Sports are an excellent way for young people to be physically active, make friends, and have fun. It can also help build essential skills like discipline and perseverance. On the other hand, pressure on young athletes to gain a competitive advantage can lead to using banned substances, including anabolic-androgenic steroids. Although these drugs are most commonly used by male athletes, it is not uncommon for female athletes use them as well.
Until the athletes are playing a sport that doesn't require mass muscle or strength to be competitive, the athlete stays on a regular diet, but in sports like bodybuilding, weightlifting, wrestling or boxing, or sometimes football and baseball, the pressure to increase your body’s mass can compel and athlete to start taking illegal anabolic steroids in hopes to enhance their performance. However, there are sports where frequent doping tests are conducted, and the athletes get banned for years for violating the rules by using steroids. This can sometimes also lead to irreversible medical complications and even their deaths in some instances.
These are the type of steroids which are used worldwide by the Olympic-level athletes under the table. Still, the difference between their use in Pakistan and the developed countries is that abroad they use it in a controlled and monitored environment, whereas, in Pakistan, the practice of suggesting steroids to amateur athletes is mainly done by unprofessional coaches.
Use of Anabolic Steroids
Anabolic-androgenic steroids are the medical term for the drugs that some athletes use illegally to gain an unfair advantage over their opponents. Some types include; Testosterone, Methyltestosterone, Androstenedione, and Danazol. The steroids like TestosteroneTestosterone used for enhancing performance are sometimes called doping or juicing, either in the form of tablets or injections.
Different types of steroids are available not just in the developed countries but in Pakistan too. Most of the steroids used in Pakistan are imported from abroad. "There are many steroids available here at a much cheaper rate than in other countries, and the practice of its use by amateur athletes is prevalent in Pakistan. In the early days, only professional athletes used it, but now every other person who wants to enhance their body starts using it," told Pakistan's professional Bodybuilder Ramiz Ibrahim to The Express Tribune.
"Some bodybuilders who win a regional or national competition open their gyms. Those gyms are not registered by the Pakistan Bodybuilding Federation (PBBF). Once they get famous, they open up their branches," said Ramiz. "Usually there is a practice that many investors are coming into this field, and they come just for the sake of investment, which leads to the misguidance of the young bodybuilders."
He added that these unregistered gyms suggest the use of steroids to the people looking to enhance their body either they want to compete in the competition or look suitable for modelling or acting. "Everyone wants to become like their role model who is either a film actor, bodybuilder or to make their personality to impress others, and this is where they head towards the steroids," said Rameez.
Unsafe use
There is a common practice in the world where sports events like Mr Olympia are played by athletes. They are allowed to use steroids but are controlled and monitored by professional doctors who make their cycle according to the athlete's body. In Pakistan, it's the opposite; there are nearly no experienced steroids physicians.
"The athletes in Mr Olympia have massive bodies that weight more than 150 to 180KGs. They inject a high quantity of steroids; if someone does it in Pakistan, they might die. But there only the professionals use these, not the amateur. Also, they go through a safe process under the guidance of their doctors and then follow the plan and cycle accordingly," he added.
"In a sport like bodybuilding, the athletes who use steroids are bound to use them as they know that the one they will be competing with must have used steroids, and to stay competitive, they use it too. But in Pakistan, there is no one professional, and they just start using steroids of their own will, which definitely causes issues," said Rameez, adding that the younger generation wants to build their body like their role models, but they don't know what they have gone through to become who they are and this cannot be achieved overnight with the excessive use of steroids.
A cricketer and a fitness trainer Shehzar Muhammad give fitness training to different athletes, especially cricketers, and said that there are minimal sports that use steroids in Pakistan. "The cricketers are not allowed to use it, and if they do, they face a ban from cricket. It is mostly used by bodybuilders and weightlifters who want to succeed in Olympic or international sports. They use it under the table from which they can lift extra weight, but that is also under guidelines from the expert."
"People who just like to work out don't take steroids but want to look larger than life do. If you are an actor or get paid by your appearance, you will take steroids to keep looking good, but no one will admit it," said Shehzar.
Many cricketers including Muhammad Asif, Ahmed Shehzad, Shoaib Akhtar, Abdul Rehman, Reza Hasan and Yasir Shah have in the past have tested positive for consuming a prohibited substance. For crickers, the its consumption can help them recover faster from injuries, but they need to consume it in precise small amounts in order to still test negative for it.
The Lance Armstrong case was a significant doping investigation of athlete using performance-enhancing drugs, which led to retired American road racing cyclist Lance Armstrong being stripped of his seven consecutive Tour de France titles, along with one Olympic medal.
