What are the short- and long-term risks?

Creatine's short and long-term risks:
If the possible increase in muscle mass from creatine use is due to an increase in water inside muscle cells or fibers, this may cause dehydration to the rest of the body. If dehydration occurs, and athletes are working in conditions of high heat and humidity, heat stroke and possibly death could result. These conditions of high heat and humidity can result from rubber or plastic suits, saunas, or superheated wrestling rooms. These conditions are further exacerbated when athletes, such as wrestlers, are trying to lose weight.

Nausea and stomach upset are short-term risks of creatine use for some athletes. Concerns have been raised about an increased occurrence of muscle cramping, sprains and strains in those using creatine supplements.

Information about the risks of creatine supplementation for more than one year is not available at this time. There appear to be no well-controlled trials of this length. Thus, one of the great risks of creatine supplementation is that the long-term risks are unknown. Also, there is the tendency of athletes to take more than the recommended doses, believing that if the recommended dose is good, more will be even better. Research is not available on larger dosages of creatine.

Concerns have also been raised about possible long-term or permanent suppression of the body's production of creatine in the liver, pancreas, and kidneys. The higher intake of creatine has been shown to suppress the synthesis of creatine by the body.

These and other concerns prompted the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports to recommend funding for research on the "physiological effects of creatine other than performance." Grants have been awarded for one year studies to the University of Kansas, Pennsylvania State University and Georgia Institute of Technology. The studies should be released in August of 1999. Depending on the preliminary results, longer studies may be planned. Stay in touch with the NCAA to obtain the results of these studies. http://www.ncaa.org

Androstenedione's short and long-term risks:
Few controlled studies on androstenedione are available. One recent study, conducted at Iowa State University, shows that the use of 300 milligrams of androstenedione per day over an eight week period lowered the so-called "good" cholesterol which protects against heart disease. The supplement was also found to increase blood serum estrogen, one of the female sex hormones. (June 2. JAMA, 1999; 281:2020-2028c) www.ama-assn.org/sci-pubs/journals/archive/jama/vol_281/no_21/ci80062a.htm

The synthesis of androstenedione into estrogens may result in the enhancement of female characteristics in both males and females (such as breast enlargement), as well as other side effects such as an increased risk of heart disease and pancreatic cancer.

The conclusion of these researchers was that "androstenedione supplementation does not increase serum testosterone concentrations or enhance skeletal muscle adaptations to resistance training in normotestosterogenic young men and may result in adverse health consequences." Other researchers have noted that this study was conducted on young men who were not already involved in weight resistance training. The results may be different among conditioned athletes, or at dosages larger than those taken during the study.

Since androstenedione can be synthesized into testosterone, one can probably assume that the short-term and long-term risks are similar to other androgenic-anabolic steroids. Anabolic-androgenic steroid use can affect the liver and the cardiovascular system as well as the reproductive system. Liver function can be damaged, resulting in jaundice, blood-filled cysts, and tumors (including those that are cancerous). Blood cholesterol levels often increase because steroid use changes how sugars and fats are handled. This and increased blood pressure can lead to the early development of heart disease, which can increase the risk of heart attacks and strokes. For males, production of naturally occurring hormones, like testosterone, may be decreased. This may result in shrinking of the testes, low sperm counts, and infertility. Because anabolic-androgenic steroids are derivative of male hormones, female users may take on more male-like characteristics, such as broader backs, wider shoulders, thicker waists, flatter chests, more body and facial hair and deeper voices. The clitoris may enlarge and menstrual cycles may become irregular or stop. Steroids may also affect muscles and other parts of the musculoskeletal system. Tendons and ligaments may not strengthen at the same rate the muscle tissue develops. As a result, these tissues appear to be injured more often among steroid users. Also, for adolescent athletes, steroid use may cause the growth plates in long bones to close faster than usual, which can result in lower height. Oily skin and acne are also common among steroid users. Some users experience dramatic mood swings. Anxiety, irritability, aggressiveness, and impulsiveness may occur.

Evaluation by the Food and Drug Administration
Most nutritional supplements have not been evaluated by the Food and Drug Administration (FDA). Because creatine and androstenedione have been categorized as nutritional supplements, they have also not been closely evaluated. Although the manufacturer of a nutritional supplement must provide sufficient information (in FDA-specified format) about the composition of the product, manufacturers and distributors do not need to register with FDA or get FDA approval. Thus, there can be a difference in the composition of various creatine supplements. Some investigations of supplements have shown that the actual ingredients are not in the amount they claim to be. One investigation found that the actual ingredients in several supplements, including a creatine product, deviated significantly more than 20% from what the product actually claimed. The creatine supplement claimed to contain 6.0 grams per serving. The test revealed 2.25 grams per serving.