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Performance-Enhancing Drugs: What Do the Docs Say?

Dr. Amanda Weiss Kelly from University Hospitals, Rainbow Babies & Children’s Hospital answers our questions about performance-enhancing drugs and health consequences for teen athletes.

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Q: What are performance-enhancing drugs?

Weiss Kelly: All substances taken to improve athletic sports performance.

Q: What are the most common performance-enhancing drugs used by teens and what do they do?

Weiss Kelly: Creatine is a naturally occurring substance in the body that is also sold as an over-the-counter supplement. Studies show that a Creatine supplement along with weight training may increase muscle mass in some people. Creatine is popular with athletes who participate in sports that require short bursts of power. It is legal and has been proven safe for adults; however, safety for teen usage has not been tested. Protein supplements, such as whey, can help athletes who are strength training to build muscle. Caffeine is used by many teens because it gives them energy and is readily available.

Q: Why do teens take performing-enhancing drugs?

Weiss Kelly: High school athletes competing for college scholarships feel considerable pressure to succeed. Wanting to improve their performance, they may feel that supplements will help them become stronger and faster. Teens participating in track, football and wrestling are often at a higher risk for using dangerous supplements. Bodybuilders interested in enhancing their physiques may find anabolic steroids easily obtainable in community gyms. Girls may take anabolic steroids to decrease fat mass and build muscle mass. Teens who are teased for being skinny may also be at increased risk for using performance-enhancing drugs or supplements.

Q: Can you define anabolic steroids?

Weiss Kelly: Anabolic steroids are supplements but not all supplements are anabolic steroids. Anabolic steroids increase muscle mass, speed and strength when used in conjunction with strength training.

Q: What are the psychological risks of using anabolic steroids?

Weiss Kelly: Anabolic steroids create many problems. The mortality rate of the people who use them is four times higher than average. (Anna Petersson, Drug and Alchohol Dependence 2006.) Anabolic steroid use can cause violent behavior, also known as “roid rage”. Moreover, individuals who stop using without the care of a doctor can experience serious withdrawal symptoms, such as mood swings, fatigue, loss of appetite, insomnia and depression. Some depressive symptoms associated with anabolic steroid withdrawal have been known to persist for a year or more after the abuser stops taking the drugs. Halting usage of steroids should only occur under the care of a doctor.

Q: What are the health effects of performance-enhancing drugs?

Weiss Kelly: Anabolic steroids can cause:

  1. Liver enzymes to rise, which can change the processing of other medications.
  2. Severe acne.
  3. Gynecomastia (breast development in boys).
  4. Bones to stop growing, so they’re particularly dangerous for teens who are still growing.
  5. An increased risk of liver cancer or other diseases.

The use of anabolic steroids can cause an increase in bad cholesterol, a decrease in good cholesterol and heart disease. Girls can experience facial hair growth and a deepening of their voice that will persist after usage has stopped.

Creatine can cause weight gain, nausea and muscle cramps. High doses of Creatine can harm the kidneys.

Q: Which performance-enhancing drugs can be purchased over-the-counter?

Weiss Kelly: Creatine, Vitamin D, whey proteins and DHEA. DHEA can be purchased over-the-counter, but it is prohibited in competitive sports because its side effects are similar to those of anabolic steroids.

Q: Are some supplements more dangerous than others?

Weiss Kelly: Ephedra and anabolic steroids are considered the most dangerous supplements for teens to use.

Q: How can parents identify if their teen is using anabolic steroids or supplements?

Weiss Kelly: Parents may notice a change in behavior, like increased irritability or an onset of acne. Also, because supplements are expensive, teens may ask for additional money, or money may inexplicably disappear.

Q: What warning would you give to parents regarding supplement use?

Weiss Kelly: Steer away from supplements that are not FDA regulated. If a supplement is not FDA regulated, all ingredients may not be disclosed on the label, so a supplement may contain ephedra or steroids without the consumer’s knowledge. The burden is on the consumer to know what ingredients they are ingesting. College athletes have lost scholarships because they tested positive for steroids that were added to other supplements.

Q: Are there any supplements that you would recommend for teens?

Weiss Kelly: Encouraging appropriate calorie intake and following a nutritious diet is the healthiest way for teens to achieve their optimum level of performance. Calories are necessary in order for a teen to build bone mass. Restricting calories can increase the risk of stress fractures or osteoporosis. Athletes looking to improve their performance may want to meet with a sports nutritionist or dietician to help them create a healthy performance diet. Also, it is important for teens to have enough calcium, a multi-vitamin and a vitamin D supplement. Vitamin D is important for bone density and bone health. Iron supplements can be helpful for distance runners. Teens using iron supplements should have their iron and blood counts tested regularly.

Q: How can teens deal with athletic pressures and competition in a healthy way?

Weiss Kelly: Participating in organized sports is important for teens because it teaches them how to compete and encourages a healthy attitude. Teen athletes are more likely to graduate high school and go to college, and they are less likely to become pregnant or do illegal drugs. That being said, the expectation for teen athletes should be to enjoy physical activity, improve concentration, be healthy, meet people, learn time management and become well rounded. The goal should not be to get a college scholarship. Parents should encourage their kids to have fun and enjoy playing sports.

Q: What can parents do if they suspect use?

Weiss Kelly: Parents should enlist the help of a professional—pediatrician, sports medicine specialist, psychologist or psychiatrist.