In Orlando, a 38-year-old contractor suffers from erectile dysfunction, a side effect of the drug he takes for depression. The anti-ED prescription his doctor gave him doesn’t help. He seeks steroids instead.
And in a town north of Seattle, an eighth-grade boy wants steroids for school sports. If he can get his weight up to 170, he thinks he can make the football team.
Here, from the business records of a Florida wellness center that was closed after a 2007 law enforcement raid, are the faces of the nation’s infatuation with performance-enhancing drugs – people who sought to buy steroids, human growth hormone and other powerful prescription drugs over the Internet to address deeply felt problems and concerns.
Since the BALCO steroid scandal broke in 2003, the national dialogue about performance-enhancing drugs has focused on high-profile athletes accused of using steroids to gain an unfair advantage in the hyper-competitive world of elite sports. Last week, New York Yankees superstar Alex Rodriguez went on national television to confess that he had used banned drugs, as Sports Illustrated first reported; two days later, former American League Most Valuable Player Miguel Tejada pleaded guilty to lying to Congress about a teammate’s steroid use while with the Oakland Athletics. That focus on celebrity athletes and banned drugs is likely to intensify March 2, when former Giants slugger Barry Bonds, baseball’s all-time leading home run hitter, is scheduled to go on trial in San Francisco, accused of lying under oath when he testified he had never knowingly used steroids.
But computerized records reviewed by The Chronicle show that only a handful of the thousands of customers of the Palm Beach Rejuvenation Center, as this online clinic was called, were sports stars whose use of banned drugs might bring another multimillion-dollar contract.
Instead, the clinic’s customers were ordinary people with an array of medical, physical and emotional complaints – and faith that their problems would be solved if only they could obtain drugs that their own physicians wouldn’t prescribe for them.
“Is this truly the miracle I have been waiting on?” a Tennessee man e-mailed to the clinic in 2005. “And how long will it take to see results? And how much will it cost?”
The Palm Beach Rejuvenation Center was part of a network of online clinics and pharmacies in the southeastern United States that was targeted by the Albany, N.Y., district attorney for illegal sale of steroids and growth hormone. By law, the drugs can only be prescribed for valid medical use.
Often, the district attorney charged, physicians hired by the center wrote fake prescriptions to make Internet drug sales seem legitimate. Many prescriptions for growth hormone were written by a former dentist who had lost his license for fraud and incompetence, Florida state records show.
After the center was raided in 2007, the clinic’s top two executives and a physician who worked there pleaded guilty to drug-related felonies, according to a spokesman for the Albany district attorney’s office. They were among 14 people convicted of crimes in the prosecution of the network of pharmacies and clinics. Further prosecutions stalled in 2008 after an Albany judge dismissed charges against proprietors of an online pharmacy in Orlando that also was targeted, citing missteps by prosecutors. Today, the Palm Beach Rejuvenation Center is out of business.
For an inquiry into the who and why of the nation’s demand for steroids, The Chronicle reviewed six years of transactions and 66,000 customer records from the Palm Beach Rejuvenation Center, focusing especially on a sample of about 2,200 people whose contact with the clinic included detailed information about why they sought the drugs.
The Chronicle has withheld customers’ names out of privacy concerns.
Queries came from prospective customers in all 50 states and more than 30 foreign countries. Customers ranged widely in age, occupation and physical condition. There were soldiers fighting in Iraq and elementary school teachers in Middle America; police officers and firefighters; Hollywood stuntmen; pastors and physicians; retirees and schoolchildren. Two inquiries came from officials of the United Nations. One came from a lawyer for the U.S. Congress.
Obesity and sex problems were by far the most common reasons that customers cited for seeking the drugs.
Other people said they wanted drugs to improve at amateur sports; to recover from injury or illness; or to slow the aging process or otherwise improve how they looked. Although steroid abuse is associated with heart and liver damage, prostate cancer, depression and birth defects, few customers expressed misgivings about side effects or questioned the legality of obtaining prescription drugs online.
