The WWE says reports speculating that steroids played a role in the apparent murder-suicide of professional wrestler Chris Benoit, whom police say killed his wife and son before taking his own life, are "sensationalistic" and are not supported by evidence in the case.

Muscular Development supports the WWE stance that this murder was in no way linked to the use of performance-enhancing drugs; and as further evidence, we've reprinted the following articles by TEAM MD staff writers Dr. Dan Gwartney, MD, Jose Antonio, PhD, and Legal Muscle expert, Rick Collins, JD.

THE 'ROID RAGE DEFENSE

by Rick Collins, J.D.

Q: How common is “roid rage,” and does it stand up as a legal defense for violence and assaults?

A: Picture a rabid dog, fangs bared, eyes bulging, mouth foaming. “Take anabolic steroids and that will be you.” Isn’t that what we hear all the time from mainstream sources? The public believes uncontrolled ’roid rage is a widespread side effect of juicing. When someone using gear commits an act of violence, the steroids are blamed. Case in point: a British man was arrested after attacking his girlfriend on two occasions, once with a head butt and then days later with a kung fu kick to the gut. In court, steroids took the rap, and the Cambs Times headlined the story as “Man on Steroids Butted Partner” (June 30, 2006).

But is this kind of spontaneous, irrational, hyperaggressive violence really common among steroid users? The answer is, no, according to the experts. “Such spontaneous acts of hyperviolence are rare in and of themselves, and the association of steroid use with them is even rarer,” says Dr. Jack Darkes, who has written authoritatively on the topic and is an assistant professor of psychology and director of interventions at the University of South Florida’s Alcohol and Substance Use Research Institute. In their 1998 book, The Steroids Game, steroid authorities Dr. Charles Yesalis and Virginia S. Cowart wrote: “If [‘roid rage’] is real, it is relatively rare (probably less than 1 percent) among steroid users.”

While violent, criminal, ’roid rage is mostly hype, in a small percentage of possibly “predisposed” individuals, steroids can lead to increased irritability or aggressiveness. The appearance of psychiatric symptoms in steroid users is generally correlated to dosage, and may also be rooted in previous mental illness or abuse of other drugs. Jay Cohen, a clinical/forensic psychology doctorial student and lead researcher of a survey of 1,955 adult American male steroid users notes that of the small minority of respondents who reported an anger problem, the large majority had it before using steroids— and most had a family history of violence. If you’ve got a screw loose to begin with, or use narcotics, jacking up isn’t going to fix your problems. But, says Cohen, even among the few who experienced anger issues. “The consequences connected to their anger were minimal and do not appear clinically significant.”

If some loose cannon who’s been on gear for years one day takes some other drug and acts out, how much can steroids be reasonably blamed? Take our earlier example of the British “bloke” from the Cambs Times. Steroids got the heat, but the body of the article revealed that the guy was drunk both times, and that before the first attack he had slammed down five or six pints of beer and between 10 and 15 double vodkas with Red Bull! The dude was “as drunk as he could get,” according to the prosecutor. Look, I worked as a bouncer in nightclubs that advertised a fixed, “all-you-can-drink” price policy in an era when the drinking age was 18. My experience is that nothing comes close to excessive alcohol for provoking violence.

As far as employing steroid use as a “get-out-of-jail-free card” in court, a sampling of these cases (see A. Lubell, “Does Steroid Abuse Cause— Or Excuse— Violence?,” The Physician and Sports Medicine, 1989, 2;17: 176-185) generally reveals that such legal defenses were unsuccessfully raised, probably due in part, to the fact that in many cases, the dosages administered were unspecified— or too low to be persuasive. Another factor may be the general reluctance of juries to acquit murder case defendants based on insanity defenses, especially where a voluntarily consumed substance caused the insanity. So, from both a behavioral and legal perspective, ’roid rage is great for headlines, but mostly much ado about nothing. Anyway, that’s it for this month— bring your questions about steroids or supplements to Las Vegas and look for me at the Olympia expo.

‘Roid Rage...Oh Boy

                                                                        By Jose Antonio, PhD

When I first saw this story on Fox News, one had the feeling that they would pin this criminally insane act on you know what…’roid rage! What happened is that former pro wrestler (the fake wrestling, not real fighting) Chris Benoit killed his wife, 43-year-old Nancy, and son Daniel. Benoit was a Canadian born in Montreal and was a former world heavyweight champion, Intercontinental champion and held several tag-team titles. His name in the ring was “The Canadian Crippler,” according to news reports. So, of course, journalists, who pretty much have the intelligence of a grapefruit when it comes to reporting scientifically accurate information on the steroid category, have used the term “’roid rage” as the most logical reason for a guy who kills his family and himself.

