Smark Out Moment

Welcome to another edition of Smark Out Moment WRESTLING DOCTOR'S NOTES where we discuss medical issues that are either being reported in the wrestling world or generally afflict wrestlers. As always, please review the disclaimer at the bottom of the article.

This article is Part 2 of 2 in my discussion of WWE's Wellness Policy in light of multiple recent wellness policy violations. For an overview of the wellness policy and illicit drug testing in general, please take a gander at that article here.

I will be discussing "steroids" in this article: what we mean when we talk about steroids for athletic purposes, their history in sporting and wrestling in particular, how they are tested for, and what this all means for the WWE today. I hope you will find this article enlightening as there are a ton of misconceptions out there, many of which stem from not being given a basic foundation of what "steroids" are.

GETTING OUR TERMS CORRECT:

When we say "steroids" in reference to substances used to enhance one's physique and athletic performance, we really mean androgenic-anabolic steroids which is commonly abbreviated as AAS. These are just one group of the family of steroid hormones, many of which are made naturally in the body (in men and women) but can also be synthetic and taken in multiple forms. There are two major classes of hormones, peptide and steroid. Steroid hormones act by crossing into cells and interacting with the cell's DNA, altering what proteins the cell produces and how the cell behaves in general. As such, steroid hormones tend to have very broad and wide-reaching affects in the body. They affect multiple organ systems, their effects last longer, and they can potentially have permanent effects if they are kept at high levels for a sustained period of time. Many inflammatory conditions are treating with "steroids," and people commonly think these are the same as AAS. These medications are actually derivatives of glucocorticoids which are steroid hormones that have an anti-inflammatory property throughout our cells along with many, many other effects. These "steroids" are not the same as the muscle-building AAS.

Are you bored yet? Sorry, but it's important to have this straight before we move on. From here on out in the article when I say "steroids," I am referring to AAS.

AAS are synthetic derivatives of the male sex hormone testosterone. Being steroid hormones they have diffuse effects like other steroid hormones, but their major property is to promote male physical characteristics. The most sought after of these is a promotion of muscle mass. By just taking steroids and not changing any other activity, a person will have a general increase in muscular strength between 5% and 20% and will increase their overall muscle mass by 5-12 pounds. There is also a slight increase in the production of red blood cells and hemoglobin which could theoretically increase athletic endurance, but this hasn't been proven.

A sampling of various AAS in injectable form. Image courtesy of healthline.com.

NEGATIVE PHYSICAL EFFECTS:

Prolonged use of any steroid hormone has its consequences. AAS are no different. People who take steroids experience development/worsening of acne and increase in body hair. Perhaps counter-intuitively, males will have promotion of breast tissue and decrease in size of their testicles. The reason for this is complicated, but basically if the body is getting a ton of testosterone from a pill it decides it doesn't need to make its own. So you paradoxically have some féminisation of the male body parts on top of this.

Notice the small amount of breast tissue around the nipples in this otherwise muscular man. While this is not definitely proof of AAS use, it should raise one's suspicion for it. Image courtesy of Researchgate.

PSYCHIATRIC ISSUES:

Much attention has been given to the psychiatric effects of long-term steroid use. This is a difficult topic to pin down. People who abuse steroids in the first place often have an underlying depressive disorder and/or a tendency towards addictive behaviors to begin with. There is often a component of Body Dysmorphia, a group of conditions where a person is irrationally dissatisfied with their physical appearance and engages in negative behaviors to "correct" their perceived flaws. For these reasons, it's challenging to know how much of a steroid abuser's psychiatric issues are due to the AAS or a manifestation of their pre-existing problems. We do know that AAS promotes aggressive behavior and an increased sex drive, though this could be in part due to the person believing they are meant to act this way or being more confident in themselves. We know that prolonged use is associated with mood swings and that patients who stop taking AAS can have severe withdrawal symptoms that are heavily mood related. Similar to a women who recently delivered her baby and is having post-partum depression, suddenly decreasing levels of steroid hormones can send the brain into a deeply depressive state.