Experts who reviewed The Chronicle’s findings said the quest for performance-enhancing drugs reflects a modern “instant gratification culture” and a related urge for “magic fixes” to health problems, as Charles Yesalis, professor emeritus at Pennsylvania State University and a consultant on sports doping issues, put it.
Dr. Gary Wadler, a New York University medical professor and an official with the Olympic movement’s World Anti-Doping Agency, described the dynamic this way: “You aren’t happy with your body, you go get a drug and that can change it – obviously, things like exercise and nutrition are too slow,” he said.
Unfortunately, Wadler said, people run grave risks when they take powerful drugs without medical supervision – or, indeed, without medical need.
“I talk myself blue in the face, trying to explain to people that this behavior may be hurtful,” he says. “They say, ‘Oh come on, I take 15 pills a day and I’m doing great.’ ”
According to the records, customers heard about the center from magazine advertising, other steroid users, and, especially, from surfing the Web. Not every inquiry resulted in a sale.
But some customers spent thousands, encouraged by a sales staff that pushed steroids and growth hormone, as well as other prescription drugs to offset the side effects of steroid use.
In six years, the clinic filled $38 million worth of orders, the records show. Here, from the records, is a look at the ordinary people who made up the steroid clinic’s clientele.
No. 1: Obesity
Steroids – artificial testosterone – were developed to treat muscle wasting, while human growth hormone is prescribed for dwarfism in children. But as competitive bodybuilders long have known, the drugs also help the body burn fat, replacing it with lean muscle. Of the people whose records reflect their reason for seeking performance-enhancing drugs, 26 percent said they hoped to lose weight. Some said they were desperate to lose hundreds of pounds.
“I’ve tried all kinds of diets and they just don’t work for me,” wrote a 41-year-old man in Maitland, Fla. “I just weighed myself this past weekend. I’m up to 432 lbs.”
Men in Tallahassee and Long Beach had the same goal: “Lose 200 pounds,” they both wrote.
In the eastern Massachusetts town of Rochester, a 34-year-old man needed to shed 100 pounds.
“I work out hard four hours a day and results are very small,” he wrote.
“Can you please help me out with some testosterone? … I don’t want to die from over weight.”
Among them, too, was the Berkeley seminarian, who blamed her weight problems in part on a thyroid condition. “I currently weigh 310 pounds, and am considering this therapy as an adjunct to weight loss,” she wrote, saying she wanted growth hormone. She gave a detailed medical history, then broke off contact without making a purchase.
For some people intent on losing weight, the lure of steroids and growth hormone was a family affair.
“Me and my 14 yr old son and 16 yr old daughter want to join this,” wrote a woman in the central Iowa town of Newton. “My son weighs 280 at 14. Plz help him, mainly. I had the gastric bypass and lost my weight.”
Some said they had used steroids to control their weight in the past.
“In 1994, (I) lost close to 75 lbs in a very short time – three shots a week and a strict diet,” wrote a woman in Phoenix. “Gained some weight back, need to lose this.”
A handful of prospective customers weren’t obese at all. A Detroit-area man who said his percentage of body fat was 13 percent – far leaner than average, according to experts – wanted drugs to lose even more weight.
“Trying to get my body fat composition down to 9-10%,” he wrote.
“Currently train 3 days a week with a personal trainer with 3 additional days of cardio and weight training.”
A sense of urgency was reflected in some queries.
“I am 30 yrs of age and putting on weight really fast,” wrote a New Jersey man seeking growth hormone. “I am getting married next June and I want to burn off some of the fat ASAP! Can you help me out?”
As a man in Grand Rapids, Mich., put it: “I WANT IT OFF. I WANT TO BE A LEAN STUD AGAIN, INSTEAD OF A FATTY!!!”
No. 2: Sex problems
Steroid abuse has been linked to sexual dysfunction in men. Nevertheless, sex problems – especially erectile dysfunction and impaired libido – were the second most common complaint cited by people who sought steroids, 17 percent of the total. Many believed more testosterone would solve the problem.
