title: The efficacy of ergogenic agents in athletic competition. Part I: Androgenic-anabolic steroids.
abstract: OBJECTIVE
  To summarize the literature describing the epidemiology, pharmacology, efficacy, and adverse effects associated with androgenic-anabolic steroid (AAS) use among athletes.
  
  
  METHODS
  Relevant articles were identified from a MEDLINE search using the search terms "Doping in Sports," "Anabolic Steroids (exploded)," and "Androgens (exploded)." Additional references were found in the bibliographies of these articles.
  
  
  METHODS
  We reviewed studies of AAS use among professional athletes. Interpretation of these studies is difficult because of poor research design. The efficacy studies lacked adequate placebo control. Much of the literature describing adverse effects consists of anecdotal reports. All of this literature was considered for review.
  
  
  RESULTS
  Of all ergogenic drugs, AASs are the most widely abused. Abuse of AASs among high school students is estimated at five to ten percent. AASs are hypothesized to produce ergogenic effects during periods of concomitant positive nitrogen balance via antagonism of the catabolic effect of glucocorticoids released during intense exercise. Despite years of study, the extent of the ergogenic effects associated with AASs remains unclear. This may be because most studies have failed to approximate athletes' AAS usage patterns. The primary toxic effects of AASs are divided into four areas: hepatic, reproductive, cardiovascular, and psychiatric. Athletes do not consider these effects severe enough to refrain from using these drugs.
  
  
  CONCLUSIONS
  Athletes view AASs as an essential component for success. Without adequate intervention measures, AAS abuse is likely to continue unchecked.
authors.affiliation: Division of Clinical Pharmacy, College of Pharmacy, University of Iowa, Iowa City 52242.
authors.forename: D A
authors.initials: DA
authors.lastname: Smith
authors.forename: P J
authors.initials: PJ
authors.lastname: Perry
mesh_terms: D045930:Anabolic Agents / Q000009:adverse effects / Q000494:pharmacology*; D004300:Doping in Sports; D005260:Female; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic
chemical_list: D045930:Anabolic Agents