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The Dangers of Taking Steroids
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
Dr. Wadler explains the health risks pose to both mind and body.
Higher education faces challenges that are unlike any other industry. What path will ASU, and universities like ASU, take in a post-COVID world?
- Everywhere you turn, the idea that coronavirus has brought on a "new normal" is present and true. But for higher education, COVID-19 exposes a long list of pernicious old problems more than it presents new problems.
- It was widely known, yet ignored, that digital instruction must be embraced. When combined with traditional, in-person teaching, it can enhance student learning outcomes at scale.
- COVID-19 has forced institutions to understand that far too many higher education outcomes are determined by a student's family income, and in the context of COVID-19 this means that lower-income students, first-generation students and students of color will be disproportionately afflicted.
What conditions of the new normal were already appreciated widely?<p>First, we understand that higher education is unique among industries. Some industries are governed by markets. Others are run by governments. Most operate under the influence of both markets and governments. And then there's higher education. Higher education as an "industry" involves public, private, and for-profit universities operating at small, medium, large, and now massive scales. Some higher education industry actors are intense specialists; others are adept generalists. Some are fantastically wealthy; others are tragically poor. Some are embedded in large cities; others are carefully situated near farms and frontiers.</p> <p>These differences demonstrate just some of the complexities that shape higher education. Still, we understand that change in the industry is underway, and we must be active in directing it. Yet because of higher education's unique (and sometimes vexing) operational and structural conditions, many of the lessons from change management and the science of industrial transformation are only applicable in limited or highly modified ways. For evidence of this, one can look at various perspectives, including those that we have offered, on such topics as <a href="https://www.insidehighered.com/digital-learning/blogs/rethinking-higher-education/lessons-disruption" target="_blank">disruption</a>, <a href="https://www.nytimes.com/2020/02/20/education/learning/education-technology.html" target="_blank">technology management</a>, and so-called "<a href="https://www.insidehighered.com/sites/default/server_files/media/Excerpt_IHESpecialReport_Growing-Role-of-Mergers-in-Higher-Ed.pdf" target="_blank">mergers and acquisitions</a>" in higher education. In each of these spaces, the "market forces" and "market rules" for higher education are different than they are in business, or even in government. This has always been the case and it is made more obvious by COVID-19.</p> <p>Second, with so much excitement about innovation in higher education, we sometimes lose sight of the fact that students are—and should remain—the core cause for innovation. Higher education's capacity to absorb new ideas is strong. But the ideas that endure are those designed to benefit students, and therefore society. This is important to remember because not all innovations are designed with students in mind. The recent history of innovation in higher education includes several cautionary tales of what can happen when institutional interests—or worse, <a href="https://www.insidehighered.com/news/2016/02/09/apollos-new-owners-seek-fresh-start-beleaguered-company" target="_blank">shareholder</a> interests—are placed above student well-being.</p>
Photo: Getty Images<p>Third, it is abundantly apparent that universities must leverage technology to increase educational quality and access. The rapid shift to delivering an education that complies with social distancing guidelines speaks volumes about the adaptability of higher education institutions, but this transition has also posed unique difficulties for colleges and universities that had been slow to adopt digital education. The last decade has shown that online education, implemented effectively, can meet or even surpass the quality of in-person <a href="https://link-springer-com.ezproxy1.lib.asu.edu/article/10.1007/s10639-019-10027-z" target="_blank">instruction</a>.</p><p>Digital instruction, broadly defined, leverages online capabilities and integrates adaptive learning methodologies, predictive analytics, and innovations in instructional design to enable increased student engagement, personalized learning experiences, and improved learning outcomes. The ability of these technologies to transcend geographic barriers and to shrink the marginal cost of educating additional students makes them essential for delivering education at scale.</p><p>As a bonus, and it is no small thing given that they are the core cause for innovation, students embrace and enjoy digital instruction. It is their preference to learn in a format that leverages technology. This should not be a surprise; it is now how we live in all facets of life.</p><p>Still, we have only barely begun to conceive of the impact digital education will have. For example, emerging virtual and augmented reality technologies that facilitate interactive, hands-on learning will transform the way that learners acquire and apply new knowledge. Technology-enabled learning cannot replace the traditional college experience or ensure the survival of any specific college, but it can enhance student learning outcomes at scale. This has always been the case, and it is made more obvious by COVID-19.</p>
