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Double Play
A Hopkins endocrinologist weighs in on steroids and human growth hormone.

blank Dome asked endocrinologist Roberto Salvatori, a founder of the Johns Hopkins Pituitary Center, to explain what performance-enhancing drugs are and how they can be used or abused.

That exhilarating clarion call of spring—“Play ball!”—will soon be heard in major league baseball parks across the country. Yet the beginning of the baseball season is unlikely to quiet the controversies about the use of such banned substances as anabolic steroids and human growth hormone (HGH) by professional athletes and others.

Q. What’s the difference between anabolic steroids and HGH?
They are very different. Anabolic steroids are male hormones, testosterone or a derivative of testosterone. They’re what cause men to grow beards, have more muscle, increased strength, grow taller, have a different kind of voice than women. Growth hormone is produced in both females and males. Its main effect in childhood is to make us grow and make our bones
stronger. The pituitary gland produces growth hormone and is necessary for the testes to produce testosterone. HGH is a synthetic form of growth hormone.

Q. What are the legitimate, therapeutic uses of anabolic steroids and growth hormone?
There’s a legitimate medical use of steroids as a replacement therapy for men who have a low testosterone level because of deficiencies in their testes or pituitary gland.   Testosterone is important to maintain bone strength, muscle mass and sexual function. HGH also is used as replacement therapy for growth hormone-deficient children and for adults who have a pituitary tumor or who had radiation to the pituitary gland and have become HGH deficient.

Q: Do you prescribe steroids and growth hormone?
Yes, absolutely. I prescribe growth hormone to adults if their bone density is low, their muscle mass is low or they have high cholesterol because of proven growth hormone deficiency. We replace what their pituitary no longer makes. We prescribe testosterone to men who have problems in their pituitary gland and are no longer able to make testosterone.

Q: What are your opinions on the sports scandal?
I believe the problem is much more widespread than people think. Science in this thing is way behind the street. Bodybuilders knew for decades that testosterone increases your muscle mass and strength, but the first it was proven scientifically was in the early ‘90s. When I saw the paper published, I smiled, because they could have gone to any gym on the corner and any bodybuilder could have told them that.

With human growth hormone, it may be similar. We have no scientific proof that it improves performance. In fact, a review published last month seems to show that it does not, but it relates to a small number of subjects studied for a relatively short time. There’s such widespread use of it among athletes that there may be at least some effect—or maybe it’s all placebo.

What we do not know is what the long-term side effects will be. Contrary to anabolic steroids, it takes very sophisticated tests to detect growth hormone abuse, and if the athlete is smart and doesn’t use it 24 hours before testing, it’s almost impossible to detect.       

— Reported by Neil A. Grauer



Johns Hopkins Medicine

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