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Meeting Summary
Issue:
The 1999 results of the Monitoring the Future Study, which is an annual survey of drug abuse among adolescents across the country, showed:
- Increases in steroid abuse among 8th and 10th graders.
- In 12 graders, the percentage of students who believed that taking steroids causes health risks declined from 68% to 62%.
Problem:
Over time, abuse of anabolic steroids is associated with the following health risks:
- Increase risk for heart attacks and strokes.
- For those who share needles or use nonsterile injection techniques, risk for contracting dangerous infections, such as HIV/AIDS, hepatitis B and C, and bacterial endocarditis.
- Steroids also have gender specific effects.
- In males, reduced sperm production, shrinking of the testicles, impotence, difficulty or pain in urinating, baldness, and irreversible breast enlargement.
- In females, development of more masculine characteristics, such as decreased body fat and breast size, deepening of the voice, excessive growth of body hair, and loss of scalp hair, as well as clitoral enlargement.
- In adolescents of both sexes, premature termination of the adolescent bone growth, so that steroid abusers remain shorter than they would have been without the drugs.
Action
As an initial response to this problem, the National Institute on Drug Abuse (NIDA) sponsored "Science, Steroids and Youth: A Research Roundtable on Anabolic Steroids." The meeting fostered much discussion regarding the problem of steroid abuse while informing the public and scientific community about the development of effective prevention interventions for steroid abuse. This event not only allowed NIDA to address disturbing trends in steroid abuse and attitudes but also afforded us an opportunity to showcase some our best science in this area.
The speakers for the round table included Charles Yesalis, Sc.D., Pennsylvania State University; Marilyn McGinnis, Ph.D., Mount Sinai School of Medicine; Harrison Pope, M.D., Harvard University; and Linn Goldberg, M.D. and Diane Elliot, M.D., Oregon Health Sciences University. Following is a brief summary of their presentations:
- Dr. Yesalis discussed the historical perspective of anabolic-androgenic steroids (AAS) in sports and exercise. He described sources of anabolic steroids, coercion of athletes, and moral and philosophical concerns. Dr. Yesalis concluded with a discussion of the impact of social values on steroid use as well as healthy alternatives to AAS use.
- Dr. McGinnis followed this historical and epidemiological overview with a presentation of animal models of steroid abuse. Dr. McGinnis discussed the behavioral effects of anabolic androgenic steroids (AAS) in mouse models and reported on the reproductive behavior, circadian rhythm, and aggressive behavior of animals that received AAS.
- This presentation of animal models was followed by Dr. Pope's presentation of his study if AAS abuse in humans. A growing body of scientific literature has suggested that the illicit use of high doses of anabolic-androgenic steroids can result in aggression, irritability, and even violence. Dr. Pope discussed his study in which normal volunteers were administered supraphysiologic doses of steroids, more closely approaching the doses actually used illicitly by athletes in the field. The consensus of these AAS abuse studies is that large doses of steroids clearly induce hypomanic or manic syndromes in a small number of vulnerable individuals. These syndromes may be associated with greatly increased irritability and possible violent behavior. A striking finding of the studies has been that these reactions are quite unpredictable. A majority of individuals do not exhibit marked mood changes, even when taking large doses of steroids, whereas a minority of individuals exhibit profound changes. These psychiatric effects pose a threat not only to the steroid user himself, but also to the potential victims of his irritability and aggression.
- Lastly Drs. Goldberg and Elliot describe the ATLAS (Athletes Training & Learning to Avoid Steroids) program, a universal drug and alcohol prevention program that targets male high school athletes. This study showed that new anabolic steroid abuse was reduced by 50%, while abuse of other illicit substances (marijuana, amphetamines and narcotics) and alcohol were also significantly lowered for those in the ATLAS program. Fewer students in the ATLAS program reported drinking and driving or using "athletic enhancing" supplements. ATLAS trained students improved their nutrition behaviors and showed improvement in strength, increased muscle mass and a reduction of body fat.