What conditions of the new normal were emerging suspicions?<p>Our collective thinking about the role of institutional or university-to-university collaboration and networking has benefitted from a new clarity in light of COVID-19. We now recognize more than ever that colleges and universities must work together to ensure that the American higher education system is resilient and sufficiently robust to meet the needs of students and their families.</p> <p>In recent weeks, various commentators have suggested that higher education will face a wave of institutional <a href="https://www.businessinsider.com/scott-galloway-predicts-colleges-will-close-due-to-pandemic-2020-5" target="_blank">closures</a> and consolidations and that large institutions with significant online instruction capacity will become dominant.</p> <p>While ASU is the largest public university in the United States by enrollment and among the most well-equipped in online education, we strongly oppose "let them fail" mindsets. The strength of American higher education relies on its institutional diversity, and on the ability of colleges and universities to meet the needs of their local communities and educate local students. The needs of learners are highly individualized, demanding a wide range of options to accommodate the aspirations and learning styles of every kind of student. Education will become less relevant and meaningful to students, and less responsive to local needs, if institutions of higher learning are allowed to fail. </p> <p>Preventing this outcome demands that colleges and universities work together to establish greater capacity for remote, distributed education. This will help institutions with fewer resources adapt to our new normal and continue to fulfill their mission of serving students, their families, and their communities. Many had suspected that collaboration and networking were preferable over letting vulnerable colleges fail. COVID-19's new normal seems to be confirming this.</p>
President Barack Obama delivers the commencement address during the Arizona State University graduation ceremony at Sun Devil Stadium May 13, 2009 in Tempe, Arizona. Over 65,000 people attended the graduation.
Photo by Joshua Lott/Getty Images<p>A second condition of the new normal that many had suspected to be true in recent years is the limited role that any one university or type of university can play as an exemplar to universities more broadly. For decades, the evolution of higher education has been shaped by the widespread imitation of a small number of elite universities. Most public research universities could benefit from replicating Berkeley or Michigan. Most small private colleges did well by replicating Williams or Swarthmore. And all universities paid close attention to Harvard, Princeton, MIT, Stanford, and Yale. It is not an exaggeration to say that the logic of replication has guided the evolution of higher education for centuries, both in the US and abroad.</p><p>Only recently have we been able to move beyond replication to new strategies of change, and COVID-19 has confirmed the legitimacy of doing so. For example, cases such as <a href="https://www.washingtonpost.com/education/2020/03/10/harvard-moves-classes-online-advises-students-stay-home-after-spring-break-response-covid-19/" target="_blank">Harvard's</a> eviction of students over the course of less than one week or <a href="https://www.nhregister.com/news/coronavirus/article/Mayor-New-Haven-asks-for-coronavirus-help-Yale-15162606.php" target="_blank">Yale's apparent reluctance</a> to work with the city of New Haven, highlight that even higher education's legacy gold standards have limits and weaknesses. We are hopeful that the new normal will include a more active and earnest recognition that we need many types of universities. We think the new normal invites us to rethink the very nature of "gold standards" for higher education.</p>
A graduate student protests MIT's rejection of some evacuation exemption requests.
Photo: Maddie Meyer/Getty Images<p>Finally, and perhaps most importantly, we had started to suspect and now understand that America's colleges and universities are among the many institutions of democracy and civil society that are, by their very design, incapable of being sufficiently responsive to the full spectrum of modern challenges and opportunities they face. Far too many higher education outcomes are determined by a student's family income, and in the context of COVID-19 this means that lower-income students, first-generation students and students of color will be disproportionately afflicted. And without new designs, we can expect postsecondary success for these same students to be as elusive in the new normal, as it was in the <a href="http://pellinstitute.org/indicators/reports_2019.shtml" target="_blank">old normal</a>. This is not just because some universities fail to sufficiently recognize and engage the promise of diversity, this is because few universities have been designed from the outset to effectively serve the unique needs of lower-income students, first-generation students and students of color.</p>
