The use of drugs in sports is so pervasive that most athletes must use drugs if they wish to remain competitive (Di Pasquale, 1992b). AAS use is an extremely secretive behavior to many, perhaps due to it being thought of as cheating by many sports federations and much of the public (Yesalis, Wright, & Bahrke, 1989). In order to make sports competitions fairer, most sporting federations have instituted drug testing programs (Di Pasquale, 1992b). Despite these efforts, drug use has not necessarily declined (Di Pasquale, 1992b; Landry & Primos, 1990). At present, all that has been achieved is a decrease in the use of some drugs by some athletes (Di Pasquale, 1992b). Athletes have learned to avoid detection by various methods and will continue to do so despite more sophisticated and comprehensive testing. Many athletes have simply altered what drugs they use and when they use them (Di Pasquale, 1992 a, b).
One of the most common methods of escaping detection when using anabolic steroids is simply discontinuing the use of oral AAS several days prior to a drug test. Oral AAS, such as Anavar, Winstrol (tablets), and Dianabol, are usually undetectable 3 to 4 days after cessation. Injectable steroids usually have a much longer detection interval. Metabolites of nandrolone have been found in the urine of some athletes after 2 years it was reportedly last used. Stanozolol (Winstrol-V) has been detected in the urine of an athlete 4 months after cessation of its injection (Di Pasquale, 1992a). Oral AAS metabolites can be cleared from the body in only fourteen days after discontinuing use and are therefore more commonly used when drug testing is a concern (Council on Scientific Affairs, 1988). Incidentally, many oral AAS are more highly associated with liver abnormalities and adverse psychological changes (Council on Scientific Affairs, 1988; Bahrke, Yesalis, & Wright, 1990).
Athletes have used various methods before drug testing to either decrease the excretion of banned drugs or prevent the detection of these drugs in the urine. Compounds that have been used to decrease the excretion of unblock steroids and their metabolites include uricosuric agents (e.g., probenecid, carinamide, sulfinpyrazone, phenylbutazone, benzbromarone), corticosteroids, estrogens, oral contraceptives (containing norethindrone), Depo-Provera, phenytoin, pyrazinamide, dexamethasone, and apple cider vinegar. Compounds used to prevent the detection of banned drugs in the urine include various diuretics, Defend, and chemical contaminants such as sodium hypochlorite, and bacteria. Defend acts by both decreasing the excretion of the drug and by diluting the urine (Di Pasquale, 1992a).
Case studies have been used to study drug detection techniques on athletes who self-administered anabolic-androgenic steroids (de Boer, De Jong, van Rossum, & Maes, 1991).