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Sympathy for the Devil
Everything you thought you knew about steroids is wrong
By STEVEN KOTLER
Thursday, July 28, 2005 - 12:00 am
The road to the future is paved in blood ? my own. Not too long ago, a nurse went a little crazy with my hemoglobin. Somewhere in the middle of the second vial, I got too dizzy to pay attention, but it felt like she took pints, quarts, gallons, whatever comes after gallons, gleefully mining my veins for any secrets they might conceal. The blood was sent to a medical lab that ran a battery of tests and then shipped the results to a doctor named Ron Rothenberg, with whom I would meet to discuss what portents it held. Besides the blood work, getting in to see Rothenberg also required signing a 10-page waiver, filling out a 20-page health-and-lifestyle questionnaire and being profoundly willing to look my medical future square in the eye.
Rothenberg, himself, is a medium-size guy, smooth-skinned and strong-shouldered, with sandy-brown hair, dark eyes and darker eyebrows. He looks a little like a Jewish version of a Latin American soap star, which is to say he looks nothing like his 59 years. He is open about his age, just as he is open about the fact that he feels 25, but unlike most who brag of their youthful virility, because of the way Ron Rothenberg now makes a living, his youthful virility is perhaps no idle claim. Rothenberg runs the California Health Span Institute in Encinitas, California, and to the limited number of people who know of him and understand the world of anti-aging medicine, he is considered something of a pioneer ? which is saying a lot when you consider that the Western tradition of anti-aging medicine dates back at least to the 1500s, when someone named Juan Ponce de Le?n accidentally discovered Florida while looking for the Fountain of Youth.
Rothenberg was not trained in anti-aging medicine, because, at the time he was trained, anti-aging medicine was not something one got trained in. Instead, he graduated from Columbia Medical School in 1970, moved out West, learned to surf, and completed his residency in 1975 at Los Angeles County?USC Medical Center. He received an academic appointment to teach emergency medicine at the University of California, San Diego, in ?77, and became a full professor in ?89. Throughout, Rothenberg has kept on surfing. Back in 1975, he was one of the first Americans to venture to Bali to try his hand at those now-legendary Indonesian waves. He has a house down deep in Baja, right in front of one of the better breaks in Mexico. Surfboards hang on his office walls, as do pictures of him riding overhead waves with a charging stance akin to that of Greg ?The Bull? Noll. These pictures were taken last year, when Rothenberg was 58, but it was a few years before this, around the time he turned 50, when his interest in surfing pointed him toward the then-emerging field of anti-aging medicine.
?Around the half-century mark, I saw all these changes in my body,? recalls Rothenberg. ?I felt fuzzy. I felt like I was losing my edge. My energy was low, my libido was low, things didn?t look as good as they used to. When I went surfing, I would get winded on the paddle-out. I wasn?t used to getting winded on the paddle-out. I read a Newsweek article about the anti-aging properties of DHEA and started to wonder if there was something I could do about the way I was feeling and the changes my body was undergoing.?
Rothenberg got in touch with the nascent American Academy of Anti-Aging and began re-educating himself. ?Most doctors are frozen in time,? he says. ?They stop learning when they get out of medical school. Unfortunately, one of the first things they teach you in medical school is that nearly half of what you?ll learn there is wrong ? only no one is exactly certain which half.? One of the main things he learned in medical school was that time marches on and aging is an unstoppable process. For Rothenberg, this turned out to be part of the half that was wrong.
How wrong is still a matter of debate, but few disagree that the version of anti-aging medicine as practiced by Rothenberg and his cohorts represents one of the more radical departures in Western medical thought to surface in centuries. ?Traditional medicine is reactive, disease-based medicine,? says Dr. Robert Goldman, chairman of the American Academy for Anti-Aging Medicine. ?Anti-aging medicine is the opposite. It?s about finding the problem and fixing the problem before it occurs. If sports medicine is about optimizing the body for maximum athletic performance, then anti-aging medicine is about optimizing the body for living in general.?
Goldman believes that anti-aging is the future of medicine. And Ron Rothenberg was one of the first to venture into that future. He became the 10th doctor in the world to become board-certified in anti-aging medicine and among the earliest to hang a shingle and open his doors to the public, in 1998. He had been self-medicating for a little while before that, and his earliest patients were fellow doctors who noticed that Rothenberg seemed younger, faster, stronger and who wanted some of that good magic for themselves. His prescription for them was very similar to his prescription for me ? and this is where the road to the future takes a sharp left turn ? because the basis for both prescriptions was hormones. Though, as Rothenberg and others like to point out, ?There?s a joke in the medical community: When someone has something nice to say about the work we?re doing, they use the word hormones. When they don?t have something nice to say, they like to call them steroids.?
My journey to see Dr. Rothenberg did not begin with an inquiry into anti-aging medicine, but it did begin with steroids. It began with a onetime baseball player named Jose Canseco and the stir caused by his memoir of ?wild times, rampant ?roids, smash hits and how baseball got big.? It was in Juiced that Canseco claimed to be the man who popularized steroids in baseball. It was also in Juiced that Canseco defined road beef as ?any girl you met on the road and had sex with.? For this reason and others, there?s very little in the book that gives one faith in its author?s opinions. He repeatedly argues that steroids are the wonder drug of tomorrow, but nowhere in the book is a medical paper cited or a scientist quoted. He promises that someday soon ?everyone will be doing it. Steroid use will be more common than Botox is now. Every baseball player and pro athlete will be using at least low levels of steroids. As a result, baseball and other sports will be more exciting and entertaining. Human life will be improved, too. We will live longer and better. And maybe we?ll love longer and better, too.? As it worked out, these rosy prognostications came around the time that pundits and politicians were making plenty of hay saying the exact opposite.
file:///C:/Users/foster/AppData/Local/Temp/msohtml1/01/clip_image001.gif
Life begins at 59: Dr. Ron
Rothenberg seems to have
found the fountain of youth,
and it's not in Baja.
