Pain, Sports, and Anabolic Steroids
by Forest A. Tennant, MD, DrPH
 The recent use of anabolic steroids by some Olympic
athletes and professional baseball players has again thrust anabolic steroids into the
headlines. What’s different from previous episodes of anabolic steroid abuse is that
androstendione is part of the headlines. Physicians who treat pain should closely follow
the developments in this controversy.
Androstendione is an intermediate compound in the adrenal and sex organ synthesis of
estrogen and testosterone. Pregnenolone, the primary precursor compound in glucocorticoid
and sex steroid synthesis, is derived from cholesterol, and it initially forms
dehydroepiandosterone (DHEA) and androstendione (ANDRO) which convert to testosterone.
These compounds also enter the serum and exert their own anabolic affects on a variety of
tissues. At this time DHEA and ANDRO are sold over-the-counter as dietary supplements
while testosterone and estrogen are prescription drugs. Testosterone is even classified as
a controlled substance, since it has been abused by athletes and body builders.
Pain physicians and patients need to be precisely aware that athletes take testosterone
and its derivatives, known as anabolic steroids, to enhance strength, stamina, pain
relief, muscle mass, and tissue growth and healing. Tissue growth includes bone marrow and
red cells in both males and females. Both sexes are critically dependent upon adequate
levels of serum testosterone for healing and pain relief. In addition, testosterone is now
often classified as a “neurosteroid” along with pregnenolone and DHEA. Why?
These compounds exert potent, stabilizing effects on the nervous system, and are necessary
for such nervous system functions as nerve growth and prevention of depression.
Males and females having severe, intractable pain and who require treatment with opioid
drugs will commonly develop hypotestosteronemia which can be easily diagnosed by a single
serum screening of total testosterone concentration. Testosterone screening should become
routine in pain treatment as should testosterone replacement with the new, easy to use
topical gels and other preparations. Our pain patients deserve to have the same biologic
enhancements of tissue growth and healing that athletes cherish and seek from testosterone
and related compounds. These compounds are currently a great area of research and inquiry
in pain treatment. While politicians and regulators may rightfully determine a need to
restrict access to testosterone and androstendione by athletes, they must leave them
available to pain physicians and patients.
— Forest A. Tennant, MD, DrPH
Editor in Chief
— May/Jun 2004
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