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• Martin Tudor

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CONTENTS Dedicated to my wife Barbara and my children: Rob, Ron, Chris, Laura and David; I love them all.

Foreword .............................................. ii

Special thanks to my family for their particular patience with me during the writing of this book.

Chapter One ......................................... 15 Laboratory Tests

TO: Dr. and Mrs. Harold Chandler, who guided me to things biological, hence, to where I am today.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Diet and Supplements Chapter Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Steroids, An Over-all View

TO: My Chief Office Nurse: Lana, for the special interest she takes in aiding the athletes. Without her my life would be a great deal more hectic.

Chapter Four . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Anabolic Steroids

TO: Tony, my office manager and my two nurses: Carmel and jennifer for their fine assistance and friendship.

Chapter Six . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Anavar

TO: Mrs. Irene D. Twardy for her splendid typing. TO: Larry Kidney and Bill Pearl for their inspiration. And to all my patients for their confidence in me; to their cooperation and friendship throughout these years.

Chapter Five Anadrol-50

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Chapter Seven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Deca-Durabolin Chapter Eight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 7 Dianabol Chapter Nine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Methandriol Chapter Ten .......................................... 59 Maxibolin Chapter Eleven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 STH- Human Growth Hormone

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Copyriglit,© 1982 by Robert Kerr, M.D.

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s ~seryed. No part of this book may be i"., • reprooucoo:of- utilized in any form or by any means, ~/" /·· ~lectron,ie'~t mechanical, including photocopying or ~//"/' r,k~9tCling, or by any information storage or retrieval ' '''S'fls~dm, without the prior permission in writing from the author. Brief text quotations for book review purposes are exempted.

Chapter Twelve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Testosterone Chapter Thirteen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Miscellaneous Anabolics Chapter Fourteen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Human Chorionic Gonadotropin Chapter Fifteen ...................................... 81 Other Drugs Related to Athletics Summary ............................................ 89

FOREWORD Before we begin this discussion of anabolic steroids I would like to emphasize, and will keep emphasizing throughout the book, that this is not a guide book for self-help. The material included in this manuscript is simply to give the athlete some background information, while supplying some useful imformation for the physicians who are treating and medically guiding these athletes. The indiscriminate use of these drugs will pose a definite hazard to your health without close, personal medical supervision. So, if any of the enclosed information is of interest to you, please see your physician. R. Kerr, M.D.

San Gabriel, California

In the last analysis, we see only what we are ready to see, what we have been taught to see. We eliminate and ignore everything that is not a part of our prejudices. Jean Martin Charcot, M.D. (1825- 1893)

INTRODUCTION Out of 18 years of private medical practice, I have been treating athletes with anabolic steroids for 16 of those years. In the early days, as I struggled to gain size and strength for playing the position of prop in Rugby football, I was continually approached by friends from the local gym for guidance with their anabolic steroids. Their drugs had generally been purchased in Tijuana, Mexico with no medical prescription. And with no medical guidance, the athlete was questioning the drugs' effectiveness, safety and adequate dosage. I had to confess to them that like all other physicians, I had not been trained or experienced in the drug's usefulness. With probably 50 or more volunteers, I learned along with them as they used the various anabolic drugs and I witnessed the gains and the minor setbacks, until I gained enough experience to be able to guide them, and others, in a more secure manner. There are a number of people both in and out of the medical community who could be thinking that I treat these athletes strictly for my own gains. Well, if you know me and if you know how I charge my patients- you certainly couldn't think that. Perhaps I am in this for some personal gratification. That's quite correct, don't we all look for acceptance in our deeds and acts? If I can help someone to achieve a goal, whether it be a well-recognized

body building title or a World title in track or power lifting, or a professional contract for a football player ... isn't that really quite nice? It's always nice to know that you played a small role in helping someone achieve some of their goals in life. What about the ethics of prescribing or helping athletes obtain these controversial drugs? How about the question of "doping" the athlete-is it natural for someone to gain something that they perhaps could never have achieved without the drugs? Well, let's explore these areas for a moment. In my own mind I don't really know if it's absolutely to the best good for someone to alter their body processes away from the true normal-to take medication that they don't really need for their health or to prolong their life. In this area, what about silicon breast injections or implants, is it really normal? I think that you'll agree that if the "alteration from normal" is neither a true hazard for the patient, or others, and if the patient derives a certain amount of happiness or satisfaction from it, then perhaps it isn't so bad after all. Whether you, or I, agree with people taking anabolic steroids-it really doesn't matter, the important factor is that they're going to take them anyway. The surgeon general notes on each cigarette package that they "could be harmful to your health" and the implication is clear that cigarettes could cause lung cancer. Has that notation or warning really halted cigarette smoking? It should-but it hasn't. Marijuana possession is illegal, but does that stop people from buying and using it? A state or federal law could be passed outlawing the sale and use of all anabolic steroids, but the use would be little affected. Somehow people would obtain the steroids and use them, perhaps even more flagrantly than now. The only change would be that there would be a new crime with a new group of criminals and probably with the old criminals illegally supplying drugs for the new ones. My feeling is that athletes are going to use these drugs, whether you or I, the International Olympic Committee, or the NCAA, or whoever likes it or not. So, if they're going to take these drugs anyway, then at least I can play a role in guiding them in the right direction. To advise the athlete on appropriate use of the drugs and be on the watch for any sign of a side-effect appears to be a worthwhile activity. If I should stop performing this work right now who would my few thousand anabolic steroid patients go to for help, understanding and guidance? Unfortunately, there are so few of us scattered throughout the country. I think that some of the physicians who are advising athletes in these matters are shy or afraid

to announce their expertise, so as not to arouse any wrath from their medical colleagues. Perhaps this treatise might arouse some interest in other physicians or convince others to speak out on their statistics with anabolic steroid therapy. The steroids have been tucked away in the closet long enough. In regard to "doping," what about those critics of anabolic steroids who still place these drugs in that category called "doping." To my way of thinking "doping" is a term for the use of medicinal agents that will cause an athlete to act or think in a highly abnormal manner. A drug that energizes the athlete by causing him to feel "high" or hyperactive, or to perform in an abnormal way before and during an athletic event, is not proper. A "natural high" should suffice, but something that causes the sensorium to function in an abnormal manner should not be used. Now, I often refer to anabolic steroids as exercise aids. They do not replace good work-outs, but simply enable the athlete to make the very most out of his weight training. Unlike stimulants, if anabolic steroids are taken just before a contest, nothing will happen. The effects are cumulative- that is the gains are gathered over a prolonged period of time. If work-out or exercise aids are improper, then is not the Nautilus or similar type of exercise equipment cheating, after all this new technology was developed to give greater gains with less effort-isn't that why anabolics are taken? Many of my new patients first came to me for assistance with their anabolic steroid therapy after working out in a "natural manner" (without drug assistance) for years and experienced gains that were very few and far between. If you've ever experienced this type of extremely slow and exasperating trainingyou'll realize why many potentially successful athletes have dropped by the wayside. Anyone experienced in body building, let alone power lifting and many other sports, will tell you that this sport would not be making the tremendous gains that it has made in popularity in the last number of years, were it not for the use of anabolic steroids. Body building has taken literally thousands of short, small and shy men out of their doldrums, and produced a new generation of well-built men with a sound sense of pride and self-confidence. These men would have given up a long time ago in most cases, had they not had the benefit of faster and greater gains through steroid therapy. Is anyone telling the Russians and East Germans not to use anabolic steroids? It would appear that they are the World paceset-

ters when it comes not only to athletic anabolic therapy but to the full gamut of the unconventional in training to win athletic contests. So, can our trackmen and powerlifters abide by the code of conventionaltiy and refuse to take the strength and speed gaining drugs and allow the other countries to defeat us- of course they can't. Until the time comes that all athletes agree to refrain from taking anabolic drugs, then most athletes are going to continue to find the ways and means to excel, and this means taking anabolic steroids. Do we really want our international athletes to come in a far second, or third, or worse, behind athletes from other countries who do not have the willingness to refuse to take the drugs? I don't think in the long run that we do. We might say that we have certain standards that we feel we must follow, but in the end we really want to win at nearly any cost- and you know that's true. We've been witnessing today, and for the last number of years, how our female athletes are being defeated in certain strength and power sports by Russian and East German women who just seem to have an edge- a masculine edge. Right now we don't want our women to be defeminized in order to win, but in the next olympics, or the next after that, will we still be willing to feel the same way? I don't know, I hope in this case that we don't change. New tartan tracks for racing have allowed runners to run faster; new running shoe developments have also increased the racer's speed. The flexible pole vaulting poles have allowed vaulters to reach new heights never imagined before. Well, I could goon reciting such examples of track and field innovations but I'd just as soon not-the point is, man is just not content with retaining old standards. New records are constantly being sought in all forms of athletic endeavor. So why is it so strange that man wants to take drugs that will increase his strength or dimensions? After all, isn't this just speeding up evolution just a bit. To return to the question of "doping," to me, then, "doping" is the use of stimulating drugs. Amphetamines have been and are used for just such stimulation. They are used by some body builders in their daily work-outs and some power lifters in competition, but only a few to my knowledge. I don't condone or prescribe these drugs to my patients and I don't feel that there is a justified need for them in either weight work-outs or contests. Mind altering drugs of any kind have no place in athletics, and to be honest with you, I don't know any athlete who takes them. In returning now to my commentary on my past work with athletes-in researching a drug or group of drugs, physicians are