First of all, ANYONE who kills his child and wife has problems that go way beyond the use of anabolic steroids. There are plenty of killers who do the most insane things and yet couldn’t spell the word steroid. So, what does the science say? Again, like all drugs, you have to keep in mind the type of drug used, the dosage used and the frequency and duration of use. If Chris Benoit had pre-existing psychological problems, was a multiple drug user and used androgens, then certainly ALL of these factors could have played a role in his mindless, inhuman behavior. But if you look at androgens alone as a factor, it would be impossible to draw a cause-and-effect link between this hormone and homicidal behavior. Anyone who says otherwise is stupid. For instance, “supraphysiological” doses of testosterone, when administered to normal men in a controlled setting, do not increase angry behavior. These data do not exclude the possibility that higher doses of multiple steroids might provoke angry behavior in men with pre-existing psychopathology.

KILLER DRUGS?
Steroids and Suicide

By Dan Gwartney, MD

When it comes to discussing anabolic steroid use for performance enhancement or physique development, there are differing positions. Unfortunately, anabolic steroid use generates polar opinions rather than allowing for rational discussions. Advocates make declarations about personal freedoms, health and performance benefits; opponents argue ethics and health risks. This is not the first time a topic has had such a divisive effect on public opinion; there are many examples in U.S. history.

Doomed to Repeat History?

The most dramatic example of the black and white debate of absolutes was so pervasive that it defined a decade in American history and generated some of the most notorious characters on both sides of the law. Alcohol has been widely enjoyed by nearly every culture of man. Unquestionably, alcohol is a double-edged sword— bringing health benefits and adding to the quality of life when used responsibly, but causing injury and tragedy when used irresponsibly.

During the first decade of the twentieth century, a zealous woman by the name of Carrie Nation went on a crusade against drinking establishments and alcohol in general.¹ Described as a woman who “felt divinely ordained to forcefully promote temperance,” Nation clubbed, axed and smashed her way through saloons to protest drinking and its effects upon American society. Nation’s ire was fueled by a failed marriage to an alcoholic and religious extremism. Though the chronicles remember her kindly as a woman of principles, she was the daughter of a slave owner who harassed anyone whose morals differed from her own.

Nation’s crusade survived her death, with the passage of the 18^th amendment to the Bill of Rights beginning the era of Prohibition.² Forbidding the transport, sale or consumption of liquor did little to stop drinking, however. Instead, criminal syndicates formed that controlled bootleg suppliers and speakeasy saloons, defining the “Roaring ‘20s.” Without Prohibition, the rise of infamous gangsters such as Al Capone (the original “Scarface”) would not have been possible.³ Prohibition continued for 14 years, until it was repealed by the 21^st amendment to the Bill of Rights.² Supporters of Prohibition believed they were doing the right thing, but in the end, Prohibition proved itself to be a failed experiment.⁴

There is a saying: “Those who fail to learn from history are doomed to repeat it.” Sadly, it appears the lesson of Prohibition is no longer part of the political curriculum.

Alcohol and Tobacco are OK

Certain drugs and substances are so potent and addictive, that for the sake of society, access has to be controlled. Familiar examples include PCP, LSD and cocaine. There are other less potent substances with a lower addiction potential offering benefits, or at least gratification, when used responsibly. This category has a place in society, as long as access is controlled. Responsible, mature and emotionally stable adults are able to use these substances without undue harm, but in the hands of immature, irresponsible or unstable individuals, grievous injury or even death may occur.

Alcohol and tobacco both have addictive properties in addition to having been linked to innumerable deaths and injury.^5,6 Distribution of alcohol and tobacco, as well as firearms, is vigorously controlled and monitored by many agencies including the Bureau of Alcohol, Tobacco and Firearms. Yet, despite the high risk and proven harm caused by these three, the rights to bear, use and access two of them are guaranteed by the Bill of Rights of the U.S. Constitution.² The third, tobacco, is such a staple of the American economy that a smoking prohibition could cripple the stock market.

