Dr. Silverman's Huge Bodybuilding Q And A!

Rick Silverman is one of the most famous Internet gurus ever! He has competed in many competitions and has written for many of the top muscle magazines.

The Weights mailing list has been around for 12 years, before the Internet was a part of everybody's life. Here are some of the answers I have given to reader's over the last 6 years regarding bodybuilding and fitness. I hope this helps you!

LEGALIZE STEROIDS?

Dr. Silverman, how do you feel about legalizing steroids? You appear to have a good background for understanding the issues involved. My feeling is that if the stuff were legal, but required a prescription, that it would be better for everyone. Medical oversight for people who now use illegally, testing and regulation of the medicines themselves, much more thorough medical literature about long- and short-term effects, training for physicians who choose to prescribe, etc. I don't really know how many of the 'steroid use in high school' stories are real, but it seems that getting everything about these products out into the open would be better. I'm not naive; I'm sure there would still be unregulated, excessive or secret use, but we have that now, so what do we lose?

Interesting thoughts. Proponents of the legalization of steroids usually cite hormone replacement therapy (HRT) in women, and indeed, many more men are looking toward the same sort of HRT for themselves, thus the anti-aging centers springing up around the country. At such places, you can have all of your levels measured and monitored and adequate dosages of testosterone and GH and so on administered by prescription. It is costly, however, and not really available to everyone due to the high price. This sort of therapy, however, is not the same as what you seem to be proposing, which is legalizing steroid use for performance enhancement.

There are multiple problems with this move. Number one is safety. As with birth-control pills and HRT in post-menopausal women, there are risks to the use of these drugs. With BCPs and HRT, there are thought to be health benefits which outweigh the risks. With steroid use for performance enhancement, this is not so clear. Sure, we can do research more readily to demonstrate risks and benefits, but in the meantime, who takes responsibility for the side effects and failures--the patient or the physician who prescribes. Moreover, as one sees in the sport of bodybuilding, a little is never enough. Small dosages will never satisfy the athletes who are looking for an edge, so they will self-medicate and increase their risk--all the while having the comfort of a doctor's prescription, and potentially the recourse of suing the doctor if things don't come out perfectly. As far as I'm concerned, I have no interest in getting into this sort of situation.

As for high school students, as many as 11% in some series of high-school students are using anabolic steroids (males)...as per my 1997 article for M&F "I was a teenage science project". This is a very high number, when one considers that these kids are at greatest risk of long-term sequelae. They are also probably the most impatient, looking for instant results from working out.

I am a believer in dissemination of information. But educating people about steroids--or any drugs, including crack cocaine, heroin and the like--doesn't require that they are legalized. It merely requires that information is made available, and that people take advantage of that information, that parents and teachers/coaches talk to their kids about it. I have spoken to groups, and made myself available, but very few take advantage of my services in this regard. A few schools were hesitant because of the "mature" nature of the discussion (talking about SEX hormones, after all). I don't charge for my lectures, and I can adjust the discussion as needed. Lately, though, I'm called upon maybe once or twice a year. So much for educating our youth!

BUILD HUGE TRAPS?

I been training 12 years now, and have always loved training my traps/shoulders. I've got pretty developed traps,and very good delts. However, I just can't seem to really build my traps up, you know like those guys who have freaky traps that connect up under their ears/necks. What am I doing wrong?

You should be critical of the physiques you see and try to emulate, as in some cases, in the absence of a genetic "gift", the shape of a physique may be influenced by more than just training techniques. Namely, anabolic steroid users generally have highly developed traps partly as a function of specific focus of steroid enhancement. If you're juicing up, then you may be able to achieve that same development, but if not, you may have to settle for human, rather than "super human" trapezius development.


Nasser El Sonbaty has super human traps. (C) Avidan

TRUST DOCTORS WHEN BODYBUILDING?

Do doctors really know anything about sports nutrition?

