Testosterone a Controlled Substance: Why?
Did you know that as you read this your body is manufacturing a substance that the U.S. Congress has determined to be a controlled substance? How can a hormone that the body naturally makes, not only in men, but also in women and children be considered to be dangerous enough to classified as a controlled substance?
With the passage of the Anabolic Steroid Act of 1990 Congress bypassed the usual regulatory process (which a few years earlier under the Reagan Administration concluded that anabolic steroids should not be classified as controlled substances) that determines which drugs should be controlled, and concluded that testosterone and other anabolic steroids be classified as controlled substances.
What few realize is that leading up to those Congressional Hearings the AMA, FDA, and DEA all opposed the classification of anabolic steroids as controlled substances – because they did not meet the criteria of the Controlled Substances Act.
Controlled Substances Act
The original purpose of the Controlled Substances Act was to provide more strict legislation related to the prescription and distribution of drugs that are principally psychoactive and which are abused exclusively by virtue and because of their psychoactive (mind-altering) effects. Though anabolic steroids are sometimes abused (as are many other drugs that are not controlled substances), they are not abused for their psychoactive effects. Psychoactive drugs include narcotics, hallucinogens, stimulants, and depressants.
The Congressional Hearings that led to Anabolic Steroid Act of 1990 were convened to deal with the use of anabolic steroids in sports. At the time there was a growing concern in sports related to athletes “cheating” by using anabolic steroids. It should be pointed out that a substance does not to be controlled for a sport to ban it if it so chooses. In fact, many drugs banned in sports are not controlled substances. In the case of anabolic steroids the last straw was when it was discovered the Canadian sprinter Ben Johnson tested positive for anabolic steroids in the 1988 Olympics and was stripped of his gold medal. There was a huge outrage and the general feeling that something must be done to curb such “cheating” in sports (though some have made some reasonable persuasive arguments that performance enhancing drugs should be permitted in sports if athletes choose to use them – click here to see such an article).
Rick Collins is considered the foremost legal authority on anabolic steroids in the United States. In testimony as part of a federal hearing in 2005 he made 10 points in which he provides interesting comments, observations, and distinctions between anabolic steroids and other controlled substances. His comments will challenge those who believe anabolic steroids are as dangerous as the media and government reports. His 10 points begin on page 8 of the following transcripts from a public hearing on April 12, 2005 in front of The United States Sentencing Commission. Article found here: USSC April 12 2005 Collins Anabolic Steroids.
Medical Evidence: Not Much Presented at Congressional Hearings
Between the Senate and House of Representatives hearings that led to the Anabolic Steroid Act of 1990 there’s about 500 pages of testimony of which only 50 or so deal with the medical evidence. In those days no randomized controlled studies existed on anabolic steroids, and back then and as is still the case today, there were no long-terms studies to guide any decision-making. The only evidence available were “expert opinion” and case studies, which are considered the two lowest levels of evidence when judging medical information.
Having read the many pages of testimony at these Congressional Hearings it is my conclusion that the impetus to curb “cheating” in sports was strong enough that Congress relied on weak medical evidence to ascribe a legal remedy to what ultimately is an ethical issue – cheating in sports.
The unfortunate result is the Anabolic Steroid Act has created the perception that testosterone is dangerous for legitimate medical purposes leading physicians and patients away from using testosterone. Testosterone is safe when prescribed by a knowledgable physician and under close medical supervision, but synthetic anabolic steroids do carry some health risks. So there is a distinction between testosterone – the stuff your body makes – and synthetic anabolic steroids abused by athletes.
Since those hearing several randomized controlled studies have been performed using testosterone (not synthetic anabolic steroids) in supra-physiologic doses, the landmark study being Bhasin’s study published in the New England Journal of Medicine in 1996. This and other studies have shown that even in doses 6 to 10 times normal testosterone is relatively safe in an injectable form, though there can be transient laboratory abnormalities that resolve generally within 3 months of discontinuation of high dose testosterone use. Such laboratory abnormalities are far less frequent when physiologic or normal doses are used.
So why is testosterone a controlled substance? In my opinion, to curb cheating in sports (yet few elite athletes have ever been prosecuted). Unfortunately, in the process we have allowed what a few thousand professional athletes can and cannot do potentially affect the health of those in the general population who may be testosterone deficient.
To learn more about the benefits of testosterone read the following: