Steroids and Kids: A Troubling Trend

WebMD Live Events Transcript

Steroid use and abuse is nothing new, but with the Olympic Games in the news this year, the issue is in the spotlight again. For parents of teen athletes, it's a reminder that the lure of being bigger, faster, and stronger is powerful. We looked at the strong argument against mixing kids and steroids when we welcomed Linn Goldberg, MD, on Aug. 19, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome, Dr. Goldberg. Just how widespread is the problem of kids and steroids?

GOLDBERG:
There are increasing amounts of use of anabolic steroids and other so-called performance-enhancing supplements in middle, high school, and college athletes, in the United States, emulating many professional and Olympic sports participants. This is nothing new. For hundreds of years, athletes have taken various drug mixtures trying to improve their athletic performance.

MEMBER QUESTION:
Where are kids getting this stuff? Are steroids dealt like street drugs?

GOLDBERG:
Steroids are usually obtained by kids from body builders or weight lifters in local gyms. Often these substances will come from Mexico or the Internet. Most recently, over the past two years, a steroid ring of high school students was broken up in Utah, and another one last year in Arizona.

MEMBER:
I have to disagree about where kids are getting the steroids. The majority of body builders do not deal directly to younger kids. The risks are entirely too high to make the small amounts of money from them. I feel the majority may come from the Internet, as you said. I am sure you're aware that the production of pure powders in Asia is easily finding its way into America.

GOLDBERG:
When surveyed, most kids say that they get their drugs from local distributors. Often those distributors are at the local private gyms. They are people who may approach the kids, or the kids approach them. I agree that the Internet is a readily available source for these substances; however, that does not negate the fact that many kids report getting anabolic steroids from local gyms. Rarely do they obtain them from a physician or veterinarian.

MEMBER QUESTION:
So they could be taking something that's not even manufactured with any standards or safety controls?

GOLDBERG:
Yes, that is true for nearly all supplements. The DSHEA Act of 1994 excludes the FDA from analyzing supplements that are sold in your local stores. Thus, it is truly, "May the Buyer Beware." Ephedra is a prime example. It took many deaths, heart attacks, and other adverse events to finally ban that substance after years of use and very dangerous consequences. The International Olympic Committee did a study that involved supplements in the United States. They found 18% of supplements were spiked with true anabolic steroids, although the label did not show them as containing these substances. So in the United States, because of this law, it is definitely buyer beware.


"When surveyed, most kids say that they get their drugs from local distributors. Often those distributors are at the local private gyms."

MEMBER QUESTION:
What role do you think parents play in kids using this stuff? I've seen some pretty rabid parents in the sports stands.

GOLDBERG:
Parents are and can be a powerful influence for using and not using these substances. Their influence tends to decrease as children mature. However, steroid users believe, either rightly or wrongly, that their parents are more accepting of their use of anabolic steroids. Anabolic steroids are different than typical drugs of abuse, since they are pro-social, and they are not used to get high or drop out of society. A few of the ways they can be used include:

  • To gain a position on a sports team
  • Gain a scholarship
  • Enhance physical performance
  • Gain a professional contract

So these substances are different, and this pro-social effect may mean that parents are unknowingly influencing their children to use them.

MODERATOR:
Do parents who push their children to excel at sports contribute to the problem then?

GOLDBERG:
Yes, I believe that parents who have unrealistic expectations of their children's performance are, in part, responsible for the overemphasis of sports among children in those that are in athletics, in middle, high school, and collegiate level.

MEMBER QUESTION:
What about all that body-building powder and pills they sell at GNC and other places? Can those be harmful to teens?

GOLDBERG:
There are many powders and substances available to teens. In a study we did, about three quarters of the athletes were taking some supplement to try to improve their performance. Because such supplements are not regulated, we don't really know what is in some of them. In a number of studies, what is listed on the label does not necessarily correspond to what is actually in that supplement. So certain supplements can certainly be harmful. If we can reflect on the International Olympic Committee study with 18% of supplements having true anabolic steroids in them, then these would be very dangerous for young athletes.

The subject of creatine often occurs among young athletes. Creatine, which is comprised of three amino acids, has never been studied among kids under the age of 18, and no studies have been lengthy; they are usually a very short duration of days to weeks. In these studies, there have been problems with elevations in markers of kidney function. We really don't know what creatine does to young athletes who use it for a prolonged period, so again, for all these substances, may the buyer beware.

MEMBER:
Creatine is most certainly not harmful if taken within reason and with proper hydration. And from all the documents and studies I have seen, andro will not increase testosterone levels in a teenaged boy.

GOLDBERG:
There is research demonstrating that andro certainly can cause an elevation in testosterone. At low doses this elevation occurs in females; at high doses there can be an elevation in testosterone, as well. Elevations in estrogen levels will be seen in males with low-dose use of andro. Most of the supplements that were tainted, seen by the International Olympic Committee, were supplements containing nandrolone and that is probably why many of the NCAA athletes caught for steroid use over the past few years had nandrolone identified in their specimens.