not usually handed just such as large a group of more-than-willing subjects as was I. The list of subjects would grow as others saw the unexpected gains without the oft-mentioned side-effects. My practice today includes both private patients and anabolic steroid patients, alike. The anabolic patients number several thousand and come not only from the United States but from a number of foreign countries, as well. A few of my patients seek my advice simply for gaining weight and for developing a trim, muscular, "beach physique," but the majority of my anabolic steroid patients are involved in power lifting or body building in all levels, from amateur to world class competition quality. I see athletes today from most every athletic endeavor, except perhaps for marathon runners, as they're interested in stamina, not just size or speed. They appear to be quite content with just finishing a race, beating their "personal best." This is a fine, healthy attitude, but totally unrealistic for nearly all the other athletic events of today. The idea in most sports today, perhaps unfortunately, is to winto be number one- the best. This attitude seems to become intensified as each year goes by. No one boasts of being number two or number five. It appears that everyone wants to be number one. I suppose that it's fine to have lofty goals, if the athlete is willing to spend the time and energy to meet such a goal. Natural talent, of course, plays a big role in the attainment of success in athletics. Many sports have shown us that with only a small amount of natural talent, but with a great deal of time, energy, perspiration, and good guidance an athlete can reach pinnacles that he or she never dreamed were accessible before. In this process the drive forces the person to use methods never anticipated beforehand- a willingness to use any method necessary to out-achieve and defeat all of the other competition. And to be crowned the best in the world, the body builder must defeat all other body builders of his or her sex in the entire world! Power lifters, on the other hand, have a slightly easier schedule to become the holder of a world's record. Here they must defeat all of their sex in their particular weight category. That still leaves a mightly difficult position for any power lifter. I've stated that my practice is made up of athletes from many disciplines, but the number is made up nearly entirely of male athletes. The female athletes that I see for anabolic steroids are extremely limited. I see only one or two female body builders and only a few more power lifters. Female body building has generally remained an extremely feminine activity, quite divorced from the

male counterpart. At first I was repulsed, like most men, by the thought of women with highly developed muscle groups, but I was plea.s~ntly surprised to find them to be charming and ultrafemmme. The naturalness to their symmetry was pleasant to the eye and t~e "rout~ne" was more like a dance routine than the gross muscle display given by the men. If you haven 't seen a women's body ?uilding contest-please do, I think that you'll be pleasantly surpnsed. The female body builders that I see as patients see me for the usual physical problems of any athlete and not for the male hormones that the males all expect that they take. I'm glad that the women have thus far been able to keep the naturalness in their end of the sports, but how long will that last? Sometimes on the road to winning the athlete will be tempted t~ use anything and everything in order to reach his or her goals. Sixteen ~ears ago, with no real medical guidance, the power lifters an.d particularly body builders, took literally "anything and everythmg" that they felt might give them some gains. At a popular southland weight training center some 15 or 16 years ago, the "usual" dose of anabolic steroids recommended to the novice, not by the gym management, but by other body builders was 100 Dianabol tablets, 100 Anavar tablets and perhaps 40 or 50 Anadrol tablets per day! Can you imagine that? I'll bet that somewhere today someone is still taking similar amounts of medication with no more gains, I'll wager, than those on sensible doses. I spok~ once to a world class competitor who admitted to me that he once felt it n~cessary to take 1500 Dianabol tablets each day! Even with Dianabol at $5.00 a hundred in those days, that's ridiculous just from the price alone, forgetting the expected side-effects from this dose. One current patient of mine confided in me that he had once found an old medical text of his grandfather's a few years ago in the garage. In that old physician's journal it mentioned the good effects of strychnine on muscle tissue. The grandson did not read that the text said smooth muscle, not skeletal muscle. He probably ~ould not have recognized the difference in any regard, but a great difference there is. Up until twelve or so years ago, strychnine was sol~ for various medicinal remedies, impotency was one. My patient thought he had fallen into a long forgotten secret from the past and somehow purchased some strychnine tablets and started taking one a day. One of his work-out partners somehow was let in on the supposed secret, and as he wanted to be even bigger than his partner, he took two tablets a day. Another acquaintance discovered the plot and as he wished to be bigger than the other two, he

took ten tablets a day! He apparently soon became quite ill and the causative agent was brought to light. The boy lived but all concerned learned a lesson through the Emergency Room physician about strychnine poisoning. I admire the courage of the one lad in confiding to me his nearly serious error, but, as you can see, some people will do almost anything to reach their goals! Physicians are not experienced in anabolic drug therapy for two simple reasons. Very rarely do any physicians see serious competitive athletes in any quantity and, number two, the drugs themselves are rarely used by the medical community in conventional medical patients. You learn about anabolic steroids simply from clinically using them, using them in a large number of athletes and using them for a number of years. There is no way that you can learn the clinical use of these drugs in just a short period of time or with an inadequate supply of willing patients. Dr. Wright, in his fine treatise on "Anabolic Steroids in Sports" points out the meager research performed on athletes in the past. Thus far, Dr. Wright's book has been the only one that I'm aware of on this subject. I hope that this book of mine will fill the void, but it's certainly not going to be the definitive work on this subject. I, myself, learn new things about anabolic steroids practically every day, and I'll continue to learn as the years go on. An up-to-date revised edition of this book, years from now, will probably reveal information not even dreamed of at this time. My steroid patients are great in number at this time, but with ten or more new patients per week, more information is yet to be gleaned as new difficulties are found and solved. With the welcoming of more physicians into the practice of athletic medicine-anabolic steroid therapy, obviously there is even more to be gained as new ideas are introduced and tried by the medical community. New blood with fresh ideas can never hurt, only help. Anabolic steroid therapy is individualized therapy. You just can't stereotype a group of athletes, predicting drugs, dosages, etc. It just doesn't work. The patient must be appraised from a number of areas. What sport is the person mainly interested in? Are there more than one sport endeavor in which the patient is participating? What gains has the person made up to this point? What gains does he hope to make from anabolic therapy? Are the gains realistic from a standpoint of the patient's training habits and motivation? Any history of disease entities in the past, or in the family? What is the patient's current health? Does he or she take medication regularly? Any history of taking anabolic steroids, and, if so, what

successes or side-effects were encountered? Is the patient allergic to anything, medication or whatever? Are there any current abnormal psychological or physical signs or symptoms? Age could have a bearing, though slight, on the steroid therapy. In the female athlete, is she currently using an adequate birth control method with some of the drugs this could be quite important. Are he; menstrual cycles regular or are they abnormal? A very important factor is the patient's structure, size and weight. Are there abnormal deposits of fatty tissue? Does the patient work out at an adequately supplied weight training center? Who is advising the athlete in regard to a weight training regimen? Does the person work out often enough or perhaps too often? Does he work out well or just going through the motions? Who advises the patient on his nutritional status? Does he take in an adequate amount of protein? Is there a protein supplement being taken, if so, what kind? What vitamin supplements are being taken and when? Well, we could go on but I think that you can see that there is a great deal of information that must be gleaned from the patient before deciding upon an appropriate form of anabolic therapy for him or her. I don't really think that the pharmacist in Tijuana, Mexico or the black market anabolic supplier at the neighborhood gym is at all concerned with these figures. Generally it's: "here are some D-bol, they're great- they made Arnold as big as he was,'' or some similar bit of nonsense. I'm certain that Arnold himself would not be willing to advise someone in so haphazard a way. As you'll read, Dianabol can be a wonderful drug for some, a tragedy for others. For those body builders who are opposed to the use of anabolic steroids, there are contests that are referred to as "naturals." For one thing, a weight trainer who is not enticed by either his friends or his competition into taking the anabolics is to be admired. He must certainly have self-confidence, and few are found today to have that. Lack of self-confidence is certainly a major reason for many men entering into body building today. Along with the muscular development comes a self-assuredness not present before. Sometimes the shy, retiring man develops a "chip-on-theshoulder" attitude along with the muscles. This new attitude and outlook is probably very good psychologically as it pulls the person out of his shell where he can converse well with others as never before. Some successful body builders might overdo the selfassuredness thing once in a while, but I'm certain that they're better overall because of it. ,

But back to the non-steroidal body builders, I mentioned that they must be admired for their willingness to pass up the pressures of their peer group and refuse to take the anabolic steroids. T he ones that I've seen are not dramatically developed, but they do have that certain "naturalness." They are no match in a mixed contest with steroid users, however, and frequently succumb to the temptation for greater size through steroid therapy usage. It really is a shame that to successfully compete today you must follow the dictates of your competition or fall by the wayside and not many are willing to fall. Sometimes this follow-the-leader attitude forces the athlete into feeling that he must take more and more drugs just to keep up. Instead, he should follow the heed of the "natural" body builder and develop as much as he can without any drug stimulation at all. Then, when the gains finally become few and far between and he wonders if it's worth all the effortthen the addition of a single, oral anabolic drug could make a world of difference. But, remember, nothing takes the place of a good work-out. The use of anabolic steroids is not a short cut as far as horter work-outs are concerned. If anything, the athlete on anaholies must work harder, not less. It must be clear that anabolic teroids are for the sincere, well-motivated athlete who needs omething that will simply accentuate his own natural development or talents. Some of my patients are in their later teens and their parents have sometimes expressed some doubt concerning their son's interest in weight training. Many people from my parent's era in life related body building with being gay. They felt that the sometimes exaggerated poses developed to show up or accentuate musle groups, appears to be effeminate in appearance. The younger people today know that this is ridiculous. Body builders are no more or less masculine than the rest of the community. It's a sport like all others and sexual preference plays no important role in it. Now, one important reason for aiding these athletes and not I tting them become discouraged is that they become better persons. The body builder, as an example, does not smoke, does not use alcohol, does not use narcotics, does not generally eat "junk food," is oriented to health and, therefore, should live longer, and be healthier than the rest of us. These athletes usually don't age like the rest of us- isn't that nice? They workout in the gym, work ttt t he job, or go to school- they're too tired to get into trouble with the law. This is also a fine feature for it implies good citizenship.