Chronic use of any of the steroid hormones can lead to mood swings including depressive, manic, or aggressive episodes.

Of note, AAS are a huge group of different drugs with variations in their chemical properties. As such, they have varying degrees of potency and effects. So not all steroids affect a person the same way and a given person may react differently to one steroid than another person will. The affects are dose dependent as well, so higher doses over a longer period of time are more likely to produce deleterious effects.

When it comes to professional wrestling, AAS have been implicated as a component that led to tragic ends of multiple performers. This includes Eddie Guerrero and Eddie Fatu, but none more famous than Chris Benoit. From the psychiatric standpoint, the grisly Chris Benoit murder-suicide has been linked to him using/abusing AAS. AAS were found in the Benoit home during the police investigation as well as within his bloodstream. One can speculate that prolonged AAS may have contributed to Benoit's mental state via psychiatric side effects of depression, mood swings, and potentially psychosis. While the majority of attention has been given to Chronic Traumatic Encephalopathy (CTE) as the root cause of Benoit's actions, it's hard to believe from a medical standpoint that AAS abuse didn't play a role.

Chris Benoit had a well documented history of AAS use for years.

TESTING FOR STEROIDS:

For a discussion of what we know about the WWE's policy on testing for AAS, please refer to Part 1 of this article series here. Of note though, is that virtually all athletic commissions test for AAS randomly on a a very short notice to the athlete/performer in question. Due to AAS requiring a prolonged usage period with multiple dosings, it is considered standard practice to not give the person much notice if they are going to be screened in order to more reliably determine if they've been abusing.

The history and details of testing whether someone is using synthetic or exogenous (meaning not made within the body) androgenic hormones is very complex. Historically, it has been extremely difficult to determine whether someone was using AAS because there are natural variations of male sex hormones between individuals, the measurable blood levels of the hormones peak and trough relatively quickly after they are taken (14-28 days within your system, but that's pretty short if you only get tested once a year), and the components that are excreted in urine vary quite a bit. Also, the illegal AAS industry is quite sophisticated and has produced numerous "designer" steroids over the years that are quite literally identical to endogenous (meaning made within the body) hormones and if taken appropriately can't be reliably detected by any drug screen. Reviewing the medical and athletic literature extensively, I honestly believe that if an athlete/performer was educated and cautious about it, they could get away with taking AAS even while being periodically screened.

That being said, most people who get caught either leave a paper trail, aren't clever with their dosing, don't buy the higher end drugs, or a combination of those factors. The current basis of testing for AAS use is measuring the ratio of a person's testosterone to epitestosterone via their urine. Epitestosterone is a naturally modified version of testosterone in the human body, and depending on a person's (mainly men, but somewhat women) balance between the two they will have differing amounts of male-associated attributes/maladies. For example, the ratio of epitestosterone has a role in whether a man will have male pattern baldness of prostate enlargement. Nearly all people (men or women) who aren't using AAS will have a T/E ratio - the ratio of testosterone to epitestosterone in their bloodstream - that is less than 6 to 1. Note that it is the ratio that matters and not the absolute amount. Women will have overall less androgenic hormones then mean and there is variation on the total hormone throughout the day, but the ratio within a given person is fairly constant. And when I say nearly all people, I mean that there are only scattered case reports of people who naturally have a ratio higher than this. When someone administers AAS to themselves the steroids that they have provided nearly always err towards the more potent epitestosterone effects. And because they are giving themselves hormones from the outside, their body doesn't make as much of it's own natural testosterone. This is why the ratio gets altered in people taking AAS. For the (extremely) rare person who naturally has a T/E ratio higher than 6, the standard is that if a person fails an initial screen that they are retested in a short time period to see if the result persists. This is explicitly how the WWE operates. There is also an option to test hair follicles as this is less affected by random variation and is considered less cumbersome, though arguable more invasive.