MEMBER QUESTION:
But could that not just be due to a direct conversion to estrogen? And how about males who are already in reference range?

GOLDBERG:
No studies have been performed with very-high-dose androstenedione; however, with very high use, it is most probable that testosterone will increase among males who are in reference range. Yes, it is a direct conversion to estrogen, and estrogen is increased among males with low-dose use of andro.


"In a study we did, about three quarters of the athletes were taking some supplement to try to improve their performance."

MODERATOR:
Has anyone ever shown that these hormones actually improve an athlete's abilities?

GOLDBERG:
I think the overwhelming data and information from the athletic community is without question, these substances work, from local weight lifters to those who have abused at a collegiate, professional, or Olympic level. You can see today athletes who have used or been accused of using these substances in the past, many of them did not make the Olympic team, even though they held national and/or world records very recently. Ben Johnson, in the 1988 Olympics, is the poster child for enhanced performance by anabolic steroids. When he came back cleaner, his performance significantly decreased. Again, when he took anabolic steroids a second time, his performance improved, until he was caught and banned for life.

MEMBER QUESTION:
Don't athletes with drug-induced ripped muscles get injured more easily? I seem to remember a baseball team a few years ago whose members got injured frequently because their muscles were no longer flexible due to drug use.

GOLDBERG:
I don't believe muscle and flexibility have much to do with the injuries. I believe it may have to do with adaptation of the tendons in bones secondary to rapid muscle growth and strength. Athletes improve their muscular strength, endurance, and power, more slowly and there is time for the tendons and bones and those insertions to adapt to the increasing strength and load placed on their body. A rapid change of increased strength does not allow the tendons and bones to adapt as well. I believe that is the main reason for the increase in injuries claimed by these athletes.

MEMBER QUESTION:
You mentioned ephedra. Do you really feel that the use -- not abuse -- of ephedra is all that harmful? Last year alone there were more deaths from over-the-counter cold medications with the primary ingredient acetaminophen.

GOLDBERG:
The small community of people taking ephedra is the difference between acetaminophen and other substances. Ephedra use (especially in sports supplements), coupled with exercise, makes the supplement doubly dangerous. That's because adverse effects are compounded when you exercise, which increases adrenaline naturally, then supplement it with another adrenaline-like substance, such as ephedra. So for someone who is overweight and exercising, that makes this a much more potent and dangerous substance. The marketing of ephedra heightened the danger; it used a vulnerable target audience to reap profits -- and didn't inform them of the dire dangers of the supplement when used during physical activity.

MEMBER QUESTION:
What are the health consequences of this trend? Can't steroids make you sterile? Are we producing a bunch of mules here? Strong animals with no ability to reproduce?

GOLDBERG:
You are correct that for males, anabolic steroids are a form of birth control. One of the side effects of using anabolic steroids is shrunken testicle. The return of normal testicular function may take months after stopping anabolic steroid use.

MEMBER QUESTION:
Is there any steroid product out there that can be taken responsibly and safely by a young person, with the oversight of a doctor?

GOLDBERG:
Unless they're used to replace the testosterone a young male is not producing on his own, the answer is no.

MEMBER QUESTION:
What exactly is the danger of raised testosterone?

GOLDBERG:
There are a number of problems that exist, and they're both physical and psychological. For girls, it includes:

  • Facial hair
  • A deep voice that will not revert back after use
  • Increased body hair
  • Enlarged clitoris

For boys, it may include:

  • Female breast enlargement
  • Shrunken testicles

For both boys and girls it can be:

  • Severe acne
  • Loss of hair
  • Liver abnormalities -- this includes a problem called peliosis hepatitis, which are blood-filled cysts that can occur and do not show up on laboratory evidence of liver functions.
  • Increase in the harmful LDL cholesterol and a decrease in the healthy HDL cholesterol
  • "Roid" rage, which are angry outbursts or uncontrolled aggressive behavior
  • An increase in blood clots, due to coagulation disorders
  • High blood pressure

MEMBER QUESTION:
Can't some of this damage be reversed through other supplements?

GOLDBERG:
Certainly certain other hormones and substances can counteract the adverse effect of other hormones, such as the use of anabolic steroids and the use of HCG to increase testicular size. The problem and fallacy of those arguments is that you're using other drugs and hormones to try to alter the effects of excessive hormones taken by an individual. You are really playing with Mother Nature in your body's normal output of hormones. You do not know the consequences of all these drugs that you're using to try to counteract the drug you are abusing.

Again, it is your right to do this, but you should beware of the very unhealthy consequences that you are perpetrating on yourself or others when you advocate this pharmacy approach to either looking better or achieving better performance.

