The use of anabolic steroids by professional athletes to enhance performance is a common media topic. According to a new study, the use of these substances begins in high school—and even middle school—by both boys and girls. Researchers affiliated with the University of Minnesota (Minneapolis, Minnesota) and Columbia University, New York, New York) published their findings on November 19 in the journal Pediatrics.
The researchers note that media images of men and women have become increasingly muscular, and muscle-enhancing techniques are available to teens. Therefore, they noted that the identification of populations at risk for unhealthy muscle-enhancing behaviors is of significant public health importance. They designed a study to examine the prevalence of muscle-enhancing behaviors and differences across demographic characteristics, weight status, and sports team involvement.
The study group comprised 2,793 diverse adolescents (average age: 14.4 years) who attended 20 urban middle and high schools. The majority of teens surveyed were poor or middle-class. The researchers assessed five muscle-enhancing behaviors: changing eating, exercising, protein powders, steroids, and other muscle-enhancing substances. They developed a summary score that reflected the use of three or more behaviors. The data was analyzed in regard to differences in each behavior across age group, race/ethnicity, socioeconomic status, body mass index (BMI) category, and sports team participation.
The investigators found that muscle-enhancing behaviors were common among the students for both boys and girls; however, most behaviors were significantly more common among boys than girls. Not taking gender into account, they found that 34.7% of the students used protein powders or shakes and 5.9% reported steroid use. When they adjusted the data for all variables (i.e., grade level, race/ethnicity, BMI category, and sports team participation), muscle-enhancing behaviors were commonplace. For example, overweight (odds ratio: 1.45) and obese (odds ratio: 1.90) girls had significantly greater odds of using protein powders or shakes than girls of average BMI. (The higher the odds ratio above 1, the higher the usage.)
Almost all of the students had engaged in at least one muscle-building activity in the past year, most often working out more to get stronger. However, up to one-third of them used what the researchers deemed to be unhealthy means to gain muscle mass, including taking steroids and other muscle-building substances or overdoing it on protein shakes, dieting, and weight-lifting. Student-athletes were more likely than their peers to use most methods of muscle-building; however, steroid use was equally common among athletes and non-athletes. In addition to steroid use, more than one-third of boys and one-fifth of girls in the study said they had used protein powder or shakes to gain muscle mass; 5-10% percent used non-steroid muscle-enhancing substances, such as creatine.
The researchers concluded that the use of muscle-enhancing behaviors is substantially higher than has been previously reported and is cause for concern. They recommended that pediatricians and other healthcare providers should ask their adolescent patients about muscle-enhancing behaviors.
Health impact of anabolic steroids:
Physical side effects:
Men: Although anabolic steroids are derived from a male sex hormone, men who take them may actually experience a “feminization” effect along with a decrease in normal male
- sexual function. Some possible effects include:
- Reduced sperm count
- Development of breasts
- Shrinking of the testicles
- Difficulty or pain while urinating
Women: Unlike men, women often experience a “masculinization” effect from anabolic steroids, including the following:
- Facial hair growth
- Deepened voice
- Breast reduction
- Menstrual cycle changes
With continued use of anabolic steroids, both sexes can experience the following effects, which range from the merely unsightly to the life endangering. They include:
- Bloated appearance
- Rapid weight gain
- Blood clotting disorders
- Liver damage
- Premature heart attacks and strokes
- Elevated cholesterol levels
- Weakened tendons
Special dangers to adolescents:
Anabolic steroids can halt growth prematurely in adolescents. Steroids close the growth centers in an adolescent’s bones. Closure of these growth plates is permanent; therefore, growth may be stunted to varying degrees.
Behavioral side effects:
Anabolic steroids can cause severe mood swings. These changes can range from bouts of depression or extreme irritability to feelings of invincibility and outright aggression (“'roid rage”).
Take home message:
The authors recommend that pediatricians and other healthcare professionals should be on the lookout for the use of performance-enhancing substances among teens. However, parents should be observant in this regard as well. All high school athletes will gain muscle mass by engaging in an athletic program; however, if behavioral changes such as mood swings or other suspicious behavior is noted, the parents should initiate a dialogue. One factor involved in children aspiring to perform better—at any grade level down to elementary school—is parental pressure to perform well. One only has to attend a weekend Little League or soccer game to observe examples of parental pressure. Thus, to varying degrees, parental pressure may increase the likelihood of the use of performance-enhancing substances.