Where can the new normal take us?<p>As colleges and universities face the difficult realities of adapting to COVID-19, they also face an opportunity to rethink their operations and designs in order to respond to social needs with greater agility, adopt technology that enables education to be delivered at scale, and collaborate with each other in order to maintain the dynamism and resilience of the American higher education system.</p> <p>COVID-19 raises questions about the relevance, the quality, and the accessibility of higher education—and these are the same challenges higher education has been grappling with for years. </p> <p>ASU has been able to rapidly adapt to the present circumstances because we have spent nearly two decades not just anticipating but <em>driving</em> innovation in higher education. We have adopted a <a href="https://www.asu.edu/about/charter-mission-and-values" target="_blank">charter</a> that formalizes our definition of success in terms of "who we include and how they succeed" rather than "<a href="https://www.washingtonpost.com/opinions/2019/10/17/forget-varsity-blues-madness-lets-talk-about-students-who-cant-afford-college/" target="_blank">who we exclude</a>." We adopted an entrepreneurial <a href="https://president.asu.edu/read/higher-logic" target="_blank">operating model</a> that moves at the speed of technological and social change. We have launched initiatives such as <a href="https://www.instride.com/how-it-works/" target="_blank">InStride</a>, a platform for delivering continuing education to learners already in the workforce. We developed our own robust technological capabilities in ASU <a href="https://edplus.asu.edu/" target="_blank">EdPlus</a>, a hub for research and development in digital learning that, even before the current crisis, allowed us to serve more than 45,000 fully online students. We have also created partnerships with other forward-thinking institutions in order to mutually strengthen our capabilities for educational accessibility and quality; this includes our role in co-founding the <a href="https://theuia.org/" target="_blank">University Innovation Alliance</a>, a consortium of 11 public research universities that share data and resources to serve students at scale. </p> <p>For ASU, and universities like ASU, the "new normal" of a post-COVID world looks surprisingly like the world we already knew was necessary. Our record breaking summer 2020 <a href="https://asunow.asu.edu/20200519-sun-devil-life-summer-enrollment-sets-asu-record" target="_blank">enrollment</a> speaks to this. What COVID demonstrates is that we were already headed in the right direction and necessitates that we continue forward with new intensity and, we hope, with more partners. In fact, rather than "new normal" we might just say, it's "go time." </p>
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Hollywood has created an idea of aliens that doesn't match the science.
- Ask someone what they think aliens look like and you'll probably get a description heavily informed by films and pop culture. The existence of life beyond our planet has yet to be confirmed, but there are clues as to the biology of extraterrestrials in science.
- "Don't give them claws," says biologist E.O. Wilson. "Claws are for carnivores and you've got to be an omnivore to be an E.T. There just isn't enough energy available in the next trophic level down to maintain big populations and stable populations that can evolve civilization."
- In this compilation, Wilson, theoretical physicist Michio Kaku, Bill Nye, and evolutionary biologist Jonathan B. Losos explain why aliens don't look like us and why Hollywood depictions are mostly inaccurate.
Can an orgasm a day really keep the doctor away?
- Achieving orgasm through masturbation provides a rush of feel-good hormones (such as dopamine, serotonin and oxytocin) and can re-balance our levels of cortisol (a stress-inducing hormone). This helps our immune system function at a higher level.
- The surge in "feel-good" hormones also promotes a more relaxed and calm state of being, making it easier to achieve restful sleep, which is a critical part in maintaining a high-functioning immune system.
- Just as bad habits can slow your immune system, positive habits (such as a healthy sleep schedule and active sex life) can help boost your immune system which can prevent you from becoming sick.
How masturbation affects your brain...<p>Orgasms are a very common human phenomenon. The physical and mental health benefits have been researched frequently as a result, and yet, there is still so much to be learned about how our bodies and brains react to the chemicals and hormones released during and after experiencing this type of sexual release.</p><p>"The amount of speculation versus actual data on both the function and value of orgasm is remarkable" explains Julia Heiman, director of the <a href="https://kinseyinstitute.org/" target="_blank">Kinsey Institute for Research in Sex, Gender, and Reproduction</a>.</p><p>Masturbation causes a rush of <a href="https://www.webmd.com/mental-health/what-is-dopamine" target="_blank">dopamine</a>, which is a chemical that is associated with our ability to feel pleasure. Along with the rush of dopamine that is released during an orgasm, there is also a release of a hormone called <a href="https://www.livescience.com/42198-what-is-oxytocin.html" target="_blank">oxytocin</a>, which is commonly referred to as the "love hormone."<br></p><p>This concoction of chemicals does more than just boost our mood, it also can play a key role in decreasing stress and promoting relaxation. Oxytocin decreases <a href="https://www.webmd.com/a-to-z-guides/what-is-cortisol" target="_blank">cortisol</a>, which is a stress hormone that is usually present (in high volumes) during times of anxiety, fear, panic, or distress. </p><p>According to BDSM and fetish researcher <a href="https://www.psychologytoday.com/us/therapists/dr-gloria-brame-colbert-ga/278388" target="_blank">Dr. Gloria Brame</a>, an orgasm is the biggest non-drug induced blast of dopamine that we can experience. </p><p>By boosting the oxytocin and dopamine levels and subsequently decreasing our cortisol levels, the brain is placed in a more relaxed, euphoric, and calm state. </p>