Regarding nutrition for doctors and nutrition for athletes, there are a couple of issues. It is true that we don't spend much time learning about nutrition in medical school, but when one considers the volume of what we have to learn, that is hardly a surprise. In general, physicians who deal with sick or stressed patients (intensivists and surgeons) or those who deal with diseases of the digestive system probably have the most exposure to nutrition.

As a surgical resident, I had to understand the principles of providing nutrition to patients who often times couldn't eat on their own. This was done either by way of an intravenous into the central vascular system, or if possible, by way of a tube into the gastrointestinal tract (G-tube into the stomach or J-tube into the jejunum). Each day, we would check laboratory values and make adjustments, mostly focusing on the electolyte balance, rather than protein requirements. Caloric need was determined with Harris-Benedict equations, which we sort of knew how to do, but fortunately had a nutritionist to do them correctly. I learned alot about nutrition in that circumstance, but what relevance would that possibly have to a competitive athlete.

Surprisingly enough, more than you'd suspect. While "normal" nutrition has little to do with athletes' needs, surgical nutrition is more relevant, because in both situations, the individual is "stressed". So when Glutamine became popular as a dietary supplement, I was reminded of studies which looked at the effectiveness of adding supplemental Glutamine to enteral feeds in trauma and burn patients. There are a number of studies looking at use of Growth Hormone and alternatively Oxandralone to bring patients into "positive nitrogen balance"--in other words, an anabolic state. It takes imagination, however, to extrapolate these findings to the gym setting, and let's face it--not all physicians have imagination. Needless to say, not all physicians get this training.

It is more than likely that unless you find a doctor who has a specific interest in athletic endeavors, you will be hard pressed to find someone who is familiar with sports nutrition. Most of us, however, are willing to learn. So if you have questions for your doctor, do a little research yourself first, and take appropriate reading material (not stacks and stacks, by the way, but a few well-chosen items) and ask him or her to help you along. You might be surprised.

BEFORE AND AFTER SURGERY

The bottom line is that I will be having a hysterectomy in January. I have two questions.

1. I plan on lifting as usual until about a week before the surgery, and then taking that week off to let my body fully recover and be strong for the surgery. Does that sound reasonable?

2. What recommendations do any of you have as far as easing back into lifting after the surgery.

As a surgeon and as an athlete, I have a couple of thoughts. For one, there is no reason to take time off before your surgery. In fact, if your like many of us, the less time off the better--from a psychological standpoint. Maintain good nutrition and good hydration, as you should always be doing, and you will be more than ready for your surgery. Then, afterwards, you will be more comfortable taking some time off to recover from the surgery, without having that nagging sensation that you'd already taken a week off before...chomping at the bit to get back.

As for your recovery and return to training, I operate on lots of bodybuilders and athletes. I make general recommendations and then modify them according to the individual needs and progress of each patient. It would be nice if your surgeon has some sense of what your training is all about, and then he or she might be able to help you with this plan. Basically, though, I suggest the first week completely off. I let my patients walk at a casual pace, but no cardio to elevate heart rate or blood pressure, since you don't want to bring about bleeding or a fluid collection around the operative site.

After the first week, I let nearly all of my patients start back on cardio, bringing it up to a level with which they're comfortable. After two weeks, in most cases, I let them start lifting, and gradually resume all activities over the next two weeks. My one exception is in ab work and heavy work after abdominoplasty (tummy tuck) or hernia repair, in which case, I limit heavy work for 6 weeks to allow for healing at the repair site. Otherwise, they might pop a stitch or the tissues might be too weak to support the activity. I've had no complications in any of my patients following this regimen. You should talk to your surgeon before doing anything, but you might tell him or her a little bit about what I've suggested.

STRETCH MARKS?

Is it possible to lift weights without getting stretch marks? For what reason do I get them? What do they mean? I only have them on my right between my shoulder and pectorial and nothing really on my left side. Can you explain this to me?

Stretch marks result from stretching of the dermis and are basically a scar, of sorts. Not everyone gets them. They aren't clearly related to Anabolic steroid use, which many people seem to think, but rather may be genetically determined. There haven't been many studies in this regard. Some people describe their development with normal growth, others only get them during periods of rapid growth. Personally, having originally gained 60 lbs over a 3 1/2 year period, I don't have any! There isn't really any way to predict their development either.