So, I really can't think of any good reason for keeping someone from "working out." The trouble with many athletic endeavors, and particularly weight training, is that certain early gains are reached fairly easily but to gain further is seemingly near impossible. The weight trainer struggles for long hours to make only meager gains, or none at all. It gets discouraging, when someone else, working out either as hard, or less than you, is making better gains than you are. That's enough right there to convince you to take up tennis or racquet-ball. Then you find out that he's taking "steroids." That's all it is, you're not deficient or abnormal-he's just got an edge on you. So, what do you do about it? Do you find someway to get the drugs yourself or do you forget about the whole thing? You've heard the guys at the gym talking about those terrible side-effects from "steroids." You know-the liver or kidney failure or the baldness, or even worse ... the sterility. Let me say that in sixteen years of working with anabolic steroids and thousands of patients, I've never seen any of these side-effects happening to any of my patients. Now, I don't mean that these medicines are absolutely safe-like any medication, there is always a chance for side-effects. But in my practice they have thus far been extremely remote. In preparing for this book I surveyed the year 1981. In this last year, with a few thousand patients on various anabolic steroid regimens, I had fifteen patients report to me that they had developed acne. I had twelve patients develop high blood pressure from their anabolic drugs, and I had one patient with gynecomastia (an enlarged, tender nipple). In all of these twenty-eight patients I simply changed their medication and the problem disappeared. One patient with a long history of hypertension and who did not wish to halt his medication, was placed on a mild anti-hypertensive tablet with good results. I said twentyeight patients, out of several thousand. Now any physician who uses antibiotics, or pain-relievers, or arthritis medication or blood pressure medicine or heart medication or blood cogulation medicine or cough or cold products-or most any kind of medication on his patients, will tell you that he sees a certain percentage of side-effects. In practically every case, the percentage will be higher than that that I find in my anabolic steroid patients. What I'm saying is that if the physician develops a good knowledge of these drugs through experience and if he hopefully gives the right drug to the right patient, the chances are great that the anabolic will be as safe, or safer, than any other type of drug that he could give to that particular patient. Again, I don't want to imply that self-medica-

tion is fine-it isn't. There is no one better at guiding and directing your medication than a physician. The wei.g~t training coach will do an excellent job of developing your trammg program and the nutritionist is best at recommending dietary needs, but only a physician should recommend and prescribe your dr~g ther~py. H~s knowledge of pharmacophysiology with drug mteractlons IS unsurpassed by any other. Of course, you expected me to say that didn't you, but it's quite the truth. . Earlier I was discussing the side-effects that I see m my patients, the four things mentioned as side-ef~ects to. ana~lic teroid therapy are baldness, sterility, liver and kid~ey fail~re. I ,ve aid that in 16 years of practice in using anabolic ste~mds I ve never seen any of these disease entities in any of my patients who are following my advise. First, in regard to baldness. I see thre~ or four men who are bald, they were bald before they started taki!lg teroids and their fathers were bald before them. The anabohcs imply did not cause their baldness. I don_'t k~ow of any of my patients who are complaining of losing their hair today, actually hey generally comment on how much mor~ luxurious th~ir hair is growing. A slight increase in body hair will be found with some thletes taking the anabolic steroids. Some athletes state th~t their straight hair is now becoming wavy. I can't r~ally ex~lam his last statement, but why don't I see more bald weight tr~mers than I do? Why is there not the same percentage of baldnes~ m the weight training athletes as in the rest of the male popul~tlon? Do balding men not work out with weights? I can't really behev~ t?ey don't. Could it be that a good exercise program, clean hvmg, vitamins, protein supplements, (or perhaps anabolic ~te~oids) are keeping men from balding? Now, just as an observatiOn It almost appears that this is so. In regard to sterility, I perform a sperm count on. my no.nasectomized male patients every three months, as will be discussed later under laboratory tests. Occasionally I do find a pecimen with a very low sperm count. H~lting the ana?olic ste~­ oid or using human chorionic gonadotropm usually reheves th~s problem. Occasionally the problem is associa~ed With ~ ~ro.stat.Ic infection. In this case, clearing the infection with an antibiotic will t liminate the sterility problem. . Liver and kidney problems have never been present m my patients and yet liver and kidney tests are performed every ,three months in looking for just such problems. Now, I shoul?n t say never, but there is an explanation. This last year I received the

routine laboratory reports back from one of my old patients. He had stated that he was feeling fine and was preparing for a contest, but the liver tests were grossly abnormal. The lab, after seeing the results, ran a test for viral hepatitis and this was read as normal. So, I asked the patient to come in and see me. I read from his chart that he was taking four Anavar tablets per day and 100 mg. of Deca-Durabolin each week. I told him that I couldn't really imagine how that dose could cause the liver picture present on the lab test. I told him that I thought that he was taking much more than that dosage. He confessed that while training for the contest, he had been unable to train as often as he would have liked due to his job. He was taking fourteen Dianabol and fourteen Maxibolin tablets with Deca-Durabolin and testosterone cypionate in rather large doses intramuscularly each day. No wonder his liver reacted! After halting all the medication for one week, the liver tests returned to normal. They remained normal after he later returned to the Anavar and Deca-Durabolin dosage. He learned a lessondon't fool with mother nature by using too many steroidal drugs. In a recent medical journal the comment was made that anabolic steroids can cause euphoria. Webster's defines euphoria as a feeling of well-being. I certainly can't believe that statement. Well-being most assuredly can come from successfully working out, being satisfied with a more muscular frame, or from correcting a previous feeling of shyness or inadequacy with a new feeling of self-confidence. I can think of other reasons for a feeling of well-being- but certainly not anabolic steroids. I wonder where the author of the article ever heard that one? He also reports that oft-heard bit of garbage seen on anabolic steroid insert sheets: "anabolic steroids have no effect on strength or athletic performance!" Anyone who believes this statement must be either totally misinformed or is like an ostrich- with his head stuck in the sand and ignoring everything he sees or hears. I'm sure that body builders from forty and fifty years ago worked out very hard, and yet I would imagine that Mr. America from somewhere in the Forties would have difficulty today in just placing in the Mr. Los Angeles contest. Today's athletes are obviously stronger and bigger than ever before. Does this mean that today's power athletes work out harder than power athletes from years agoprobably not. The athlete today has many advantages not obtained before. Anabolic steroids is only one of these advantages, but perhaps the one advantage with the greatest influence. Why are power lifting records being continually broken? Now certainly new

innovations have been developed in lifting techniques, but let's ace it, anabolic steroids have played the major role. Anyone who s ys that anabolic steroids does not build stronger, bigger, faster 1 dies is simply blind, deaf and ignorant, or just misinformed. Prostatic hypertrophy (enlarged prostate gland) and peptic tlcer have been quoted by a few medical authorities recently as 1 ing caused by anabolic steroids. In 16 years I have never seen t•ither condition in any of my patients. Prostatic hypertrophy is g nerally thought to be an enlarged gland caused usually by.an adenoma (a benign tumor)- I've never heard of any athlete havmg this condition, whether on anabolic steroids or not. Prostatitis is < used by a bacterial infection, while prostatosis is usually found with sexual abstinence, again not anabolic steroids. Peptic ulcer emcompasses two main disease entities: gastric or stomach ulcer, and the duodenal ulcer. Gastric ulcer is rather 11 ncommon and affiliated with a stomach irritant: charcoal-cooked f od for one, not anabolic steroids. Duodenal ulcer is simply a r • ponse to internalization of adverse external stimuli: stress at work mostly- again not anabolic steroids. So, I can't imagine where some of these medical, and lay, authors derive their inforltlation on anabolic steroids. Hearsay probably plays a great role .t nd you know how a rumor changes as it spreads. I have quoted my "ide-effect statistics and as I've not seen any of these often quoted o..,i de-effects-I'd really like to know who is seeing these problems, .tnd are these patients, if they're present at all, taking sensible o~mounts of anabolics under good medical supervision? In the course of this book I will be mentioning gynecomastia ,, · a possible side-effect. This condition involves the male nipple .md breast tissue. It can be uni- or bilateral, though unilateral rn volvement is much more commonly found in my practice. The rn volved nipple becomes enlarged, due to the inflamed breast t i sue beneath it. The degree of tenderness can range from no pain 1c a very sharp pain. More comments on this condition will be found throughout the commentary. Hypertension is another term that will be mentioned from t i me to time in my discussion. Hypertension is high blood preswre, and in my mind hypertension basically is present when the o..,ystolic (upper number) is over 150 mm; The lower number, or diastolic pressure, is abnormal if it is found to be over 90 mm. Now various physicians will be found that will have different numbers f r their criteria, but these are the criteria I use. When in the course of the book I mention labile hypertension,

I'm speaking of a patient whose blood pressure can elevate either systolically or diastolically, or both, with only slight prov~cation. The emphasis here is that this individual must be monitored closer than the normotensive person (his blood pressure is taken more often) . . In mentioning something about an appropriate dose, how do I arnve at what is an appropriate dose of anabolic steroids for someone?. Well, I w?uld say first that the least amount of drugs th~t contmues to give a good effect is the best idea. Stacking, or usmg more than one drug, is fine if the one drug, an oral first has now lost it's effecti~eness. Don't rush headlong from one dr~g to three or start out With both an oral and an injectable drug. First, get the most good out of the oral. Probably your gains couldn't be bet~~r, and then add the injection only after absolutely "peaking out on the oral product. Just because your work-out partner is on two or ~hree drug~, that doesn't mean that you need to go to that many, JUSt stay With it- probably eventually you'll be on two or three drugs, but not now, not as a novice. Don't listen to other lifter~ .telling you what drugs are probably best for you. Your physician knows better than anyone else, listen to his guidance, not to some loudmouth at the gym. He could mean well but he'll probably only confuse things worse than ever. . A.ll the criteria mentioned earlier in the chapter are used as gmdelmes for dete:mining medications and dosages. In the chapters on the anabolic drugs, to follow, I'll outline with whom and w~ere I would use the various drugs and combinations thereof. Without a doubt, the wrong drugs or the wrong combination of d~ugs, or drugs taken at the wrong time in competitive training will have a definite adverse effect. Recently on television a power meet was seen involving some of the strongest men in the world. Two of the contestants were patients of mine, and they fared quite well. Another contestant from the Eastern United States, I believe, was noted on T.v: close-ups to have hundreds of acne lesions all over his face, neck, shoulders, back and upper arms. My concensus is that this indi~id~al is incorrectly taking high doses of injectable testosteronem-oil. The ~ower.that he has achieved is fine-but for a high price. My two patients m that contest lifted just as well and had no acne lesions. In fact, none of my thousands of patients at this time have any such defects in their complexion. I think that with better guidance th.e other lifter could be just as strong, or stronger than now, and without any mar to his health and complexion.

