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Steroids on Everest
The latest trend in mountaineering may be pushing climbers over the edge. By Ken Kamler, M.D.


Illustration: a pill inside a brain

"So, do steroids make you impotent?" I was not-so-casually asked by a climber as we sat together on an icy slope of Mount Everest at 21,000 feet (6,405 meters). At 19,000 feet (5,795 meters), another climber had asked me if steroids make you fat and give you pimples. Both used the same oblique approach to confess to me, the expedition doctor, that they were taking dexamethasone (commonly called "dex"), a steroid pill. Since those side effects generally come only with prolonged use, I told him that he'd still be virile and her that she would still be attractive. But while my answers seemed to reassure them, their questions left me more concerned than ever about what may be the most dangerous trend in climbing. Dex has evolved from a lifesaving tool that helps climbers get off the mountain safely, into a crutch that helps some get up it—and the mountaineers who choose to ease their way to the summit could end up paying with their lives.

LAST-RESORT REMEDY
Steroids have been used on the tallest peaks since 1969 as a temporary remedy for high-altitude cerebral edema, a life-threatening condition that afflicts some 2 percent of mountaineers each year. As altitude increases, the amount of oxygen in the air decreases. The brain, the body's most voracious baseline consumer of oxygen, is the first to feel the shortage and compensates by diverting more blood to itself. Capillaries engorge and begin to leak, causing the brain to swell.

Before long, the brain's outer layers—the cerebral cortex, responsible for thought and aggression control; and the cerebellum, responsible for coordination—get squeezed against the skull. Victims become confused and clumsy—deadly behavior on heavily crevassed slopes. An emergency dose of steroids can help to combat this inflammation by stopping the leakage from the capillaries, which, in turn, halts the swelling of the brain and restores clear thought and coordinated movement.

During a "house call" at Everest's Camp II in 1995, I treated a climber who could not manage to unzip his sleeping bag. In any case, he said, he wouldn't leave his tent without his girlfriend.

"Ricardo, who won the World Cup?" I asked.

"I did," he replied.

Three minutes after I administered a dose of dexamethasone, he was out of his tent, knew Brazil had won the World Cup, and remembered that his girlfriend was home in South America.

DEX'S NEW USE
Recently, some mountaineers have come to believe that if a one-time dose can improve a sick climber, steady usage can do wonders for a healthy one. Some climbers estimate that as many as 15 percent of their colleagues use dex prophylactically. A small group has even started to apply the same ethical argument to steroids that they do to another high-altitude climbing aid, supplemental oxygen, saying that both effectively "lower" the elevation of the tallest peaks and amount to unsportsmanlike conduct.

Unlike baseball players and other athletes who use steroids to reach levels of performance beyond their natural abilities, mountaineers take them to maintain their natural abilities in a highly unnatural environment. (In fact, ballplayers take anabolic steroids to build tissue, while dex, a catabolic steroid, breaks tissue down.) By using steroids before the onset of any brain swelling, climbers can keep their thoughts clear and motor skills sharp. They also get a slight euphoric jolt and, according to the results of a soon-to-be published Swedish study, added protection for their lungs at high altitude.

DANGEROUS EXPERIMENTS
But with increasing altitude, climbers might well require higher and higher doses of steroids to counteract the relentless brain swelling and to maintain a steady level of performance. The effectiveness of the drug may become blunted, or climbers might run out of dex altogether. Symptoms would then come on with a vengeance, and mountaineers who had been climbing on borrowed time would find themselves higher, colder, and more tired than they would have been had they relied solely on their natural abilities and fitness.

Every season on Everest, climbers are rescued, or not, after collapsing from exhaustion. I wonder how many of these collapses are due to steroids wearing off. My fellow physician and climbing partner, Geoff Tabin, M.D., (see "What Climbers Say," below) relates a haunting experience he had on Everest in 1988. Jozef Just was leading a four-man Czechoslovakian team attempting an alpine ascent of the difficult southwest face. Before the climb he asked, "You have drug for all-or-nothing?" Tabin gave him a supply of dexamethasone. The team pushed on through brutal weather, and Just summited, but all four died on the way down. Did they run out of luck or run out of steroids?