Standard urine testing is commonly used to screen for AAS use/abuse. Imaging courtesy of roidtest.com.

HISTORY OF STEROIDS IN WRESTLING:

It's easy for us to look back on athletes in the 1960s-1990s and judge them and their respective athletic commissions for their "backwards" views on steroid use. But we have to consider that we have the benefit of hindsight and the accumulated work and research of the scientists over many years since. Back then, steroids weren't seen to be as much of a problem as we know them be now. A "healthy" male was one who was muscular, virile, and maybe even had an aggressive streak. Taking steroids was seen by many as just a potent male supplement, augmenting what one already had within himself. Furthermore, the side effects just weren't known about because so many of them manifest years after prolonged use.

So prevalent was the use of AAS that - while not discussed explicitly or publicly - it was more of less assumed to be universal in some sports. It was virtually accepted by everyone that all bodybuilders were using AAS, even when various federations prohibited them. This prohibition was clearly put forth with a wink and a nudge as testing was hardly, if ever used. In his book Encyclopedia of Modern Bodybuilding which was published in the mid-1980s, WWE Hall of Famer Arnold Schwarzenegger has a chapter on steroids. It's actually refreshing to read a candid discussion of the topic from the man who was at the top of the bodybuilding world. Schwarzenegger affirmed that most if not all bodybuilders used AAS around that time.

Arnold's excellent book is worth your time if you can get a hold of it. It provides so much insight into a very bizarre world and does so in a succinct way.

With regards to the world of wrestling, there is evidence and stories of AAS use dating back to the territory days. Superstar Billy Graham is perhaps one of the most notable older performers who has admitted to steroid use during his time at the top, no doubt influenced by his experience in the world of bodybuilding. He would later become an anti-steroid advocate, although recently he garnered a lot of heat by recommending Kofi Kingston take steroids to beef himself up in order to appear as a more credible champion.

Looking at Billy Graham's physique with modern eyes it's pretty easy to be suspicious that he was using AAS. Image courtesy of roidvisor.com.

Conversations around AAS use have cropped up in the world of wrestling for years. But as the WWF began to become the mainstream entity it once was in the early 1990s, the issue became more public and contentious. The WWF was being marketed as entertainment for everyone, including children. And Hulk Hogan was being built as a superhero with huge appeal for the younger markets. Perhaps it is for this reason that Hogan's appearance on the Arsenio Hall Show in 1991 was such a landmark moment. Hogan was asked directly if he used steroids—which he denied, except for medically approved usage for healing muscles after injury including a prior biceps tear (side note: I'm not an expert on what orthopedic medical therapy was in the early 1990s, but this sounds like nonsense from a medical perspective). Hogan's response infuriated many in the pro wrestling world who called it out as a blatant lie. Much of the response was likely sour grapes towards Hogan's success, but this would be a harbinger of what was to come.

The WWF Steroid Trial of 1994 was one of the most significant events in the history of the WWF/WWE. Briefly, a ringside physician name George Zahorian was under the employ of WWF from 1984 to 1989. He was busted as part of a steroid ring in 1988 via a sting operation (not a Sting operation, I don't think he was involved) when he sold drugs to a former powerlifter who was an informant. Review of Zahorian's documentation showed that he had supplied AAS and pain medication to a number of WWF wrestlers and even Vince McMahon himself, with some invoices documenting delivery directly to the WWF headquarters. Ultimately McMahon was acquitted of charges due to a combination of uninteresting testimonies and multiple errors by the prosecuting team. One wrestler, Kevin Wacholz (Nailz), did state under oath that Vince McMahon had directly pressured him to use steroids and was supplying steroids to wrestlers. His testimony was weakened due to allegations by the defense that he had a "bone to pick" with McMahon. Perhaps his orange prison jumpsuit didn't help?

The most famous image of Vince McMahon in court during the 1994 steroid trial.