“For sex I have (to) eat a bottle of Cialis, which doesn’t seem to work half the time,” wrote a man in Boonville, Ind., referring to the heavily advertised ED drug. “My doctor says I’m fine, go figure.” He sought testosterone supplements.
“My mind says yes but my body says no,” wrote a 71-year-old man in Bedford Heights, Ohio. He sought steroids that wouldn’t react adversely with his diabetes and hypertension medication.
At times, a mate’s dissatisfaction led to the quest for steroids. A man living in Austria wrote that he was on the verge of divorce because of an unhappy love life.
“I have to try something secretly that I can surprise her with,” he wrote. Occasionally the query came directly from the dissatisfied mate.
“Will it help my husband’s sex drive?” e-mailed a woman who didn’t provide the clinic with her home address. “Because he drinks a lot of beer and I think it interferes.”
Many customers had decided that their bodies weren’t producing a normal amount of testosterone.
“I don’t have a deep voice,” wrote a 23-year-old New Jersey man. “I have a very low sexual drive, and I’m very sensitive with no aggressiveness at all.”
Some sought steroids to counteract the effects of prescribed medicines.
A Minneapolis woman with “no sex drive” blamed the antidepressant drug Effexor; a man in Nashville blamed either his Prozac anti-anxiety medication or the Lotrel he took for high blood pressure. Other queries came from diabetics who blamed their dysfunction on insulin.
“As a man I feel lost,” wrote a diabetic man from Glen Burnie, Md.
Among them, too, was the Orlando contractor who blamed ED on his antidepressant meds. Over a three-month period in 2005, he bought $1,000 worth of human growth hormone and the injectable steroid Sustanon, along with syringes.
Some sought steroids for issues of sexual identity.
“My voice sounds like a female, I want to change it,” wrote a Middletown, N.J., man.
“I’m a transgender woman, not wanting to completely morph into a male,” wrote a woman in Brooklyn. She sought steroids for “body fat redeposit, less moodiness, less sensitivity, etc.”
In some cases, customers blamed steroids for their sexual dysfunction, according to the e-mails. A repeat customer from Dixon, Mo., complained of “no sex drive” and “nipple sensitivity” while cocktailing the bodybuilders’ steroids Winstrol and Deca-durabolin. Both are common side effects of steroid abuse.
“Get him on growth!” wrote the clinic sales clerk in a note on the account, suggesting the patient be sold human growth hormone instead of steroids. For the nipple problem, the clerk proposed the female anti-cancer drug anastrozole, sometimes used by male steroid users to counteract the development of female sexual characteristics.
Some were willing to run profound risks to overcome sexual problems. A Michigan man who suffered impotence after prostate surgery wanted steroids despite an explicit warning from his physician.
“Urologist seems to feel that testosterone is worst thing to take at this time as (the) grade of cancer I had seems to ‘feed’ off testosterone,” he wrote. Nevertheless, he said he felt it was safe to begin using steroids – he’d been cancer-free for 14 months.
No. 3: Sports
Athletes – most of them amateurs seeking an edge in sports they played for fun – made up 13 percent of the people who described why they sought steroids.
As The Chronicle reported in 2007, a handful of the clinic’s customers were major-league baseball players. They included pitcher Paul Byrd, who bought $25,000 worth of HGH while on the Atlanta Braves and two other teams, and outfielder Jose Guillen, who ordered growth hormone and steroids while playing for the Cincinnati Reds and Oakland Athletics. Another customer was former Giants star Matt Williams, who ordered growth hormone after he retired from the game.
But far more of the inquiries and orders came from amateur athletes – runners, cyclists, tennis players and, especially, bodybuilders.
“Just interested in getting huge in a short time,” wrote a man in suburban Chicago.
“Will it be able to turn me into a Greek god of muscle?” asked a 265-pound weightlifter from Nashville.