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CHAPTER ONE

LABORATORY TESTS Laboratory tests give the physician clues to the inner world of I he patient. Changes in the body chemistry can predict a very early

arning of an impending problem. The physician with his educaion and experience is the only person capable of truly unlocking I hese clues to the inner body, as the non-physician, who is not working daily with and interpreting these tests, cannot hope to 11nderstand all of the complexities involved with the interpreta1ion. Even with a good basic understanding of laboratory interpre1ation, the athlete, whether he be on anabolic steroids or not, must b viewed in a different light than the non-athletic patient. Some of I he lab tests can be interpreted at face value with results showing no real difference between athlete and non-athlete alike. Some of I he tests, however, must be read with the athlete definitely in rnind. His drug intake, type of athletic endeavor, diet, supplements .tnd body habitus all play a role in deciphering the information. Let's look first at the blood glucose determination: the blood " ugar" must be viewed with an understanding of when the 1 atient last ingested food or drink prior to the blood being taken. I he time of ingestion is important, but equally as important is the I ype of food or drink taken in and the quantity ingested. Two hours , after an average meal the blood glucose should rise to about 150 1

mg./dL, while 190 mg./dL is acceptable one hour after ingestion of food. Likewise, a 12-hour fast should produce a level much below 90 mg./dL. These levels are examples only, and the rates vary from physician to physician and laboratory to laboratory. So what is deemed borderline by me might be considered quite abnormal by someone else or in the high normal level by a third physician. The above quoted glucose levels are found in non-athlete patients, while in the athlete, lower than expected values are quite commonly found in the blood glucose determination. The non-athlete with a glucose level of 20 mg./dL would be questioned for signs and symptoms of hypoglycemia (or low blood sugar), whereas the athlete will "burn up" his sugar stores for energy while training and abnormally low-appearing glucose levels are frequently found on blood panel studies of asymptomatic athletes. In my practice a blood glucose of 18 or 20 mg./dL is not surprising in a training athlete, though most are higher than this. Upon questioning the patient he tells me how well he feels with no symptoms referrable to his relatively low blood sugar levels. Thus, an athlete might be expected to have a lower normal blood glucose reading than the non-athlete, while higher than normal blood glucose levels are never found in athlete or non-athlete alike. In the latter case, further studies are needed to rule out diabetes mellitus. One recent medical writer has theorized that the use of anabolic steroids can aggravate or be causative of diabetes mellitus. I've found no physiopharmacological basis for this idea and my experience has shown just the opposite to be the case. The diabetic patient on anabolic steroids generally improves, requiring a lessening in his daily medication or dietary requirements. The reason for this is not a direct action of the anabolics, but rather a decreasing blood glucose level due to a more spirited work-out and increased dietary controls. Also, I've never seen a case of diabetes be precipitated by anabolic steroids and/ or good weight training. In my practice I send the blood specimens to a laboratory, as I'm certain do all other physicians. Reports are uniformly conveyed to my office the next morning as two copies of the final reports. One copy I file in the patient's permanent chart, while the orginal is sent to the patient himself. A list briefly describing the function of each test is included with the report and I write a note on the lab report itself, analyzing the results of the entire test for the patient. This is done for a better understanding of the test's meaning, though any abnormality is discussed with the patient in person, again for better understanding.

What I've said so far regarding the handling of laboratory sts is probably the very same method used by most physicians t day. Today people want to know exactly where they stand, ·xactly what is wrong with them, if anything, and how severe the problem might be. Years ago physicians routinely kept laboratory 1 sts a secret from their patients and generally explained little! day that's all different. Athletes are probably more interested in their laboratory test results than the non-athlete, as the athlete is u ually more health conscious and certainly more literate about h alth problems than the average person. In this monograph I'm not going to try to tell your physician h w to interpret your own laboratory tests. I do hope, however, I hat I can pass on to other physicians some comments on the tests 1hat I have found to be pertinent in evaluating athletes. If a physician is open for suggestions, possibly he can make use of · orne of this material to expand his own knowledge. As physicians w quite often learn from one another. Let's speak now of some of I h specific laboratory tests that I recommend be routinely performed on anabolic steroid patients. By routinely, I might say that I've found throughout the years that every three months seems to Ia• a safe interval of time for testing. Any more often makes testing ,.x pensive for the athlete's budget, any less often makes it difficult lo fi nd a problem early and arrest it's development. There are 1 hose cases, of course, where re-testing, more often, is to be d(• ired. For example, if a certain test on the panel study is abnorrnal and the patient is given a specific therapeutic regimen in order 1o liminate the problem, a repeat evaluation of that particular test 111 ight be in order before three months has passed. On the other It and, I can't think of any case where I would delay the tests longer 1han the three month's period of time. I've already made some comments about the blood glucose l,·v 1found in athletes. Now let me mention the other tests, one by nn , with a suitable commentary after each. First, the white blood count (or WBC); I've seen no deviation I rom the normal range with patients on anabolic steroids. An !I!Tasional upper respiratory infection or such will give an ,. p cted rise in the count, as might be expected in anyone, but 11c·v r a depletion as might be found with many other non-anabolic · lc•roids , or other drugs, for that matter, taken for a prolonged twriod of time. I'm speaking here of aplastic anemia, as realistic.cll y might be found with the long term use of certain antibiotics 11 HI arthritic medications.

Next, the red cell count (or RBC), plus the MCV, MCH and It' l , is a serious consideration, though an extremely rare one in MCHC - thesefour tests tell us of the amount of red cells, the cell's 111 patients. size and shape, plus the amount of hemoglobin within the cells. The uric acid can be indicative of an impending case of gout, ,1• with any individual. Many times the uric acid is found to be Goodman and Gilman in their fine text, refer to large doses of androgens causing ''excessive erythropoiesis leading to moderate .It g h. tly or moderately eleva ted in weight tra~ners du_e t? the excess polycythemia." This means an increased amount of red blood .11 nount of purine foods taken in with the1r protem mtake. _For cells. This reference that Goodman and Gilman make appears to ,.. tmple, many athletes will take in copious amounts of l~ver be the entity that we used to call stress polycythemia. This was , t r ct tablets to increase their body's protein level. The punnes described as an increased red cell mass seen in males who are IHc';\kdowninthebodyintouricacid,andanover-abundance,that under increased stress and strain. In no one case have I found a 1• not eliminated from the body, can lead to the development of an deviation from the expected RBC normal except in cases of dehy,. qui itely tender, gouty joint. Diuretics (or "water pills")_tak~n dration (excessive perspiration and/or the use of diuretic medica11 , 1t hletes to reduce their fluid weight, can increase the unc ac1d tion, without replacement of orally taken fluids). In the case of "'"''the same as the hypertensive patient who takes the diuretic dehydration, the fluid in the blood is decreased making the cells tilt 1t antihypertensive qualities. . . appear to be in greater supply. Liver function studies- namely: total protem, albumm, globThe hemoglobin and hematocrit: these two tests refer to the t1ltn A-G ratio total and direct bilirubin, alkaline phosphatase capacity for the red cells to carry oxygen to the tissue levels. Again, d in one 111 d' rglutamyi trans peptidase. These are ~ound elevate_ t, 11 111 or another in cases of liver dysfunction (as seen m those an increase is seen, and expected, in mild dehydration. A decrease, as with any patient, deserves a good hematologic work-up to detect 1 11\ 111 g abnormally high levels of anabolic steroids), viral h~patitis, the cause-bleeding or whatever. 1 1 cs ive Vitamin D intake, dehydration (or over-hydration) and Thedifferentialistheenumerationofthepercentageamounts 111 ,dnutrition. When I see an elevated alkaline phosphatase and of the various types of white cells. Here once again no change is 1 ,, .'II I think of an obstruction to the bile flow (as in gallbladder seen in anabolic patients or athletes in general. ,11 ··a~ ). When one or the other of these two tests is elevated I look The mineral calcium can be elevated in those people taking in f111 , 1 hemical cause of the problem (liver overload from drugs). more of this mineral via their mineral tablets each day than is , 11,.1 1fically with the GGTP, here an elevation can be caused ~Y necessary. An increased level such as this can lead to kidney de nh 1 certain narcotics and other drugs, though not necessanly ' stones and other factors. A high calcium level can be found also in 111 , 1holic steroids. patients who are taking an over-abundance of milk for it's protein 'I he transaminases: SGOT, SGPT and LDH levels are liver qualities, or milk and antacids for some upper bowel problem such (11111 t i n studies and are also called ''muscle enzymes.'' An elevaas hyperacidity or peptic ulcer disease. The over-usage of some 1,, 111 of these is found with cholestasis (the obstruction of bile), as types of diuretics will also increase the calcium level in certain 11 . 11 with an over-abundance of anabolic steroids, but is very people (diuretic usage is discussed further in another chapter). 11111 monly seen with just simple mechanical exercis~. ~het?er the The mineral phosphorus can be decreased with the same 11111 •• ri is injured by a poorly conditioned man strammg h1s ~ack diuretic medication. This is the only change I see in my patients' t 1 ~ lifting some heavy object over the weekend, o~ the w~1~ht phosphorus level. It 11111 .r who constantly "injures" his muscles by we1ght trammg BUN (or blood urea nitrogen) and creatinine levels: these will tilt "I ulking and pumping up" exercises, an elevation again will be slightly increased with mild dehydration from loss of body 1•1• 11 with these enzymes. In other words, if the LDH, SGPT ~r fluids and a notation to increase the fluid intake will be made to the ,( ,.1 i~ lightly, abnormally high, this I expect in someone who 1s patient. A decrease in BUN is seen rarely in athletes as over11 1 ,.~~fully exercising his skeletal muscles, whereas I would not hydration is seldom a problem. The high protein diet required of 11 ,., t to find these elevated in a non-exercising, well pers?n. In anabolic steroid users quite often also elevates the BUN. Kidney Ill\ 11 , a tice as the athlete begins to train successfully, w1th or disease, as evidenced by high elevations of these two laboratory _ ..__....u.........."' ut th anabolics, usually the LDH is the first of the enzymes

