The subject ate a combination of all food components every
meal. Thus, the subject was not concerned about the glycemic
index of each food. Workouts usually began 1 hour after the completion
of a meal. Premature hunger followed by mild hypoglycemia was
experienced if the percentage of calories from fat approached
or dropped below 20%. It was hypothesized that an adequate amount
of dietary fat was needed to slow the emptying of the gut for
a sustained release of foodstuffs into the body. Anabolic-androgenic
steroid use may alter glucose tolerance, and induce hyperinsulinism
(Yesalis, 1989). Powerlifters using anabolic steroids have been
shown to develop insulin resistance and diminished glucose tolerance
(Cohen, 1987). Although chronic exercise generally decreases
serum insulin levels (Viru, et. al. 1992), this is accompanied
by an increase peripheral insulin sensitivity (Richter, 1989).
No relationship was found between dietary intake and body
composition. In contrast to previous studies, the subject maintained
a relatively high caloric diet while incorporating a long duration
walking regimen. The variation of daily activities may of accounted
for the fluctuation in body fat. Unfortunately, a detailed record
of walking duration and intensity was not included in the training
logs. This is a serious deficiency in this study.
Overfeeding has been shown to lead to an increase of lean
body mass possibly as a result of increased plasma somatomedin-C,
testosterone, and insulin (Forbes, et. al. 1989). Insulin facilitates
and increases the transport of glucose and amino acid into muscle
cells. Insulin can also stimulate the synthesis and storage of
cellular protein and glycogen in muscle cells (Di Pasquale, 1993).
Although insulin's effect on amino acid uptake into the cell
may not be indicative of increased muscle mass (Florini, 1989),
insulin may permit maximum protein synthesis to occur in ideal
physiological situations (Di Pasquale, 1993). Insulin and other
anabolic compounds may act synergistically to produce significant
anticatabolic and anabolic effects (Di Pasquale, 1993). Intercellular
amino acid is essential to the action of anabolic steroid's role
in protein synthesis.
It must be noted, though, insulin increases lipoprotein lipase
action and can enhance the synthesis and storage of triglycerides
in fat cells (Di Pasquale, 1993). Anabolic steroids may play
a physiological role in the regulation of fatty acid oxidation
in liver and fast twitch muscle mitochondria even in the absence
of intense physical training (Guzman, 1991). It has been argued
that a high fat diet has a positive effect on muscle growth (Di
Pasquale, 1992, B).
The subject took virtually no nutritional supplements for
several years. Many claims made for commercially marketed supplements
for bodybuilding athletes are not supported by current research
The subject attempted to increase muscle mass by a modified
carbohydrate load by discontinuing resistive training four days
before the show and increasing calories slightly in effort to
restore glycogen in the muscle. Balon, Horowitz and Fitzimmons
conclude that carbohydrate loading has no additional advantage
to enhancing muscle girth in bodybuilders over weight-lifting
alone (Balon, et. al 1992). The effectiveness of the subjects'
carbohydrate loading was not tested in this study. See "Exercise Discussion below".
The greatest results came from the initial administration
of Oxymetholone (Anadrol). As the cycle progressed, a higher
dosage was needed to continue progress.
Anadrol seemed to be the most effective single substance in
the synthesis of lean body mass. Anadrol combined with Primobolan
Depot was the most effective combination later in the cycle.
Winstrol-V and Equipoise seemed to weak by themselves. Though,
they did seem to increase the effectiveness of Anadrol. The combination
oral and an injectable may be of benefit to those who may have
side effects with higher dosages of orals.
Descending dosages seemed to reduced lean body mass. Similarly,
dosages significantly lower than the dosages administered in
the previous period lowered lean body weight. Although, increases
in body weight were apparent in periods 13 and 14 when no drugs
or descending dosages were present. The increased Calories after
both competitions probably increase body weight substantially.
Bodybuilders have been known to rapidly gain weight prior to
competition after breaking their precontest diet (Hildebrand,
1989; Hickerson, 1990).
The greatest lean body weight was at period 10. Lean body
mass gains (4.8 lbs) surpassed all previous losses in lean body
mass (-4.1 lbs) with a lower dosage (157.1 mg/day) than the greatest
dosage (178.6 mg/day) at period 7. Four possible explanations
exists; 1) The introduction of Primobolan Depot. 2) A synergistic
effect between a combination of drugs. 3) An up regulation of
androgen receptors from the previous dosage reduction. 4) A relative
decrease of Steroid Binding Hormones due to the previous dosage
reduction 5) The relative magnitude of increase from the previous
dosage is the greatest of all periods. This change was 50 mg/day
over period 9.
At week 11, Methenolone enanthate (Primobolan Depot) not used,
but Oxymetholone (Anadrol) and Stanozolol (Winstrol-V) were continued.
Lean body mass decreased (-1.6 lbs) despite the similar overall
dosage of all drugs (150 mg/day) compared to the period 10 (157.1
Hurley attempts to dramatize the dosages of pharmaceuticals
used by the athletes by drawing reference to the dose usually
administered for androgenic deficiency. This is a misleading
reference to judge athletic dosages, since anabolic-androgenic
steroids are often used in greater dosages for purposes other
than androgen deficiency. For example, Hurley illustrates Oxymetholone
(Anadrol) was used by one subject in an average dosage of 87.5
mg/day, 5.8 times that usually administered for androgen deficiency.