They had been saying the exact opposite for years, but Canseco?s book and the BALCO scandal combined to add new fuel to the fire and helped spark this past spring?s congressional steroid hearings ? a circus act that saw everyone from Mark McGwire to Sammy Sosa look uncomfortable fudging answers to questions raised by Juiced, while Canseco seemed relaxed and in control, and shameless by comparison. One memorable moment came when former pitcher and current Republican senator from Kentucky, Jim Bunning, decried the nightmare scenario of baseball players actually getting better as they aged: "Mr. Chairman, maybe I?m old-fashioned. I remember players didn?t get any better as they got ?older.? We all got worse. When I played with Henry Aaron, Willie Mays and Ted Williams, they didn?t put on 40 pounds and bulk up in their careers, and they didn?t hit more home runs in their late 30s as they did in their late 20s. What?s happening in baseball now is not natural, and it isn?t right."
The results of all the hysteria were new drug-testing and steroid-suspension policies in all major sports including baseball, where Commissioner Bud Selig has proposed 50-game suspensions for a first offense, and football, which increased the possible number of random off-season drug tests from two to six. There was also the re-drafting of the 1990 Steroid Control Act into the updated 2005 Steroid Control Act, and this doesn?t include the two sports-related anti-steroid bills pending in the House of Representatives.
The experts were nearly unanimous in their Canseco condemnations, but despite all of this, the reason I found myself sitting in Ron Rothenberg?s office last June was because I had started to harbor what seemed the most ridiculous of all suspicions: What if Jose Canseco was actually right?
The real reason I started to wonder this had little to do with steroids and plenty to do with another taboo class of chemicals. It is well known that back in the 1960s, when Timothy Leary snuck LSD out of Harvard and into mainstream culture, all sorts of tie-dyed hell broke loose. Our young people were at risk; the very foundation of our society was in jeopardy. Hallucinogens, we were told, were diabolical. They induced insanity. You want proof? Did not the Grateful Dead become the most successful bar band in the history of the world? Perhaps less familiar is the fact that before Captain Cosmonaut came on the scene, psychedelics had been the basis of some really promising science ? so good that nearly all of modern pharmacological psychology is based on this research. LSD led us to the neurotransmitter serotonin, and serotonin jump-started the entire Prozac nation. Studies dating back almost to the 1920s hint that hallucinogens are uniquely suited to treat some of our more intractable diseases, but most of these studies have been buried so long and so deep that the core component of the Schedule One classification ? where hallucinogens currently reside ? states that they contain no beneficial medicinal properties.
There were, however, a few folks who knew what was what, and these folks have been stubbornly lobbying the powers that be for more than three decades. In 1990, a managerial decision to depoliticize the Food and Drug Administration forced the rest of the government to finally reopen this door. There are currently a half-dozen hallucinogen studies under way at major universities, the early results of which are seriously promising. All of which led me to wonder, if psychedelics weren?t the bogeymen they had been made out to be, maybe everything we?re hearing about steroids being the devil incarnate is wrong as well.
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Strong medicine: Approaching 60,
Dr. Mauro Di Pasquale (right), a
former champion weightlifter,
says don't believe the negative
hype about steroids.
If you want to know anything about steroids, Mauro Di Pasquale is a pretty good place to start. He?s a two-time world-champion power-lifter, eight-time Canadian champ, two-time Pan-American and two-time North American champion. Along the way, Di Pasquale also went to medical school and became one of our foremost authorities on performance-enhancing drugs. He has since written eight books on the topic, worked as a columnist for half a dozen fitness magazines and as editor in chief for the international quarterly newsletter Drugs in Sports and the bimonthly Anabolic Research Review (both are no longer published). In the early ?90s, when World Wrestling Federation founder Vince McMahon decided it was time to get his empire off the juice, Di Pasquale was the one who got the job. He later became the medical director to the World Bodybuilding Federation and the acting medical review officer for NASCAR, helping both sports develop their stringent drug-testing policies.
I reached him at his home in Toronto after a frustrating morning spent trying to find a clear-cut definition of steroids. ?You won?t find one,? said Di Pasquale. ?When people use the word, they are usually talking about one of two things. Doctors use it to mean corticosteroids, which are catabolic hormones that break tissue down. Corticosteroids are the body?s natural anti-inflammatories, produced as part of our normal reaction to stress. When the general public talks about steroids, they sometimes mean our actual sex hormones, but mostly they mean testosterone or substances designed to mimic testosterone.?
Testosterone is both an anabolic and an androgenic steroid. Anabolic means the exact opposite of catabolic; it?s a hormone that builds up tissue rather than breaking it down. Androgens are any hormone that controls the development and maintenance of male sexual characteristics, just as estrogens are any hormone that controls the development and maintenance of female sexual characteristics. Testosterone is the upstream precursor of estrogen, meaning testosterone breaks down into estrogen. Quite literally, if there were no such thing as testosterone, there would be no such thing as women.
Our earliest known research into the effects of tampering with testosterone date back to 1767, when Scottish scientist John Hunter failed to learn much of anything by transplanting the testicles of a rooster into the abdomen of a hen. A hundred years later, a German zookeeper and professor named Arnold Berthold picked up Hunter?s thread and performed one of our first recorded experiments in endocrinology. He castrated a series of cockerels and afterward reported that his animals? most definitive male sexual characteristics vanished right alongside their testicles. Gone were the flamboyant comb, the aggressive behavior and any interest in the opposite sex, but ? and this was the finding that first paved the road into the future ? Berthold also found that these changes could be reversed by injecting the castrated rooster with the as-of-yet-unnamed substance extracted from its testicles.