uldilive in his vitamin-mineral intake. A decrease gives cause for to become elevated. Later, as the training becomes more rigorous, "·" m and further studies are needed to determine the cause. the SGPT is the next most likely to elevate. Finally, an occasional Magnesium-! find this mineral to be low in many weight mild elevation of the SGOT is seen. In other words, I expect these t 1,11ning athletes, the cause of which is not always clear. My elevations to occur with good weight training in most individuals. 111 v y has shown no particular anabolic steroid, nor any other If a toxicity to the liver is suspected, then the other liver studies d' 1w r dietary regimen, to be at fault. should and will reflect this. In the case of a suspected liver abscess , odium, potassium and chloride: these chemicals (or electroor cyst all of these tests can be normal with the exception of an ! t , ...,)are elevated, or depleted, in various states such as dehydraelevated white count and abdominal physical symptoms. I have '"'" (or over-hydration), chemical imbalances, over-use of diuretics never seen nor found a liver abscess nor cyst in any of my anabolic 111d profuse sweating, to name just a few of the often seen causes steroid patients in 16 years now. I do see a rare case of a liver reacting to over-dosage of medication now and then. The cause is 111 .1thl tes. Urinalysis-in my office we perform various tests upon the always the same: the insecure or misguided body builder or power p,tlll'nt's urine: pH, urobilinogen, bilirubin, specific gravity, sugar, lifter who ignored my therapy plan and decided that a greater ld1tod, nitrite, protein and ketones. Examination of the urine sedidosage of steroids was needed. 1111 111 ·an be performed in looking for such things as casts, bacteIt should be mentioned that a heart attack (the heart being made of muscle) can be implied from elevated enzymes also. But in 11'· 1nineral sediment and others. The density of the urine is tested with the specific gravity. I this case a greatly elevated level will be found for each enzyme and l't, tly found an unusual disease entity in one of my new patients not the mild elevations that I implied would be found in weight 11 It this test. The disease is diabetes insipidus, it is a disease of training athletes. In the suspected heart attack patient, other lu tnluitary gland and not to be confused with "sugar diabetes" blood enzymes can be used to rule this condition in or out. It d wt r mellitus). This disease is rare and is in no way connected Cholesterol (a true chemical steroid-but not an anabolic one) is a blood fat. This is often found to be elevated in my patients due '' h anabolic steroids. I h urobilinogen and bilirubin gives an early warning of to the high protein diets consisting usually of a large quantity of 1 , .thlc liver disease, while the pH can vary sometimes with the eggs, fatty meats and milk products. A notation on their laboratory t ltl1·ll' diet. A persistently alkaline urine can lead to a renal results sheets for them to decrease their high fat intake (and substitute other protein forms in the diet) will nearly always bring on a decrease in the cholesterol content to the blood. Comments are 1h urine with sugar in it must be considered as diabetic, made in journals now and then that anabolic steroids can give a 11,,11 •h the blood sugar determinations are much more accurate in cholesterol rise, but I don't find this to be true. I believe that the 111 , as . A follow-up two-hour, post-prandial blood glucose is athlete's diet plays the biggest role in the blood fat elevation. If the 11 1111Lt! ry. dietary fat is decreased, then the blood fat content will be Blo din the urine is found now and then with male athletes decreased also, even though the anabolic steroid is continued. At t h .1rute prostatitis. This is a non-venereal disease that is not thistimeihaveonlyoneanabolicsteroidpatientonafat-lowering 111 ~;tl 'd with anabolic steroid therapy. Blood cells can also be drug regimen in combination with the low fat diet. n 11clt outinely in kidney or urinary bladder infections, and, even Triglyceride is also a blood fat and similar comments can be h ~~~~~ 11 it' an uncommon disease, cancer of the bladder. So, when 1 1tlnocl ells are detected in the urine, a good urological evaluamade for this as with the cholesterol, except that here a mild 11 "' 1n, ndatory. This is true of athlete and non-athlete alike. elevation is expected if the athlete has not been on a fat-freediet for the 24 hours prior to the blood being drawn. Thus, I call a mild itrit s in the urine can be a predictor of a renal tract triglyceride elevation as normal; the cholesterol level, it might be 11 1 11on, while ketones could be found in athletes who are simply mentioned, can be elevated in a person who is emotionally upsetl1 It 1l1 ;tied. nervous or under undue stress. l't olt•in in the urine I have saved until last. Simple exercise Iron can be found to be elevated in the patient with an irou_.._---&..£U.J...LLL~uu•a.cL.t;JkLain_._amoun f om · · th urin an while

this finding might be an ominous sign in a non-athlete, it is an 11 rtll . It might be noted that the semen examination can also expected thing in many athletes. First, athletes are usually on a ., 1 du s to the presence of a prostatic infection. very high protein intake and "spillage" of excess protein in the In the above dissertation on laboratory tests, I have menurine from the blood might certainly be found. Protein in the urine llllltt·d hat the urine and semen tests are generally performed on a should be a reason to examine the urine sediment. True exercise 1 '"''n basis-every three months-on my patients who are takproteinuria (protein in the urine of exercising athletes) will fre'"f .utabolic steroids. Obviously, like the blood tests , the test quently show the presence of hyaline or granular casts in the 1r ttl I can offer to the physician an ever wider variety of diagnossediment. Orthostatic proteinuria means, simply, protein found in 11 1 111 than I have mentioned. I have discussed abnormalities the urine of someone who has been in the upright position for a found in my athlete patients, abnormalities that are not number of hours. There are specific recumbency tests that can 1 ,, found in my non-athlete patients. The more obvious conrule this condition in or out. If repeated urinalysis show persistent ton reached with these tests I need not relate to another moderate to heavy amounts of protein, then a careful urological 1111 H •an, as he is well aware of the meaning or interpretation of work-up is again called for. Exercise proteniuria has been reported 1" , t p ls under non-athletic conditions. in some cases to show red blood cells as well as protein in the urine, but I've never seen this in any of my anabolic steroid patients, thus t' hind Diana bol and Anadrol as the least expensive Ill tonal oral anabolic agents that I routinely prescribe. , I 'nl of neric Dianabol this last year has found this 1 • 1o lld h least expensive of all-by far. Searle has had 1 111111 It lik Dianabol's Ciba Laboratories in one respect I h., r utinely withdrawn from the manufacture of , , ntH' or two times per year basis. This left the athletes I "' < t' through Anavar floundering for a substitue lit '" 1wo until Searle decided to produce the drug once 1 II ttu lt·vpry time, to my recollection, the heralding of the I I "IIIII' drug was preceded by an announcement that the I I I, ,, dollar or two higher than before. Currently most 1 ' ' ' ot $2:3 a hundred tablets, but some have reported 1 lr ' hit less for their Anavar. 1 ' til pr ·scribe th drug on a two-tablet, twice daily II "'''~ ts 1 tt r a b. orb d, in my exp rience, when '' tlllt'

-..I:::E:.:....:......-- . . ; . . . . -

This is my standard..routine for men, but for women I recomme starting with one tablet, twice daily with usually very g results. The drug can be used in combination with other drugs f optimum results after "peaking out" on the Anavar alone. If so size is required and no injection drug is desired, Dianabol Anadrol can be combined with the Anavar. Here, I usually sugg initially adding one ianabol, twice daily, or Anadro1, one tabl per day. Later, and for greater size gain, going to the full fo Dianabol or two Anadrol per day, with the four Anavar table each day. For greater gains I would rather recommend to my patien that an injection be added to the Anavar when the gains ha halted. The injection would vary from Deca-Durabolin for "c ting up," to methandriol for some size gains, or perhaps a lo acting testosterone for optimum weight and strength gains. you can see, there are variable factors governing the determi tion of which drugs to use and what dosages would be appropria Talking to the patient and examining him will generally guide to a reasonable and successful solution. Anavar is the one drug least likely, in my experience, to cau any side-effects. I honestly cannot remember when someone Ia complained about some ill or unexpected effect from this dr There is rarely any fluid gain from Anavar, thus generally dee ing it the drug of choice with labile hypertensive patients. In t area, it should serve well with the patient who must keep weight down to the minimal amount for a contest (for "cutting u or "making weight.") I have not found this product to be especially useful wi speed athletes. Dianabol usually gives a much better gain in raci speed, but there are occasionally those who should not take Di abol. Severe acne is just another example of the latter. Anavar is the best drug of choice for the body builder in t latter months prior to a contest, when "cuts and vascularity" are prime importance. The power lifter who must maintain his wei carefully also likes Anavar. I have had some World Class po lifters declare that Anavar was, by far, the best drug for gaini strength. I don't know if I would wholeheartedly agree with t statement, as Dianabol and Anadrol can produce some electrifyi examples of strength and power, but for the strength-gain, wi out an appreciable weight-gain, nothing can touch Anavar in practice.

1h1111}:h very limited. To this date I have seen no evidence of 1 111!11 ization in any of my few female patients. I start them 1 d1ll'! twice daily and increase the dose as "peaking out" I 1 1n I hree and finally to four tablets per day, though this 1 1 1.11 1 ly necessary. The signs and symptoms of masculini11 1 .11· fully explained during the first visit with both the 1 11111 h ·r husband, or training partner or friend. She is told 11 t In 111 immediately any deviation from the normal. Mas1 11111 rould include persistent hoarseness or deepening of u IH' 1decreased libido (or sex drive), enlargement of the l1 VIH'. of the vaginal tissue or a smaller breast size. I 11 tile women finally "peak out" after reaching four 1 d.1y eca-Durabolin is usually a good addition, though 1 11~dly progress quite far without resorting to the injec11 tllon. Obviously some use these drugs and are unwilllntil Ill ir usage to others (or to me)! 1 nl1on d earlier, a certain amount of testosterone in man 1It d h the body into estrogen. This process can, in some I ~ d lw f und to convert more than the usual amount of 1 111• 111 t the estrogen. A softening of the tissues can occur 1 1 llft•nt f minine-type breast development. Anavar is the I 1!11 ;tndrogenic product that will not convert into estro111 11 I!Ill', can be very beneficial when treating this unus' 1 p.d 11'11l. The usual dose in this case is the same as that '""'" .1b ve. In this same respect, the patient who devell!lll.t' 1Iii or acne with the more androgenic products will ' pon I much more favorably with Anavar. After "peakIt h Anavar, adding the injectable testosterones will II 11 l11111g back the same adverse signs and symptoms of 11 11 , ,, noted before, so methandriol can cautiously be tl11 navar, or more safely and with less weight I

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, '''" ;tl lin. lwt·n staling that my usual dose of Anavar is two , d. ttl , ft r meals, but there are a few patients who It 11 .ttl by oingfromfourtabletstosixtabletsperday. I"' 1,tlly 1ru for the patient who is benefitting from the 11 Ito 1s h ' itant (or plain unwilling) to go next to the " ' IIIJI'I t a hi type of medication. In this latter situation 1 1 1hat h Lak imply three tablets, morning and Ill< II c• than s ix Anavar p r day is only inviting the ulc· l'ffec ts. I us ix tabl t p r day only in a few ~~~~~~~~~~

side-effects statistics with you earlier so I feel that four tablets best and I never prescribe more than six per day. Anavar is also the drug of choice for initiating anabolic apy in an over-weight person. Here the fat-weight is to be lost the athlete changes the fat into firm muscle. The "bulking" Dianabol and Anadrol, will only add to the problem by · further weight gain (probably regardless of the restricted diet rigorous training routine). Anavar will generally allow the IJa,_u;;o~~• the opportunity to lose total weight while gaining muv\.,u••• strength. I recommend that the patient take the usual dosage outlined above. To recap Anavar: this is the oral anabolic drug that is best "cutting up." It is found to be low on the androgenic list therefore, a good drug to use in the patient with a history of gynecomastia or hypertension. My experience has shown drug to be the least likely oral to show any side-effects, and price is quite affordable.