Anabolic steroids are a potent class of hormones that offer great therapeutic benefit and may improve the quality of life in healthy and aging adult males, when used properly under medical supervision.⁷ Some of the benefits of steroids have been demonstrated by record-breaking athletes, celebrities and even a certain politician who have entertained the public and established productive careers due in large part to the advantages offered through the use of steroids. There are other advantages that are little mentioned, such as improved stability and independence for the elderly, lessened depression and decreased risk of metabolic-based diseases (obesity, syndrome X, etc).⁸

Little academic research has been published regarding supraphysiologic dosing of anabolic steroids (aside from case reports) due to the stigma attached to the topic as a result of Olympic doping scandals, BALCO, and the like. Only recently have any researchers investigated supraphysiologic anabolic steroid therapy, finding that moderate cycles of testosterone enanthate are well tolerated with no significant side effects during the period studied.^9,10 While 600 milligrams per week of testosterone enanthate will not build the championship physiques that parade across the stage of professional bodybuilding competitions, it’s sufficient to improve strength training performance and increase muscle hypertrophy when used in conjunction with a proper diet and exercise program.¹¹ If provided through trained physicians or clinical support staff, candidates for supraphysiologic anabolic steroid therapy could be screened, monitored and followed to minimize any dangerous or untoward effects. This is the reasonable approach to take with anabolic steroids.

Prohibition Again in America?

Unfortunately, control of, and access to, anabolic steroids is being debated before congressional committees and in the media, without the benefit of equal representation. For reasons that have not been made evident, prominent elements within the media are demonizing steroids, focusing only on the ethical argument of doping and the dangerous example being impressed upon today’s youth. Politicians are eagerly tackling the issue, and if they are successful in riding the wave of anti-steroid sentiment, it’s possible the U.S. will see another era of Prohibition. Already, the scheduling of anabolic steroids as a controlled substance and restrictions against prescribing the drugs for performance enhancement or physique development have created a Prohibition-like industry distributing the drug through criminal channels.

One consequence of forcing steroids underground into the black market is that access is uncontrolled, with profit being the sole motivation of the distributors. Once, steroids circulated only among a select group of athletes who shared access and information in a tight social network. Often, physicians assisted in monitoring athletes, at times even dispensing the drugs in controlled clinical settings. Now, steroids are pushed, along with other drugs, by criminal street dealers to anyone expressing the slightest interest. Of course, this includes adolescents enamored of the concept of snaring the forbidden fruit and getting the edge being used (allegedly) by famous athletes.

Even without the guidance of physicians, anabolic steroids have long been used with a reasonable degree of safety. Despite estimates well in excess of two million users, relatively few serious adverse effects of anabolic steroid use have been reported, and this is in the setting of uncontrolled use by poorly educated users forced to access questionable material through the black market.^12,13 Many male users experience minor side effects, often transitory or of a cosmetic nature (acne, hair loss, irritability).¹⁴ More disfiguring side effects are experienced by some, especially females. But restricting the discussion to males, gynecomastia and testicular atrophy are the most common.¹⁴

A small number of deaths have been documented in anabolic steroid users. The majority of these relate to vascular disease or liver disorders.¹⁵ In personal communications with numerous individuals well positioned to know and track thousands of bodybuilders, no cases of suicide are known among previously healthy, adult male bodybuilders.

Suicide and a Matter of Credibility

Sadly, suicide has occurred among suspected users of anabolic steroids. Several suicides among teenagers and young adults have been reported in the press, providing the perfect examples to fuel the argument to lock down anabolic steroids entirely.^16-18 Currently, two different congressional committees are meeting to debate the future of anabolic steroids, including the Committee on Government Reform and the Committee of Energy and Commerce. Politicians are clamoring to point the finger at Major League Baseball for despoiling the ethics of minors. The self-inflicted deaths of a few young men and adolescents are being blamed on anabolic steroids; the tearful faces and weeping voices of the parents describing the losses experienced.

There is no question that sports heroes are idolized by adolescents who will mimic their actions, language and behaviors. Cleaning up the public image of role models is vital to the well-being of America’s youth. The claim that anabolic steroids cause suicide is less clear.

Newspaper reports detail motivated young men who used anabolic steroids to pursue a dream, whether it’s building a better body or playing a collegiate or high school sport. Following a period of anabolic steroid use, these young men faced the challenges of depression and personal crises. These challenges surpassed their ability to cope and they each made the unfortunate decision to end their lives. As these highlighted tragedies occurred in persons with a history of anabolic steroid use, blame is being directed at steroids.