As Shehzar points out: "Do you think he was the only one using steroids? Everyone must have used them - all of the cyclists, from top to bottom. They know that their opponent is taking them and they have to take it. But some of the athletes take it in a manner that they are not tested positive, and Armstrong is a prime example."
Stacking
Relying on the anabolic steroids that can improve competitiveness and performance, the uninformed or misguided athletes are sometimes encouraged by parents or coaches to use these drugs to build muscle mass, increase body weight and promote aggressiveness.
However, while taking the performance enhancer steroid, some athletes take two or more anabolic steroids together, mixing the tablet and injectable types or sometimes adding other drugs, such as painkillers, or growth hormones, is called stacking. The athlete believes different medications will produce greater strength or muscle size than just one drug. What they don't know, or choose to ignore, is the damage to the body that abuse of these drugs can cause.
Shehzar, while talking about overdosing and stacking, shared just how dangerous the practice can be. Once you start injecting into your body, you always have to keep a check on lab reports, blood tests and organ tests. "A high level of growth hormone is injected. As a result, the body grows, but you might face issues like high blood pressure and others. So everything has to be monitored,"
"The famous athlete who has steroids cycle under the table are well researched, with homework done, whereas in Pakistan it is dangerous as the weather is hot and there is a trend of any random bodybuilding coach called ‘ustaad' develop cycles according to their own experience and knowledge. It doesn't involve any research or science. This is why we see any amateur athlete getting steroids injected and then dying at an early age. They don't know the cycle and trust anyone who has participated in the local or national championships," added Shehzar.
He added that an overdose of steroids is also dangerous and can develop complications. "Usually, it is taken from 200-300mg, but some use it up to 3500mg. The side effects occur when you put this much load on your body. They don't follow lab reports, due to which they don't know about the condition of their body, and when you don't know how to use it, you overdose your body. Neither goes for post-cycle therapy. The same dosage doesn't fit all. Everybody has a different capacity and behaviour to the steroids."
"I would never recommend using steroids unless the doctor asks to, and I don't want to go through the process of lab tests. When you take overdoses of steroids, and the body gets used to it, its natural reactions stops functioning. You have to take steroids to make your body produce. If one takes two pricks weekly, that makes eight in a month and 96 injections in a year. So if you want to strengthen your body or are not happy with it, then they go to the use of steroids," said Shehzar.
Side effects and deaths
Anabolic steroids can cause serious health problems such as high blood pressure and heart disease, liver damage and cancers, and stroke and blood clots when improperly used. Other side effects of steroids include nausea and vomiting, increased risk of ligament and tendon injuries, headaches, aching joints, muscle cramps, diarrhoea, sleep problems and severe acne.
While the total impact of anabolic steroid abuse is unknown, health care providers have observed that problems occur in developing cholesterol patterns associated with coronary heart disease, obstructed blood vessels, or stroke. It can also include; increased cholesterol, increased blood pressure, impaired liver function, tumours, stunted growth caused by premature closing of cartilage-like growth plates in adolescents, increased rate of muscle strains/ruptures, the appearance of or growing acne and other skin rashes or ailments, and immune system. Psychologically steroid consumers have mood swings, aggressive, violent behaviour, depression, psychotic episodes, and addiction.
Whereas effects on the hormone levels of male and female abusers can be found as anabolic steroids are derived from Testosterone. These effects can cause many problems in men, including; temporary infertility or sterility, altered sex drive, prostate enlargement, increased prostate cancer risk, irreversible breast enlargement, painful erections, shrinkage of the testicles, and reduced levels of Testosterone, abnormal sperm production, and increased levels of estrogen.
For the women, while most the men's problems can occur in women, too but the health care providers have reported; an increased risk of cervical and endometrial cancer, increased risk of osteoporosis, birth defects in future children, changes in fat distribution, growth of facial and body hair, deepening of the voice, shrinkage of the breasts and uterus, clitoral enlargement and menstrual irregularity.
Changes in the male reproductive system are often reversible if anabolic steroids have not been abused for an extended period. Unfortunately, some of the changes in women are not reversible. Prolonged abuse of anabolic steroids often results in physical addiction, and Abusers must undergo a strict, medically-supervised withdrawal program.
Several deaths occurred in the world and in Pakistan that raised the alarm, and one of the most recognizable bodybuilders in history, Arnold Schwarzenegger, called out the sport as ‘the most dangerous’ in the world.
A legendary bodybuilder, Rich Piana, who had quit competing to focus on growing his nutrition company, collapsed in his home on August 7, 2017, after experiencing symptoms of impending cardiac arrest. An autopsy later revealed his heart and liver were enlarged, twice the size of typical organs.