Two decades after Berthold?s breakthrough, our first steroid controversy arrived when noted British neurologist Charles Edward Brown-Sequard began injecting himself with an extract of animal testes. No one really knows which species he preferred, but he sampled guinea pigs, dogs and sheep and so enjoyed the experience that he spent the later years of his life tarnishing his illustrious career in the eyes of the medical community by touting his potion?s rejuvenating qualities and advocating injections as a means of prolonging human life. It was hard to persuade the general public to go this extract route, but in the 1930s a Dutch pharmacologist named Ernst Laqueur managed to isolate 10 milligrams of crystalline testosterone from 100 kilograms of bull testicles, and that changed everything. Suddenly, we could pick apart testosterone?s chemical structure; suddenly, we could experiment. Synthetic versions were soon to follow, as were the Swedish athletes taking Rejuven, a performance enhancer that worked its magic with a small amount of testosterone. Other shenanigans ensued. In the 1936 Olympics there were rumors that German competitors ? fueled by Hitler?s dreams of Aryan perfection ? were taking even larger doses.
A few years after that, as John Hoberman writes in his book Testosterone Dreams: ?Testosterone became a charismatic drug because it promised sexual stimulation and renewed energy for individuals and greater productivity in society. Physicians described the optimal effects of testosterone as a feeling of ?well-being,? a term that has been used many times over the past half-century to characterize its positive effect on mood. In the early 1940s, testosterone was hailed as a mood-altering drug whose primary purpose was the sexual restoration and reenergizing of aging males.?
But the real dam broke in 1945, when science writer Paul de Kruif published The Male Hormone. When the book came out, it was big news. Newsweek wrote a full-page review, and Reader?s Digest excerpted the work. Reviewers cited both de Kruif?s bioethical fearlessness and his scientific excellence. The book was about testosterone and the impact it would have on our economy and our health. De Kruif foresaw riches for its manufacturers; however, he didn't predict that steroids would become a huge black-market business. He foretold increased vigor and extended life for its consumers. About health, de Kruif was downright prescient, though very few people know this, and the reason very few people know this is because it?s quite possible Paul de Kruif?s was the last unbiased opinion on the subject.
So strong are those biases and so fervently have they been promoted that calling the world?s top steroid experts and asking them questions ? especially in light of the president?s inclusion of steroids as public enemy No. 2 in his most recent State of the Union address ? was having a hall-of-mirrors effect.
?As used by most people, including athletes, the adverse effects of anabolic steroids appear to be minimal,? says Di Pasquale. ?Steroids do not cause cancer. They don?t cause kidney failure. There have been thousands of steroid studies and about a hundred of those point out bad side effects. But if you look at those studies carefully, there?s no one-to-one correlation, and a one-to-one correlation is the hallmark of good science. Do anabolics produce ?roid rage? They produce an incredible amount of energy, but you need to think about the kind of people taking steroids. If really competitive and aggressive people start taking drugs that give them more energy, then common sense says that sooner or later you?re going to have some problems, but are steroids the problem or the fact that this person didn?t know how to control their anger long before the steroids came along??
Di Pasquale says the same thing is true about all the scary steroid stories hanging around cautionary-tale cases like Lyle Alzado and Steve Courson. Alzado was the All-Pro-defensive-lineman-turned-actor who died of inoperable brain cancer in 1992 at the age of 43. Alzado blamed longtime steroid use for his condition. Steve Courson, who once lined up opposite Alzado, wrote the tell-all book False Glory: Steelers and Steroids about the juiced-up ways of the ?70s Steelers. Courson was recently on the heart-transplant list before correcting his gravely enlarged heart with diet and exercise. Both were known for living large as well as being large.
As Di Pasquale and many others have pointed out, people with a proclivity for risk take steroids; people with a proclivity for risk also play professional sports, drink too much, take recreational drugs and have unprotected sex. For almost every famous steroid-related tragedy, there are a host of underreported extenuating circumstances, but sports are big business, and pill-popping booze hounds with a penchant for unprotected sex don?t sell tickets like they used to.
Which is not to say anabolics aren?t without complications. When teenagers use steroids, the results can be disastrous. When weightlifters ingest 10 times the normal amount of anabolics for years at a time, there?s excessive hair growth in unwanted places, premature baldness and gynecomastia (the development of so-called ?bitch tits??) in men, and clitoral hypertrophy (the development of so-called ?big clit?) in women. Men also face testicular atrophy, which may or may not go away once they stop using steroids. As for the long-term effects, until very recently, almost nobody had studied them.
One of the first such investigations was undertaken a few years ago by UCLA orthopedic surgeon and sports-medicine specialist Nick Evans, who writes the ?Ask the Doctor? column for MuscleMag International. When I asked Evans why it had taken so long for anyone to do such a long-term study, he reminded me that while steroids have been increasing body mass and strength in athletes for nearly 75 years, it wasn?t until 1996 that medical science got around to admitting that steroids actually could increase muscle mass and strength. ?It?s the craziest thing you?ve ever seen,? said Evans. ?It was like scientists bought into all the negative hype and propaganda and never bothered to walk into a gym and talk to a bodybuilder.?
