Written by Anthony Roberts
19 February 2021

 Anabolic Steroid Pioneer

 

Anabolic Steroid Pioneer Dr. Michael Dullnig and the Evolution of Steroid Laws

 

By Anthony Roberts

 

Meet Dr. Michael Dullnig

 

It was June 1st, 1994. Dr. Michael Dullnig’s guests were having a great time drinking champagne, listening to music, and talking with the guest of honor – the doctor himself. This, he thought, is the best party of my life. Dullnig made his way around the crowd, posed for pictures, and discussed the future of his work; it was centered around medical treatment for AIDS-related wasting. The focus was on anabolic steroids. The alcohol was flowing, and everyone took advantage of their chance to get together with Michael on his big day.

 

But this wasn’t Dr. Dullnig’s birthday party – it was his deathday party.

 

As the evening drew to a close, the doctor walked to his bedroom carrying a cup of his favorite yogurt – which he’d laced with a fatal dose of Demerol. He consumed the mixture, lay down, and died. 

 

Dr. Dullnig wouldn’t be told how and when his life would end – especially not by human immunodeficiency virus. His health had been deteriorating over the past few weeks. His compromised immune system allowed a mild rash to bloom into head-to-toe agony, followed by cytomegalovirus retinitis. As scary as that name is, it may actually be worse than it sounds. The prognosis is pain, lots of it, followed by blindness, and eventually death. 

 

 

 

Although he had likely contracted HIV in 1982, it wasn’t discovered until 1991 when he was hospitalized with pneumonia. Within two months he’d lost 45 pounds and found out he was HIV-positive. As a Summa Cum Laude graduate of Baylor Medical School, and member of Phi Beta Kappa, he knew that lean body mass is directly related to survival rate (not just for HIV, but for any wasting disease). A paltry 5% muscle loss can increase the chance of infection as well as morbidity. A 33% muscle loss is totally incompatible with survival. He was down 25% and counting. He knew he had to do something to stop losing muscle. But he needed to do more. Stopping the muscle loss wasn’t enough; he needed to stop it, then reverse it – he needed to increase his muscle mass. To survive, Dr. Dullnig would have to gain muscle. Note that this is medical steroid use and not steroid abuse.

 

With confidence gained from having nothing to lose, he began experimenting with anabolic steroids. As a doctor, he knew that the best way to gain muscle (pharmacologically speaking) is through anabolic steroids. A prescription for anabolic steroids, he figured, could potentially be the first step in reversing his rapid weight loss. Regrettably, he couldn’t write himself a prescription. In the year prior to Dr. Dullnig’s diagnosis, anabolic steroids became “defined” as Schedule III controlled substances in a peculiar (never-before-seen) modification to the Controlled Substances Act (CSA). Doctors writing their own prescription for a controlled substance is a big no-no.

 

The Evolution of Illegal Anabolic Steroids

 

Anabolic-androgenic steroids (AAS) became controlled substances in 1990 when Congress “defined” them as Schedule III (the CSA has five schedules, with Schedule I being the most dangerous and Schedule V being the least). This piece of legislation created the nation's first set of steroid laws. This scheduled an entire category of drugs that did not otherwise fit any of the criteria for being controlled substances (i.e., psychoactivity, or in layman’s terms “getting high,” the reason all other scheduled drugs are controlled substances). In 1988, the Drug Enforcement Administration (DEA) testified to Congress that anabolic steroids should be kept entirely out of the CSA:

 

The CSA was designed to encompass drugs that are abused exclusively for psychoactive effects and are characterized either as narcotics, stimulants, depressants, or hallucinogens. In this respect, the law is poorly suited to the steroid drugs. It is clear, based on the legislative history, that the Congress did not intend to encompass them within it.

 

Illegal Steroids, Athletic Performance, and Anabolic Steroid Misuse

 

Until 1990, AAS weren’t controlled substances; they were just another medication – illegal without a prescription but not controlled. This doesn’t mean we’re talking about legal steroids, simply not controlled substances. The DEA, which is the law enforcement agency in charge of enforcing the CSA, wanted nothing to do with anabolic steroids. [The same holds true for human growth hormone]. When the Department of Justice (DOJ) testified to Congress at the original steroid hearings, it was in opposition to classifying AAS as controlled substances. Specifically, the DOJ told Congress that the Administrator of DEA concluded that anabolic steroids should not be made controlled substances. Also, as the DOJ explained, this opinion was supported by Health and Human Services Secretary Otis R. Bowen, who they quoted as saying:

 

“(T)he available evidentiary base concerning steroids, although growing, is not comprehensive.