Similar happened to another bodybuilder, the 26-year-old Dallas McCarver, who died suddenly after choking on his food. An autopsy found that his death was an acute cardiac episode, and his heart was severely enlarged nearly three times the average. The condition of his heart indicated that steroid use contributed to his death.
There have also been several bodybuilder deaths in Pakistan due to using steroids. In 2016, it was reported that four bodybuilder in 17 days lost their lives due to the use of steroids, but Rameez has a different opinion. He says that the real cause of death is either a heart attack or an organ failure.
Reports claimed that body-enhancing drugs and steroids were illegally brought from Dubai and Iran, some of which had already expired. The Pakistan Bodybuilding Federation (PBBF) president Sheikh Farooq Iqbal said, "With the help of government of Pakistan, we cancelled the registration of all the gyms across the country and formed a five-member committee that registered all the gyms again and took oath from all the gyms not to use illegal drugs and those found using them will be sealed and a stern action taken against them.”
“We have also planned to organise awareness programmes which will make the bodybuilders aware of prohibited stuff and proper diet plan for the improvement,” he added. "There is a dire need to set up an anti-doping laboratory.”
Ramees added that every year, a bodybuilder passes away, and the cause is said to be the use of steroids. “Overuse, misuse, and high dosage impact the body, but in Pakistan, the cause of death of bodybuilders is 90% because of old age," he said. "When a bodybuilder is in the mid of his career, he is at the peak of using illegal steroids to keep his body competitive. They start taking steroids at an early age, and during their career, they keep track of their diet and work out, but once they retire, they stop working out, stop caring about their diet and change their daily routine. This causes an increase in the blood pressure or organs disorder," said Rameez.
He further added that the death doesn't need to be caused by the use of steroids but more by not keeping the same diet and workout after leaving steroids and bodybuilding. "Around 90% of the bodybuilders die due to different diseases. This happens because they have been practising and following the diet during their career, but after they retire and start unhealthy diets, different diseases start to occur. Most of the deaths are caused by either taking overdose of the steroids or their own mistakes of not taking care. If they even follow 50% of the diet and workout plan, the deaths would reduce," he said.
Alternates of steroids
The experts suggest that it is unnecessary to use steroids to build your body or bring it into shape, but alternative food supplements can be taken that are anabolic-free. "One can build their body with food supplements, which don't have any anabolic formula. People search the internet and start taking steroids, and many athletes are misguiding. But commonly, in Pakistan, people who go for shortcuts take steroids. They don't want to wait for the body to build organically but want overnight results," said Rameez.
"We go through the dope test to play international events, which means we can't take anabolic steroids and instead build on food supplements. Most people think that if someone is a bodybuilder, he must be taking steroids, which is not true. Many professional bodybuilders, including me, have built their bodies with food supplements."
He added that people don't realize the efforts to achieve this type of body. "We go through intense exercising, follow a proper diet and do six-hour training under the sun. They don't know the hard work behind it. There is much misconception which will take time to be fixed," he said. "Some people who use steroids and demand results face side effects and death. When they see someone on the internet that a builder is using a specific amount, they start using the same. They don't see the body weight he has and just start copying having half of the weight," added Rameez.
Meanwhile, Shehzar informed that the cricketers cannot even take protein supplements. "During the anti-doping sessions, the Pakistan Cricket Board (PCB) categorically asks cricketers to stay away from the supplements. Cricketer Umaid Asif was banned for two years for taking a supplement he didn't even know he was taking. He faced an allergic reaction, and the doctor gave some injections that came in the dope test while playing domestic cricket," said Shehzar.
Similarly, Pakistani weightlifter Talha Talib, who represented the country in the Tokyo Olympics, was ruled out of the 2022 Commonwealth Games following his doping violation that was identified in a drug test conducted in April this year. The weightlifter's blood samples were found to contain illicit drug samples. But Talha refused, claiming he never used any forbidden drug.
Testosterone therapy
In the USA, doctors have started recommending steroids to middle-aged men from 35 to above 40 to take Testosterone therapy. Testosterone is a hormone produced primarily in the testicles, and Testosterone helps maintain men's bone density, fat distribution, muscle strength and mass, facial and body hair, red blood cell production, sex drive, and sperm production.
"Testosterone levels that are generally peak during adolescence and early adulthood gradually decline when you age, typically about 1% a year after age 30 or 40. So, the doctors have started to advise steroids to keep the level high and avoid mid-age complications. But it must be under a professional doctor and properly monitored," said Shehzar.
Experts believe that amateur sports athletes must be made aware of the physical and mental dangers associated with abusing steroids. The 'win at any cost' attitude approached by some athletes must be replaced by personal dedication to the sport, detailed knowledge of the sport's demands and requirements, maintaining a healthy lifestyle, and an appreciation of the satisfaction of participation.