A New Mexico man who said he had already run seven marathons sought drugs so he could compete in an Ironman Triathlon.
“Forever young,” he wrote.
Athletes on the fringe of elite sports inquired.
A professional arm wrestler from Beebe, Ark., bought $1,200 worth of the steroids nandrolone and stanozolol in 2004 and 2005, records show.
Another inquiry came from a quarterback for the Soquel-Capitola Sharks of the Northern California Amateur Football Federation. “I will be taking injectable HGH,” he wrote. “I want to increase strength but I don’t care about getting too big. … I don’t want to grow breasts, either.” He didn’t make a purchase.
Some customers had Olympic dreams.
One was a former collegiate runner who has repeatedly tried to make the Olympic sprint team, most recently last year, at age 37. In 2001, he was banned from sports for two years after testing positive for steroids, records show. He ordered about $300 worth of growth hormone from the clinic in 2004, the year he was reinstated. “I want to be the world’s fastest human,” he wrote on his Web site.
A 46-year-old competitive cyclist from Santa Monica wrote that she was considering the Olympic trials because the ban on transsexual competitors had been lifted.
“I’m interested in HGH to help me compete,” wrote the woman. “I was born XXY chromosomally and (am) not your typical” transsexual.
A basketball referee in Pea Ridge, Ark., bought $2,300 worth of steroids. A football coach in Indiana inquired about growth hormone – one of 14 inquiries from people whose e-mail addresses indicated they were involved in coaching.
Then there was the query from the schoolboy in Snohomish, north of Seattle.
“I want to weigh 170 for football and wrestling next year,” he wrote. “And I want to be a lot stronger and faster.”
The note indicated the boy was 14. He was among about 150 prospects rebuffed because they were too young, the records show.
No. 4: Total rejuvenation
For some, steroids held out the prospect of recovering from serious injury or illness. For others, the quest for drugs was simply about looking better or younger.
People who said they had suffered serious injury or illness made up about 11 percent of the queries that specified why steroids were being sought.
“I was in the best shape of my life until about a year ago when a drunk driver hit me,” wrote an Akron, Ohio, man. A severe back injury left him unable to exercise. “Since the accident I’ve lost a good 15-20 pounds of muscle mass and gained at least 20 pounds of body fat,” he wrote. “While (I have) never tried enhancement products before I am in desperate need of help getting my life back.”
An Arizona woman also had an urgent concern – her 49-year-old husband’s chronic pain from tendinitis in shoulders and knees. But there was an additional concern – he suffered from “stage 4 primary bi-lateral cirrhosis of the liver,” as she put it. Would steroids further harm his liver?
Other queries came from women “in desperate need” of relief from menopause, as a Lehigh Acres, Fla., e-mailer put it.
“I am going through menopausal hell and all the doctors want to do is put me on antidepressants,” e-mailed a woman in Pasadena. “There has got to be another way!”
But more than 10 percent of the queries came from people who acknowledged they had no medical problem at all.
“Basically, I want to look good naked,” a Daly City man wrote.
“I would like to look good in my leather thong and chaps,” a Tacoma man wrote.
A self-described New York metrosexual wondered whether steroids would help him “maintain a younger fresher look to my face,” while a New Jersey man sought drugs to make him taller: “I am just too short for a professional look.”
“I would love to have my slim figure again after having a baby one year ago,” a Los Angeles woman wrote.
Others wanted growth hormone for its reputed anti-aging properties.
“I tried my normal physician and she blew me off by just saying ‘you’re getting older,’ ” wrote a Raleigh, N.C., man with a heart condition. “Needless to say this was not the answer I was looking for.” He bought about $2,800 worth of growth hormone and steroids, the records show.
A 92-year-old woman from La Brea (Orange County) volunteered to “be in a research program to see how long ‘I can be around,’ ” as she put it.
Other queries defied categorizing. A Southern California woman sought growth hormone to cure her son’s thinning hair. “His wife is against this,” she wrote. “She thinks the product is harmful.”