The data available do not establish that steroids possess psychoactive effects comparable to those substances currently scheduled.”

 

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Defining a Performance-Enhancing Drug

 

The inclusion criteria for the five CSA schedules requires evaluating their potential for abuse, medical utility, and potential for dependence. Anabolic steroid abuse accounts for less than one fatality per year. They aren’t your typical illicit drugs [street drugs]. But inclusion on the CSA would create tougher penalties under the federal sentencing guidelines for anabolic steroid misuse. Remember, the DOJ is an agency of lawyers, not scientists – it is entirely reasonable that they defer to the scientists employed by the DEA for this type of law enforcement decision (at least when making scientific determinations). Although we have seen numerous instances of the DOJ (again, lawyers not scientists) prosecuting steroid cases against the scientific opinion of DEA scientists (notably with recent prosecutions under the Designer Anabolic Steroid Control Act), this type of behavior borders on prosecutorial misconduct (and by “borders on,” I really mean “should be grounds for disbarment”). 

 

As the DEA and HHS have said, steroids don’t get the user high – which is the whole reason for the CSA’s existence. Every drug listed on the CSA has some ability to get the user high, even if it’s negligible (i.e., pharmaceutical cough suppressants with low doses of promethazine + codeine). Well … I guess every drug except for the ones found in the anabolic steroid category. 

 

Steroid Laws, Simple Possession, and Harsher Penalties

 

Regardless, in 1989, Congress decided to define anabolic steroids as Schedule III controlled substances. By 1990 when the Anabolic Steroids Control Act (ASCA) took effect, they became unavailable to prescribe for “building muscle.” Congress expressly ignored the governmental agencies opposed to the Act. For good measure, they also ignored the non-governmental agencies; the American Medical Association sent a letter to Congress opposing the scheduling of anabolic steroids. Regardless, ASCA passed Congress and was signed into law. As (bad) luck would have it, ASCA went into effect right before Dr. Dullnig found himself in need of gaining back at least a quarter of his bodyweight. Throughout the next decade and beyond, this new anti-steroid law had the practical effect of tying the hands of doctors whose patients were HIV-positive and dropping weight rapidly.

 

The optics were desirable, even if the legislation made little sense – even if the legislation resulted in deaths. Consider the fact that for the past several decades (for which statistics are available), AAS have been responsible for less than one death per year. Now think about how many people died because of muscle-wasting and related HIV-positive complications. The first steroid control act literally killed people. But deaths in the LGBTQ+ community weren’t important to Congress. Especially not when steroids in sports were on the front page of every newspaper. 

 

In the ‘90s, steroids were the exclusive domain of disgraced sprinters and temperamental linemen. Ben Johnson had recently become the fastest man in history, with a commensurately fast loss of that title when he tested positive for stanozolol. At this time, HIV wasn’t discussed in polite conversation. For the decade prior to Dr. Dullnig’s diagnosis, HIV wasn’t part of any conversation, thanks to a virtual media blackout. 

 

But steroids were big news, and Congress routinely seizes on the boogeyman of anabolic steroids to make headlines. When baseball players started looking like football players, hitting too many home runs, and blaming prohormones [steroid precursors], Congress responded with the Anabolic Steroid Control Act of 2004 (ASCA 2004). Never mind that repeated, peer-reviewed, double-blind studies later revealed that prohormones (such as the infamous “Andro” [dietary supplement] used by Mark McGwire) did nothing to build muscle. And in 2014, the Designer Anabolic Steroid Control Act (DASCA) was passed as the Congressional response to some other athletes testing positive. But while so-called “designer steroids” were big news between 2004 and 2014, DASCA doesn’t actually contain the word anywhere but the title. It never defines the phrase “designer steroid” and therefore can’t possibly make them illegal. But the title is sexy and the optics are spectacular.

 

When Dullnig contracted HIV, only the most basic types of anabolic steroids had been made illegal, not “prohormones” or “designer steroids” (whatever that means). Back then, word had recently begun circulating through the gay male community about a mysterious type of cancer. But unlike cancer, HIV per se isn’t the cause of death, but rather a condition that allows opportunistic infections to manifest. And loss of muscle is essentially a blank check for opportunistic infection to begin making withdrawals on the immune system. Most of those infections can also cause muscle loss, and the cycle repeats, with infection causing muscle loss, and vice versa, until the body can no longer maintain its life-sustaining functions.

