Chinese Olympic swimmer Pan Zhanle was the subject of doping accusations at the 2024 Paris Olympics after he secured his team a gold medal in the 100-meter freestyle event, shattering the world record in a dominant finish that surpassed Australia’s silver medalist by 1.08 seconds. Pan subsequently denied those allegations, saying that he passed all 21 doping tests administered in the few months before the games.
Like virtually all of its kind that precede it, the 2024 Summer Olympics has been rife with doping scandals. In addition to accusations like those made against Zhanle, there have been four confirmed cases of anti-doping rule violations and controversial rulings like that of Erriyon Knighton, who was cleared to compete after his positive drug test result on March 26 was determined to have been a case of unintentional contamination.
As distrust towards the integrity of the games spreads, athletes and spectators question the standards of regulatory organizations like the World Anti-Doping Agency (WADA). Performance-enhancing drugs (PEDs) are, however, not only a concern of Olympic event organizers but also a worry for physicians, especially given the rapid increase in their misuse by young adults in recent years.
Primary among WADA’s lengthy list of prohibited PEDs is a class of drugs called anabolic steroids, of which use for non-medical purposes is illegal in many countries, such as the United States. How do anabolic steroids confer an advantage to athletes and bodybuilders, and why can misuse be dangerous?
In everyday conversations, people commonly refer to anabolic steroids as steroids or “roids,” but steroids are a broad class of biomolecules that includes hormones such as anabolic steroids. Anabolic steroids generally refer to more efficient, synthetic versions of androgens, which are sex hormones that are primarily involved in the development of male characteristics. The most important and well-known of these androgens is testosterone.
Our reproductive systems naturally produce androgens — though to a greater degree in males — and release them into our bloodstream. As our blood travels throughout our body, the androgens enter various cells. Many of these cells have a biomolecule called an androgen receptor, and when an androgen interacts with an androgen receptor, the cell responds. Skeletal muscle cells may respond by growing their muscular structures. Anabolic steroids function in the same way as androgens do, except that anabolic steroids have been modified to amplify muscle growth and recovery.
But how do cells other than muscle fibers respond to anabolic steroids? There are also other biomolecules involved in the cellular response to anabolic steroids, and the array of relevant biomolecules varies across cell types. Different cells respond differently to anabolic steroids. Therefore, the side effects of misuse are plenty: cardiovascular complications, liver disease, reproductive organ damage, reduced fertility, acne and mood instability, to name a few.
Despite these side effects, a 2014 meta-analysis of 187 studies on usage rates found that 6.4% of males and 1.6% of females studied have taken anabolic steroids at least once in their lifetimes, typically to enhance strength or improve physical appearance. Moreover, the lifetime usage rates for recreational and professional athletes were 18.4% for male athletes and 13.4% for female athletes. The lifetime usage rate among adolescents, who have yet to fully develop hormonally, was reported to be approximately 3% in the United States by the 2017 National Youth Risk Behavior Survey. However, the University of Massachusetts Boston found in a 2013 national survey that only 19% of the public perceives steroid abuse as problematic for adolescents. It is important to note that because non-medical steroid use is illegal, the data is likely to be underreported.
Given the prevalence of intentional doping in elite sports, which has been estimated to be between 14–39% internationally in an analytic review of testing results and questionnaires, record-shattering Olympic feats are often accompanied by doubt and skepticism. Informed, data-driven and organized testing can improve detection and reduce the burden on athletes, whose lives and training are disrupted due to frequent testing. Some studies suggest that investing in structural, social and psychological support for athletes to encourage clean sports behaviors may be more effective than investing in improving drug tests. A similarly holistic approach to steroid use prevention may also be the answer for preventing misuse in the general population. For instance, researchers could further investigate how the portrayal of male and female bodies in the media contributes to steroid misuse.
The efforts of researchers and organizations like WADA toward ridding ordinary lifestyles and elite sports of steroids have been insufficient; steroids have plagued the health of global populations and deteriorated spectators’ trust in the Olympic Games. Resolving these issues may require novel strategies. Research on the sociopsychological components of steroid misuse in both athletes and non-athletes, a relatively unexplored avenue, may bring us closer to a steroid misuse-free future.
