Steroid Substitutes and Alternatives
a No-Win Situation For Bodybuilding Athletes
By Kevin L. Ropp
From athletes in international competition to college and high school
athletes to the teenager who simply wants to "bulk up," people of all ages and
abilities have found alternatives to replace anabolic steroids.
Regulated by the Drug Enforcement Administration, anabolic steroids were
placed in the Controlled Substances Act's Schedule III (which includes some
narcotic drugs, stimulants and depressants) by the Anabolic Steroids Act of
1990. Unlawful distribution and possession with the intent to distribute
anabolic steroids is a federal crime, punishable by up to five years in prison.
Since the law was enacted, many athletes have avoided anabolic steroids
because of the penalties associated with their abuse, says Donald Leggett, a
compliance officer in the Food and Drug Administration's Center for Drug
Evaluation and Research. "They have looked at other chemicals that perform in a
similar fashion but are not technically regulated as or called anabolic
Those alternatives include prescription, veterinary, investigational, and
unapproved drugs, and dietary supplements.
Dietary supplements are regulated as foods. No data has been submitted to FDA
to prove bodybuilding claims for these substances, and the short- and long-term
effects of their use are unknown.
"Many alternatives are labeled as 'dietary supplements' even though they make
anabolic and other athletic enhancement claims. Such attempts to market directly
to the public may represent a circumvention of the safety and efficacy
provisions required of drugs. Thus, the short- and long-term effects of their
use are generally unknown," Leggett says.
When supplement manufacturers make bodybuilding and drug- type claims, FDA
can, and often does, issue warning letters to the manufacturer or prosecute for
consumer fraud. FDA's Center for Drug Evaluation and Research recently won
several court cases involving consumer fraud by supplement manufacturers,
The consumer is defrauded by believing these supplements will build muscles
or promote testosterone production, when in fact they do no such thing, he says.
In a study, published in the Aug. 26, 1992, Journal of the American Medical
Association, of bodybuilding magazine advertisements, Rossanne M. Philen, M.D.,
and colleagues, report that they counted 89 supplement brands, 311 products, and
235 ingredients, most of which were unspecified amino acids. More than 22
percent of the products had no ingredients listed in their advertisements.
The study also found that many steroid-type ingredients, called sterols, were
being advertised. With the exception of ecdysterone, the sterols were all plant
derivatives. Ecdysterone in an insect hormone with no known use in humans.
The abuse of many of these ingredients, as well as prescription, veterinary,
investigational, and unapproved drugs, concerns FDA.
Agency investigators have collected more than 3,000 drug samples from the
black market over a 10-year period, according to Leggett. Many of those samples,
he says, were not steroids but other, potentially more dangerous, prescription
Some steroid alternatives popular among athletes include the investigational
drugs clenbuterol and gamma hydroxybutyric acid, or GHB, and approved
prescription drugs such as human growth hormone and erythropoietin, better known
ClenbuterolClenbuterol is used in several European countries by animal
trainers to build muscle mass and strength in exhibition livestock. It has never
been approved for any use in the United States.
Athletes use clenbuterol because they think it has the same mass and strength
building capability in people as it does in animals.
But clenbuterol also has serious, immediate side effects in humans. In Spain,
between March and July 1990, 135 people became ill after eating beef liver that
contained clenbuterol residues. Their symptoms included fast heart rate, muscle
tremors, headache, dizziness, nausea, fever and chills. Symptoms appeared from
30 minutes to six hours after they ate the liver and lasted for nearly two days.
Like most other steroid alternatives, the long-term effects of clenbuterol
are not fully known. But, Leggett says, some serious cardiovascular
complications may result from their use.
In many instances, veterinary drugs are used simply because they are easier
than human drugs to obtain, Leggett says. "Historically, there are places in
this country, particularly in rural areas, where just about anyone could walk in
and purchase a veterinary equivalent of a (human) drug that would require a
Gamma Hydroxybutyric AcidGamma hydroxybutyric acid, better known as
GHB, is another steroid alternative used widely by teenagers and athletes of all
GHB is an investigational new drug that powerfully and rapidly induces sleep
and depresses the central nervous system in animals and humans, according to
The drug has been illegally marketed as a steroid alternative both openly and
"in the back room" in gyms, spas, and health food stores and advertised in
bodybuilding magazines. Promoters claim it stimulates production of human growth
hormone and thus produces muscle mass and weight loss. It has also been promoted
as a sleep aid and touted as a street drug.
But GHB is extremely dangerous.
A Duluth, Ga., teenager getting ready for
his high school prom on May 11, 1990, drank a concoction of water and Somatomax
PM, a powdery substance containing GHB his friend had bought at a health food
store. Instead of getting the "high" he had expected, he was in a coma 20
minutes after taking the drink. Fortunately, his parents soon found him, and
with emergency treatment he recovered.
There were 80 hospitalizations from GHB use reported through November 1990,
according to a national Centers for Disease Control study published in the Nov.
30, 1990, issue of Morbidity and Mortality Weekly Report.