In 2007, a second steroid scandal rocked the WWE. The timing of the events is convoluted due to the nature of the scandal being centered around a national network of online distributors and multiple parties at play. In short, Signature Pharmacy in Orlando, Florida was the center of a steroid ring and was found to be producing and distributing AAS to multiple sites across the country utilizing online distribution and sales. Multiple WWE performers were ultimately found to be clients of the steroid ring including Randy Orton, John Morrison, Mr. Kennedy, Edge, Booker T, Rey Mysterio Jr., Santino Marella, William Regal, Umaga, Chavo Guerrero, and Funaki (freaking Funaki, what?!). Other performers who were no longer under the employ of WWE were also clients of the steroid ring, including the late Chris Benoit and Eddie Guerrero. Batista was also implicated as being a client, which he categorically denied. In response WWE met with investigators and eventually released a statement that they were doing an internal investigation and that any wrestlers who failed their wellness policy from November 1st, 2007 onward would be suspended and publicly announced. Ultimately, 10 performers were suspended.

WWE has most recently been in the news with regards to AAS in January 2018, when Roman Reigns was named as a client of a steroid ring run by one Richard Rodiguez. Rodriguez named Reigns as a client of his in an interview he took part of from prison. Reigns has denied ever knowing Rodriguez.

Roman just can't EVER catch a break can he? Image courtesy of proboards.com.

Other performers have intermittently been suspended for "wellness policy violations" over the last few years. As discussed in my prior article, that term is so nebulous and vague that it's not possible to know what these violations exactly mean. We can suspect quite strongly that wrestlers are still using AAS in the industry, but the culture of the industry nowadays likely makes this a much less common practice. In particular, the shift of focus from massive musclebound figures to more lithe and agile wrestlers likely is a major contributor to this. We can also attribute the increased attention given to negative effects of long term AAS abuse as a factor to their phasing out.

IN CONCLUSION:

Thank you for sticking it out to the end. AAS are poorly understood in general, and their history in the world of professional wrestling is a convoluted one. The very nature of the profession is to present larger-than-life superstars who perform feats that require great strength on a frequent basis. It's no wonder that so many wrestlers have used AAS over the years, as it could mean the difference between a mediocre versus a stellar in-ring performance or help them amp up their physique to get noticed. AAS are a short cut to be sure, but professional wrestling is a world of artifice and short cuts. For this reason AAS use for years was not only expected, but likely encouraged.

I'll end this with two quotes. The first is a quote by Scott Steiner from 2005 discussing the WWE Wellness Policy. Obviously, consider the source ... but I believe his statement is quite telling if true. "I told them to have Triple H pick me up in a limo, then we could go test together. They never asked again. I've never failed a drug test in my life. Their Wellness Policy is a political issue. A lot of people have addictions. And if they don't have the willpower to control it, that's when it becomes a problem."

The second is a quote from Superstar Billy Graham from a deleted scene from the 2010 documentary Card Subject To Change; Graham has become dedicated to anti-steroid education in his later years. The quote is one of many that he has said about steroids and professional wrestling in general. "Professional wrestling was conceived and continues to exist on deception. It has never been real. It will never be real. So therefore, when you're involved in a deception, a lie, that opens the door to every evil thing that could enter your business. Because you're deceiving people."

Let's hope that the future of professional wrestling is a better one, where AAS use continues to be discouraged and both the industry professionals and the fans push for performers with healthy, natural physiques.

Disclaimer: These articles are general discussions about medical topics/diagnoses. As we are not personally interacting with wrestlers and do not have intimate knowledge of their maladies, we cannot comment specifically on their medical courses unless information has been previously freely reported. These articles reference wrestlers as examples based on what is either reported by them or their companies, but what is said beyond that is only speculation based on the general course of a given diagnosis. Any information here should not be used for self-diagnosis. If you are experiencing medical issues yourself, I advise you to see a licensed physician for a full evaluation.

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