More and more, our society views winning as something more important than the game itself. Success in competition brings status, popularity and fame, not to mention college scholarships. Today's athletes are looking for an advantage over the competition that will help make them winners. Unfortunately, the adolescents of today are caught up in this high stakes competition frenzy. Because of this reality, teenage use of performance enhancing drugs is growing evermore popular.
Performance enhancing drugs can be regarded in four classes: androstenedione, creatine, anabolic steroids, and ephedra alkaloids. All of these drugs are available over the counter with the exception of the anabolic steroid class. Since 1994, these nutritional supplements are no longer controlled by the FDA. As a result, there is no control over their purity, efficacy, or distribution. In fact, most of these substances market themselves to the general public as "safe" and "natural."
Androstendedione (Andro) and its derivatives DHEA and 19-nortesterone are prohormones that convert in the liver to testosterone, and come in pill form. It is uncertain the amount of adolescent usage of these drugs, but most studies are quoting in the range of 2.5-5% adolescent usage. A few years ago, Andro was brought to the forefront when Mark McGwire broke the single season homerun record while using this supplement. Initial studies indicated that these drugs did not raise serum testosterone levels, but newer studies are noting that they do in fact produce that effect if taken in higher doses. Data is also present to indicate that serum levels of estrogens also increase with Andro.
Adverse effects include irreversible gynocomastia - the premature closure of growth plates - acne, hair loss, testicular atrophy and changes in personality, including aggressive behaviors. These behaviors can include "steroid rage" or "roid rage," an inappropriate intense anger response. Besides the abuse of this class of drugs, there is no reason to believe that addiction is not a possibility with certain types and amounts of dosages. From a legal perspective, all of these drugs in this class are readily available in nutritional supplement stores. Adolescent athletes have no trouble attaining these drugs. However, several governing bodies in the world of sports have banned their usage. These include the IOC (International Olympic Committee), NCAA, NFL, and NCAA.
Creatine, a protein, is a very popular nutritional supplement sold as fine white powder. It is important not to confuse this chemical with creatinine. This protein is synthesized in the liver at a rate of 1-2 grams per day. Creatine is also found in red meats and in some fish. Most individuals need about 2 grams per day. In our skeletal muscle, creatine plays an important role in the production of ATP. The goal of this nutritional supplement is to provide the muscles with large stores of creatine for maximal exertion. Far and away, creatine is the most commonly used nutritional supplement among high school athletes with usage around 10% of adolescent athletes. Most athletes believe it increases their performance and decreases soreness after strenuous workouts.
Adverse effects include weight gain secondary to water retention. GI distress is not uncommon. Increased cases of muscle tears upon maximal exertion have also been noted. The most concerning adverse effect is renal. Because creatine is a protein, it is known to raise serum levels of creatinine. The long-term effects of this response have not been studied in detail, but there certainly is the possibility of renal dysfunction. At a minimum, the athlete on this supplement needs to be well-hydrated.
The androstenedione class of prohormones and creatine need to be studied further. Despite some earlier study data, these classes of supplements will more likely be determined to be even more dangerous and usage by adolescent athletes should be strongly discouraged. In that the Andro class of drugs converts to testosterone in the liver, we have no reason to believe they are any safer than their predecessor, anabolic steroids.
Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Nationwide Children’s Hospital Sports Medicine is available to diagnose and treat sports-related injuries for youth or adolescent athletes. Services are now available in five locations. To make an appointment, call (614) 355-6000 or request an appointment online.