The subjects dosage was approximately only 1 mg/kg body weight
per day (Hurley, 1984). The actual recommend dosage for children
and adults is 1-5 mg/kg body weight per day for a minimum of
3 to 6 months (Physicians Desk Reference, 1993).
Early in period 4, the subject claimed he did not feel the
sensations he has experienced when on Testosterone cypianate.
A counterfeit drugs may contain either no anabolic steroid or
a substitute commercial anabolic steroid (Di Pasquale, 1992 (A);
Walters, 1990). After Stanozolol (Winstrol-V) was used later
in the cycle, small gains were found. Although, the gains seen
during period 4 may be due to contamination of the unusually
long lag time of equipoise in period 5.
Table 4 outlines the strategy employed by the subject.
Case studies have been used to study drug detection techniques
on athletes who self-administered anabolic-androgenic steroids
One of the most common methods of escaping detection when
using anabolic steroids is simply discontinuing the use of oral
anabolic steroid(s) several days prior to a drug test. Anavar,
Winstrol (tablets), and Dianabol are usually undetectable 3 to
4 days of after cessation. Injectable steroids usually have a
much longer detection interval. Metabolites of nandrolone have
been found in the urine of some athletes after 2 years it was
reportedly last used. Stanozolol (Winstrol-V) has been detected
in the urine of an athlete 4 months after cessation of its injection
(Di Pasquale, 1992, A).
Many oral anabolic steroids are more highly associated with
liver abnormalities. Their metabolites can be cleared from the
body in only fourteen days after discontinuing use and are therefore
more commonly used when drug testing is a concern (Yesalis, 1989).
Athletes have used various methods before drug testing to
either decrease the excretion of banned drugs or prevent the
detection of these drugs in the urine. Compounds that have been
used to decrease the excretion of unblock steroids and their
metabolites include uricosuric agents (e.g., probenecid, carinamide,
sulfinpyrazone, phenylbutazone, benzbromarone), corticosteroids,
estrogens, oral contraceptives (containing norethindrone), Depo-Provera,
phenytoin, pyrazinamide, dexamethasone, and apple cider vinegar.
Compounds used to prevent the detection of banned drugs in the
urine include various diuretics, Defend, and chemical contaminants
such as sodium hypochlorite, and bacteria. Defend acts by both
decreasing the excretion of the drug and by diluting the the
urine (Di Pasquale, 1992, A).
Bilateral gynecomastia developed during the steroid treatment
but disappeared a few months after cessation of the pharmaceuticals.
The severity was described as "hardly noticeable."
Men have been shown to be more susceptible to gynecomastia as
a result of anabolic-androgenic steroid use (Yesalis, 1989).
Gynecomastia in athletes has been associated with the increase
of serum estradiol concentrations during the use of anabolic-androgenic
steroids (Alen, 1985).
When athletes discontinue the use of anabolic steroids, they
experience a refractory period where they do not produce physiological
amounts of endogenous testosterone (Di Pasquale, 1992, A). Anabolic-androgenic
steroid can reduce endogeneous testosterone, gonadotrophic hormones
and sex hormone-binding globulin (Yesalis, 1989). Weight trained
athletes have been shown to have low serum testosterone concentrations
immediately after cessation of an anabolic-androgenic steroid
cycle but return to normal within weeks (Alen, 1985).
It should be noted, the effects of anabolic steroids vary
significantly depending upon the type and dose of steroid as
well as for different individuals and situations (Yesalis, 1989).
It may be a serious error to overgeneralize the effects and
potential side effects of specific anabolic-androgenic steroids
to all other anabolic-androgenic steroids. Likewise, it may be
also erroneous to assume the effects and potential side effects
of certain steroid use in relatively large dosage and/or long
duration will have the same effects and potential side effects
at a relatively lower and/or shorter duration. Furthermore, it
is not correct to assume the effects and potential side effects
of a certain steroid therapy on medical patients, or even individuals
within the "normal" population for that matter, will
have the same effects or potential side effects on a given athlete.
All of the effects of anabolic steroids have been demonstrated
to be fully reversible within several months following cessation
of use; except changes in in myocardium which has not been followed
The subject engaged in walking to utilize fat and to avoid
overtraining. Lower intense submaximal exercise utilizes proportionally
less carbohydrates. Intense or prolonged exercise can rapidly
deplete muscle glycogen (Di Pasquale, 1993). Protein can supply
up to 10% of total energy substrate utilization during prolonged
intense exercise if glycogen stores and energy intake is inadequate
(Di Pasquale, 1992, C; Brooks, 1987).
Cortisol is a catabolic hormone which induces the breakdown
of cellular proteins. Cortisol increases as intense exercise
is prolonged (Di Pasquale, 1992, C). Submaximal exercise at lower
intensities (i.e. 63% maximum oxygen consumption) stimulates
lower cortisol response than higher intensities (i.e. 86% maximum
oxygen consumption) (Farrell, 1983; Naveri, 1985). Significant
elevations in cortisol seem to reduce endogenous testosterone
by acting directly upon the testis to impair the biosynthesis
of testosterone (Di Pasquale, 1992, C).
Resistive training was ceased four days before the show in
effort to restore glycogen in the muscle. In light of studies
that do not support the premise that carbohydrate loading increases
muscle girth (Balon, et. al 1992), it is suspected that muscle
girth could have been enhanced by continued weight training up
until the day before the show. The subject later noted that various
muscle girths decreased approximately 0.5 inch (1.27 cm) after
a layoff as little as 4 days. It seems localized muscle edema
diminishes days after weight training.