Evans, on the other hand, had no problem with bodybuilders. In the early ?90s he started talking to plenty of them and in 1996 published his first paper, ?Gym and Tonic: A Profile of 100 Steroid Users,? in the British Journal of Sports Medicine. That was followed by an even more rigorous look at 500 long-time juicers that was presented this year at the American College of Sports Medicine?s annual meeting. Like Di Pasquale, Evans found no concrete links between steroids and the deadly panoply with which they are often associated, though at the extreme-bodybuilding end of the spectrum, he has some serious concerns about the heart. ?The heart is a muscle and steroids increase muscle size. If the heart starts getting bigger, it becomes less efficient at doing its job, and over time that can cause big problems.?
Evans also feels that if users had access to proper medical advice, many of these problems could be avoided. He finds America?s current steroid policy slightly ridiculous, not because he believes that people should be taking steroids, but because of the reasons most people are taking steroids. ?There?s this idea out there that the only people who use these drugs are professional athletes ? that regulating steroids will clean up professional sports and make the problems go away, but that couldn?t be farther from the truth. There are 3 million steroid users in the United States. In both of my studies I found that 80 percent of them were using them for cosmetic purposes.?
What I found interesting about this is that when steroid-related complications are compared to complications from other radical cosmetic practices like liposuction or breast augmentation, the statistics show across the board that elective surgeries produce far more problems, and far more serious ones at that. What I found more interesting was that unlike these cosmetic practices, steroids hold real promise. Plastic surgery may hide wrinkles by cutting them out, but steroids might actually make you feel younger from the inside out. All of which raises the question: If steroids are not nearly as bad for us as we?ve been led to believe, and if they show far more potential as anti-aging medicine than anything else currently available, then what the hell is the problem?
NHL hockey teams are worth about $150 million each. NFL teams are worth about $530 million each. The New York Yankees are valued at about a billion dollars. But it is not just the teams themselves that appear at risk from the steroid menace, but also all the downstream profits generated by these teams. The range of such profits is immense, with everything from television contracts to the added value stadiums bring to urban areas to Nike shoe sales to the salary of the baseball reporter at the Kansas City Star included in the assessment. The general feeling is that steroids threaten all of these enterprises because steroids threaten the level playing field that many people think is the very foundation of sport. In other words, juicing is considered cheating.
That steroids threatened the level playing field became readily apparent in the 1960s, when androgynous Eastern Bloc female athletes started doing a little too well at the Olympics. By 1975, steroids were added to the Olympics? list of banned substances. College and professional football followed, with other sports eventually following suit. But it was already too late. The word had gotten out: Steroids built muscle, shortened muscle recovery times, helped speed the healing of injuries and made you feel good along the way. And the word was bad for business.
It wasn?t just that using steroids was cheating ? other factors came into play. ?There?s a whole subset of the industry that?s very devoted to the record books,? says Rodney Fort, Washington State University professor of economics and author of Pay Dirt: The Business of Professional Team Sports. ?These are everyone from the people who make baseball cards to the journalists who cover baseball. They believe you can?t argue about who?s the best batter ever if some of the best batters were on steroids. They?re a subset, but they?re an impactful and vocal subset, and when it came to steroids, they were almost unanimously against.?
This entire fracas meant that something had to be done, though what was actually done seems asinine until you remember the history of hallucinogens and exactly what became of Nixon?s war on drugs. ?The organized-sports establishment decided they would solve the whole problem by educating the athletes,? wrote Rick Collins, one of our foremost authorities on performance-enhancing drugs and the law, in his book Legal Muscle: Anabolics in America. ?They would present the facts to discourage competitive athletes from using steroids. The establishment devised a strategy: to convince competitive athletes that anabolic steroids don?t build muscle. But they needed a credible source through which to sell the message. It was decided that the American College of Sports Medicine would be the entity to spread the news, a bit like the ?Ministry of Truth? had the job of spreading false propaganda in George Orwell?s classic book about a totalitarian future, 1984.?
This wasn?t yet 1984, this was 1977, and the College of Sports Medicine took to issuing proclamations: ?Steroids had no effect on lean muscle mass; the effects athletes were seeing were water retention; the effects athletes were seeing were the placebo effect.? These claims were propped up by what many consider to have been flawed studies. Nonetheless, they held sway until the real 1984, when there was so much anecdotal evidence to the contrary that the college finally had to admit that, yes, those 300-pound beasts playing left tackle could only have gotten to be 300-pound beasts with the help of anabolic steroids.
So they came up with a different approach ? tell the athletes that steroids are bad for them. Make them sound horrible. As these things can go, they made them sound horrible enough that the media picked up the story (and ran with it and are running with it still). Then another fact came to light ? high school kids were starting to use steroids. Saving our children fills war chests, and Congress couldn?t resist. In 1988, Ronald Reagan signed the Anti-Drug Abuse Act of 1988, which made trafficking in steroids illegal, and a variety of subcommittees were formed to hear testimony about whether or not steroids should become a controlled substance. Among those who testified was Charles Yesalis, a professor of health and human development at Penn State and the world?s leading steroid authority at the time. ?Steroids do have a medical use,? Yesalis testified. ?From an epidemiologic point of view of the health dangers, I am much more concerned about heroin; I am much more concerned about cocaine; I am much more concerned about cigarettes than anabolic steroids.?
The American Medical Association, the Drug Enforcement Agency, the Department of Health and Human Services, and the Food and Drug Administration ? the four regulatory agencies that are supposed to have control of the drug-scheduling process ? all testified against turning steroids into a controlled substance. It didn?t matter. Senator Herbert Kohl spoke for many when he said, ?Steroid users set an intolerable example for our nation?s youth.? At the time he was speaking, Senator Kohl also owned the Milwaukee Bucks.
