Russias Ekaterina Galitskaya competes in the womens 100m hurdles final at a track and field meet in Moscow on 28 July, 2016. Russias athletics federation held a competition for the athletes banned from the Rio Olympics. Photograph: Kirill Kudryavtsev/AFP/Getty Images
The steroids found in Russias doping cocktail nicknamed The Duchess by a Russian official are often abused. Around 3%-5% of the population uses steroids, estimates Thomas Hildebrandt, assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai. Doping in amateur sport has gained popularity in recent years, with anabolic steroids showing up in non-professional cycling and triathlon competitions. Most users, however, are men whom Hildebrandt describes as gym rats in their late twenties and thirties to early forties.
In his research study of anabolic steroid users, Eric Ip, chair of the clinical sciences department at the Touro University California College of Pharmacy, found that the typical user was a single Caucasian male in his late twenties who had a bachelors degree and worked in a white collar profession.
While the muscle boosting effects of doping are well known, it is the mental effects, and what happens when someone finally stops using, that are often ignored. Anabolic steroids dont just make people stronger and faster, they also help give them the feeling of a runners high. Anabolic steroids make exercise feel very good, which is where part of their addictive potential lies, explains Hildebrandt.
Using the drugs discovered in the Russian doping scandal once or twice would not have any lasting effects, but long term use is another story. Anabolic steroids break down white matter in the brain, says Hildebrandt.
The mental effects of anabolic steroids can differ from person to person. In general, when using, it makes people more aggressive with a lower tolerance for frustration. How that manifests depends on what the person was like before they started using, says Hildebrandt. If someone was not an aggressive person, they are not going to start bar fights all of a sudden, but they will be more irritable and quicker to react, he explains.
While they are using, the flood of androgens to the body from anabolic steroids also comes with a host of physical symptoms like testicular shrinkage and breast development in men, and deepened voice, reduced breast size, balding and facial hair growth in women, along with a number of reproductive problems.
Studies of heart function after longer term anabolic steroid use found damage, weakening and an increased risk of heart failure.
Oral anabolic steroids, like those used by the Russian Olympic team, are also associated with liver toxicity, says Ip.
In the case of East Germanys Olympic doping scandal, the high doses of anabolic steroids the female athletes were exposed to caused masculinization and severe health effects.
A number of East Germanys former athletes sued over the damage to their health in 2000, winning a settlement from the government.
The negative effects of anabolic steroids are well established, but research into the exact effects of each of the various anabolic steroids that are abused has been difficult, as most users take a cocktail, like the Russian athletes, and the makeup of the cocktails differ from user to user.
Helping anabolic steroid users get clean is another challenge. When athletes stop using, their bodies stop producing androgens and they enter a low testosterone state which may accelerate brain aging. According to Ip, some users also develop depressive symptoms when stopping, which may push them to remain on the drugs.
Unlike traditional recreational drug abuse, research based treatment protocols dont exist for anabolic steroid use.
Any type of drug abuse comes with its own societal stigma, making it more difficult for addicts to get help. Most amateur athletes dont seek assistance for fear of exposure. Even in the case of East Germanys highly publicized state-sponsored doping program, some of the former athletes entitled to compensation from the government never came forward.
With the type of steroid abuse uncovered in Russia, there is a double stigma, says Hildebrandt. Since Russia continues to deny proof of widespread doping, those who partook may never seek help for fear of being branded both drug addicts and cheaters.