Gary I. Wadler, M.D., FACP, FACSM, FACPM, FCP, is an internist with special expertise in the field of drug use in sports. He is the lead author of the internationally acclaimed textbook, Drugs and the Athlete. Dr. Wadler currently serves as the Chairman of the World Anti-Doping Agency's (WADA) Prohibited List and Methods Sub-Committee and serves as an ex-officio member of WADA’s Health, Medicine, and Research Committee. Additionally, he has served as a Medical Advisor to the White House Office of National Drug Control Policy, a Trustee of the Board of the American College of Sports Medicine and of the Women’s Sports Foundation. Among his other sports medicine activities, he has served as Tournament Physician of the U.S. Open Tennis Championships.
For his groundbreaking work in the field of drug abuse in sports, Dr Wadler received the International Olympic Committee's President's Prize in 1993. He is a frequent lecturer on the subject and his opinions are widely sought by the print and electronic media nationally and internationally. In 2007, he was selected by the Institute for International Sport as “One of the 100 Most Influential Sports Educators in America” and serves Chairman of the Communications and Information Committee of the American College of Sports Medicine. In addition, he is Chairman of the American Ballet Theatre's Medical Advisory Board where he oversees the development of medical guidelines for the healthy and sound training of dancers in the United States. Dr. Wadler is the Chairman of the College Council of the State University of New York at Old Westbury. Dr. Wadler maintains a private practice in Internal Medicine and Sports Medicine in Manhasset, New York and is a Clinical Associate Professor of Medicine at the NYU School of Medicine.
Question: What are the dangers of taking steroids?
Gary Wadler: Well, these are- first of all, they’re controlled substances for a reason. They are dangerous drugs. And they’re wonderful drugs when you have a medical need for them. In fact, most of the medical needs have disappeared over the years for anabolic steroids. We use other drugs. What are anabolic steroids? Anabolic steroids are nothing more or less than synthetic derivatives of the male hormone testosterone, and molecules have been modified for a variety of reasons which we can get into, but fundamentally they’re all variations of the testosterone molecule. And, you know, we have a surge of that in puberty and then it levels off. But people have taken anabolic steroids to try to become more than they otherwise would be. So they’re looking for increased strength, improved recovery time, more aggressiveness, assertiveness, more acceleration. It does work. You can’t just take the anabolic steroid and go to sleep and wake up stronger. You do have to work out, you have to put your muscles under stress and resistive exercises, you have to be on a high-protein diet. And there was a big debate for many years. The American Medical Association for years said it did nothing. Well, the athletes knew better. It clearly does work, but it is clearly dangerous. And the side effects can be in the short term, the long term, some are predictable, some are not predictable, some involve the secondary sex characteristics, some have effects on other parts of the body. There’s psychiatric effects. There’s a profound depression when you stop these drugs. We can talk about later as well. And for teenagers, there’s a particular concern in that they will close their growth centers of their long bones so they never achieve their genetically determined height and wind up permanently shorter than they would have been otherwise. And for teenagers very importantly as well as other abusers, severe acne comes as part of the package as well.
Question: What are the dangers for men, women and teenagers?
Gary Wadler: Well, there are some effects which affect teenagers, men and women alike. There are those things that affect women, there are those things that affect teenagers and there are those thing that affect males. In the simplest term, a male becomes feminized. Why? Because in the body, testosterone is transformed into the female hormone, estrogen. And so you’ll see a high-pitched voice, development of breasts, shrinkage of their testicles, change in their hair patterns. They literally become feminized while they’re trying to get increasingly masculinized. It’s sort of a strange paradox. They also get bigger and stronger, but they also get feminized and some of those changes are permanent. Conversely, a woman who takes anabolic steroids becomes masculinized. And so she will develop a deep voice, develop facial hair, clitoral enlargement, menstrual irregularities and a large Adam’s apple. So they very much become in the direction of a male. And as far as teenagers are concerned, the thing that’s unique to them of course is the growth terms in the fact that they never reach their full genetic potential if they take things long enough. So each segment of the population has its unique consequences from abusing anabolic steroids.
Question: What are the psychological effects?
Gary Wadler: Well, I can tell you a very concrete example. About three years ago, I got a phone call one day from Mr. Don Hooten. Don Hooten, who lived in Texas, had a son who was sixteen years old who pitched for his baseball team in Plano, Texas, was very good. Coincidentally, he had a cousin who played in the major leagues by the name of Burt Hooten. At the end of the season, his coach said, “Look, you want to get to the major leagues like your cousin, you just keep working the way you are, but you got to get bigger,” and left it at that. Well, being in Texas, it wasn’t very hard to get to Mexico. In Mexico, anabolic steroids are readily available. And so off went Hooten’s son, Taylor Hooten, and in fact got bigger, stronger, acne, personality change, ‘roid rage, puts his fist through a wall, very significant breakup of his relationship with his girlfriend. Parents took him around to various experts, didn’t understand what was going on. Parents finally said, “Look, you have to stop this,” and he did. One day, he went up to his room, took two belts and hanged himself. Mr. Hooten called me shortly thereafter and said he just felt compelled to share this horrible story with other parents so they don’t wind up in a similar situation. And I suggested to him that he establish a not-for-profit foundation, educational foundation which will devote itself to getting this message out. And that gave rise to the Taylor Hooten Foundation, which I’m Chairman of the Board. And Mr. Hooten testified, as I did, before the hearings in Congress in baseball and at the Mitchell Report he met with Senator Mitchell, met with the leadership in many aspects of this field, and we’re happy to report that Major League Baseball actually has donated a substantial amount of money to the Taylor Hooten Foundation to do what we call Hoot’s Chalk Talks in which we will run in all thirty major
league stadiums around the United States sessions devoted to steroid abuse prevention and healthy alternatives to abusing steroids. So it’s a long way of saying that there was a very significant price to pay in this. And, you know, we heard about the wrestling case of the wrestler who ultimately committed suicide, killed his wife and young child. These are horrible stories, but they’re not rare and they’re not unpredictable. And most people don’t recognize or concentrate on the psychiatric aspects of steroid abuse as much as they do on some of the other aspects, particularly what is it doing to baseball records and the like.
Question: How can you tell that someone is taking steroids?
Gary Wadler: Well, one of the concerns we have for parents is to recognize that a teenager has an increase in their own testosterone. And another individual the same age group may have a rise because they’re taking testosterone or other anabolic steroids. So how do you distinguish a kid who is going through a difficult adolescence, took no drugs, but has a lot of acne, is
irritable, change in his relationships with his friends, wants to look good, goes to the gym? How do you take that individual and contrast it for a parent who suspect that their kid is using drugs and got acne and going to the gym and doing all these things? They have to A, be aware that it’s a possibility in this day in age. And it’s a sad thing to say that their adolescents in fact may be using anabolic steroids. But they also have to recognize they can’t make that assumption. It may be that their kid already is going through a difficult adolescence. Imagine how bad it can be when suddenly your parents are questioning you and your behaviors. So if in doubt, you have to seek a solution with your physician and share that information with your physician and then there are ways to evaluate which of the two is at play here. But, you know, for the average teenager, it may be not so obvious whether this is natural or whether this is drug-induced.
Recorded on: 04/25/2008