Sympathy for the Devil
Everything you thought you knew about steroids is wrong
By STEVEN KOTLER
Thursday, July 28, 2005 - 12:00 am
The road to the future is paved in blood ? my own. Not too long ago, a nurse went a little crazy with my hemoglobin. Somewhere in the middle of the second vial, I got too dizzy to pay attention, but it felt like she took pints, quarts, gallons, whatever comes after gallons, gleefully mining my veins for any secrets they might conceal. The blood was sent to a medical lab that ran a battery of tests and then shipped the results to a doctor named Ron Rothenberg, with whom I would meet to discuss what portents it held. Besides the blood work, getting in to see Rothenberg also required signing a 10-page waiver, filling out a 20-page health-and-lifestyle questionnaire and being profoundly willing to look my medical future square in the eye.
Rothenberg, himself, is a medium-size guy, smooth-skinned and strong-shouldered, with sandy-brown hair, dark eyes and darker eyebrows. He looks a little like a Jewish version of a Latin American soap star, which is to say he looks nothing like his 59 years. He is open about his age, just as he is open about the fact that he feels 25, but unlike most who brag of their youthful virility, because of the way Ron Rothenberg now makes a living, his youthful virility is perhaps no idle claim. Rothenberg runs the California Health Span Institute in Encinitas, California, and to the limited number of people who know of him and understand the world of anti-aging medicine, he is considered something of a pioneer ? which is saying a lot when you consider that the Western tradition of anti-aging medicine dates back at least to the 1500s, when someone named Juan Ponce de Le?n accidentally discovered Florida while looking for the Fountain of Youth.
Rothenberg was not trained in anti-aging medicine, because, at the time he was trained, anti-aging medicine was not something one got trained in. Instead, he graduated from Columbia Medical School in 1970, moved out West, learned to surf, and completed his residency in 1975 at Los Angeles County?USC Medical Center. He received an academic appointment to teach emergency medicine at the University of California, San Diego, in ?77, and became a full professor in ?89. Throughout, Rothenberg has kept on surfing. Back in 1975, he was one of the first Americans to venture to Bali to try his hand at those now-legendary Indonesian waves. He has a house down deep in Baja, right in front of one of the better breaks in Mexico. Surfboards hang on his office walls, as do pictures of him riding overhead waves with a charging stance akin to that of Greg ?The Bull? Noll. These pictures were taken last year, when Rothenberg was 58, but it was a few years before this, around the time he turned 50, when his interest in surfing pointed him toward the then-emerging field of anti-aging medicine.
?Around the half-century mark, I saw all these changes in my body,? recalls Rothenberg. ?I felt fuzzy. I felt like I was losing my edge. My energy was low, my libido was low, things didn?t look as good as they used to. When I went surfing, I would get winded on the paddle-out. I wasn?t used to getting winded on the paddle-out. I read a Newsweek article about the anti-aging properties of DHEA and started to wonder if there was something I could do about the way I was feeling and the changes my body was undergoing.?
Rothenberg got in touch with the nascent American Academy of Anti-Aging and began re-educating himself. ?Most doctors are frozen in time,? he says. ?They stop learning when they get out of medical school. Unfortunately, one of the first things they teach you in medical school is that nearly half of what you?ll learn there is wrong ? only no one is exactly certain which half.? One of the main things he learned in medical school was that time marches on and aging is an unstoppable process. For Rothenberg, this turned out to be part of the half that was wrong.
How wrong is still a matter of debate, but few disagree that the version of anti-aging medicine as practiced by Rothenberg and his cohorts represents one of the more radical departures in Western medical thought to surface in centuries. ?Traditional medicine is reactive, disease-based medicine,? says Dr. Robert Goldman, chairman of the American Academy for Anti-Aging Medicine. ?Anti-aging medicine is the opposite. It?s about finding the problem and fixing the problem before it occurs. If sports medicine is about optimizing the body for maximum athletic performance, then anti-aging medicine is about optimizing the body for living in general.?
Goldman believes that anti-aging is the future of medicine. And Ron Rothenberg was one of the first to venture into that future. He became the 10th doctor in the world to become board-certified in anti-aging medicine and among the earliest to hang a shingle and open his doors to the public, in 1998. He had been self-medicating for a little while before that, and his earliest patients were fellow doctors who noticed that Rothenberg seemed younger, faster, stronger and who wanted some of that good magic for themselves. His prescription for them was very similar to his prescription for me ? and this is where the road to the future takes a sharp left turn ? because the basis for both prescriptions was hormones. Though, as Rothenberg and others like to point out, ?There?s a joke in the medical community: When someone has something nice to say about the work we?re doing, they use the word hormones. When they don?t have something nice to say, they like to call them steroids.?
My journey to see Dr. Rothenberg did not begin with an inquiry into anti-aging medicine, but it did begin with steroids. It began with a onetime baseball player named Jose Canseco and the stir caused by his memoir of ?wild times, rampant ?roids, smash hits and how baseball got big.? It was in Juiced that Canseco claimed to be the man who popularized steroids in baseball. It was also in Juiced that Canseco defined road beef as ?any girl you met on the road and had sex with.? For this reason and others, there?s very little in the book that gives one faith in its author?s opinions. He repeatedly argues that steroids are the wonder drug of tomorrow, but nowhere in the book is a medical paper cited or a scientist quoted. He promises that someday soon ?everyone will be doing it. Steroid use will be more common than Botox is now. Every baseball player and pro athlete will be using at least low levels of steroids. As a result, baseball and other sports will be more exciting and entertaining. Human life will be improved, too. We will live longer and better. And maybe we?ll love longer and better, too.? As it worked out, these rosy prognostications came around the time that pundits and politicians were making plenty of hay saying the exact opposite.
file:///C:/Users/foster/AppData/Local/Temp/msohtml1/01/clip_image001.gif
Life begins at 59: Dr. Ron
Rothenberg seems to have
found the fountain of youth,
and it's not in Baja.