 

Even before 1990, few doctors in the United States were willing to prescribe anabolic steroids to build muscle. Research on both HIV and AIDS was sparse. Then, when Congress made steroids a controlled substance, doctors became even more hesitant to prescribe them. There were a couple of physicians in Southern California experimenting with injectable testosterone and nandrolone (the stuff Roger Clemens allegedly used), and a few ongoing studies with oxandrolone (one of the many steroids Russian athletes definitely used). But that was it. For gay and bisexual men, there were few alternatives.

 

There was also a question of where to get the drugs. Most North American firms had been winding down their research into anabolic steroids following the initial gold rush of steroid patents filed throughout the ‘50s and ‘60s. The domestic selection and availability for the AAS was sadly lacking, as was relevant data. Because of Congress’ shotgun approach, nearly every domestically available anabolic steroid was now controlled. Most steroids available through legitimate pharmacies in the United States were ill-suited for Dr. Dullnig’s situation, as the Food and Drug Administration tended to approve the weaker ones (weaker in anabolic, or muscle-building effect, which doesn’t always translate to being milder on cholesterol and such). 

 

For his first cycle, Dr. Dullnig opted for more cosmopolitan fare than would have been available at the local pharmacy, importing a rare (and thus expensive) form of oral testosterone from Germany, plus injectable methenolone, a non-FDA-approved anabolic (making it both rare and expensive). With that cycle, he started down a path that would result in anabolic steroids becoming accepted adjunct treatment for future HIV-positive men.

 

***

A cure for HIV remains elusive, but medical science has slowly refined the cocktail used to treat the virus, adding year after year to the life expectancy of those afflicted, until it’s drawn nearly even with America’s average life expectancy. Not infrequently, that cocktail includes anabolic steroids, and Doctor Dullnig is one of (if not the primary) reasons for this.

 

Despite the fact that his work undoubtedly extended (and continues to extend) untold lives, few contemporaries knew his name. That relative obscurity stems from the fact that he was only active in bringing attention to anabolic steroid use in HIV-positive-related wasting for a single year. This was the final year of his life, a length of time bookended by his 1991 diagnosis, the year of his first cycle, and the day of his leave-taking ceremony in 1994. Nonetheless, he produced an impressive body of published work in that relatively short time, plus a manuscript, the progeny of which includes far more than simply the work at hand.

 

To appreciate the prolific nature of his output, realize that Dr. Dullnig began researching ways to halt the muscle loss that threatened his life, and at that time, the process involved more than typing keywords into a search bar from home. In the early ‘90s, this involved heading to a medical library and photocopying journal articles. A “library” was basically like Google, but IRL (in real life), and “articles” are like internet pages made from trees. Can you believe that? The ‘90s were a wild time.

 

While the rest of the city was spellbound by the arrest of O.J. Simpson, Dullnig was looping an endless, repetitive circuit from his home to the UCLA medical library. He had planned to author a book, aggregating current research on anabolic steroids, dietary supplements, and combining that with his best thoughts as a medical doctor and human lab rat. All told, 650 pounds of material was photocopied and annotated. This 650-pound gorilla was, of course, ignored by lawmakers, who were only too happy to continue updating steroid legislation without paying attention to scientific literature. Misguided prosecutors, perhaps even well-meaning ones (if such a creature exists in the wild), treated anabolic steroids like traditional street drugs.

 

The poundage of his research is known because when he realized how little time he had left, and that it would end with him unable to complete a book of the intended magnitude and importance, his work and research material was shipped, and paid by the pound, via Federal Express to Nelson Vergel, who promised to see the work completed. 

 

Meet Dr. Walter Jekot, the doctor featured in an LA WEEKLY article titled “Sympathy For The Devil.” As fate would have it, Vergel’s job had transferred him from Houston to the Los Angeles area in 1990. A chemist by trade, three years earlier he discovered that he was HIV-positive. Shortly thereafter, he was 20 pounds lighter, dropping from 160 to 140. This is when he began looking into anabolic steroids. Eventually, after searching the Los Angeles area, he found Dr. Walter Jekot, a physician who had been prescribing anabolic steroids for HIV-related wasting. Dr. Jekot had been doing this for at least as long as the disease had a name (or at least a permanent name – “gay cancer” was the original moniker, followed by GRID, Gay Related Immune Disease). 