Yet, this argument lacks credibility. To begin with, suicide is very common in the United States, being the eleventh leading cause of death and the third leading cause of death in teenagers.¹⁹ Of the many conditions associated with suicide, anabolic steroid use has never been directly implicated, though substance abuse is often a factor.²⁰ The substances abused in the cases of completed or attempted suicide primarily include psychoactive drugs. Risk-seeking behavior is also listed as an associated factor with suicide, and the euphoria and aggression that certain steroids provide can certainly satisfy many thrill seekers. Risk seeking and substance abuse are traits that may lead to anabolic steroid use, rather than being caused by steroid use. Granted, in predisposed people, these traits may be amplified during high-dose cycles.

The most common factors associated with suicide are poor self-esteem and a disrupted family structure.²⁰ The condition of body dysmorphia is often associated with anabolic steroid use in males, as it drives boys and men to build their physiques, much as anorexia drives some women and girls to literally starve themselves to death in an attempt to become thin.²¹ The underlying problem is a serious psychological condition that often requires intensive counseling and treatment. Anabolic steroids are often used by body dysmorphics, but there is no indication to suggest that steroid use induces body dysmorphia.

Some Things Just Don’t Add Up

High levels of testosterone are associated with aggression, but the suicides are not occurring during the peak of the androgen cycles. Surprisingly, many of the suicides took place several weeks after the drug use has discontinued. The physiologic basis for this may be explained by examining a group at the opposite of the age spectrum. Though suicide is the third leading cause of death among teenagers, the population accounting for the most suicides is elderly men.²² If high levels of androgens were responsible for suicide, then this group, elderly men, would be protected from such thoughts and actions. Instead, elderly men have low, sometimes very low, testosterone levels.²³

Similarly, low levels of testosterone are frequently experienced by users of anabolic steroids if they do not cycle off gradually or incorporate the use of ancillary drugs to “restart” natural testosterone production.^24,25 These ancillary drugs include aromatase inhibitors and human chorionic gonadotropin (hCG).

The details of one young man who committed suicide after discontinuing anabolic steroids were chronicled in a recent New York Times story.¹⁶ The young man was confronted by his parents who discovered several pills and vials. The young man agreed to talk with his family doctor who advised him to stop using steroids completely, “cold turkey.” Unfortunately, as many underground gurus and experienced users know, stopping a cycle immediately from a high dose can lead to plummeting androgen levels, loss of physical gains, emotional instability and depression. Restoration of natural testosterone production to normal, pre-cycle levels may take weeks or months. The gentleman who committed suicide was described by friends and teammates as being an aggressive user. His cycles were described as having included extremely high doses. Two other suicides being presented to the Committee on Energy and Commerce have similar details.

Do these stories demonstrate an inherent risk of suicide with anabolic steroid use? No, despite their emotional impact, the stories do not justify banning all uses of anabolic steroids. A recent study found a very low incidence of suicide among users of anabolic steroids, lower than the rate of suicide among the general public.²⁶ The study concluded there was no statistically significant correlation between steroid use and suicide. If anything, these examples demonstrate the void existing in providing information to potential users of anabolic steroids, and the need for physician education in the use and management of supraphysiologic anabolic steroid use. Excessively high doses bring risks, especially in people predisposed to violence or psychiatric conditions. Withdrawal of androgen treatment can lead to long periods of hypogonadism (low testosterone levels), which need to be managed medically.

Pushing steroids deeper underground will only exacerbate the problems that currently exist. Former bodybuilder and current Governor of the State of California, Arnold Schwarzenegger, downplayed his use of anabolic steroids during an interview with George Stephanopolous on “This Week,” stating they were not controlled substances at the time and he received medical supervision.²⁷ If the governor believes that statement rationalizes and justifies his use, then he must disagree with the current direction legislators are pursuing.

Getting it Right

Ask a representative of the many responsible users of anabolic steroids and they will agree with many of the steps being proposed. Anabolic steroids are too potent to allow access to the drugs for minors, just like alcohol. If the rules of the sport, be it the Olympics, MLB, NFL, or any other organization, do not allow anabolic steroid use, then test and fine the players appropriately. Yet, in this land where personal Freedom is one of the founding beliefs, do not restrict responsible people from accessing this class of drug from qualified professionals. Do not force law-abiding citizens to make a choice between strongly held personal goals and arbitrary laws. Do not subject the populace to the risks of dealing with the black market and criminal distributors, when access to alcohol, tobacco and firearms is guaranteed and protected.

It is time to look at anabolic steroids openly and discuss how best to manage the risk and how to punish those who would place our youth in danger. It was not so long ago that the pharmaceutical industry included the comment “anabolic steroids do not improve Athletic Performance” in package inserts. This fallacy discredited the medical community. Instituting an anabolic steroid prohibition based upon a false claim of danger, one that if it exists does so only because of current laws, would only further polarize the issue.