Examples of common bodybuilder stretchmarks on the arms. Oh yeah!

As for treatment or prevention--get different parents. Like I said, there is probably a genetic component. Treating them is problematic. No real good treatments at present. I've written about stretch marks in the past, and mentioned treatments like Retin-A, which was not shown to be effective at eliminating them. A chemical peel may give some improvement to early stretch marks, and we've tried this on a few patients in my practice with moderate success. Carbon Dioxide Laser resurfacing, in my opinion, is probably overkill, and the Pulsed-Dye laser doesn't work well...again my observation. I have no doubt that someone is out there trying to come up with some solution, and when they do, they'll become very rich!

USE BELTS OR WRAPS?

I believe you should not use belts or gloves or anything when you lift because you are artificially helping yourself to be stronger. You should use your own body to all the work! What is your opinion on this?

I started wearing a weight belt in November of 1992. I was doing a rotation at Lenox Hill Hospital, and the bed was so bad that my back was killing me. I bought the belt--believe it or not--to go running. It helped! I had avoided using a belt or any assistive device because I didn't want to be labeled as a weight lifter or bodybuilder or something like that. I was, after all, a runner who lifted weights.

Now, six years later, I've used just about every assistive device known to mankind, to overcome all of my various weaknesses, due, in part, to running--bad knees, bad back (herniated a disc--during a layoff from lifting but I was running). I use wrist straps and gloves to try and minimize the callouses and forearm spasm, since these things detract from "the hands of a surgeon". I know that people lift heavier without these devices. I know that there are people who use everything I use--and more--and don't lift as heavy.

Bottom line, if people are lifting, paying attention to form, avoiding injury, putting an effort into improving themselves and their physiques, who really gives a hoot about what assistive devices they're using. One may try to make oneself feel better about their own accomplishments (without devices) by belittling those who aren't as accomplished, but this is purely self-serving and does not advance the science or the sport. There is certainly plenty of data and experience to support use of devices and avoidance of devices. A thoughtful approach to each individual is worthwhile as opposed to taking an "all or none" outlook.

BIG BICEP VEIN?

Some people seem able to develop what I call the "power vein". That's the vein which goes down the length of the biceps. Even on rather small arms, the power vein gives the impression of massive biceps. I am totally unable to develop The Vein, much to my disapointment.


"I've got the bicep vein and you don't!" - Jeff Long. (c) Avidan

That's called the Cephalic Vein, and as you've observed, it seems to be very important to give that look of huge arms. I have a great one on my right arm, but I don't have one on my left arm... never did, never will. It is just a bit of genetic variation, and this sort of thing occurs with veins. If it's something you really feel compelled to have, you could probably find someone to do a vein graft for you... or would that be a "vain" graft? Probably not worth the cost. Just get your biceps so big, that no one notices the lack of a vein.

GAIN MUSCLE AND LOSE FAT?

I would like some help planning my diet for a roids cycle. I am planning to do it in two phases: 1 month to get cut, rest for a month and start a new one for mass while maintaning my low bodyfat. However I haven't much experience on this. Can you give me a hand with this?

I don't use steroids, don't advocate their use, and can't advise you regarding their use... but I understand something about gaining weight/mass and getting cut. Regarding your plan to get cut and then add mass... that is rather a foolish approach with or without steroids. You will find that it is far more effective to add mass when your bodyfat is higher, as this allows you to lift higher weights to stimulate growth, than you'd be able to do when you are relatively leaner. That is one of the problems dieting for a contest. Strength drops, not only because you are depleted, but also because you are leaner. Fat is strong, because it alters the biomechanics of the lift. Just look at powerlifters. Not too many bodybuilders who are great powerlifters, at least not in "contest" shape. Just my opinion, obviously, but one generated by 17 years of lifting experience and several years of competitive experience.

STILL "NATURAL" WITH EPHEDRINE?

If you use ephedrine are you still "natural"?