"For males, anabolic steroids are a form of birth control. One of the side effects of using anabolic steroids is shrunken testicle."

MODERATOR:
There has been much discussion about the lack of good studies regarding the use of hormones. Many studies in the past were flawed or sponsored by those with vested financial interests. The one thing we have learned is that we must be extremely cautious in the use of hormones.

GOLDBERG:
You make a good point. The study of hormones and their effects on the human body takes many years and many subjects. For those who say the use of anabolic androgenic steroids are not harmful, you can look at the use of estrogens, which have been studied in large randomized trials for decades; it is only recently that we have learned that the reported benefits thought to be due to estrogen replacement are not in actuality, occurring, and that use of estrogen even at physiological doses, includes risk.

Use of anabolic androgenic steroid hormones, at extremely high pharmacologic doses that at times exceed 100 times the daily dose, will certainly have adverse effects, as we know just simple replacement doses also have these adverse effects. Fortunately, or unfortunately, no responsible institutional review board will allow a study that looks at the extremely high anabolic steroid use that is used by athletes today.

MEMBER QUESTION:
Aside from the physical dangers and the legal issues, isn't there a moral issue -- that using these things is cheating?

GOLDBERG:
Use of performance-enhancing substances, like anabolic steroids, is cheating. It's similar to taking a test knowing the answers ahead of time. You're not only cheating fellow competitors, if you're on a team you're also cheating your teammates by enhancing your performance, potentially taking the place of a more skilled teammate who is not using steroids.

MEMBER QUESTION:
With the pros and the Olympians under suspicion of using drugs, how can we expect high school kids looking for college scholarships to refuse anything that might increase their chances?

GOLDBERG:
You make a good point. Role modeling is important; however, most Olympic athletes do not use performance-enhancing drugs. It's up to the coach, coaching staff, parents, and the ethics of the school and team to influence a student to use or not use these substances.


"Use of performance-enhancing substances, like anabolic steroids, is cheating. It's similar to taking a test knowing the answers ahead of time."

MEMBER QUESTION:
Which high school sports are most prone to drug use? And which drugs are associated with which sports?

GOLDBERG:
Most of the studies have shown that high school football would probably be the highest in use of anabolic steroids, although no sport would really be free of their use. There hasn't been a comprehensive study of different sports to determine which drugs are used for which particular sport; however, a few are notable in the Olympics. Use of beta-blockers is prominent with shooters, that is, those who shoot with a rifle, and those who participate in the biathlon, which is skiing and shooting. These substances slow the heart rate so the athlete can time their shot between the beat and not have as rapid a heartbeat, which could interfere with their aim. The use of stimulants is present in almost all sporting activities.

MEMBER QUESTION:
What kind of signs should we be looking for if we suspect steroid or other supplement use?

GOLDBERG:
For girls:

  • Facial hair
  • Deepening voice
  • Increase in acne

For boys and girls it may include:

  • More aggressive behavior
  • A change in personality
  • An increase in weight and muscle that occurs fast -- such as a male athlete gaining 30 to 40 pounds over the summer
  • A preoccupation with the weight room

MEMBER QUESTION:
Can you explain the "Atlas" and "Athena" programs developed by your department? Do these programs work to curb use?

GOLDBERG:
The Atlas and Athena programs were sponsored by grants from the National Institute on Drug Abuse; its aim is to reduce anabolic steroids and other substances of abuse by teenage athletes.

Atlas reduced new steroid use by more than 50%, reduced alcohol and illicit drug use, improved nutrition behaviors, and reduced the desire to using anabolic steroids. More importantly, Atlas reduced drinking and driving by 24%. Athena, which is a newer program, has shown similar changes, with improvement in nutrition behaviors -- so important for adolescent female athletes. The risk of adolescent substance abuse is related to body image and use of unhealthy dietary habits; Athena was able to curb those unhealthy activities while reducing substance abuse, as well. Atlas has been honored with the Department of Health and Human Services award, and received the exemplary award from the U.S. Department of Education. These are gender-specific programs that have been shown to work.

MODERATOR:
Dr. Goldberg, any final words for us?

GOLDBERG:
It's important to know that since 1995-1996, use of anabolic steroids has increased 39% among eighth-graders, 67% among tenth-graders, and 84% among seniors in high school. A couple useful web sites for further research:

  • www.steroidabuse.org
  • www.usantidoping.org
  • www.hormone.org/learn/abuse.html

And our web sites:

  • Atlas: www.ohsu.edu/hpsm/atlas.html
  • Athena: www.ohsu.edu/hpsml/athena.html

MODERATOR:
Thanks to Linn Goldberg, MD, head of the division of health promotion and sports medicine at Oregon Health & Science University in Portland, for taking time to share his expertise with us.



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