Performance-enhancing substances have been used for thousands of years in traditional medicine by societies around the world, with the aim of promoting vitality and strength. The use of gonadal hormones pre-dates their identification and isolation. Medical use of testicle extract began in the late 19th century, while its effects on strength were still being studied. In 1889, the 72-year-old Mauritian neurologist Charles-Édouard Brown-Séquard injected himself with an extract of dog and guinea pig testicles, and reported at a scientific meeting that these injections had led to a variety of beneficial effects. However, almost all experts, including some of Brown-Sequard's contemporaries, had agreed that these positive effects were induced by Brown-Séquard himself. In 2002, a study replicating Brown-Séquard's method determined that the amount of testosterone obtained was too low to have any clinical effect.
Testosterone, the most active anabolic-androgenic steroid produced by Leydig cells in the testes, was first isolated in 1935 and chemically synthesized later in the same year. Synthetic derivatives of testosterone quickly followed. By the end of the following decade, both testosterone and its derivatives were applied with varying degrees of success for a number of medical conditions. It was not until the 1950s, however, that athletes began to discover that anabolic steroids could increase their muscle mass. According to sports physician John Ziegler, the first confirmed use of an anabolic steroid in an international athletic competition was at the weightlifting championships in Vienna in 1954, when the Russians weightlifters used testosterone.
Throughout the 1960s and 1970s, the use of anabolic steroids was confined largely to the professional levels of sport. In the Eastern bloc, programs of training went as far as forcing some athletes to take anabolic steroids. In the United States, sports physicians, including Ziegler, and medical texts were still widely proclaiming that anabolic steroids were ineffective in helping athletes gain muscle. These doctors did acknowledge the usefulness of anabolic steroids for debilitated patients. The package insert for Dianabol, a common anabolic steroid used at the time, stated, "Anabolic steroids do not enhance athletic ability." Despite these warnings, use of anabolic steroids began in competition bodybuilding, in track and field events, such as the shot put, and in other sports where performance depended on muscle strength or speed of recovery during training.
At the end of the 1960s, Science published a study on the effects of Dianabol on athletes. This open label study, conducted by J.P. O'Shea and colleagues at Oregon State University, confirmed the muscle building effects of anabolic steroids on athletes that followed a high protein diet. Two years later, O'Shea replicated the results in a double blind design.
At the beginning of the 1970s, sporting organizations, including the IOC and NCAA, declared the use of anabolic steroids unethical, but with no effective means of testing athletes, the issue remained academic.