As baseball season kicks into high gear, the list of professional athletes called out for illegally using steroids continues to grow, fueling the series of scandals that hasn't left the media spotlight in months. As A-listers like Roger Clemens and Barry Bonds plead their cases, the use of anabolic steroid and other muscle-enhancing drugs by teenagers is being exposed throughout the country; and it's not just aspiring athletes who are taking them—it's also teens who just want to look like sports stars.
Anabolic steroids are synthetic versions of the male hormone testosterone, and when used in conjunction with weight-training, spur muscle growth. Using them without a prescription is illegal, yet they're easily accessible. The findings of studies to gauge how many teens take them are wide-ranging, but in 2005, the U.S. government's National Youth Risk Behavior Survey found that 4 percent of high school students tried anabolic steroids, which doesn't account for teens who used other performance-enhancers, like human growth hormone (HGH) and legal but potentially risky supplements like the hugely popular muscle-building supplement creatine. Alison Field, ScD, an epidemiologist in Children's Hospital Boston's Division of Adolescent Medicine, has conducted the largest study to date on adolescents' use of hormones and supplements; she found that one in eight boys and one in 12 girls said they'd used these products.
The dangers of anabolic steroids—including exposure to diseases like hepatitis and AIDS from needle sharing—apply to anyone who takes them. But in teenagers' already hormone-overloaded bodies, they can wreak havoc. Young women can take on male traits by growing facial hair, going bald and having their voices deepen. Young men can break out with severe acne, grow breasts, stop growing taller and their testes can shrink. More serious side effects may show up decades later, including heart and kidney damage and liver failure. And, of course, there's the much-publicized 'roid rages—fits of uncontrollable anger straight out of an Incredible Hulk rampage—that go hand in hand with steroid abuse, and from the hormone imbalance that happens when a user abruptly stops using them.
"The degree of side effects, including physical addiction, is proportional to the dosage and type of steroid and depends on the genetic propensity of the user," says Ximena Sanchez-Samper, MD, of Children's Adolescent Substance Abuse Program. "Therefore, it's impossible for anyone to predict what kind of side effects a teen might encounter. However, one thing is for certain. If a teen takes extremely high dosages of steroids for extended periods of time, he may never be able to re-establish natural testosterone production and might need to stay on low-dose testosterone replacement therapy for life."
Teens can also easily become mentally addicted. "Adolescents get positive reinforcement from friends or coaches who say how good they look—and the more they stack up on steroids, the more they see the results," says Sanchez-Samper. "They get so wound up in looking and feeling good about themselves, it's a really hard feeling to let go of." Steroids also take their toll emotionally, causing manic mood swings and extreme depression. "We see bipolar behavior, personality changes, and some patients even end up committing suicide just from the desperation of having their emotions run so wild," she says.
It's a sad irony of our time: As Americans get heavier, our obsession with looking the opposite grows too, creating a widening gulf between body ideals and what the average American sees in the mirror. "As a result of this discrepancy, I think many more people are extremely concerned about their weight," says Field. "And looking good has a huge influence on how people perceive themselves." In fact, a recent survey published by Jay Hoffman at the College of New Jersey showed just how far teens are willing to go for an ego boost. He found that of students in grades eight to 12 who admitted using anabolic steroids, 57 percent said they would take such a performance-enhancing pill or powder even if it meant it might shorten their lives.
"Teens tend to think they're bullet-proof, so they put health concerns on the back burner," says Lyle Micheli, MD, director of the Sports Medicine at Children's, pointing to another study that examined how much an educational video about steroids' health risks influenced watchers' decision to use them. After teens watched the video, the chances that they would try steroids actually went up. "They didn't hear the message about steroids' dangers; they only heard that steroids make you strong," he says.
Teens' willingness to chance dying early for cosmetic reasons is part of a troubling phenomenon that encompasses eating disorders, excessive exercise and use of other performance-enhancing drugs. "Kids aren't trying steroids like they try drinking or smoking marijuana," says Sanchez-Samper. "They're not trying to get high; they want to change how they look and feel." A surge of teen steroid use a decade ago was largely confined to young, male sports players who took them in hopes of gaining an athletic edge—but that has changed. "It isn't necessarily who you'd suspect anymore," says Micheli. "Teens take steroids because they want to have a sense of being stronger or leaner, and that becomes part of their identity."
Steroids do, of course, have legitimate uses. The fact that they're "prescription," rather than "street" drugs, leads some teens to think they're safer than they are. "Adolescents believe that steroids and other medications, because they can be prescribed by a doctor for legitimate medical purposes, aren't harmful," Sanchez-Samper says. "They justify taking these kinds of drugs by thinking, 'It's not that bad—I'm not a junkie. At least I'm not taking cocaine.'"
Another reason teens assume steroids are safe is that they're so widely and readily available. They can easily learn about and buy steroids online—but often from dubious sources that sell counterfeit versions tainted with impurities. Innumerable Web sites, filled with images of Herculean figures, offer explanations on what to buy and how to dose and inject, as well as reassurances of steroids' safety. Adding fuel to the fire is the fact that steroids are called "performance-enhancers" and "athletic aids." "This positive language adds to their glorification," Sanchez-Samper says.
Whereas most people are at least marginally aware of the dangers of steroids, nobody knows what risks come with legal, over-the-counter supplements because they aren't subject to the usual FDA approval process. That means that there are no government studies on whether dietary supplements work, what side effects they could cause or how they might affect certain users, like growing teenagers. "We don't even know what's really in the bottles that people are buying," says Sanchez-Samper. In fact, one of Micheli's colleagues recently did a study on supplements' ingredients and found that the labels could be flat-out wrong. "He found contaminants in almost 15 percent of 634 different nutritional supplements," Micheli says. "And sometimes those contaminants were actually anabolic steroids. They were the secret ingredient."
Field isn't worried about every item on health food store shelves, like protein powders and power bars. But she is concerned about the muscle-building supplements like creatine and supplements claiming to stimulate human growth hormone production. "We just don't know which are safe," she says. "There's this whole argument about not wanting to have drugs coming in from Canada or Mexico because we don't know what's in them. But here's this huge segment of products coming from this country that aren't regulated whatsoever."
Indeed, there are plenty of examples of how medications uniquely affect children and teenagers, even when they've been extensively tested in adults and approved by the FDA. "Look at what's happened with the depression medications," says Field. "They found that some may actually increase the risk of suicidal behavior in young people. And here are products that don't have to be evaluated for safety in anybody—and certainly not in teenagers. It's much riskier for them."
Since a culture shift big enough to solve these problems is unlikely, what can parents do? "First, don't assume that body image concerns just affect your daughters," says Field. "They also affect boys; people don't tend to listen to them quite as much."
It's important for parents to talk to their kids about the media images they're seeing, she says. "A lot of times, kids will make comments about their body image or someone else's. Parents should listen to those comments and help them try to understand what they think would be different if they looked a certain way. Why do they think their whole life would be different if they gained or lost 10 pounds?"
Sanchez-Samper agrees that education about the risks of these products, starting at home, is a good step. "Use every opportunity that comes up in the media as a discussion topic over dinner," she says. "Spend 15 minutes with your kid talking about the baseball player who was busted for steroids. Ask them what they think of it and use it as good a family teaching opportunity. In a time of having to say 'no' to harmful substances so much, never underestimate that they're listening to you."