 

Dr. Jekot had been procuring (from overseas sources) non-FDA-approved steroids for his HIV-positive patients. Again, this was due to their relative potency and general unavailability of equivalent drugs in domestically. Those steroids, for many reasons, offered far better therapeutic value than ones domestically available. Many were both more effective in terms of gaining lean mass, while simultaneously producing fewer side effects. The government takes a dim view of prescribing anabolic steroids for off-label use, and an even dimmer view of doing so with ones that are not FDA approved. His average patient wasn’t the typical steroid user trying to look good at the beach, but rather simply trying to survive.

 

When the Anabolic Steroid Control Act of 1990 went into effect, the Feds wasted little time (almost immediately) arresting Dr. Jekot on a 27-count indictment including both illegal distribution of anabolic steroids as well as steroid possession. This type of prosecution involved minimal effort, because ASCA (1990) was basically a list of every anabolic steroid on the domestic market for the past decade. They were made illegal by virtue of their presence on a list found under Schedule III, and now under the CSA. The Anabolic Steroid Control Act of 2004 added yet another list of substances to the definition of anabolic steroids, while simultaneously giving the Executive Branch the ability to classify substances that met certain criteria. Of course, this was legislation crafted primarily because of economic and political influence on lawmakers, and not an attempt to install effective policy. But contrast these acts with prosecution under the Designer Anabolic Steroid Control Act of 2014, which went unenforced for half a decade, and currently involves prosecuting substances not found under DASCA, in Schedule III, or on any list, anywhere, of controlled substances. In fact, despite being given the authority to add new steroids to Schedule III virtually at will, the Attorney General never attempted to do so. Not even once. The issue was never even discussed. 

 

To be clear, DASCA failed to pass Congress on two prior attempts. It failed because of a provision that would have allowed unlisted substances to be proved anabolic steroids at trial. As a result, this exact type of prosecution was implicitly barred when Congress removed this provision. The DOJ seems to believe they can write the law as they go along, to suit whatever prosecution they want, but legal scholars and the guys who wrote the Constitution say otherwise. This is especially revolting when we consider the untold number of deaths caused by the original steroid control act. 

 

Dr. Jekot’s charges, according to his lawyer, were meant to send a message; that message was loud and clear to the sentencing judge. Dr. Jekot was handed the maximum sentence of five years. This stands as one of the longest given to any doctor for steroids. Most (non-doctors) mixing steroids in their home and selling them online have gotten shorter sentences. Dr. Jekot was sentenced to more time than nearly all of the 100+ defendants swept up in Operation Raw Deal, the government’s largest steroid bust ever. The principals involved in BALCO, when added up, received less time than Dr. Jekot. And let’s not forget, this sentence was given to a doctor for attempting to save lives (and succeeding, according to official records).

 

Conviction notwithstanding, Dr. Jekot’s work represented a solid foundation on which Dr. Dullnig was able to build upon and develop his own protocol. But while geographic fate allowed Dr. Jekot to be found by both Vergel and Dullnig, the two latter remained mutually unknown to each other. Even without the internet, the gay community were nonetheless able to widely disseminate anabolic steroid information. Most practical data came in this form, anecdotally, and by word of mouth. If you were an HIV-positive gay or bisexual male in the ‘90s, you knew about anabolic steroids, and that information was going to extend your life. But this was only circulating underground and was concentrated in parts of the country with higher gay and bisexual scenes. 

 

That all changed in October of 1993, when a bodybuilding magazine, Muscle Media 2000, published a letter in their “Open Forum” from a man calling himself Dr. X. The five-year sentence handed to Dr. Jekot had served to chill the brief window during which gay and bisexual men could freely ask doctors to write a prescription for anabolic steroids (and have a decent chance of success). Now, a doctor writing those prescriptions had been sentenced to five years in prison. The mysterious Dr. X appeared, seemingly out of nowhere, with specialized knowledge of steroids, but also with practical experience in using the drugs to reverse HIV-positive wasting. The letter, buried after a hundred pages dedicated to squatting, Sylvester Stallone’s training routine for “Demolition Man” and a review of weight gain powders, was Dr. Dullnig’s. It received more fan mail than anything the magazine had ever published (no surprise to anyone who’s seen “Demolition Man”). It also received more inquiries than any prior article. Dr. X answered every piece of mail and began writing a feature article for the magazine.

 

Again, his article appeared last (in a magazine which ran an anemic ~130 pages) but grew in both length and intensity. He railed against the medical establishment’s ignorance, not just about anabolic steroids, but about nutrition and resistance training. His first two articles earned him a regular column, titled X-erpts. As circulation increased, he leveraged that platform to not only educate, but to cast a net with which to gather more information. If you know or discover anything that might help HIV or catabolism, PLEASE LET ME KNOW, he implored.