Masturbation boosts your immune system and raises your white blood cell count.<p>How do those effects on the brain from reaching orgasm translate to boosting our immune system and making our body healthier?</p><p>The increase of oxytocin and dopamine that causes a decrease in cortisol levels can help boost our immune system because cortisol (well-known for being a stress-inducing hormone) actually helps maintain your immune system if released in small doses. </p><p>According to <a href="https://www.health24.com/Sex/Great-sex/incredible-health-benefits-to-masturbating-20181030-2" target="_blank">Dr. Jennifer Landa</a>, a hormone-therapy specialist, masturbation can produce the right kind of environment for a strengthened immune system to thrive. </p><p><a href="https://www.ncbi.nlm.nih.gov/pubmed/15316239" target="_blank">A study</a> conducted by the Department of Medical Psychology at the University Clinic of Essen (in Germany) showed similar results. A group of 11 volunteers were asked to participate in a study that would look at the effects of orgasm through masturbation on the white blood cell count and immune system.</p><p>During this experiment, the white blood cell count of each participant was analyzed through measures that were taken 5 minutes before and 45 minutes after reaching a self-induced orgasm. </p><p>The results confirmed that sexual arousal and orgasm increased the number of white blood cells, particularly the natural killer cells that help fight off infections. </p><p>The findings confirm that our immune system is positively affected by sexual arousal and self-induced orgasm and promote even more research into the positive impacts of sexual arousal and orgasm. </p>
Masturbation can ease and prevent pain, which allows you to achieve the restful sleep that helps your immune system stay strong and healthy.<p>The benefits of masturbation have long been debated, but the more research that is done on the topic the more we understand that there are many positive reactions that happen in our bodies and brains when we orgasm.</p><p>Orgasms can help prevent or mitigate pain, which boosts the immune system, preventing cold and flu symptoms. </p><p>According to neurologist and headache specialist Stefan Evers, about one in three patients experience relief from migraine attacks by experiencing sexual activity or orgasm. Evers and his team <a href="https://www.livescience.com/27642-sex-relieves-migraine-pain.html" target="_blank">conducted an experiment</a> with 800 migraine patients and 200 patients who suffered from cluster-headaches to see how their experiences with sexual activity impacted their pain levels. </p><p>The study showed that 60% of migraine sufferers experienced pain relief after participating in sexual activity that resulted in orgasm. Of the cluster-headache sufferers, about 50% said their headaches actually worsened after sexual arousal and orgasm. </p><p>Evers suggested in his findings that the people who did not experience pain relief from migraines of headaches during their sexual activity did not release as large amounts of endorphins as those who did experience pain relief. </p><p>According to <a href="https://www.sharecare.com/health/chronic-pain/chronic-pain-affect-immune-system" target="_blank">rheumatologist Dr. Harris McIlwain</a>, people who suffer from chronic pain have immune systems that are simply not functioning at full capacity - therefore, alleviating pain (through orgasm, as an example) can help boost the immune system. </p><p>Orgasms can also promote relaxation and make it easier to fall asleep. Serotonin, oxytocin, and norepinephrine are all hormones that are released during sexual arousal and orgasm, and all three are known for counteracting stress hormones and promoting relaxation, which makes it much easier for you to fall asleep.</p><p>There are <a href="https://www.ncbi.nlm.nih.gov/pubmed/1233384" target="_blank">several studies</a> showing that serotonin and norepinephrine help our body cycle through REM and deep non-REM sleeping cycles. During these sleep cycles, the immune system releases proteins called <a href="https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity" target="_blank"><span id="selection-marker-1" class="redactor-selection-marker"></span>cytokines<span id="selection-marker-2" class="redactor-selection-marker"></span></a>, which target infection and inflammation. This is a critical part of our immune response. Cytokines are both produced and released throughout our bodies while we sleep, which proves the importance of a good sleep schedule to a healthy immune system.</p>
Masturbation promotes a high-functioning immune system; a healthy immune system prevents cold and flu.<p>The immune system is a balanced network of cells and organs that work together to defend you against infections and diseases by stopped threats like bacteria and viruses from entering your system. While there are many things we need to do to keep our immune systems functioning at optimal levels, masturbation (or other means of achieving orgasm) has proven to have positive effects on the immune system as a whole.</p><p>Just as bad habits (such as an inconsistent sleep schedule or harmful chemicals in your body) can slow your immune system, positive habits (such as a healthy sleep schedule and active sex life) can help boost your immune system. </p>
Sallie Krawcheck and Bob Kulhan will be talking money, jobs, and how the pandemic will disproportionally affect women's finances.