but that is not the only thing that impacts the brain in athletes.

Today’s article is co-authored by Dr. J.F. Clark, Professor of Neurology and Dr. O. Choutka, Chief Neurosurgery Resident, University of Cincinnati.

Mild traumatic brain injury, and concussion, is high in the public consciousness right now because of several articles concerning high profile athletes being found to have chronic traumatic encephalopathy or CTE. The CTE is generally diagnosed after these people have died and has largely and exclusively been attributed to their playing of sports and having diagnosed or undiagnosed concussions. Here is a discussion of CTE, first “discovered” in football players in 2002 The first 1 min 40 seconds is a tribute to the Late Senator Byrd.

 They speculate that 20% of boxers might get CTE based on pugilistic dementia numbers, but 9 out of 9 football players studied had CTE. It appears that modern athletes who are prone to taking anabolic steroids and getting shots to the head are more prone to CTE.

 Lets discuss the general aspects of CTE. The observation of CTE tends to be made when an athlete has personality changes, aggressive behavior, attention issues, and inability to focus on a job or task. After a person suspected to have CTE dies the final diagnosis is made by examining the brain for plaques and protein changes in the brain. Therefore, CTE can only be diagnosed after death. These personality changes are also seen with anabolic steroid abuse.

 Note at 20 min 20 seconds they dismiss anabolic steroids. Anabolic steroids alone are not known to cause that type of pathology. That is clearly stated and not refuted. However, there is information concerning brain protein pathology with steroid use:

 Lets first be clear that the evidence that anabolic steroids ALONE cause CTE is not at issue here. Anabolic steroids are a nuclear receptor mediated signaling agent that amplifies nuclear signals. Athletes who take anabolic steroids see no muscle growth benefits if they are not working out. But if they combine steroid abuse and vigorous exercise many metabolic signals involving muscle growth are amplified. More protein is synthesized and the muscles get larger and stronger.

 There is a component of “damage” that occurs to muscle with many types of exercise. Eccentric exercise causes muscles to leak enzymes such as lactate dehydrogenase and creatine kinase and these are known to be elevated post exercise. These muscles respond with extra protein being set down inside and outside the muscle cells. Anabolic steroids for muscle are purported to accelerate healing – but as many say – at what cost. Notwithstanding there is a preponderance of literature that supports the thesis that anabolic steroids are more active with injury.

 The brain is not muscle. But the brain’s nucleus has steroid receptors and the brain can be injured. Some of the things that occur with CTE is that the cell’s have extra protein, tau protein, around them. There is a build up of extracellular protein and that there are plaques in and around brain tissues. This is distinctly different than what happens in muscle, but can be associated with signals coming from the nucleus. Remember muscle is not the brain, so different responses to steroids are expected.

 Synthesis of circumstantial evidence.

CTE may have been seen in 1 in 5 boxers many years ago – before the disease had it’s new name.

A majority of modern athletes tested in the anabolic steroid era have CTE.

Anabolic steroids alone with no injury or stimuli have fewer effects on the body’s muscle etc.

It is not known if anabolic steroids in conjunction with concussion or mTBI may lead to increased incidence of CTE.

 We believe that the increased awareness on concussion and mTBI is laudable and important public health issue. But we also want to call attention to concomitant illicit and legitimate compounds that may be contributing to some of the data that is making national news. Avoiding steroid abuse may abrogate some of the  incidence of CTE.