 

Muscle Media 2000, despite being a cliché-laden bodybuilding magazine, had a rabid fan base. And even though it didn’t have the biggest circulation, its readers were incredibly proactive. They employed a staff that included some of the best minds in the steroid world. The author of the Anabolic Reference Guide owned and published the magazine. The author of the Underground Steroid Handbook was a regular columnist – and likely a man who knew more about anabolic steroids than anyone in the world (a statement he made to The New York Times, and with which chief medical officer of the United States Olympic Committee grudgingly agreed). Dr. Dullnig corresponded with them all, adding their names to an anabolic think-tank that included Dr. Jekot and Nelson Vergel.

 

While Dullnig had been able to replace 40 pounds that had wasted off, Vergel refined the protocol and gained 45 pounds (the original 20 he’d lost plus 25 more). But getting hands-on steroids proved almost impossible, as no doctor was willing to write him that prescription. Diagnosed in 1987, after likely being infected five years prior, his original doctor offered little more than, “You are HIV-positive: go home and take care of yourself.”

 

Then, after watching friends waste away from HIV, he decided to experiment with anabolic steroids. Seeking to educate himself on the topic, he bought every bodybuilding magazine he could find. At that time, most bodybuilding magazines were telling their readers to avoid using them (hypocritically relying on content based entirely around pictures of steroid-using bodybuilders). An issue of Muscle Media 2000 was among his purchases, and the final pages included a piece by the still-pseudonymous Dr. X. Vergel set about discovering his identity. Under different circumstances, this would be an impossible task.

 

But fate conspired to place them both in the Los Angeles area, and to each part of the same relatively small community. Two days of networking and phone calls later, Vergel was introduced to the man who, he agrees, took steroid use in HIV wasting from a crazy, fringe concept, to accepted protocol.

 

To prevent future hardship in contacting him, Dr. Dullnig began writing X-erpts under his own name. He was now risking his medical license by promoting anabolic steroids for HIV (a non-FDA-approved use) immediately after they had been made controlled substances. The column took an activist tone as he not only devoured studies and opened dialogue with their authors. When the maker of oxandrolone, began studying it for HIV, he complained to the principal investigator (the guy whose name appeared as the primary author upon publication). The doses (5 to 15 milligrams) were too low. Who cares if you add a few pounds of muscle, when HIV can make you lose 40? After speaking with the author of the study and the manufacturer of the product, future studies examined higher doses and the company released a 20-milligram pill instead of the 2.5-milligram version they’d originally released.

 

X-erpts intensified with each issue.No longer buried on the back pages, he commandeered the center of the magazine for sprawling six-page columns. He accepted no pay for this work, choosing instead to be “paid” in barter with protein powder. Realizing that most doctors would refuse to write a prescription based on non-approved use of controlled substances, he wrote about obtaining them illegally, chronicling a first-person narrative of his steroid-buying trip to Mexico. He railed against the government. He reviewed and rated drugs. Andriol (the expensive oral testosterone he used on his first cycle) doesn’t work. Megace makes you fat. Oxymetholone makes you tired. 

 

But only a few issues would pass with Dr. Michael Dullnig as a contributor on the masthead. On June 1st, 1994, the day he chose to end his life, he was promoted to Celestial Editor, the title under which his name appeared on the masthead thereafter; a fitting date as it now marks the start of Pride Month (*the article you’re reading was published shortly after World AIDS Day, 2020). Both the LGBTQ+ community and the medical community should be proud of his work. Although he didn’t survive long enough to see the changes he’d catalyzed, anabolic steroids are now generally and widely available for treatment of HIV-positive wasting. Much of this was made possible through groundwork laid in the final year of Dr. Dullnig’s life. Letters poured in following his death. What had previously existed as a network confined to the gay community and constrained by locality, was replaced by national advocates and activists, connected to the greater LGBTQ+ community along with sympathetic doctors and allies. The remaining Muscle Media columnists all began answering questions about steroids and HIV. The magazine interviewed Dr. Jekot and immediately hired Michael Mooney, the doctor and AIDS activist who authored the interview, as a full-time columnist. Congress, unfortunately, continued to ignore science and crafted more laws that wrongly criminalize anabolic steroids.

 

After Dr. Dullnig passed away, Dr. Mooney and Nelson Vergel finished and saw published the book he had begun in the final year of his life. As of 2012, it was in its fourth edition, and as of 2021 anabolic steroids remain viable front-line treatment for HIV-related wasting.

 

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