They had been saying the exact opposite for years, but Canseco?s book and the BALCO scandal combined to add new fuel to the fire and helped spark this past spring?s congressional steroid hearings ? a circus act that saw everyone from Mark McGwire to Sammy Sosa look uncomfortable fudging answers to questions raised by Juiced, while Canseco seemed relaxed and in control, and shameless by comparison. One memorable moment came when former pitcher and current Republican senator from Kentucky, Jim Bunning, decried the nightmare scenario of baseball players actually getting better as they aged: "Mr. Chairman, maybe I?m old-fashioned. I remember players didn?t get any better as they got ?older.? We all got worse. When I played with Henry Aaron, Willie Mays and Ted Williams, they didn?t put on 40 pounds and bulk up in their careers, and they didn?t hit more home runs in their late 30s as they did in their late 20s. What?s happening in baseball now is not natural, and it isn?t right."
The results of all the hysteria were new drug-testing and steroid-suspension policies in all major sports including baseball, where Commissioner Bud Selig has proposed 50-game suspensions for a first offense, and football, which increased the possible number of random off-season drug tests from two to six. There was also the re-drafting of the 1990 Steroid Control Act into the updated 2005 Steroid Control Act, and this doesn?t include the two sports-related anti-steroid bills pending in the House of Representatives.
The experts were nearly unanimous in their Canseco condemnations, but despite all of this, the reason I found myself sitting in Ron Rothenberg?s office last June was because I had started to harbor what seemed the most ridiculous of all suspicions: What if Jose Canseco was actually right?
The real reason I started to wonder this had little to do with steroids and plenty to do with another taboo class of chemicals. It is well known that back in the 1960s, when Timothy Leary snuck LSD out of Harvard and into mainstream culture, all sorts of tie-dyed hell broke loose. Our young people were at risk; the very foundation of our society was in jeopardy. Hallucinogens, we were told, were diabolical. They induced insanity. You want proof? Did not the Grateful Dead become the most successful bar band in the history of the world? Perhaps less familiar is the fact that before Captain Cosmonaut came on the scene, psychedelics had been the basis of some really promising science ? so good that nearly all of modern pharmacological psychology is based on this research. LSD led us to the neurotransmitter serotonin, and serotonin jump-started the entire Prozac nation. Studies dating back almost to the 1920s hint that hallucinogens are uniquely suited to treat some of our more intractable diseases, but most of these studies have been buried so long and so deep that the core component of the Schedule One classification ? where hallucinogens currently reside ? states that they contain no beneficial medicinal properties.
There were, however, a few folks who knew what was what, and these folks have been stubbornly lobbying the powers that be for more than three decades. In 1990, a managerial decision to depoliticize the Food and Drug Administration forced the rest of the government to finally reopen this door. There are currently a half-dozen hallucinogen studies under way at major universities, the early results of which are seriously promising. All of which led me to wonder, if psychedelics weren?t the bogeymen they had been made out to be, maybe everything we?re hearing about steroids being the devil incarnate is wrong as well.
file:///C:/Users/foster/AppData/Local/Temp/msohtml1/01/clip_image001.gif
Strong medicine: Approaching 60,
Dr. Mauro Di Pasquale (right), a
former champion weightlifter,
says don't believe the negative
hype about steroids.
If you want to know anything about steroids, Mauro Di Pasquale is a pretty good place to start. He?s a two-time world-champion power-lifter, eight-time Canadian champ, two-time Pan-American and two-time North American champion. Along the way, Di Pasquale also went to medical school and became one of our foremost authorities on performance-enhancing drugs. He has since written eight books on the topic, worked as a columnist for half a dozen fitness magazines and as editor in chief for the international quarterly newsletter Drugs in Sports and the bimonthly Anabolic Research Review (both are no longer published). In the early ?90s, when World Wrestling Federation founder Vince McMahon decided it was time to get his empire off the juice, Di Pasquale was the one who got the job. He later became the medical director to the World Bodybuilding Federation and the acting medical review officer for NASCAR, helping both sports develop their stringent drug-testing policies.
I reached him at his home in Toronto after a frustrating morning spent trying to find a clear-cut definition of steroids. ?You won?t find one,? said Di Pasquale. ?When people use the word, they are usually talking about one of two things. Doctors use it to mean corticosteroids, which are catabolic hormones that break tissue down. Corticosteroids are the body?s natural anti-inflammatories, produced as part of our normal reaction to stress. When the general public talks about steroids, they sometimes mean our actual sex hormones, but mostly they mean testosterone or substances designed to mimic testosterone.?
Testosterone is both an anabolic and an androgenic steroid. Anabolic means the exact opposite of catabolic; it?s a hormone that builds up tissue rather than breaking it down. Androgens are any hormone that controls the development and maintenance of male sexual characteristics, just as estrogens are any hormone that controls the development and maintenance of female sexual characteristics. Testosterone is the upstream precursor of estrogen, meaning testosterone breaks down into estrogen. Quite literally, if there were no such thing as testosterone, there would be no such thing as women.