There are supplements which are legal and others which aren't. The term "natural" is somewhat misleading. Realistically, the entire endeavor of bodybuilding is not "natural", since we are striving for a look which isn't "natural", but rather, "supernatural". All the same, there are some individuals who train, eat, and that's it. Maybe they don't even use protein supplements. That is natural, in the truest sense of the word. Then there are those of us who use supplements which are legal, considered to be safe, and are acceptible to the various organizations in which we compete as "drug-free". Then there are the rest of the supplements, which are not legal, and may in some cases be controlled substances. Ephedrine and ephedra, at least in many circles in athletics, are acceptible legal supplements. I've used Thermadrene from Sportpharma, yet I still consider myself "natural"--or better put, drug-free.

ENLARGED BREASTS ON MEN?

I've been bodybuilding for a few years now and find that my chest has enlarged considerably. Some lifters said I have "bitch tits". Could you explain or give some ideas how to get rid of it?

"Bitch tits" or gynecomastia refers to enlargement of the male chest to the extent that it appears like a woman's, thus "gyne"=woman "mastia"=breast. Anywhere from 40 to 70% of men may develop this at some point in life, usually during puberty, but most cases resolve within 2 to 3 years.


One of my patients before and after surgery.

In the gym circles, it usually is associated with anabolic steroid use. If it's just resulting from muscular hypertrophy, then train your legs a little more, and skip a few chest workouts. If it's from steroid use, stop using them. If it's from long-term steroid use, then you might need an operation.

You can get a LOT more info on this at http://www.gynecomastia.org

BAD FOR YOUR HEART?

I'm a second year medical student. One of my friends asked a clinical pathologist lecturer about the effects of bodybuilding on the heart and he says it is bad for the heart, but I didn't really get a reason why. Is it?

As you progress through medical school and your post-graduate training, you will learn that many of your professors are clueless about certain subjects. I would suggest that exercise and its effects on the body is one of those subjects, with the exception of individuals who are specifically interested in the topic. While I have integrated what I learned during my medical training with what I've learned in bodybuilding to try and enhance the effects of my training, little of my medical education really impacts on bodybuilding, with the exception of some aspects of anatomy and surgical nutrition.

That said, I suspect that one consideration with regard to the heart and bodybuilding is the extent of hypertrophy of the heart which may follow from heavy resistance training. In the absence of cardiovascular training, excessive hypertrophy could cause problems if cardiac muscle perfusion isn't adequate during stress or exercise, since this could lead to ischemia (lack of oxygen). This would more likely be a problem if someone was predisposed to coronary artery disease (atherosclerotic) or coronary artery spasm. I don't think, however, that this would be a problem for every bodybuilder, just certain ones. I can't think of any other reasons why your professor would say bodybuilding can cause problems. Then again, I'm not a cardiologist!

STEROID EFFECTS ON PROS?

Obviously these pro competitors today are taking enormous amounts of drugs, supplements, food, protein, etc...in order to be as beasty as they are. And in the off season they get even more beasty at over 300lbs. Normally a 300lb person would be terribly unhealthy and compromised at such small heights (I'm not talking the 6'6 or 7ft beasts like Lou Ferrigno but the 5 or 6ft lifters).

Does all these drugs, supplements, food, beasty size (beyond what genetics intended) take its toll on health or body? I mean, it's known boxers, football players suffer a great deal after their careers, but what about bodybuilders?

Finally, we all know they take drugs, but do they actually ever publicly address their drug use as an important part of their training?

The use of drugs, and the discussion of drugs as part of the training regimen, you'll never see that in FLEX, the official journal of the IFBB. The fact that these drugs are illegal is reason enough. Additionally, the athletes use different regimens, some more, some less, and this is part of the "science" of bodybuilding which gives one a competitive edge over another. A vital point, though... the biggest guys are not necessarily the guys who use the most drugs. Genetics, training regimen and diet still play a vital role. In that regard, it would be educational to know what one or another does in terms of drugs to get a better understanding of what can be accomplished from a given routine--with or without drugs. As a drug-free competitor, however, I have long relied on other drug-free athletes for advice, since I am under the same limitations. As stated, not all "drug-free" bodybuilders are truly drug-free, but I know enough men and women who are to know who can give me good advice.