Patients reported that within 15 to 60 minutes of taking one-half to three
teaspoons of GHB, they developed symptoms such as vomiting, drowsiness,
dizziness, tremors, seizure-like movements, unconsciousness, slowed heartbeat,
lowered blood pressure, breathing difficulty, and breathing cessation. Patients
recovered, usually with emergency room care in 2 to 96 hours. There have been no
Human Growth HormoneHuman growth hormone, or HGH, is another popular
steroid alternative. Produced naturally by the human body, HGH's only approved
medical use is to treat pituitary dwarfism, but it is under investigation to
treat other disorders.
Human growth hormone, manufactured using recombinant DNA technology, is
identical to the natural hormone. Some athletes believe that HGH promotes muscle
growth and muscle strength although researchers have not confirmed these claims.
Lyle Alzado, a former Los Angeles Raiders defensive lineman, said in a July
4, 1991, New York Times article that human growth hormone has become the drug of
choice for today's athlete, primarily because it undetectable in drug tests.
Alzado died May 14, 1992, from a rare form of brain cancer, central nervous
system lymphoma, which he attributed to his prolonged use of steroids and HGH.
Too much human growth hormone, produced by a hyperactive pituitary gland or a
tumor, is the cause of acromegaly, a condition characterized by excessive growth
of the bones of the hands, feet and face. Acromegaly is ultimately fatal because
of resulting heart disease and other metabolic problems.
ErythropoietinErythropoietin, or EPO, is another steroid alternative
used in the international sports community although it has seen limited abuse in
the United States.
EPO, approved for treating anemias associated with chronic renal failure and
zidovudine (AZT) therapy in HIV-infected patients, stimulates bone marrow to
produce red blood cells. The hormone appeals to athletes because they tire less
easily when taking it and because it is undetectable by tests presently used.
"It (EPO) increases the red blood cell count, and therefore the athlete is
able to absorb more oxygen and increase stamina- the oxygen-carrying capacity of
the blood system is just unbelievable," Leggett says.
But EPO use is not without risk. As the body's red blood cell count rises and
the blood thickens, blood clots, heart attack, or stroke could result.
Abuse of EPO is especially risky among marathoners and long- distance
bicyclists. As these athletes compete, Leggett explains, they lose body fluids,
including blood fluids. Reducing blood fluids concentrates the already
abnormally high red blood cell count, which can lead to polycythemia, an
abnormal increase in circulating red blood cells.
"EPO can turn their blood to the consistency of Jell-O," he says.
Here are some potential health effects of drugs and
other substances-ranging from the mildest to the most severe-used as
alternatives to anabolic steroids.
- greasy skin
- severe acne
- premature balding
- bloating associated with water retention
- muscle tremors
- fast heart rate
- slowed heart rate
- bloody diarrhea
- seizure-like movements
- lowered blood pressure
- breathing difficulty
- breathing cessation
- blood clots
- cardiovascular problems
- liver disease
- heart attack
FDA is particularly concerned with
athletes' abuse of prescription drugs because they usually take the drugs
without a physician's supervision and in higher doses than recommended for their
limited medical uses.
"We consider these things to have the potential for hazard when they're not
monitored or taken in accordance with the supervision of a licensed
practitioner," Leggett says.
"Many of these people take way above and beyond the directions for use simply
because they feel 'the more the better.' That was true of anabolic steroids,
too. The people who are taking these drugs are essentially saying, 'If one
teaspoon is recommended, I'm going to take five and grow five times as fast.'"
With that philosophy, the potential for an overdose is very high-and so is
the potential for death.
FDA is also concerned about the prescription, veterinary, investigational,
and unapproved drugs used as steroid alternatives primarily because little is
known of the short- and long-term effects these drugs may have on humans,
especially when taken in higher-than-recommended doses or in combination with
Comparing anabolic steroids to those steroid alternatives, Leggett says, "We
approved all of these anabolic steroids for domestic use in treating diseases
like anemias, osteoporosis, and certain cancers. We know what to expect from
their label dosage and overdoses."
"We have no idea what a normal dosage or overdose is for many of the steroid
alternatives or what might be their effect. This is because we've never seen any
clinical studies reflecting their use in humans. So, we're completely without a
Some short-term reactions from using steroid alternatives are similar to
those associated with anabolic steroid abuse. These reactions include: bloody
diarrhea, nausea, vomiting, severe acne, premature balding, bloating associated
with water retention, and greasy skin.
"Those are all soft effects, which may or may not be very serious," Leggett
says. "But if the preliminary effects from using steroid alternatives are
similar to those associated with anabolic steroid abuse, then there is the
potential for some of the long-term effects, too. Effects long-term steroid
abusers experience include cardiovascular problems, liver disease, certain
Clenbuterol, gamma hydroxybutyric acid, human growth hormone, and
erythropoietin, all banned in international competition, are some of the more
popular steroid alternatives athletes are now abusing. But, Leggett says, this
list is likely to grow as athletes experiment with different and new chemicals.
As athletes strive for bigger, more muscular bodies through chemicals,
Leggett, expecting the worst, says, "I'm sure they'll come up with something
someday that's even more disastrous than the few (drugs) we've seen in recent
Kevin L. Ropp is a staff writer for FDA Consumer. A Reprint From FDA
Consumer Magazine Printed July 1993. This article originally appeared in the
December 1992 FDA Consumer. Publication No. (FDA) 93-1207 We hope you found this
reprint from FDA Consumer magazine useful and informative. FDA Consumer, the
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Government Printing Office 1993-342-343-/80027