either oral or injection routes possible Evaluation an abnormally low high-density lipoprotein level should alert the physician to the possibility of steroid use in an athlete. blood testing examines for testosterone to epitestosterone ratio of > 6:1 Physical exam increased body weight testicular atrophy irreversible deepening of female voice alopecia (irreversible) reduction in gonadotropic and sex hormones (estrogen and testosterone) can lead to decreased bone mineral density oligospermia or azoospermia growth retardation gynecomastia Type of steroids Human Growth hormone (HGH) the most abundant substance produced by the pituitary gland. Growth hormone has a direct anabolic effect by accelerating the incorporation of amino acids into proteins. It is becoming an increasingly popular anabolic steroid substitute; similar effects from insulin-like growth factor (IGF-1) increased muscle size but not strength Side effects: myopathic muscles development carpal tunnel syndrome insulin resistance Androstenedione an androgen produced by the adrenal glands and gonads acts as a potent anabolic steroid and is converted in the liver directly to testosterone with a resultant increase in levels after administration. DHEA is a naturally occurring hormone made by the adrenal cortex. it is converted to androstenedione, which in turn is converted to testosterone. the beneficial and adverse effects of DHEA can be correlated directly with those of testosterone. Erythropoietin (EPO) stimulates hemoglobin production and increases O2 carrying capacity side effects increased blood viscosity which can lead to stroke or myocardial infarctions Somatotropin a growth hormone that causes hypertrophy of type 1 muscles and atrophy of type 2 muscle Catabolic Hormones Glucagon has a catabolic effect on skeletal muscle Supplements Creatine Introduction derived from glycine, arginine, and methionine a muscle and power building supplement (not an anabolic steroid) mechanism is that creatinine is converted to phosphocreatine, which acts as a source of ATP for muscle studies have shown although it can increase work in anaerobic trials, it cannot increase peak force widely used in conjunction with off-season weight lifting programs Outcomes studies show mixed results with regard to enhanced sports performance Risks pulls water from blood vessels into cells, creating a theoretical risk of dehydration Reports of cramps increased muscle injury renal insufficiency (rare) Stimulants Includes caffeine doses of 2 to 3 mg/kg have been shown to improve performance works by reducing fatigue and increasing alertness previously banned by the International Olympic Committee (IOC) now allowed up to 12 micrograms per milileter of urine ephedra ephedrine "ma huang" often included in energy drinks amphetamines Risks include dehydration impaired heat management high blood pressure nervous system impairment