CHAPTER SEVEN

I >ECA-DURABOLIN holi n, or nandrolone decanoate injection, is availLaboratories in strengths of 50 and 100 mg. per 1 , , ,. quit expensive, though probably well worth the ,, Ire •.1111s derived. The same chemical product, called a "' 1111tfactured by quite a number of companies. The 1r d"' 1• .1r xactly the same as the name brand in all 1 11 1·. do sa , effect, et al. The only difference is the "' '" ;1n quite a bit cheaper. I I ,, rlin is th premiere "cutting up" drug. Thereten1 r1l1 1h'ra urabolin is very minimal, if present at all. , '"' 11 y 1..., quite low and is, therefore, excellent for the 11 11 1 .. II all r quired. "Deca," on the other hand, is a lit dr11~: for "bu lking up," as little weight gain can ~e '" 11 In rn y sixl n years experience in treating stermd , , 111111111 (' tr mely few cases of side-effects with this t 11 1IIi . ., tim I can't recall the last time anyone de c•llr·c t with ca-Durabolin therapy and acne has l.t 1 "' \ ,, h any of my patients using this drug, nor I• ''

11 .1

111or1

cient size so that "bulking" is no longer needed or desired. patient who is heavy and in need of weight reduction before taining any thoughts of competition could benefit from this after reaching a stalemate with an oral product. I might also this drug as my drug of choice for injection in cases where borderline or unstable hypertensive is found, and also in pa · with acne vulgaris. The companion drug, Durabolin, is available but I have found a good application for it. I think that the Deca-form, or other drug, for that matter, would be a better choice Durabolin. The drug information sheet found with the drug states this drug "is a synthetic derivative of testosterone." "The action mainly anabolic (protein sparing) in that it promotes the building tissue-building process.'' ''The nitrogen balance improved but only when there is sufficient intake of calories protein." This latter statement is important as deficient of protein will lead to poor gains. An adequate caloric intake likewise necessary, with the amount dependent upon the pauo;:;••Lstage of training-"bulking up" or "cutting up" -prior to contest. The drug insert also makes that non-sensical "anabolic steroids do not enhance athletic ability." I think that all know that this is a false statement probably written by one who either doesn't know, or is trying to dissuade the u vised athlete from experimenting. More on this statement is to found elsewhere in the book. The drug is contraindicated in patients who are pregnant are in an advanced state of kidney disease. The drug is also advised in people who are concomitantly taking oral · drugs (these are drugs that are designed to "thin" the blood are used primarily in blood clotting disorders). I don't believe patients with as severe a medical problem as this would involved in weight training to the same degree as the heal athlete, but, of course, the ill-guided might do anything, so warning is well worth mentioning. So, let's repeat that Deca-Durabolin is a fine, injectable for the athlete who is "bulking up" a bit, if it is combined "bulking" oral such as Dianabol or Anadrol. I generally mend that the patient use two Dianabol5 mg. tablets twice after meals, with 100 mg. of Deca-Durabolin once a week, or t same "Deca" dosage with Anadrol used twice daily by mouth.

u ting up," or maintaining the person's weight, but , II II' 1h strength, I would suggest to the athlete that he use 11 , 1\ o tablets twice a day, after meals and 100 mg. of Deca' .! 111 p rweekintramuscularly. Thestrengthanddefinition 1 1111 1t e along with the "vascularity," while the only 1 1111 i being derived from the increased muscle mass, not 11 .1ppreciable fluid weight. As the body builder nears lllllt', he Deca-Durabolin can be increased, if the need be, ' W 1wi -weekly (rather than 200 mg. once-weekly). There 1 llllt''i where I might even use 200 mg. twice-weekly in 11111sUc 1 worthwhile cases for short periods of time only. 1 I h 1r bolin is then halted entirely, or in certain.excep' d( reased to 100 mg. per week in the athlete who must 111 1111 ·d ia tel y following this one con test for another con test 1 11111 •t• weeks hence. As you can see there are exceptions to 1 1111 d( age rules to compensate for individual variations. I , .1:1' d viations can only be judged by the physician guid1 nl builder. Everyone is in someway different from the 11d o individual variations dictate a change in quantity , · wh never a custom-designed "steroid" plan for the l11 11111ividual is desired. , ll ll t' n athletes- body builders and power lifters-the , tlu1l1n generally works quite well with doses of 50 to 100 11 pt' l w ek in conjunction with Anavar-two to four 1, 1 t1 .1 . Both of these drugs are low in the androgen 1 111d ,II' (' least likely to develop masculine signs in the 1

11

",

CHAPTER EIGHT

DIANABOL '' thol i Ciba Laboratory's trade name for methandros11• lit~ • drug is available in two commercial strengths, 2.5 tl l.t Ill ts. The 2.5 mg. tablets are quite useless for our 11 I lt.tll be forgotten. When I refer henceforth to Dianabol 1 ' til that I'm always speaking of the 5 mg. tablets,

llwv h the conventional Dianabol or the generic drug. "111 sixteen years ago when I was first asked for some 1,, .om Rugby teammates with their newly purchased •I t lw drug cost them something in the neighborhood of lundrt·d. In the last sixteen years I have seen the cost 11 I , or sometimes twice yearly, to the present $25.00 a I 'l•l,•t s. 'I his is a good price found at discount drugstores I '1 •It I'll wager that most of you have been charged, or I h 11 ,, s much higher, by other drugstores or, of course, on 1 11 l" ·t. I 'v been told that the once inexpensive Mexican ",. now harging $35.00 to $38.00 per hundred tablets I t1 IItts ·o t, plus the possibility of confiscation at the I tl• hmcliana bol varies in price from $9.00 to $15.00 per l•lt t , which make it quite a worthwhile bargain. I've 1

I•

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:::..;._

and I've found no surprises. The drug works exactly as it should exactly like the Ciba-manufactured product. Thus far, I've no complaints from my patients and I've heard no reports unexpected side-effects, and the gains are every bit as generous with the conventional drug. One objection we've always had · t he Ciba Company was that once, occasionally twice, a year t company would suspend production of Dianabol. It was li unobtainable from any American source. Then the would appear that the drug's price would be raised another doll a a-hundred and within a day or so it would be available~-.,·-···· ·· once again. But from the time the company suspended until the drugstores could obtain supplies of it again-two had elapsed. This, of course, was a catastrophe to the counting on the availability of the drug for his training. At times I generally had to find a fast substitute for the Dianabol my phones were jammed with calls from anxious athletes. were the times when I called upon that drug that finds an sional breath of life in my practice- Maxibolin. Just about one on Maxibolin was greatly relieved, however, when Diana was once more available to them. Many found that this period time was a good time to take a break or rest period in their trai routine. The generic Dianabol has every promise of maintaining steady supply with no quiescent periods. With new patients are candidates for Dianabol therapy, I generally explain the ence between the two drugs and with their agreement I us write the prescription for the less expensive generic product. To honest with you , for those patients who are on a prepaid insurance plan, where the drug costs nothing or perhaps a dollar prescription, I write the prescription for Ciba's Dianabol. Ci was, after all , quite good to us as the only supplier of the drug for many years, so that I do want to continue to support them in convenient manner in which I can. I don't believe that Ciba made great deal of profit from their Dianabol sales throughout the and yet, unlike so many products from other companies, t never abandoned the drug altogether. I prescribe many of Ci other products as I can count on their quality and effectiveness all times. As this book is being written, an announcement has made that Ciba is now discontinuing the manufacture of product Dianabol. The generic equivalent, however, has not affected by this move. Ciba states that its only reason for this