An Orange County business consultant with a new baby sought growth hormone “to increase breast milk supply,” she wrote. An Indiana farmer inquired about growth hormone for his “show animals (goats and sheep),” while a Denver man also sought growth hormone for his pet dog, which was “not growing tall enough,” he wrote.
A Louisiana man inquired about steroids to counter the effects of youthful steroid use. “During my college years of ball playing test(osterone) was used by all of the players,” he wrote. “And now years later I am experiencing side affects like sexual issues and joint problems.”
For clients, the clinic drew heavily on local people – 11 percent of the customers were from Florida. But nearly as many came from California (10 percent), and queries came from prospective customers in every state, and from around the world – South Africa, Bangladesh, Hong Kong, American Samoa.
Most customers didn’t describe their occupations. Those whose occupations could be identified ranged widely.
Ninety-one queries came from U.S. armed forces personnel, 21 of whom said they had been deployed to the Iraq war.
“U.S. Army soldier stationed in Iraq,” wrote a sergeant from Virginia. “I’m very active in sports and physical training. Local (physician’s assistant) recommended testos(terone) therapy.”
A soldier from Iowa wrote: “I want to build muscle pretty quick but do it in a healthy way. I am 19 years old and I have tried all kind of things ever since I have been here in Iraq.”
From Washington state, another soldier wrote: “While on military duty in Iraq we used test(osterone). Test(osterone) enhanced my physical abilities in the field, and noticed a feeling of well being … How do we go about this?”
Queries also came from police officers, deputy sheriffs and firefighters – although some were reluctant to acknowledge their ties to law enforcement.
In 2005, an Alabama man who said he worked in a bank inquired about nandrolone decanoate, a bodybuilders’ steroid.
“Very cautious,” the clerk wrote in a note on the file, and then later noted why. “He is actually a police officer.”
A customer from Biloxi, Miss., was described as a “28 year old cop … big-time loss of libido.”
Educators – from grade schools to colleges – also expressed interest. A third-grade teacher from Orlando sought steroids “for health, more sex appeal and to help slow down Mother Nature’s aging,” as she put it. Another Florida teacher had progesterone shipped to her elementary school in Boca Raton. An associate professor of psychology at the University of Southern California and a clinical instructor at the UCLA medical school inquired, as did a professor of food science at the University of Florida.
In all, the clinic got queries from more than 400 people using e-mail addresses from the nation’s colleges and universities, including Harvard, Yale, Princeton and UC Berkeley. Most were probably students.
More than 80 queries came from government employees from agencies including the Department of Veterans Affairs, the Federal Bureau of Prisons, NASA, the Department of Homeland Security and the Department of Justice.
Inquiries also came from U.N. officials, one in Amsterdam, the other in Jerusalem. “I am taking Sytropin HGH spray presently,” he wrote, referring to an ersatz growth hormone product sold on the Internet. “Can I take your product at the same time?”
An order also came from an attorney in the U.S. House of Representatives’ Office of the Legislative Counsel, which helps lawmakers draft bills.
In 2006, using her government e-mail account, she ordered $346 worth of growth hormone and testosterone. The records don’t reflect why she wanted the products.
About 9 percent of the queries came from prospective customers who wanted to know about potential side effects.
They included a Hollywood stuntman with a seizure disorder who wondered whether HGH would react adversely with his anti-convulsant medication.
By contrast, fewer than 1 percent were worried about legal consequences of using the drugs.
Among them was a Texas oil refinery firefighter who said he was subject to drug testing: Would steroids also trigger a positive test?
Meanwhile, some customers contacted the clinic to blame new physical problems on their use of the powerful drugs.
A pastor in Crystal River, Fla., complained of rapid heartbeat and flushed skin after using growth hormone and injectable testosterone. The clinic switched him to a testosterone cream.
After cycling through $1,800 worth of steroids and HGH, a 35-year-old New Jersey man reported he had been hospitalized with high blood pressure and elevated heart rate. He was ceasing steroid use, he said.