As for health effects, you might ask Ronnie Coleman, who was backstage sucking down oxygen at the Olympia to find out what sort of effects he experiences. He probably wasn't the only one. I've seen Dillett doing the same. There are many reasons to stay drug-free, and as a physician, I have seen enough of the side effects to keep me clean. This is not to say that there is no benefit to be gained by "hormone replacement therapy" for anti-aging, though this isn't something I do in my practice. I'm still watching from the sidelines to see how this stuff pans out. But, needless to say, the dosages used for anti-aging are significantly lower than those used by the Olympians!

2001 MR. OLYMPIA RESULTS?

What do you think about the judging at the 2001 Mr. Olympia where most of the crowd believed that Jay Cutler should have beating Ronnie Coleman?

I was the presenter for SportPharma (3rd place at both the Fitness O and Mr. O--along with Monica Brant), so I was back stage afterwards, mainly to see Jay Cutler, who is a good friend. Keeping that in mind, I'm probably a little biased. But as you may know, Jay was ahead at the end of pre-judging. For those of you who follow competitive bodybuilding, that is normally the deciding factor, and finals has very little impact on the overall results. In fact, there has been some debate in the magazines over whether or not finals should play a bigger role in the judging. Guys who are good posers, like Melvin Anthony and King Kamali, always push for more attention to be given to the routines. Jay is a good poser, but certainly not as entertaining as Marvelous Melvin or the King...or Darrem Charles, who is one of my favorites as well. But he is certainly as good as, if not better (in my opinion) than Ronnie Coleman.

Jay was up by anywhere from one to six points at the end of pre-judging. The order of competitors was Coleman #1, Cutler #2 and so on. Ronnie came out to a rowdy crowd, appropriately so, for finals. He did a routine, about three minutes, ripped off his trunks to reveal a red-white-and-blue posing suit, and did another full routine. He certainly got the crowd going with that. At no point was anything said about the fact that he really went over the time limit--of course, he was the reigning Mr. O, and he was wearing patriotic trunks. Jay then followed him, still looking phenomenal--no gut, by the way, and with deep cuts, beyond belief--and he did a two to three minute routine, as specified in the "rules".

After Ronnie's routine, the response was--"Hey Jay, why was your routine so short?" Obviously, the question which should have been asked was why was Ronnie's routine so long. The rest is history. As Mike said, it's tough to beat the incumbent, even if he's got a bloated belly and not as well-conditioned as usual. I don't think, though, that the crowd would have been disappointed to see an upset. If nothing else, Ronnie had best be better prepared next year, or we'll see the first dethroning of a Mr. Olympia since the '80s!

COMPETITION TANNING?

I have heard that you have used Dream Tan before. Do you feel this is the best for competition tanning?

I did in fact use Dream Tan for two guest posing appearances, and for that purpose it worked great. Easy application, no pretanning necessary in the off-season, and it gives you a bit of a shimmer, which is kind of cool when you're the guest poser.

For competition I have a few reservations, at least with the bronze formulation that I was using. I felt, for one, that the overall effect was one of softening, and that some of the sharpness of one's cuts might be lost. Others shared my concern. Since I wasn't in contest shape for one of the events, it was difficult to say that that was a problem. The second time I guest posed and used it, I was two or three weeks out from the Nationals, and I was right on target. Reviewing photos from afterwards, I was amazed at how smooth I looked, and I was told (by none other than Nancy Andrews, of list and WNBF fame) that I looked much better than the photos would have suggested. Perhaps it's just in photos that it flattens you out, but I'd worry about looking flat on stage too--obviously depending on lighting.


Dream Tan on a competitor.

For competition, I've found the best combination with a few coats of Pro Tan--which is a pain in the butt if you have to operate the day before a contest--followed by one or two coats of Jan Tana Competition Tan. This makes me a dark brown, rather than bronze, and things really show up that way.

