It's hard to miss: Performance-enhancing drug use in America is out of control.
Many, but by no means all, of these drugs are anabolic steroids. In the body, they turn into the male sex hormone testosterone, boosting muscle growth and strength. Others include the blood booster EPO, human growth hormone, and insulin. The full list covers nine pages. All are safe when used, as intended, to treat illness. None are safe when used to improve athletic performance -- or, increasingly, when taken to improve one's appearance.
Illicit use of these medications isn't new. We've become apathetic about professional athletes' use of steroids and fashion models' use of stimulants. We're still surprised, but no longer shocked, to hear that elite athletes in world sports competitions are using state-of-the-art pharmacology to beat drug tests.
What may still spur us to action is concern for our kids. But if we're going to act, the hour is getting late. Use of performance-enhancing drugs is widespread -- and increasing -- among teens. Kids as young as10 are getting into the act.
"The latest figures are absolutely startling about kids using these drugs," Charles Yesalis, ScD, MPH, tells WebMD. Yesalis is professor of health policy and administration, and exercise and sports science at Penn State University. He's studied performance-enhancing drug use for more than 25 years. Among those he has served as a consultant to include: U.S. Senate committees, FDA, CDC, NFL Players Association, U.S. Olympic Committee, and the NCAA.
Younger and Younger Kids Use Performance-Enhancing Drugs
Why is Yesalis startled? In the late 1980s, his research team published a study in the Journal of the American Medical Association showing that at any one time nearly 500,000 kids had used steroids. Now anabolic steroids aren't something you take just once -- that would have no effect. Steroids are used in six- to 12-week cycles.
But that's not the scariest part. In June 2004, the CDC published its latest figures on self-reported drug use among young people. It's called the Youth Risk Behavior Surveillance or YRBS report.
"We had been looking at 1% to 2% of girls and 5% to 6% of guys who'd used steroids," Yesalis says. "Now the girls are over 5%. You are talking more than a million kids now. From 2001 to 2003, girls' steroid use went up 300%. Guys went up 20% or so."
And the kids taking these drugs are getting younger. Among 12th graders, 3.3% of girls and 6.4% of boys have used steroids at least once. But 7.3% of ninth grade girls -- and 6.9% of ninth grade boys -- have already been using these hormones.
Anabolic steroid use means that a child is flooding his or her body with a synthetic version of the male sex hormone testosterone. In boys, this has an array of ill effects. The effects of these performance drugs may be even more devastating in younger children. But in girls, the effects are even more harmful including menstrual abnormalities, deepening of the voice, acne, increased body hair especially in a male pattern, and enlargement of the clitoris.
"What is a concern is the predictable, long-term masculinization of girls and women," Yesalis says.
"There is a serious health issue," Farnaz Khadem, spokeswoman for the Montreal-based World Anti-Doping Agency, tells WebMD. "The use of performance-enhancing products is happening earlier and earlier. And a lot of these young people have no idea of what this is doing to their bodies. This is a real health danger."
Why are kids doing it? Some want to improve athletic performance. But many just want to look more like those slender, muscular people they see in movies and in magazine ads, says William Roberts, MD, president of the American College of Sports Medicine.
"There are a lot of kids at a high school level using steroids to increase performance, but a lot of them are just trying to look better," Roberts tells WebMD.
And where would kids get the idea that this is OK?
"It is not just a young person thing," Roberts says. "Look at all the plastic surgeons who are doing well. All kinds of people are nipping that and tucking this and getting implants to make their calves look better. A lot of people are dissatisfied with the way they are. Chemicals are one way to change that. Away from athletics, you see that going on everywhere."
How Widespread Is Doping?
Some say the performance-enhancing drug use is widespread throughout professional sports and elite athletic competitions. The recent allegations in the ongoing BALCO scandal (involving charges against four of America's most-beloved track-and-field stars) are just the tip of the iceberg, Yesalis says.
"This canard that there are only a few bad apples in the barrel is a subterfuge perpetrated by sports organizations. I've always argued that in many sports there are only a few good apples, and that the majority of athletes do drugs," he says. "Doping in sport is as big a secret as the army Jeep is a secret weapon. Anybody in sports knows about it. It has been epidemic since the last quarter of the 19th century. It is not debatable, it is a fact: Drug use cuts across all sports."
Others maintain that it's a relatively small number cheaters who give sports a bad name.
"Our view on that is the vast majority of athletes are clean," Khadem says. "It would be very discouraging to think this is systematic and everyone is doing it. It has always been there, it may always have been there. But the more people realize this is not right, the more I think people will be inclined to fight it."
Yesalis says athletes take dope because fans are addicted to ever-bigger thrills.
"The frustration is this is not going to change because fans don't care," he says. "I think what people are looking for is bigger-than-life people doing bigger-than-life things. Performance-enhancing drugs facilitate that. And that has made these sports and their federations multimillion-dollar operations."
Roberts, however, says athletes and sports associations must take responsibility.
"I have a hard time blaming the public. A lot of the public really doesn't understand how much drug use there is," he says. "It's like fighting in hockey. The NHL thinks they need fighting to draw the fans. But it is already a good, clean, fast sport with a lot of excitement. If you assume you need fighting, and don't change the rules to make fighting disappear, is the public to blame?"
A Question of Values
Doping raises another troubling question. If doping is cheating (and every expert who spoke with WebMD says it is) why is it so widespread? Don't our role models in sports know it's wrong? Don't we know it's wrong?
"A lot of us try to be more than we really are," Roberts says. "If kids grow up with having to be the best, they start looking for things that make them the best. And for a lot of kids, without drugs they will never be close to the best. Society has made expectations that everybody can be the best. But they can't."
Roberts and Khadem are very optimistic that full acceptance of the World Anti-Doping Code and more stringent testing will curb doping in professional and elite sports. They are hopeful that the current round of scandals has angered the public -- and scared sports officials -- so much that both will insist on this.
Yesalis remains skeptical about getting drugs out of elite sports in the near future. But he joins Roberts and Khadem in insisting that the long-term solution is to change the messages we are giving young people.
The only workable answer is parents doing the right thing. We have to raise kids with a strong moral foundation so they can make moral judgments whether to use performance enhancing drugs," Yesalis says. We need to infuse these values in a strong way. And the men and women who coach need to state, with as much intensity as in their pregame talks, that using these drugs gives only false glory and hollow victory. "
Roberts points out that positive examples speak louder than dire warnings.
"If we can get folks to say we have to stop doping at the elite level, it will trickle back down," he says. "When you look at younger kids' doping, it is monkey see/monkey do. People pattern themselves after actions more than cautions. They see pro athletes and world-class athletes using drugs and advancing, and say, 'If it is good enough for them, it is good enough for me.'"
The wrong thing to say, Roberts notes, is that performance-enhancing drugs don't work. They do -- but that's not the whole picture.
"Early on in our history, we said, 'These drugs don't work so don't use them.' That cost us a lot of credibility," he says. "Now we stress the health and ethical reasons they shouldn't be used. We promote good nutrition, good training, and healthy lifestyle. We really look down on the illegal or unethical use of drugs to enhance performance. It is just cheating."