A Petaluma woman, meanwhile, contended that steroids had driven her husband into depression.
“He can no longer take nandrolone decanoate because it causes a change in his personality,” a clerk wrote in the file. “His wife is concerned he might do something drastic.”
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ScienceDaily (Feb. 3, 2009)
— Researchers at UT Southwestern Medical Center have uncovered crucial clues about a paradoxical disease in which patients with no body fat develop many of the health complications usually found in obese people.
The findings in mice, appearing online Feb 3 in Cell Metabolism, have led to the initiation of a National Institutes of Health-funded clinical trial to determine whether eating an extremely low-fat diet could prevent many of the metabolic complications brought on by lipodystrophy.
Lipodystrophies are metabolic disorders characterized by the selective loss of fat tissues and complications of insulin resistance. Scientists speculate that the condition could be caused by the failure of stem cells to become fat cells.
“These patients don’t have fatty tissue, even inside their abdomen,” said Dr. Abhimanyu Garg, professor of internal medicine at UT Southwestern and senior author of the study. “They basically lack all the fat we see in a typical person, but their livers are loaded with fat. That’s a big problem because too much fat in the liver leads to liver damage.
“We cannot do anything to reverse fat loss, but our findings might lead to the development of new therapies for the metabolic complications of lipodystrophy, such as diabetes, fatty liver and high triglycerides,” said Dr. Garg, an investigator in the Center for Human Nutrition.
Dr. Garg has been studying patients with lipodystrophies for more than 20 years. He and colleagues at UT Southwestern have led the way in identifying gene mutations responsible for several forms of lipodystrophy and in identifying novel therapeutic approaches for these patients.
In this study, researchers genetically engineered mice to lack a specific enzyme called AGPAT2, which is also lacking in humans with generalized lipodystrophy. Under normal conditions, AGPAT2 is involved in the production of fat in body fat cells. In 2002 Dr. Garg’s lab found that the AGPAT2 gene is mutated in patients with congenital generalized lipodystrophy.
“We generated this mouse model to learn why humans with this type of lipodystrophy develop metabolic complications,” Dr. Garg said.
The researchers found that mice without the AGPAT2 enzyme used a novel, previously uncharacterized pathway to synthesize fat in their liver. Dietary fat also contributed to fat accumulation in the liver. Typically, particles called chylomicrons carry dietary fat throughout the body and release it in peripheral tissues so that it can either be stored in adipose tissue for later use or immediately burned as energy by muscles. Normally, adipose tissue provides fatty acids for fat synthesis in the liver. In these lipodystrophic mice, however, the adipose tissue did not release the excess fatty acids and the dietary fat accumulated in the liver.
What is surprising about this, Dr. Garg said, is that the amount of fat stored in the liver dropped substantially when researchers put the lipodystrophic mice on a fat-free diet. “Just eliminating the dietary fat reduced liver triglycerides by approximately 50 percent,” he said.
In addition to establishing a clinical trial, Dr. Garg said the next step is to study the stem cells from the mice with lipodystrophy in order to determine why their stem cells become bone and muscle but not fat.
Other UT Southwestern researchers involved in the research were Dr. Victor Cortés, lead author of the study and postdoctoral researcher in molecular genetics; Dr. David Curtis, surgery resident; Dr. Xinli Shao, research scientist in immunology; Dr. Vinay Parameswara, instructor of internal medicine; Dr. Jimin Ren, instructor in radiology at the Advanced Imaging Research Center; Dr. Victoria Esser, associate professor of internal medicine; Dr. Robert Hammer, professor of biochemistry; Dr. Anil Agarwal, associate professor of internal medicine; and Dr. Jay Horton, professor of internal medicine.
The research was funded by the NIH, Southwestern Medical Foundation and the Perot Foundation. Dr. Cortés is supported by a postdoctoral fellowship from Pontificia Universidad Católica de Chile and a presidential fellowship from the Chilean government.