111111 np r use of Diana bol by some "developing countries of 11111 ''Apparently Dianabol is used in some areas of the world 1111'1'1 it stimulant and is apparently being used in these II 111lant and young children, male and female alike! Ciba, 1, , \\ ishes to dissociate itself from such erroneous usage as t lt11d w can all understand their move but many an athlete lll ld i thankful for the generic product entering the tli1 Ia t winter. 11 t11.1hol is basically and simply a "bulking" drug. The 1 l1 r•lop weight and strength. It is also a very dramatic 11 tng in a very fast and effective manner. My typical tl ll ',t'r gains two to five pounds the very first week of l lw weight is mixed weight- that is, weight derived 1 11 .1• t•cl muscle size and density, plus weight derived from 1 11l1o1L T his latter aspect would make it undesirable for t I t, \ 1l h a fragile blood pressure. The fluid weight aspect l11 rl 111g the greatest offender in raising the blood pressure 11 ttgs I prescribe. Though I recorded hypertension in only l'·''"'nl in 1981, out of a few thousand, Dianabol was the t rt ivt• agent. Simply changing to another oral product in 1 ra e brought the pressure down to normal levels. 1 111·11 t s will not be given Dianabol again, or at least not in lrllt' .1g . If an additional "bulking drug" is to be added to a \II' '1 outine in order to add a little more weight for a short flllrlr', t h n a small dose of Dianabol could be attempted if lprr·ssur is monitored very closely. II ll111d w ight found with Dianabol could also add stress tl 1111 ln•art conditions. For instance, the older patient with ,, , on stive heart failure would have to be monitored I , tl 1h drug should be used at all with these people. The rtlr l ,1 lso serve as a nuisance factor to those athletes who I to 1h amount of weight gained. Power lifters and 11r' ,.. amples of this latter group. The strength given by 11 d•o l would be nice but not if the athlete is forced to 11 , lll'av i r, tougher weight classification. It dtll l '>t'f the solution not used immediately should be stored in the refrig~rator. This will ensure its effectiveness for up to three month's >eriod of time. The non-mixed combination package, however, can >e stored indefinitely on the shelf. So I warn my patients who are ·eceiving their injections elsewhere not to mix more than one vial :ombination at a time. Dosage could vary with HCG but I generally recommend tsing one or two cc's, that's 1,000 to 2,000 units, twice, or in rare nstances, three times weekly. With body builders the HCG could 1e added to the anabolic regimen during the last two months or so f the pre-contest cycle and continue it for three weeks or so fterward, with a lessening in the anabolic dosage if there are no urther contests in the near future. The more advanced power fters will be on a greater anabolic dosage (probably including mg-acting testosterone injections at two or three times per week 1st prior to a contest), and will, with no other contest in the next !W weeks, halt the steroids altogether after the contest. The HCG ere can be used by the power lifter during the last month or so of 1e cycle and for at least three weeks following the contest. A 'orld-renowned power lifter confided in me recently that for years ~fore coming to me for advice he dreaded the post-contest sexual ~cline. After heeding my advice in regard to the use of HCG he aims to have had no problems whatsoever with his sexual funcon or appetite. Human chorionic gonadotropin is currently being used by male body builders and to a possibly lesser extent by female >wer lifters. The drug in women could promote the production of ·ogesterone, one of the female hormones. Ovarian enlargement tn thUS enSUe due to thP (lpvpJnnmPnt f\f """"""""""' orrrr f,_J1;~1~~

The multiple ova can lead to multiple births. Enlarged ovaries can bring on pain in the lower abdomen due to the rupturing of the ovarian cysts. This, in turn, can develop into hemorrhaging of blood into the abdomen and possibly arteriothromboembolism (blood clots in the arteries). The lower abdominal pain reported with the rupture of the ovarian cysts can be severe in degree. Now the latter problems are quite rare but the possibility of multiple pregnancies within the uterus can be, of course, a much more complicated situation than a single pregnancy alone. For this reason, I would certainly not advise HCG in a female athlete who is not sterile, entirely celibate, or on an adequate birth control method. I wonder if the weight control clinic physicians ever warned their obese patients about this complication. I'm certain that obese women conceive just as readily as thin ones. One final word on HCG, it is used entirely by intramuscular injections, as there are no oral or intravascular uses for this drug.

CHAPTER FIFTEEN

OTHER DRUGS RELATED TO ATHLETICS Cytomel is a synthetic thyroid preparation manufactured by Smith Kline & French Laboratories for the treatment of hypothyroidism. It is available in 25 and 50 meg. tablets. This drug appears to be the most potent and productive thyroid medication I have found for the use of my athletes in various training situations.The drug will stimulate the metabolic mechanism of the body and will thus usually rid the body of a small amount of excessive fluid and fat deposits. Now this is not to mean that it rids the body of a great deal of these substances, careful dieting and food management will do that quite nicely. I recommend this drug for only very small amounts of fluid and at a particular time in the training cycle, and then it is forgotten. It is used by power lifters in certain cases where a small amount of weight is needed to be lost prior to a contest, but using this drug in power lifters is quite unusual in my practice. It is much more commonly found to be used with body builders in their "cutting up" process, that is the last few weeks prior to a contest. Now remember that an over-abundance of any thyroid product can lead to thyroid over-stimulation. Symptoms here could show up as a weight loss, or, more commonly, as a fine hand tremor. Nervousness, anxietv. restlessness and insnmni~ ~rP

ther findings of over-stimulation. Obviously these symptoms mid be detrimental in a number of ways to the body exhibitor, ~sides on his training partner and family. As an example of all tis: I attended a contest not too long ago where one of the guest )Sers was a man known the world-round for having a particularly nail waist and possessing great "vascularity." At the contest it as quite noticeable that the guest poser had a very noticeable md tremor. Both hands exhibited this fine tremor and he 1peared to be, besides that, a bundle of energy. It was also noted at he seemed to imbibe alcohol a great deal of the time during the enings of the contest and really showed no temperament for ~ting. My feeling was that he possibly retained a "cut" appear.ce due mainly from over-stimulation of his thyroid gland. I don't rsonally know the gentleman but from his drinking and eating opensities, I'll bet I'm correct in my guess.lf the athlete is going use a thyroid preparation at all, then a small amount for a 1ited amount of time might give some beneficial results. Injudi'us use will, in the long run, be universally harmful for his or her 1y. Muscle wasteing with resultant loss of size and strength 1ld be expected in such a case and if the metabolic rate is 1tinuously over-stimulated, a "dragged out" sensation will me. I could go on like this but let's remember not to over-use any rroid product. If I feel that a thyroid drug might lend some benefit, prejbe Cytomel25 or 50 meg. tablets, taken once daily. The dosage :ourse depends on my evaluation of the particular patient. The 1g is usually used for the last two months or so of the bodylding regimen prior to a contes , with the Cytomel being halted nediately following the event. I explain the signs and symptoms typer-stimulation of the thyroid to the patient and admonish patient to warn me of any sign of adverse stimulation. My choice of Cytomel as the particular type of thyroid prodI use is based on the principle that it is a more refined product n some of the other thyroid-replacement products on the ·ket. It gives an equal dose tablet. It's onset of action is much ·e rapid and dramatic than all of the other thyroid products that seen. One notation that has appeared in the Cytomelliterature years was the mention that Cytomel could be used for the tment of low sperm conditions. I cannot find any pharmacosiologic basis behind this principle but if the premise is true, tit might lead us to think that perhaps some anabolic effect 1t also accompany the drus;r's use. or ;lt Jp::~d rv:>rh!>nc it ""';,...1..-.

help in keeping the sperm level up during a time when the body might exercise the "feedback inhibition" mechanism to the anterior pituitary gland. Diuretics are commonly referred to as "water pills" and come in a variety of brands and doses. These are used in medicine for such conditions as hypertension and conjestive heart failure, to name just two. The drugs act in various ways to rid the body of excessive fluids, the methods of diuresis varying with the type of drug used. These drugs are commonly used by body builders and power lifters alike for either "cutting up" or "making weight." As was mentioned with thyroid preparations, with poor guidance, or no guidance at all, the diuretic drug can produce an adverse effect on the human body. All diuretics cause fluid loss from the body and most of them also cause the body to lose electrolytes. These electrolytes consist mainly of sodium, chloride, potassium and bicarbonates. The excessive loss of these chemicals can lead to muscle cramping, muscle weakness and nervous irritability. Muscle cramping could be disastrous to a power lifter straining to maintain a loaded bar, or a body builder straining a muscle group during competition. The muscular weakness would be detrimental to their training program, as valuable time could be lost from the training schedule. The irritability would be a strain on everyone around, besides the athlete himself. If I feel that a diuretic could be useful on a short term basis I might prescribe any one of a number of diuretics that are on the market today. Dyazide exerts only a very mild diuretic action and generally does not deplete the electrolytes from the body, though its usefulness is limited. Hydrochlorothiazide is produced by a number of companies and is a more potent diuretic than Dyazide. Both of these drugs could be useful if a maintenance diuresis is desired. Lasix is the most active of the diuretic drugs by far. It starts it's diuresis in a very few minutes after ingesting the pill and continues for a number of hours. If there is excessive fluid build-up the urination should be expected every few minutes, but an athlete at a "dry weight" can probably expect no change in his or her normal urination pattern. Lasix removes a great amount of electrolytes from the body during the diuresis and muscle cramping would be most likely from this drug. For a mild diuresis, Dyazide or 25 mg. of hydrochlorothiazide would be used. For a moderate amount I would prescribe 50 mg. of

1rge amount of excessive fluid can be expected, I would then use 0 mg. of Lasix. These doses might be used daily, or every other ay, or whenever needed. The frequency of use would be dictated y my clinical evaluation of the athlete's fluid problem. When I rescribe the hydrochlorothiazide 25 mg. I recommend that the :hlete replace his potassium loss by eating a banana or drinking a ass of orange juice or taking in any other food containing an lequate amount of potassium replacement. With the higher >ses of diuretics such as Lasix 20 or 40 mg. I also prescribe a •tassium replacement medication as a routine thing. There are a tmber of types of potassium on the market, some tablets, some tuid, but no matter the brand or type, the potassium here would imperative. I quite often use four tablets of Slow-K each day th Lasix and two tablets with hydrochlorothiazide 50 mg. This tassium drug is effective and does not usually upset the athlete's strointestinal tract. Anti-estrogens:Some male athletes on anabolic steroids d that an appreciable amount of their testosterone, exogenous endogenous, is converted into estrogen. Unwanted side-effects ~n occur, side-effects such as tissue softening, sagging and softng of the male breast tissue and retained fluid. First, let me te here that this is a very unusual endocrine state. The usual tse of these signs and symptoms in most normal lifters would be tply poor workouts. Sagging muscle is usually found where the ~kouts did not produce a good "pumping" effect. Improved -kouts will usually firm things up just fine without the need of · medication. The need for anti-estrogen drugs is strictly for ;e men whose hormone levels have shown that just such an ocrine anomaly truly exists. The continued or accelerated use tighly androgenic products such as Dianabol, Anadrol and osterone, will only worsen the condition. The first step ards correction, after the clinical and laboratory methods al the problem, is the use of the drug Anavar. This is the only Jolic drug that will not convert into estrogen. Human chorigonadotropin can increase the body's production of testosterthough much of this can also again be converted into the >gen. When the diagnosis is clear and all else has been tried, then :ertain products referred to as anti-estrogens seem to help. ;e products are used medically for the treatment of advanced ;t cancer in women.