There is no tragedy more devastating than losing a child. An emotional reaction will not heal that wound and may mistakenly place other families at greater risk.

References

1. Taylor, RL. Vessel of Wrath: the life and times of Carrie Nation. New American Library, New York, NY, 1966.
2. Cogan, NH. The complete Bill of Rights: the drafts, debates, sources and origins. Oxford University Press, New York, 1997.
3. Iorizzo, LJ. Al Capone: a biography. Greenwood Press, Westport. Connecticut, 2003.
4. Barry, JP. The noble experiment, 1919-1933; the Eighteenth amendment prohibits liquor in America. F. Watts, New York, 1972.
5. Centers for Disease Control and Prevention. Alcohol-attributable deaths and years of potential life lost – United States. MMWR Morb Mortal Wkly Rep, 2004 Sep 24;53(37):866-70.
6. Mokdad AH, Marks JS, et al. Actual causes of death in the United States, 2000. JAMA, 2004 Mar 10;291(10):1238-45.
7. Gruenewald DA, Matsumoto AM. Testosterone supplementation therapy for older men: potential benefits and risks. J Am Geriatr, Soc 2003 Jan;51(1):101-15.
8. Boyanov MA, Boneva Z, et al. Testosterone supplementation in men with type 2 diabetes, visceral obesity and partial androgen deficiency. Aging Male, 2003 Mar;6(1):1-7.
9. Bhasin S, Woodhouse L, et al. Testosterone dose-response relationships in healthy young men. Am J Physiol Endocrinol Metab, 2001 Dec;281(6):E1172-81.
10. Tricker R, Casaburi R, et al. The effects of supraphysiologic doses of testosterone on angry behavior in healthy eugonadal men – a clinical research study. J Clin Endocrinol Metab, 1996 Oct;81(10):3754-8.
11. Bhasin S, Storer TW, et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men.
12. Tokish JM, Kocher MS, et al. Ergogenic aids: a review of basic science, performance, side effects, and status in sports. Am J Sports Med, 2004 Sep;32(6):1543-53.
13. Berning JM, Adams KJ, et al. Anabolic steroid usage in athletics: facts, fiction, and public relations. J Strength Cond Res, 2004 Nov;18(4):908-17.
14. Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med, 2004;34(8):513-54.
15. Fineschi V, Baroldi G, et al. Anabolic steroid abuse and cardiac sudden death: a pathologic study. Arch Pathol Lab Med, 2001 Feb;125(2):253-5.
16. Wilson D. After a Young Athlete's Suicide, Steroids Are Called the Culprit. The New York Times, 2005 Mar 10.
17. Jeansonne J. Dad’s message: steroids can kill. Newsday, 2005 Mar 16.
18. Klein G. Athlete’s parents see steroid link in death. Los Angeles Times, 2005 Mar 16.
19. Centers for Disease Control and Prevention. Suicide: Fact Sheet. Available through http://www.cdc.gov/ncipc/factsheets/suifacts.htm
20. Evans E, Hawton K, et al. Factors associated with suicidal phenomena in adolescents: A systematic review of population-based studies. Clin Psychol Rev, 2004 Dec;24(8):957-79.
21. Olivardia R, Pope HG, et al. Muscle dysmorphia in male weightlifters: a case-control study. Am J Psychiatry, 2000 Aug;157(8):1291-6.
22. Salvatore T. Elder suicide: a preventable tragedy. Caring, 2000 Mar;19(3):34-7.
23. Seidman SN, Araujo AB, et al. Low testosterone levels in elderly men with dysthymic disorder. Am J Psychiatry, 2002 Mar;159(3):456-9.
24. Boyadijev NP, Georgieva KN, et al. Reversible hypogonadism and azoospermia as a result of anabolic-androgenic steroid use in a bodybuilder with personality disorder. A case report. J Sports Med Phys Fitness, 2000 Sep;40(3):271-4.
25. Menon DK. Successful treatment of anabolic steroid-induced azoospermia with human chorionic gonadotropin and human menopausal gonadotropin. Fertil Steril, 2003 Jun;79 Suppl 3:1659-61.
26. Bennett D. Are steroids as bad as we think they are? The Boston Globe, 2004 Dec 12.
27. ABC News. Schwarzenegger has no regrets about steroid use. This Week 2005, Feb 25. Story available on http://abcnews.go.com/ThisWeek/Health/story?id=532456&page=1