Our earliest known research into the effects of tampering with testosterone date back to 1767, when Scottish scientist John Hunter failed to learn much of anything by transplanting the testicles of a rooster into the abdomen of a hen. A hundred years later, a German zookeeper and professor named Arnold Berthold picked up Hunter?s thread and performed one of our first recorded experiments in endocrinology. He castrated a series of cockerels and afterward reported that his animals? most definitive male sexual characteristics vanished right alongside their testicles. Gone were the flamboyant comb, the aggressive behavior and any interest in the opposite sex, but ? and this was the finding that first paved the road into the future ? Berthold also found that these changes could be reversed by injecting the castrated rooster with the as-of-yet-unnamed substance extracted from its testicles.
Two decades after Berthold?s breakthrough, our first steroid controversy arrived when noted British neurologist Charles Edward Brown-Sequard began injecting himself with an extract of animal testes. No one really knows which species he preferred, but he sampled guinea pigs, dogs and sheep and so enjoyed the experience that he spent the later years of his life tarnishing his illustrious career in the eyes of the medical community by touting his potion?s rejuvenating qualities and advocating injections as a means of prolonging human life. It was hard to persuade the general public to go this extract route, but in the 1930s a Dutch pharmacologist named Ernst Laqueur managed to isolate 10 milligrams of crystalline testosterone from 100 kilograms of bull testicles, and that changed everything. Suddenly, we could pick apart testosterone?s chemical structure; suddenly, we could experiment. Synthetic versions were soon to follow, as were the Swedish athletes taking Rejuven, a performance enhancer that worked its magic with a small amount of testosterone. Other shenanigans ensued. In the 1936 Olympics there were rumors that German competitors ? fueled by Hitler?s dreams of Aryan perfection ? were taking even larger doses.
A few years after that, as John Hoberman writes in his book Testosterone Dreams: ?Testosterone became a charismatic drug because it promised sexual stimulation and renewed energy for individuals and greater productivity in society. Physicians described the optimal effects of testosterone as a feeling of ?well-being,? a term that has been used many times over the past half-century to characterize its positive effect on mood. In the early 1940s, testosterone was hailed as a mood-altering drug whose primary purpose was the sexual restoration and reenergizing of aging males.?
But the real dam broke in 1945, when science writer Paul de Kruif published The Male Hormone. When the book came out, it was big news. Newsweek wrote a full-page review, and Reader?s Digest excerpted the work. Reviewers cited both de Kruif?s bioethical fearlessness and his scientific excellence. The book was about testosterone and the impact it would have on our economy and our health. De Kruif foresaw riches for its manufacturers; however, he didn't predict that steroids would become a huge black-market business. He foretold increased vigor and extended life for its consumers. About health, de Kruif was downright prescient, though very few people know this, and the reason very few people know this is because it?s quite possible Paul de Kruif?s was the last unbiased opinion on the subject.
So strong are those biases and so fervently have they been promoted that calling the world?s top steroid experts and asking them questions ? especially in light of the president?s inclusion of steroids as public enemy No. 2 in his most recent State of the Union address ? was having a hall-of-mirrors effect.
?As used by most people, including athletes, the adverse effects of anabolic steroids appear to be minimal,? says Di Pasquale. ?Steroids do not cause cancer. They don?t cause kidney failure. There have been thousands of steroid studies and about a hundred of those point out bad side effects. But if you look at those studies carefully, there?s no one-to-one correlation, and a one-to-one correlation is the hallmark of good science. Do anabolics produce ?roid rage? They produce an incredible amount of energy, but you need to think about the kind of people taking steroids. If really competitive and aggressive people start taking drugs that give them more energy, then common sense says that sooner or later you?re going to have some problems, but are steroids the problem or the fact that this person didn?t know how to control their anger long before the steroids came along??
Di Pasquale says the same thing is true about all the scary steroid stories hanging around cautionary-tale cases like Lyle Alzado and Steve Courson. Alzado was the All-Pro-defensive-lineman-turned-actor who died of inoperable brain cancer in 1992 at the age of 43. Alzado blamed longtime steroid use for his condition. Steve Courson, who once lined up opposite Alzado, wrote the tell-all book False Glory: Steelers and Steroids about the juiced-up ways of the ?70s Steelers. Courson was recently on the heart-transplant list before correcting his gravely enlarged heart with diet and exercise. Both were known for living large as well as being large.
As Di Pasquale and many others have pointed out, people with a proclivity for risk take steroids; people with a proclivity for risk also play professional sports, drink too much, take recreational drugs and have unprotected sex. For almost every famous steroid-related tragedy, there are a host of underreported extenuating circumstances, but sports are big business, and pill-popping booze hounds with a penchant for unprotected sex don?t sell tickets like they used to.
Which is not to say anabolics aren?t without complications. When teenagers use steroids, the results can be disastrous. When weightlifters ingest 10 times the normal amount of anabolics for years at a time, there?s excessive hair growth in unwanted places, premature baldness and gynecomastia (the development of so-called ?bitch tits??) in men, and clitoral hypertrophy (the development of so-called ?big clit?) in women. Men also face testicular atrophy, which may or may not go away once they stop using steroids. As for the long-term effects, until very recently, almost nobody had studied them.
One of the first such investigations was undertaken a few years ago by UCLA orthopedic surgeon and sports-medicine specialist Nick Evans, who writes the ?Ask the Doctor? column for MuscleMag International. When I asked Evans why it had taken so long for anyone to do such a long-term study, he reminded me that while steroids have been increasing body mass and strength in athletes for nearly 75 years, it wasn?t until 1996 that medical science got around to admitting that steroids actually could increase muscle mass and strength. ?It?s the craziest thing you?ve ever seen,? said Evans. ?It was like scientists bought into all the negative hype and propaganda and never bothered to walk into a gym and talk to a bodybuilder.?