Of the anti-estrogens, Nolvadex from the Stuart Company is relatively low in toxicity. Clomiphene citrate or Clomid is more toxic and used less often than Nolvadex. Clomid is used medically in a much different manner also. The drug stimulates the development and hormone activity of the female ovary. It is basically used to promote pregnancy in those women experiencing ovulatory failure. This product is used by athletes to promote gonadotropin production and thus bring on an increase in endogenous testosterone, such as when "coming off" a vigorous anabolic cycle. I think that HCG will work much better, with far fewer sideeffects, and at less cost. So, why use Clomid? To get back on the track to Nolvadex once again, it is felt that this product could also eliminate fluid retention problems at contest time. Both of these above products could bring about even greater endocrine problems when taken by women athletes, even if she is on an adequate birth control method. Both of the above products should be limited to those extremely rare situations that arise so seldom, if at all. A thorough medical and laboratory evaluation is necessary before, during and after the drug is to be taken. So, don't experiment on yourself, besides that there are, no doubt, better and safer products that can be prescribed for you by your physician. Too many times the insecure body builder feels that he needs just such an off-beat drug to give him the needed edge over the competition. This is generally an unwarranted assumption that a different type of drug will bring on the miracle gains. In other unusual situations drugs known collectively as aldosterone antagonists are considered. Aldosterone is the most potent of the naturally occurring corticosteroids, and as such is released by the adrenal gland to act upon the distal tubules of the kidneys to further absorb sodium and increase the excretion of potassium from the body. This regulation of sodium and potassium balance is necessary for the body to function adequately. If there is inappropriate re-absorption of sodium and excretion of potassium, fluid will be retained. This could lead to fluid retention problems such as hypertension and congestive heart failure. Aldosterone antagonists are drugs that compete with aldosterone for receptor sites, thus allowing for greater excretion of sodium and chloride and increased body stores of potassium. Calcium is also excreted from the body with the use of these antagon;e:t;r n ...A,..~,..,..t"

Spironolactone is a generic name for the aldosterone antagosts. This spironolactone is sold under the trade name of Aldacne and is a product of Searle Laboratories. A companion product called Aldactazide. It is Aldactone plus 25 mg. of hydrochloroiazide. The drug is used by body builders, male and female to mbat the fluid retention found near the end of a "cutting up" riod prior to a contest. The most serious side-effect of spirono:tone is hyperkalemia (or too much potassium in the body), but e use of the diuretic could help in the elimination of the overundance of potassium. When the drug has been taken for a nsiderable length of time, gynecomastia has been reported, ough I've never seen this in my practice. Now it must be rememred that Aldactone and Aldactazide are used medically for pertension. A normotensive individual could become hypoten•e with the use of these drugs and, therefore, their use should be termined only by an adequately trained physician and no one e. Muscle cramping could also accompany the use of Aldactazide. In this chapter on miscellaneous drugs I don't really want to : involved into the discussion of drugs used for sports injuries, tt alone would take another book. I would like to comment, wever, on DMSO, Dimethyl Sulfoxide. This drug is not curttly, legally, available in my State of California. It is used openly physicians in other states and probably will be available at 1rmacies here in California some day. Power lifters, especially, find DMSO as a necessary additive heir work-out or contest travel case. This product is manufaced by a number of companies and is generally sold "under the mter." This leads to the problem of solution strength and unimity. The solution is clear and has the aroma of either garlic or ns, or perhaps both. The athlete never rubs this solution into sore joint, it must be wiped on, generally with one wipe. It will se the skin to appear warm with rubbing, and use after a warm wer will only intensify the warmthness. It works best on a :ler, inflamed joint. It will not work nearly as well, or at all, on a ctly muscle or tissue problem. The solution can be repeated 'to four times per day, apparently. It can be diluted with water te warming effect is so intense as to cause a rash to form. One 'd of warning, when you add water to it or place DMSO on a ;piring area of skin, more warmthness and perhaps some es might be emitted from the area. I've not heard of any side-effects from the use of this drug to date. It does appear to be a useful adjunct to therapy for a sore

joint. The side-effects from the medically alternative drugs, the anti-inflammatory drugs, could be much more likely and pronounced. Though in severe problems both are currently, commonly used together. The medical community is still waiting to hear more from research about this drug but the power lifters have appearently heard enough and use it in copious amounts on the surface of their joints.

SUMMARY Let me now briefly summarize some of the points that I have tried to make in regard to anabolic steroid usage. First, these drugs are like any other medication, some people will derive a great deal of good from them, while others could gain only undesired complications. A good medical evaluation with a recommendation of medication from a physician who has an adequate background in the use of these drugs, combined with good monitoring of the patient for side-effects, will hopefully gain the desired effects. Whereas, the use of illegal medication, dispensed by unqualified persons, can only bring sorrow for the recipient. So, let me again repeat ... if you must take anabolic steroids-do so with the help of a physician interested in you and your good health. Hopefully through this book I have been able to pass on some of the information I've gained throughout these years to physicians who are eager to increase their knowledge in this area of athletics. If the physician is willing to help these athletes, I'm certain that he'll be well received by the athletes in his area and he should gain a great deal of inner satisfaction in helping these fine people. Athletes do not generally come from the affluent portion of the population-so high fees are not involved with this work. Fees that can fit into the budget of most of the athlPtPs: will nAt hr; ... ,..

·ealth as far as money is concerned, but a wealth in helping others 1 achieve their goals in life, safely, is easily obtainable. Personal mtact between the physician and athlete is mandatory for suc$S, as it is in every doctor-patient relationship. Laboratory testg is next in importance, for through this method disease entities m be often halted before their presence is otherwise known. Anabolic steroids are unwarranted in the young athlete and most women. The power athlete who is just in the early stages his training should not need these drugs, nor the person deriving od gains from the "natural" method. Certain people with unual disease processes, as outlined in the book, should not take me or all of the anabolic steroids. Only the physician can deter[ne who can and cannot benefit from any medication. I've stated that most women athletes do not need these drugs, d yet to be realistic, I can see the time when the drugs will be :tctically mandatory for success in many women's sports. I think :tt we all hope that our women athletes will remain as feminine can be, but the trend towards masculinization, in certain sports, occurring today. Women's basketball and softball games are tyed today with a vigor that nearly approximates the male mterpart. Spitting and profanity are a small, but colorful part of l's softball, even on the highschool level. In many sports the Is today emulate the mannerisms and practices of men who play ! same sport. How long will the ladies be content playing in a 1inine manner entirely? Greater strength will no doubt be .ired and with it will be the desire for strength gaining drugs. ten we see the Russian and East German women competing in a ~erior manner in power athletics, are we really viewing what ·women athletes will be looking like in a few years-I hope not. -,.,we know that our women athletes are certainly talented but 1e are now feeling that the only advantage that the Eastern nen hold is the power advantage of male hormones. If our nen are not accorded good medical guidance, and with the ilability of the illegal drugs, masculinization is surely to come. Anabolic steroids will never be viewed by the public and !etic officials as anything but a hazard to the athlete's health il the drugs are strictly controlled by physicians. Only with 1uate, safe controls can the anabolic steroids be viewed in the e light as antibiotics, anti-asthmatic, and other medications lin daily life. To eliminate that myriad of side-effects so often t in the mis-guided is to remove the availability of the drugs 1 the hands of non-physicians. And if the physicians can show

not only expertise in the subject, but also make their fees affordable by all-then why would anyone want to obtain their drugs and guidance from anyone but a physician? Until local and federal drug agencies close down the illegal drug supplier, the dangers of side-effects from anabolic steroids will continue to pose a great threat to our athletes who choose that manner of securing their medication. But, of course, until more physicians are willing to come to the aid of these athletes, the illegal sources will continue to flourish. Typically, physicians today are denying prescriptions to their patients for anabolic steroids. If the physician has not had experience in the use of these drugs then that is exactly the correct step for him to take. But, to deny the prescription and then lecture the athlete on why he should not take the drug is very unrealistic. The athlete is simply going to take the anabolic drugs no matter what anyone says, if he believes that there are gains to be made with the drug's usage. We are well aware that people in general simply do not pay heed to what is shown to be harmful for them if they feel themselves that there is some good to be derived from the use of that product. We've all been shown in the last few years the dangers of cigarette smoking, and yet people continue to smoke. Practically every day I see the terrible effects of smoking in some of my patients and practically every day I still see physicians, themselves, smoking. The same generalizations could be made for alcohol usage. Does public permissiveness not recognize the hazards in cig!lrette smoking and alcohol ingestion and yet frown at the athletes using anabolic steroids? I say that I see practically daily the ill-effects of smoking and alcohol and yet I see no serious effects from anabolic steroid usage, only an occasional, minor, reversible effect. The effects from alcohol and cigarette smoking are rarely, if ever, reversible. One point for the athlete in this regard . . . athletes rarely smoke or drink alcohol as these are contrary to the training rules. Those officials who are speaking out for the condemnation of anabolic steroids-! wonder how many of them smoke and drink? I sympathize with their efforts to keep athletics "clean," but in regard to the use of anabolics, I question the realism of their policies. Do they really believe that the athletes will abide by the decisions to ban these drugs-of course not. If an athlete today knows that testmg for the presence of these drugs is to be carried out prior to a contest or meet-then the athlete simply halts the drugs a number of days beforehand. He has already derived all the good size and streru!th from thP clrno-c in tho J.,,:+f.o. ...

months or years, and halting the medication prior to a contest will mean little. As I've implied before, the only way that I can see athletes giving up anabolic steroids is if all athletes from all countries also give up the drugs. This will never happen. Megalomaniacal countries will use any means for their athletes to win at any cost. So, finally, find a physician in your area who is adept in using anabolic drugs and willing to work with you. Use his knowledge for guidance and ignore the rumors and ill-derived information from other athletes, and I'm certain that you'll achieve your own greatness. I hope that the information that I've tried to impart from this book will be of assistance to your physician in his quest for knowledge. If your physician has any question not covered in this book, let him write to me and I'll try to aid him in any way possible. Thank you. Robt. Kerr, M.D. 316 E. Las Tunas Drive San Gabriel, California 91776