I have used Dream Tan, but I'm not sure if it's the best for a competition. The jury is still out....

IS ROID RAGE REAL?

Have any studies proved that steroids cause "Roid Rage"?

Basically, a study that was done a while ago involved adolescent hamsters receiving "gym" dosages of steroids. The test animals exhibited higher attack rates and decreased latency (time between attacks) compared to control animals. NOT ALL OF THE TEST ANIMALS DEMONSTRATED THIS, but a significant number did. That means that statistical studies showed a meaningful relationship between steroids and aggression.

Next, the researchers looked at the brains of the animals, and showed an increase in Argnine Vasopressin, a neurotransmitter responsible for aggression based on levels in the hypothalamus, part of the brain which controls aggression. If this peptide was blocked, the animals weren't more aggressive. If additional Argnine Vasopressin was added, the animals were more aggressive. Again, a clear relationship was established statistically.

That stuff is pretty interesting. The guy doing the research has himself never used steroids, but became interesting in this area after living with a number of football players in college who did use steroids, and demonstrated clear-cut increased aggressiveness when on the drugs. Anecdotal information, however, is not adequate to establish a connection. Even in the face of laboratory findings like these, we as humans have higher centers of control, which could override our instincts to be more aggressive. Thus, not everyone who does a cycle becomes an immediate a-hole... but he/she might have a good excuse if they need one!

ABS STILL POUCHING OUT?

Are you supposed to have to conciously hold your abs in? My abs are strong enough to do the advanced swiss ball exercises and they feel tight and my stomach is flat for a few minutes after I worked them but the next thing I know my abs are relaxed and pouching out again. Do you workout your abs and then the rest of the time your stomach stays flat and tight or do you think about holding them in. I just want to know what's up with this and whether I need to be working alot harder or something.

Abs are like a woman's cleavage... assistance is usually required to create the appearance--either a bra or positioning for the camera. Abs in those photos of bodybuilders and models are tight because they are being held tight, not because they are like that all the time. Sure, a big beer drinker's gut is going to stick out further than yours which is well trained, but there is some slight conscious effort in holding it in. Totally relaxed, it will probably stick out a little.

So I hate to tell you all, but Pamela Anderson doesn't walk out of the shower with cleavage, and her tummy probably sticks out a little bit too. Of course, I'm sure she still looks pretty good!

TOO SKINNY TO WORKOUT?

I am a teenager, 16 years of age. When I was young, I was really skinny, and everyday, some jerk would come up to be and say things like "Are you anorexic" and "Oh my god, you're a twig" and nasty comments like that. The thing is, I am not anorexic, it's just that I was born with a high metabolic rate... I'm a natural ECTOMORPH, and I'm really, really skinny.

So one day, I found out about a thing called bodybuilding. I wanted to start it immediately, but I was afraid that the guys around me would tease me about going to the gym. So I procrastinated for a few years, and one day, I decided to go to the school gym at lunch. Once I was in there, I was immediately recognized by one of the "big" guys. I was teased so badly that I wanted to cry. I ran away from the school gym and since that day, have never returned. I feel really ashamed of myself for being so useless, but today, I still want to bodybuild... the problem is, I'm still afraid.

Can anyone on the face of this earth help me? Or is a weak little teenager destined to stay that way and be picked on for the rest of his days? Please help.

When I was 16 or 17 (high school senior), I was 6'1" and weighed 135 lbs. In terms of being picked on--I had an older brother who played football, and I competed on the Math team and played in the marching band. You looked up "geek" in Webster's Dictionary, and my picture was featured. Oh, well. Now all of these years later (I'm 36), at 6'1", 205+, I still feel like the same skinny kid that I was back in high school, even though I know that I'm not. I am finally to a point where I am no longer intimidated by the big guys at the gym, but only because they ask me for advice now. The whole issue of body image in bodybuilders is a fascinating topic and I'd be interested to hear about other peoples experiences. Most importantly, however, is what has been said over and over again--don't be discouraged by the looks and comments you get when you go to work out. Just do your thing and assume that they are jealous of your superior genetics which are as yet untapped!

