A Quiet, but Dangerous Habit

Illegal steroid use by Olympic, college, and professional athletes often makes the news, but the abuse of these drugs by teenagers has received relatively little attention. What's most troubling is that the health dangers can be especially devastating for teenagers.

"Adolescence is a critical time in the developmental maturation process," explains Jacques Carter, MD, MPH, of Boston's Beth Israel Deaconess Medical Center. "While the risk of long-lasting and sometimes irreversible negative health effects is present in anyone who abuses anabolic steroids, this risk may be further amplified in teenagers who abuse these substances."

What Are Anabolic Steroids?

Taken as a pill or as an injection, anabolic steroids are derived from and mimic the effects of the male sex hormone testosterone. Both men and women naturally produce testosterone, although women make very small amounts.

In males, testosterone's role in the body is two-fold. First, it maintains the reproductive system, including production and maintenance of the male sexual characteristics (eg, deeper voice, greater amounts of body hair, larger body size, and greater muscle mass). Second, for a short period of time at the onset of puberty, testosterone production rises dramatically to stimulate the bulk of the physical maturation process. This involves full bone growth, deepening voice, and growth of facial hair.

It is this ability to promote muscle growth, increase lean body mass, and decrease body fat that entices teenagers to take anabolic steroids. Those striving to improve their strength, speed, and stamina often see steroids as a quick way to pushing heavier weights and looking better.

Side Effects

Unfortunately, the high doses that are necessary to affect these body changes come with health dangers. Teens are at risk for accelerated puberty and skeletal development that leads to irreversible stunted growth.

Anabolic steroids can produce several adverse side effects in men and women of all ages, including:

• Acne
• Swelling of ankles and feet
• Jaundice
• Reduced high-density lipoprotein (HDL or "good") cholesterol
• Increased low-density lipoprotein (LDL or "bad") cholesterol
• Painful joints
• High blood pressure
• Liver damage
• Increased susceptibility of ligaments, tendons, and muscles to injury
• Mood swings, including uncontrolled anger and aggressiveness, extreme irritability, paranoid jealousy, and impaired judgment stemming from feelings of invincibility
• Possible development of psychological dependence on anabolic steroids
• Possible increased risk of cancer , heart disease , and/or heart attack
• Possible infection with AIDS or hepatitis if steroids are taken via injection with a shared needle

Some side effects specific to men include:

• Shrinking of the testicles
• Baldness
• Enlargement of the prostate
• Pain or difficulty urinating
• Reduced sperm count
• Impotence
• Development of breasts, often irreversible

Side effects specific to women include:

• Overall masculinization, including the growth of facial hair and a deepening of the voice
• Changes in menstruation cycle (menstruation stops or is reduced)
• Enlargement of the clitoris
• Reduction in breast size

Black Market Sources and "Stacking"

Because most anabolic steroid users acquire the drug via the "black market," they may receive impure or tainted steroids. This presents many health risks, including HIV infection. Another health concern stems from the practice of "stacking," which involves taking several types of steroids at once to enhance the effects. These combinations multiply the dangers.

Risky Business

Anabolic steroids do have medical uses, such as treating people who can't produce enough testosterone due to medical problems. Steroids can also help to rebuild strength in those who have lost a lot of muscle due to cancer or surgery. The levels of hormone prescribed in these case, 1-5 milligrams per day, are generally much lower than those taken for athletic gains.

Teens who abuse anabolic steroids often know about the dangers, but are driven by a desire to be bigger, stronger, and better than their peers. These athletes need the support of friends, parents, and coaches to avoid the traps of steroid use. They also need to be encouraged to reach their goals naturally.

In addition to steroids, there are other performance-enhancing substances that are abused by teens. A thorough investigation into the use of all substances should be undertaken if there is a significant level of suspicion. The American Academy of Pediatrics has published position papers on the subject, including guidelines for pediatricians and parents.

In addition to steroids, there are other substances that teens abuse to enhance their performance. More research is needed to find out how these substances affect teens.