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  • Denise Scott

Muscle-Building and Endurance Supplements in Youth - Part 3


This article delves into the hormone, hormone derivative, and hormone receptor modulator supplements. These include:

  • Anabolic agents (testosterone derivatives)

  • Human growth hormone, insulin-like growth factor I, and insulin

  • Pre-hormones - DHEA and Androstenedione

  • Selective androgen receptor modulators

The word hormones in black letters with a stethoscope and two pill bottles. Hormones, pre-hormones, and hormone derivatives are misused as body-building supplements.


I am quite familiar with these hormones due to my training and practice in pediatric endocrinology. Hormones in low or high amounts cause problems. Steroids and hormones have their place in medicine, and I prescribed them to treat medical conditions. They should not be taken lightly and can do far more harm than good when taken inappropriately.


ANABOLIC AGENTS


Anabolic agents or steroids (also anabolic-androgenic steroids) are synthetic (manufactured) versions of testosterone, the primary male hormone. These are performance-enhancing drugs. They are used to increase muscle mass, improve physical appearance, and enhance strength, so are popular with bodybuilders, wrestlers, and football players. 


These agents are artificial androgens, mimicking the effects of natural androgens by activating androgen receptors. They are similar to natural hormones triggering the body’s response. Unfortunately, their use by professional athletes trickled down to younger athletes.


Set of weights with a bottle of capsules, vial of medicine, and syringe which depicts some of the forms of anabolic agents.

These agents are taken orally, by injection, or in gels, creams, or skin patches. They are absorbed through the skin. They can be obtained illegally for use in this manner. It is against the law to use them without a prescription. These hormones are prescribed for specific medical conditions under a doctor’s care. When used as an anabolic agent, the dose can be 10-100 times greater than in prescription form.


The health effects of abusing these are many and dangerous.

These effects in males include:

Acne

Stunted growth by making bones mature too quickly

Baldness

Aggressive behavior

Liver disease

Heart problems

Kidney damage

Decreased testicular size

Infertility

Breast growth

Increased risk of tendon damage and tears

Fluid retention

High blood pressure

Blood clots

Stroke

Heart attacks


Female Effects:

Acne

Body and facial hair growth

Deepening of voice

Male-patterned baldness

Reduction in breast size

Menstrual irregularities

Lower estrogen levels


Some of these effects are irreversible but may not show up for years. Their use is illegal; purchasing them online is risky since they may contain other toxic chemicals.


HUMAN GROWTH HORMONE, INSULIN-LIKE GROWTH FACTOR I, AND INSULIN

Human GH, hGH, also called somatotropin, is taken by injection. Athletes use it to enhance muscle growth. GH is made by the pituitary gland in the brain. Levels increase significantly during puberty and decline with aging. I used it in practice to treat children who were deficient, had specific genetic abnormalities, or had their pituitary gland destroyed by trauma, tumor, or cancer treatment. It is also used in some deficient adults. Its use in sports is prohibited. This drug is very costly.


Growth hormone is only effective by injection. There is no benefit when taken orally, despite some marketing claims.


Growth hormone can stimulate growth in all tissues. When I used this in children who were post-cancer treatment, I always worried whether it could cause growth of any residual cancer cells. In adults, excess growth hormone causes a condition called acromegaly. hGH should be used to replace a deficit, not to increase what is already present.


Most of the body’s growth hormone is secreted during sleep. Sleep disruption and airway problems during sleep, such as apnea, can affect hGH production.


Risks

  • Joint pain and stiffness

  • Muscle aches

  • Fluid retention

  • Insulin resistance or worsening blood sugar control

  • Carpal tunnel syndrome

  • Increased blood pressure

  • Heart enlargement

  • Breast enlargement (males)


Photo of a male athlete with a needle and syringe full of a body-building hormone. HGH, IGF-I, and insulin are all administered as an injection.


Insulin-like Growth Factor I (IGF-I) and Insulin


Insulin-like growth factor I is a hormone primarily made in the liver in response to GH levels. As its name implies, it has some insulin-like effects but also acts similarly to GH and enhances GH effects. It is often used in conjunction with hGH and anabolic steroids. IGF-I decreases protein breakdown and increases its production. High levels of this hormone can cause hypoglycemia (low blood sugar). IGF-I and insulin are also given by injection.


Adverse effects of IGF-I are similar to hGH, but the most concerning side effect is hypoglycemia.


Insulin, a hormone secreted by the pancreas, keeps blood sugar stable and helps drive glucose and amino acids into muscles. Too little insulin causes high blood sugar (hyperglycemia); too much causes low blood sugar (hypoglycemia). Type 1 diabetes occurs when the pancreas stops making insulin.


Hypoglycemia, which can be severe, leading to seizures, coma, and death, is the primary side effect of this drug. Because these are all injections, infections and abscesses are risks. 


There is little evidence that any of these three improves athletic performance, especially in adolescents whose GH and IGF-I levels are elevated from puberty.


ANDROSTENEDIONE AND DHEA


Androstenedione and DHEA are made by the adrenal glands, testes, and ovaries and are precursors to testosterone. DHEA is converted to androstenedione, which can be converted to testosterone or estradiol, a form of estrogen. In other words, both of these hormones are made into testosterone in the body, in addition to estrogen. 


Androstenedione (andro) and DHEA can be made in the lab. Manufacturers claim these products help athletes train harder, recover faster, and boost testosterone levels. Adolescent males already have plenty of testosterone.  Studies have not shown that taking these hormones increases testosterone levels in males with normal levels, nor increases muscle strength. However, it does increase estrogen levels in males, an undesired effect, and increases testosterone levels in females. DHEA is available as a tablet, capsule, powder, topical cream, and gel; andro is in pill form.


Risks

Side effects of androstenedione in men include:

  • Acne.

  • Testicles that shrink or make less sperm.

  • Breast growth.

Side effects in women include:

  • Acne.

  • Deeper voice.

  • Loss of hair on the head.

There is also concern that these drugs can increase the risk of hormone-responsive cancers, such as prostate, breast, and endometrial. In children, they can lead to early stoppage of growth and early puberty. 



SELECTIVE ANDROGEN RECEPTOR MODULATORS


Selective androgen receptor modulators, commonly called SARMs, are synthetic chemicals that mimic the effects of testosterone and anabolic steroids. Social media posts have popularized these and made them seem safe and effective. They are not FDA-approved. The FDA has issued warnings about SARMs due to many adverse side effects. 


SARMs have been associated with significant, even life-threatening problems, including:


  • Increased risk of heart attack or stroke

  • Psychosis/hallucinations    

  • Sleep disturbances

  • Liver injury and acute liver failure 

  • Infertility

  • Pregnancy miscarriage

  • Testicular shrinkage 

  • Sexual dysfunction


The FDA encourages people to report any adverse event related to the use of SARMs products to the FDA’s MedWatch Adverse Event Reporting program.


There have been numerous recalls by the FDA of supplements containing ingredients classified, but not listed, as steroids. They have issued public health alert warnings about bodybuilding supplements regarding this. Unfortunately, these adverse events aren’t realized until long after a product has been on the market. The consumers are the guinea pigs…don’t let it be your child.



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