The Medical Minute: Beware anabolic steroid use in sports

June 17, 2008

By Matthew Silvis

Anabolic steroid abuse in sports has recently garnered much attention from the press. The Mitchell Report's investigation into anabolic steroid and human growth hormone abuse in Major League Baseball and the admitted use by several high profile athletes have led to renewed interest amongst parents, coaches and physicians.

Anabolic steroid abuse in sports is not new. Originally used by ancient Greek athletes, recent estimates suggest more than 3 million Americans are abusing anabolic steroids. Anabolic steroids are abused by a wide variety of athletes from children to older adults. While pediatric data is scarce, children and adolescents who abuse steroids typically also suffer from other high risk behaviors such as substance abuse, depression and low self esteem. In adolescents, anabolic steroid abuse has been reported in 3 to 12 percent of males and 0.5 to 2 percent of females. One study of high-school football players found anabolic steroid abuse in 6.3 percent of players with an average first-time use at 14 years. Ten percent of abusers began at ages less than 10. Anabolic steroid abuse in community gyms and health clubs has been reported in 15 to 30 percent of patrons, mostly for cosmetic rather than sports performance reasons.

Anabolic steroids are synthetic derivatives of the hormone testosterone. They are used to build muscle mass. Anabolic steroids are administered by mouth, injection or by absorption through the skin. Typically, athletes will use anabolic steroids in cycles of four to 12 with a four-to-six week "drug holiday." They tend to use mega-dose steroid regimens ("pyramiding" or "stacking") and typically abuse a host of other muscle-shaping drugs in addition to anabolic steroids. Athletes abuse anabolic steroids in an effort to gain a competitive edge -- the old adage: bigger, stronger, faster.

There is little doubt that steroids work with proven increases in strength and fat-free muscle mass. However, anabolic steroids are not without risk. First and foremost, they are illegal to use unless prescribed by a physician for an actual medical indication. Illegal possession can result in prison time and fines. Anabolic steroids cause a whole host of side effects. In fact, 88-90 percent of athletes abusing anabolic steroids will experience at least one minor side effect such as acne, injection site pain and skin stretch marks. However, anabolic steroid abuse can cause far more alarming side effects. Men suffer with infertility and swelling of the breasts. Women develop masculinizing effects such as an increase in facial hair, voice deepening, decreased breast tissue, male pattern baldness and infertility. Some side effects reverse with stoppage, but others can be irreversible. There is data linking anabolic steroids to liver inflammation, heart enlargement and neuropsychiatric symptoms such as increased aggression. In children and adolescents, anabolic steroid abuse can cause growth plate closure in bones and resultant limb shortening. Long-term health risks are largely unknown.

Education is the cornerstone of prevention. Athletes, parents and coaches need to recognize that young athletes are abusing anabolic steroids in worrisome numbers. Caregivers need to ask about possible anabolic steroid abuse during office visits and sports physicals. With education, many young athletes have been shown to reject anabolic steroid drug offers from peers. Discussing side effects of anabolic steroid abuse and alternatives to becoming more competitive (maximizing nutrition, developing sports specific skills) have been shown to be quite beneficial and will assist in keeping sports drug free.

Matthew Silvis is assistant professor of department of family and community medicine and orthopedics and rehabilitation at Penn State Milton S. Hershey Medical Center.

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Last Updated March 19, 2009