Not all steroids use is abuse

Not all steroids use is abuse

OK readers, it's time for a pop quiz on biology. Stop whining. You've probably done some recent reading on the subject, whether you intended to or not. (Who hasn't Googled human chorionic gonadotropin?) Besides, it's only one question. I'll even make it multiple choice. But this is going to be 100% of your grade, so think carefully.

Circle the correct answer:
a) Steroids weaken muscle.
b) Steroids build up muscle.

Let's check with the experts. First, Dr. Robert Shmerling, Clinical Chief, Division of Rheumatology at Beth Israel Deaconess Medical Center.

"Steroids can weaken muscles and increase the risk of infection. They can also cause weight gain from fluid retention and fat build-up," he says.

So why don't we see a bunch of bloated, flabby steroid users, you ask? We asked Dr. Abraham Morgentaler, Associate Clinical Professor of Urology at Harvard Medical School and male infertility specialist at Beth Israel Deaconess Medical Center, to step to the plate and answer that one.

"An increase in steroids can help you lose fat, build muscle and, to some extent, bone. Our bodies couldn't work without them," he says.

Holy contradiction, Batman! Looks like everybody gets an "A." You see, our bodies manufacture a bunch of different compounds classified as steroids. Hormones like testosterone, estrogen, progesterone are well-known steroids. But did you know that cholesterol is a steroid, too? The kinds of steroids Dr. Shmerling deals with most often function quite differently than the anabolic steroids we hear so much about.

"Corticosteroids have powerful anti-inflammatory properties. They are often used to treat diseases such as asthma and some forms of arthritis," Dr. Shmerling explains. "Cortisone is a common and well-known steroid that physicians have used quite successfully in an injectable form to treat tendonitis, bursitis and arthritis."

Corticosteroids also suppress the immune system and are often administered to patients who have undergone an organ transplant to decrease the chance of rejection.

However, before you start thinking that corticosteroids are good and all others are bad, keep this in mind: If it weren't for the granddaddy of all anabolic steroids, boys wouldn't be boys.

"Testosterone is necessary for development of male genitalia. In adolescence an increase in testosterone produces facial and body hair, enlargement of the larynx and an increase in muscle tissue. It's all a normal process," says Dr. Morgentaler. "The athletes we hear and read about are trying to increase their muscle development with massive doses of anabolic steroids often not even meant for human use."

When you've got levels 20-50 times what the body can produce, somebody is going to notice. But Dr. Morgentaler has been investigating the health effects of low testosterone in men, which often goes overlooked. In his book, Testosterone for Life, he estimates that low T levels may affect 20 percent of men over the age of 50. Symptoms include a lack of sex drive, low energy and general irritability.

The condition is generally treated with a testosterone gel that is usually applied to the arms or shoulders and normalizes levels. Professional golfer Shaun Micheel received a therapeutic use exemption for the transdermal gel from the PGA after he was diagnosed with low T levels. As more men become aware of the condition, Dr. Morgentaler believes that testing for testosterone levels will become as common as another steroid test -- cholesterol screening.

As for the recent jokes about Manny Ramirez getting in touch with his feminine side, Dr. Morgentaler has prescribed human chorionic gonadotropin (hCG) to men before, but only to deal with infertility and address issues of low sperm production.

I know Manny was producing at the plate before his 50-game suspension. Any other numbers, I'm not privy to.

Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of The Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.