What Climbers Say

DANGEROUS CRUTCH? SAFETY NET? STEROIDS ARE ALPINISM'S MOST RECENT ETHICAL CONUNDRUM. BY MICHAEL BENOIST


Ever since Hillary and Norgay first climbed Mount Everest with the aid of bottled oxygen in 1953, the climbing world has debated what constitutes honest alpinism. Reinhold Messner describes his O2[How to make this subscript??]-free, light-and-fast alpine style as climbing by fair means, and Charles Houston, M.D., a foremost authority on high-altitude medicine, says the use of supplementary oxygen makes the 29,035-foot (8,856-meter) summit of Everest feel like a 22,000-foot (6,710-meter) peak. Today the debate over what constitutes fair play has been reenergized by the issue of steroid use. We asked four noted climbers, all Everest veterans, for their thoughts on the ethics, benefits, and potential dangers of steroid use at altitude.

Peter Hackett, M.D., 56, affiliate professor of medicine at the University of Washington in Seattle
"There's a rationale for using steroids on summit day when climbers need to be at their best mentally and physically. I don't recommend that climbers use them routinely, but if they weigh the benefits, many will decide that short-term steroid use is preferable to falling victim to cerebral edema. While I haven't heard of that many people using it preventively, I think that as more people try it, more people are going to say: "Oh my gosh, why haven't I used this before?" Your mind becomes clear; it's like waking up from a dream. In terms of ethics, it's not all that different from a diver who takes a seasickness pill on the day of an important dive. In both cases you are taking a drug to counteract the effects of your surroundings."

Geoff Tabin, M.D., 48, head of the medical committee for the American Alpine Club
"In mountaineering, it's easy to justify the means to the end. Steroids seem to make sense when you're close to the summit and want to increase your margin of safety. But it's easy to extrapolate that into people using drugs to go further than they should. The question is, Do steroids allow you to get into a potentially dangerous situation that you otherwise might not have gotten into? If you look back, climbers have a long history of using performance-enhancing drugs. Hermann Buhl, who soloed Nanga Parbat in 1953, took a cocktail of drugs, primarily speed, before his climb; so this trend isn't entirely novel. But how do we celebrate our ascents if climbers who we thought were breaking ground en route to the summit were just taking drugs?"

Peter Athans, 48, The North Face-sponsored climber, seven-time Everest summiter
"Climbers using steroids are experimenting on themselves in a very dangerous environment. We just haven't seen enough cases—or rather not enough people have admitted to using them—to know their full effects. But it's your health, it's your life and livelihood—so if you want to use performance-enhancing drugs, well then, as long as you're not endangering anyone as a result and you are being honest with the rest of the climbing community, why not?"

Sharon Wood, 48, first North American woman to summit Everest
"When I hear that people are using steroids to help them summit, my first thought is, Steroids! Boy, you have to be getting pretty desperate! But it's hard for me to criticize new technologies or drugs that make climbing Everest easier. Imagine what Sir Edmund Hillary would think if he saw the equipment I used to summit. Things were considerably easier for me in 1986 than in '53 when he climbed it. In the end, I think what you choose to use or not to use while climbing is a personal decision."

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Illustration by Jeff Soto


Additional Excerpts
From the print edition, June/July 2005

• Great Parks 2005: Super Tours, Spectacular Lodges
**Win a Safari: Find out how you could win a safari for two by participating in the Muddy Buddy race or attending the screenings of Emmanuel's Gift.
Steroids on Everest: Some climbers are using them to cope with altitude sickness, but at what price?
Guns 'n' Butter: Pulitzer Prize-winning author Philip Caputo talks about his new novel, Acts of Faith.
Pelton's World: Our man on the scene tells when to fight or take flight.
Croatia By Sea: Contributing Editor Jon Bowermaster's dispatches from sea kayaking along the Dalmatian Coast.
"Life's an Adventure" Reader Photo Album: See readers' photos and submit your own.


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