SYMMETRICAL ABS?

What is going on with my abs? Each side is not symmetrical like I see on some people. Please help!

Regarding the "lines" on the abdominal muscles--The Rectus Abdominus muscles are paired, in other words, it isn't one muscle, but rather two muscles within their own fascial sheaths, and the sheath joins in the middle, an area called the "linea alba" or white line. In some people, this line may be wide, in others narrow, in some deep, in others shallow. As for the lines along the muscle, these are tendinous portions which divide the belly of the muscle into segments, relating to developmental and evolutionary formation of the muscle. In some people, this division is symmetric, but not always. Also, some people have a six-pack... some an eight-pack. (Of course, some people just have a "keg". Alternative to the washboard abs, "washing machine" abs...)


Chris Cormier (left) genetically has asymmetrical abs, while Lee Priest has symmetrical abs. (C) Avidan

Next time you stop at your favorite bookstore, pick up a copy of "Gray's Anatomy". There used to be a paperback edition, which I think was put out for lay-people, and then you can see how all of these muscles fit together. It's pretty cool.

LEGALIZE STEROIDS? PART 2

At the American Public Health Association meeting in NYC in Nov 1997, there were several Poster Board Research Studies represented on steroid studies by Sports Epidemiologists.

1. I am not an authority in these matters. I am only relating news.

2. I personally believe that steroids could be used by athletes under controlled circumstances for particular objectives safely. As it turns out some of these studies verify my beliefs.

3. One study found that moderate use showed no adverse damage to the individuals and only positives. There were cautions and proscriptions in the use and types. More study needs to be done. But the conclusions were plain. There can be safe use parameters established.

It further concluded that much of the "BAD press", as with marijuana and other illegal drugs for medical reasons, were reporting "worse case scenarios" e.g.. out of control anger, oversensitivity, etc. These effects were the results of persons probably over prescribing themselves or having other mental disorders that were complicated by the use of steroids. But the authorities and press lactched on to blaming the drugs.

As when abortion was illegal, when an activity is illegal and the citizenry does attempt to use it without knowing the hows and wherefores and seek remedies from underground sources, then the public is more than likley to get harmed. in the case of steroids, advice is distributed by word of mouth and often erroneously and recklessly. Eg. street sex education is another example. Lots of trash advice on contraception.

The desemination of correct information by authoritiative sources is most important in providing the public with correct public health knowledge and maintaining their own well being.

We should inculcate in our citizens the responsibility and knowledge. Not limit it. And provide meaningful informational sources of safe use thereof.

In conclusion, due to studies such as these without a hell-bent on supporting a prohibitive decree, there may be supporting proof for safe steroid use and a system of prescribing them under supervison much as some weight reduciton medications are. Is there a difference? I think not. The establishment of parameters will be the larger question. Who will decide who get them?

While you might expect me to respond vehemently against such a post as this, you'll be pleased to know that I agree with pretty much everything that you've said. Are you surprised? Does that make me a hypocrite? No--in fact if you read most of my posts about steroids, my advice is to educate people about them, not to put them in jail or shut them up. I have said over and over again that steroids are a personal decision, but one which is currently a decision with potential legal consequences. For physicians, these can be severe.

There was a time when the party line dictated that steroids weren't even effective for performance enhancement. Of course, those of us who paid attention knew better, but now everyone knows, because the New England Journal of Medicine published an article about supraphysiologic doses of testosterone in a controlled randomized study which showed greater gains in the test subjects, whether they exercised or not (NEJM, July 4, 1996, page 1). So now, all doctors can admit that steroids work.

What about side effects? Well, it's true that the media publishes all of the most outrageous things, not just the routine things. What, after all, is the purpose of the media? Is it to inform and educate? NOOO, it is to sell newspapers and magazines and make a profit! So of course, you're going to write about the high school senior who cracks his girlfriend over the head with a crow bar when he finds her with the quarterback of the enemy team--both of whom, by the way, were on STEROIDS. Just to set the record straight, I don't read the National Enquirer, except the cover at the grocery store checkout line. The side effects I'm familiar with are the ones I take care of and see on a regular basis. I don't depend on the media for this information.