Evans, on the other hand, had no problem with bodybuilders. In the early ?90s he started talking to plenty of them and in 1996 published his first paper, ?Gym and Tonic: A Profile of 100 Steroid Users,? in the British Journal of Sports Medicine. That was followed by an even more rigorous look at 500 long-time juicers that was presented this year at the American College of Sports Medicine?s annual meeting. Like Di Pasquale, Evans found no concrete links between steroids and the deadly panoply with which they are often associated, though at the extreme-bodybuilding end of the spectrum, he has some serious concerns about the heart. ?The heart is a muscle and steroids increase muscle size. If the heart starts getting bigger, it becomes less efficient at doing its job, and over time that can cause big problems.?
Evans also feels that if users had access to proper medical advice, many of these problems could be avoided. He finds America?s current steroid policy slightly ridiculous, not because he believes that people should be taking steroids, but because of the reasons most people are taking steroids. ?There?s this idea out there that the only people who use these drugs are professional athletes ? that regulating steroids will clean up professional sports and make the problems go away, but that couldn?t be farther from the truth. There are 3 million steroid users in the United States. In both of my studies I found that 80 percent of them were using them for cosmetic purposes.?
What I found interesting about this is that when steroid-related complications are compared to complications from other radical cosmetic practices like liposuction or breast augmentation, the statistics show across the board that elective surgeries produce far more problems, and far more serious ones at that. What I found more interesting was that unlike these cosmetic practices, steroids hold real promise. Plastic surgery may hide wrinkles by cutting them out, but steroids might actually make you feel younger from the inside out. All of which raises the question: If steroids are not nearly as bad for us as we?ve been led to believe, and if they show far more potential as anti-aging medicine than anything else currently available, then what the hell is the problem?
NHL hockey teams are worth about $150 million each. NFL teams are worth about $530 million each. The New York Yankees are valued at about a billion dollars. But it is not just the teams themselves that appear at risk from the steroid menace, but also all the downstream profits generated by these teams. The range of such profits is immense, with everything from television contracts to the added value stadiums bring to urban areas to Nike shoe sales to the salary of the baseball reporter at the Kansas City Star included in the assessment. The general feeling is that steroids threaten all of these enterprises because steroids threaten the level playing field that many people think is the very foundation of sport. In other words, juicing is considered cheating.
That steroids threatened the level playing field became readily apparent in the 1960s, when androgynous Eastern Bloc female athletes started doing a little too well at the Olympics. By 1975, steroids were added to the Olympics? list of banned substances. College and professional football followed, with other sports eventually following suit. But it was already too late. The word had gotten out: Steroids built muscle, shortened muscle recovery times, helped speed the healing of injuries and made you feel good along the way. And the word was bad for business.
It wasn?t just that using steroids was cheating ? other factors came into play. ?There?s a whole subset of the industry that?s very devoted to the record books,? says Rodney Fort, Washington State University professor of economics and author of Pay Dirt: The Business of Professional Team Sports. ?These are everyone from the people who make baseball cards to the journalists who cover baseball. They believe you can?t argue about who?s the best batter ever if some of the best batters were on steroids. They?re a subset, but they?re an impactful and vocal subset, and when it came to steroids, they were almost unanimously against.?
This entire fracas meant that something had to be done, though what was actually done seems asinine until you remember the history of hallucinogens and exactly what became of Nixon?s war on drugs. ?The organized-sports establishment decided they would solve the whole problem by educating the athletes,? wrote Rick Collins, one of our foremost authorities on performance-enhancing drugs and the law, in his book Legal Muscle: Anabolics in America. ?They would present the facts to discourage competitive athletes from using steroids. The establishment devised a strategy: to convince competitive athletes that anabolic steroids don?t build muscle. But they needed a credible source through which to sell the message. It was decided that the American College of Sports Medicine would be the entity to spread the news, a bit like the ?Ministry of Truth? had the job of spreading false propaganda in George Orwell?s classic book about a totalitarian future, 1984.?
This wasn?t yet 1984, this was 1977, and the College of Sports Medicine took to issuing proclamations: ?Steroids had no effect on lean muscle mass; the effects athletes were seeing were water retention; the effects athletes were seeing were the placebo effect.? These claims were propped up by what many consider to have been flawed studies. Nonetheless, they held sway until the real 1984, when there was so much anecdotal evidence to the contrary that the college finally had to admit that, yes, those 300-pound beasts playing left tackle could only have gotten to be 300-pound beasts with the help of anabolic steroids.
So they came up with a different approach ? tell the athletes that steroids are bad for them. Make them sound horrible. As these things can go, they made them sound horrible enough that the media picked up the story (and ran with it and are running with it still). Then another fact came to light ? high school kids were starting to use steroids. Saving our children fills war chests, and Congress couldn?t resist. In 1988, Ronald Reagan signed the Anti-Drug Abuse Act of 1988, which made trafficking in steroids illegal, and a variety of subcommittees were formed to hear testimony about whether or not steroids should become a controlled substance. Among those who testified was Charles Yesalis, a professor of health and human development at Penn State and the world?s leading steroid authority at the time. ?Steroids do have a medical use,? Yesalis testified. ?From an epidemiologic point of view of the health dangers, I am much more concerned about heroin; I am much more concerned about cocaine; I am much more concerned about cigarettes than anabolic steroids.?
The American Medical Association, the Drug Enforcement Agency, the Department of Health and Human Services, and the Food and Drug Administration ? the four regulatory agencies that are supposed to have control of the drug-scheduling process ? all testified against turning steroids into a controlled substance. It didn?t matter. Senator Herbert Kohl spoke for many when he said, ?Steroid users set an intolerable example for our nation?s youth.? At the time he was speaking, Senator Kohl also owned the Milwaukee Bucks.
