It is difficult to assess the effects associated with AAS due to numerous methodological shortcomings of many investigations. They include inappropriate sampling strategies, lack of adequate control groups, use of varying types, doses and length of administration of AAS, and the variety of techniques employed to evaluate the psychological and behavioral outcomes (Bahrke, Yesalis & Wright, 1990).
To further problems, most AAS used by athletes are obtained through the black market making its actual content uncertain (Bahrke, Yesalis & Wright, 1990). Samples of AAS found in the black market often do not contain the ingredients declared on the label (Walters, Ayers, & Brown, 1990).
The effects of AAS vary significantly depending upon the type and dose of AAS as well as for different individuals and situations (Yesalis, Wright, & Bahrke, 1989). It may be a serious error to overgeneralize the effects and potential side effects of specific AAS to all other AAS. Likewise, it may be also erroneous to assume the effects and potential side effects of certain steroid use in relatively large dosage and/or long duration will have the same effects and potential side effects at a relatively lower and/or shorter duration.
Some authors attempt to dramatize the dosages of AAS used by the athletes by drawing reference to the dose usually administered for specific diseased individuals. This is a misleading reference to judge athletic dosages, since AAS are often used in varying dosages for different purposes. For example, Hurley, Seals, Hagberg, Goldberg, Ostrove, Holloszy, Wiest, & Goldberg (1984) explain that Oxymetholone (Anadrol) was used by one subject in an average dosage of 87.5 mg/day. They point out that this dosage is 5.8 times than usually administered for androgen deficiency. The subject's dosage was approximately 1 mg/kg body weight per day. The actual recommended dosage for children and adults is 1-5 mg/kg body weight per day for a minimum of 3 to 6 months (Physicians Desk Reference, 1993)! Conversely, it is difficult to extrapolate the potential side effects of a certain steroid therapy on medical patients, or even a "normal" population for that matter, to a given athletic population.
Yesalis, Wright, & Bahrke (1989) state;
"Some members of the sports medicine community have, with the best intentions, adapted a conservative strategy and used strong, but often unfounded, pronouncements regarding the adverse effects of AAS. Athletes, on the other hand, have simply not witnessed long time AAS users 'dropping like flies'. This aggressive health education strategy does not seem to have had a major impact on use of AAS and has very likely added to the lack of credibility of the sports medicine and scientific communities in this area. For over 2 decades it was denied (and still is by some) that AAS enhance physical capacities or performance. Athletes were told, until 1984, that any weight gained while taking AAS was merely the result of fluid retention and that any strength gain was largely psychological (a placebo effect)."
Furthermore, Yesalis, Wright, & Bahrke, (1989) point out all of the effects of AAS have been demonstrated to be fully reversible within several months following cessation of use; except changes in myocardium which has not been followed. Although, it has been argued that the long term effects of chronic AAS use can not be determined with current data. An epidemiological investigation has been proposed to study the long-term effects of AAS. The study costing approximately $1 million was approved but was never funded.
Some experts believe legislation against drugs in sports will only increase an already thriving black market and organized crime (as what has already began to occur with AAS) (Di Pasquale, 1992b). Traditional drug education has been ineffective. The use of drugs will likely continue, especially if the incentives associated with winning remain so high (Di Pasquale, 1992b; Landry & Primos, 1990).
Di Pasquale (1992b) proposes;
"Education, an anti-prohibitionist stance, and extensive, realistic, and knowledgeable medical input and monitoring would make a substantial difference in how and when drugs are used. The result would be fewer short and long term side effects (both due to excessive use of these compounds and to contaminated or dangerous black market drugs), less crime and violence, and likely, in the long term, a decrease in the overall use of performance-enhancing compounds."