Nonetheless, I'll admit, that there probably are safe dosages of some drugs which are still anabolically active with rare side effects. But, as a physician, I have no objective information or studies to help me in making recommendations to athletes about what to take and how much to take to avoid these potential side effects. You've already seen what happens when a drug or device is used without adequate information, that is if you're familiar with the silicone breast implant fiasco. Personally, it's not worth it to me to advise patients in this realm without FDA approval. I have far too many loans to pay off, and that would be difficult to do without a license or from the "slammer".

Finally--and if I've said it once, I've said it a thousand times--compliance with these drugs would be nearly impossible to monitor and control, and would be nearly guaranteed to be poor. This is not based on information provided to me by the media. It's not even based on scientific studies, though there are a few studies that look at risk-taking behavior in steroid users, the data from which could be used to extrapolate towards a determination that compliance would be poor. Rather, it is based on my friends and patients who use the drugs. "More is better." And they don't care about potential side effects in some cases, even when they are well-educated.

Give me scientific studies, give me FDA approval, give me compliant patients, and I'll be singing a different tune tomorrow. I would love for us all to be one big happy performance-enhanced family--But it isn't realistic under the present circumstances. Don't criticize your doctors for this problem--99.9% of them don't even know "squat" about anabolic steroids. As a result of my article about adolescent steroid use, I've become somewhat of an expert in the field. Let me tell you what I'm reading now that I'm an expert: Dan Duchaine's "Underground Steroid Handbook". After all, I need some information, even if it is outdated. That information is sparse in the "scientific literature" and non-existant in standard medical texts.

It is beyond my ability or desire to predict what the future will bring with regard to performance-ehnancing drugs. In the meantime, I put forth the same request as I have before, namely that we educate ourselves about these drugs. Studies need to be performed to determine complete profiles on drugs proposed for use, including safety, so that doctors can make recommendations based on information from the PDR, not from the "USH", no matter how good a book that might be.

By the way--I haven't even touched on the use of insulin and growth hormone and drugs like nubain, which give bodybuilders the excuse to use an addictive narcotic because of it's cortisol suppressing behavior. My question for those who advocate the loosening of FDA restrictions: Who decides which drugs are okay and which aren't?

Enough of this... I'm going to work out... and yes, I'm truly drug-free, no matter what they say at the gym.

EXERCISES FOR BREAST REDUCTION?

Is there any type of weight exercises that could aid in reducing breast size? My girlfriend complains of having too much breasts (really, I am not complaining!), and she will go to the point of having surgery if nothing else works. She does some step aerobics (not too consistently) and I have gotten her involved in weights also. I have her doing basically HIT training, which should help her gain size in her arms, shoulders, etc., allowing for an illusion of reduced breast size. Should I have her do higher reps, what excercises?

Depending on your girlfriend's body type and genetics, there is little that some women can do short of breast reduction to decrease the size of their breasts. Obviously, significant weight loss if she is overweight will help. Sometimes, breast size decreases after child-bearing--but in some women, the breasts increase in size and never get smaller. As breast reduction is one of the operations I do most, I am very sympathetic to these women, who spend years with back and neck pains, grooving of their shoulders from the bra straps supporting heavy breasts, and inability to exercise or find clothing which fits properly. Fortunately, the insurance industry has been pressured enough by women in the marketplace to provide for breast reduction as a "reconstructive" rather than "cosmetic" procedure, which it was considered in the past.

If your girlfriend is desperate enough--and bothered enough to consider surgery--she should at least investigate the option, so that she has all of the information. As for exercises, there aren't any that "reduce" breast size, other than weight loss, which may help. Although you may like her the way she is, it's important for her well-being and self-esteem that you respect her decision either way. This tends to be a very difficult move for women, as the breasts have so much significance in society. So be supportive... like a good bra!!

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