Monday, December 12, 2011
Once again, a medical issue trumps athletic performance on the sports pages with the revelation that Ryan Braun, the National League’s MVP was found to have abnormal levels of testosterone in his body when tested during this fall’s baseball playoffs. Details of the story have yet to unfold, but Mr. Braun has professed his innocence and has appealed the results of the failed drug test.
Testosterone gets bad press because of its abuse as a performance enhancing drug but in reality, it has significant clinical applications in helping treat patients afflicted with many different diseases. Testosterone has two functions in the body. Not only does it have an anabolic capability to repair injured muscle and maintain lean body muscle mass, it also works as an androgen to maintain male secondary sex characteristics. When bodybuilders and athletes use testosterone, their goal is to help muscles recover from injury or a hard workout more quickly, so that there can be return to competition, muscle building activity or both. For patients, the goal for testosterone use is to prevent muscle wasting that is caused by their underlying disease.
There are plenty of ads warning men that they risk “low-T” as they age and touting the benefit of testosterone replacement as an anti-aging panacea. Testosterone sometimes suffers the same public relations fate as propofol, the drug that killed Michael Jackson. When used inappropriately and without medical guidance, dangers can occur, but when prescribed and monitored appropriately, it can be life changing.
The real use of testosterone occurs in patients who have hypogonadism, the inability to produce adequate amounts of hormones. The cause can be primary when the testes fail to produce testosterone as a consequence of infection, radiation, surgery or liver or kidney disease. Genetic disorders can also affect testicular function. But low testosterone can be caused because of problems with the hypothalamus or pituitary gland in the brain that signal the testes to work. Tumors like craniopharingiomas in kids and prolactinomas in adults can cause the pituitary to fail. Trauma, bleeding, radiation and other injuries to the brain can cause pituitary failure.
While it makes sense to replace testosterone when the body doesn’t make enough, patients who are cachexia from chronic illness may also benefit from replacement therapy. A patient who is cachectic develops weakness and muscle wasting often because any calories that are taken into the body are used to maintain basic body functions and there is not enough energy left to build muscle. This protein calorie malnutrition can make it hard for the body to function. Patients with bad COPD use most of their energy to breathe. AIDS patients use much of their energy to fight infection and the same is true for kidney and liver failure patients who gradually become weaker and malnourished. Burn patients may suffer the same issue with inadequate calorie intake to maintain muscle mass. This ability to minimize the loss of lean body muscle, maintain body mass index and increase strength may improve survivability and quality of life.
These are the same performance enhancing effects that athletes want to achieve. There would be no worries except for the significant side effects that anabolic androgenic steroids can cause. Professional athletes may be willing to life threatening side effects but the perceived competitive advantage invades kids and teenagers. If the perception that steroids are needed to be a pro, then perhaps steroids are needed in college to get the pros. Competing for a college scholarship increases the risk of high school kids looking for their competitive edge. These kids have the aura of invincibility and the thought of liver cancer, diabetes and bleeding disorders among many other side effects don’t enter their mindset.
Ryan Braun’s innocence or guilt will eventually be determined but it is good news, bad news scenario for baseball. The bad news is that steroids and other performance enhancing drugs are still an issue. The good news is that the stars of the game are not immune from the testing program or from prosecution. Hopefully the next generation of players takes notice and realizes that even if they survive the potential side effects of drug abuse, the pot of gold at the end of the rainbow can be taken away.