Don Hooton wants the world to know about his son, Taylor, a high school
baseball player who committed suicide after using anabolic steroids to"
bulk up" at the suggestion of his coach. Several episodes of rage
persuaded Hooton that his son needed help, but it took six sessions with a
psychiatrist for the boy to admit to steroid use.
Six weeks later, Taylor hanged himself during a period of acute
Hooton now travels the country to alert athletes, coaches, and physicians
about the dangers of steroids.
"Psychiatrists are seeing children today who are using steroids, but
they won't recognize it unless they are trained," he told a group at the
annual American Academy of Child and Adolescent Psychiatry (AACAP) meeting in
Chicago in October. The psychiatrist who saw Hooton's son wasn't aware that a
steroid screen was not included in the drug tests that the psychiatrist
ordered for the boy, said Hooton.
Performance-enhancing drugs have migrated from the alpine peaks of the Tour
de France down to the high school playing fields of Midwestern farm states and
everywhere in between, Gary Gaffney, M.D., said at the meeting.
Teens are using drugs of all kinds not only to become the biggest, baddest
player on the team but often just to look like one, said Gaffney, an associate
professor of psychiatry at the University of Iowa's Carver College of
"We think of drugs like steroids as used to improve athletic
performance, but because they increase muscle mass and cause weight loss, they
are also 'appearance-enhancing' drugs too, and that may be an even bigger
motivation to use them in the U.S.," he said. While all evidence points
to steroid use as a problem among adolescents, the scientific literature on
the subject is sparse, said Gaffney.
Substances to improve athletic prowess have probably been used since the
ancient Greeks invented athletics, but modern drug-development techniques have
brought continuing waves of new chemical compounds sold legally or otherwise
to boost strength, speed, power, endurance, quickness, oxygen capacity,
alertness, or motivation, said Gaffney.
Anabolic steroids are the best known, but athletes and wannabees from high
school to the Olympics also use stimulants, growth hormones, insulin,
diuretics, painkillers, erythropoietin (EPO), vascular endothelial growth
factor (VEGF), and anti-inflammatories of all kinds. Some are used to boost
results in the gym or on the field, while others lessen side effects of those
drugs or can hide them from drug testers. Users often "stack" the
drugs, taking doses hundreds of times larger than therapeutic levels of
several drug classes over a six-week cycle, then briefly going off the
Drugs are widely used in all professional sports, said Gaffney. More than
600 track athletes have been caught by anti-doping testing in the last 20
years. In the 1970s and 1980s, cyclists died from misuse of EPO, amphetamines,
and other drugs.
The "arms race" among athletes and between athletes and sports
regulators has only intensified over that time. "The East Germans doped
adolescents without their knowledge, and many female athletes later bore
disproportionate numbers of children with clubfeet or other skeletal
deformities," he said.
Access to steroids and other drugs is simple, even for American high
schoolers, added Thomas Hildebrandt, Psy.D., an assistant professor of
psychiatry at Mt. Sinai School of Medicine in New York. Many begin by using
over-the-counter nutritional supplements, attracted by dubious claims of
health and strength. It's a short step from supplements to clandestine
chemical muscle builders, he said.
"An estimated 12 to 15 percent of supplements contain illegal
prohormones or anabolic steroids, although it isn't clear whether they were
incorporated accidentally or deliberately," he said.
In a small study now under way, Hildebrandt said he found that 85 percent
of steroid users also took nutritional supplements before adding steroids to
their regimen. He sees both psychological and social mechanisms at work to
draw new users into the orbit of these drugs.
Using the same protein powder as the alpha male body builder down at the
gym is an entry into a social group that is probably using steroids too, he
said. "Using supplements in that setting also changes attitudes toward
safety and effectiveness of illegal performance-enhancing drugs."
(The veterinary supply chain is often another source of the drugs for rural
The list of side effects of steroids is long, depressing, and familiar to
physicians although apparently not well enough known to young athletes. Males
can develop acne, early male pattern baldness, jaundice, gynecomastia,
testicular atrophy, swelling of the kidneys or liver, and edema. Female users
may exhibit genital hypertrophy, hirsutism, clitoral hypertrophy, high blood
pressure, and, paradoxically, weight gain.
Performance-enhancing drugs also induce psychiatric symptoms such as mood
instability, rage, insomnia, and symptoms of mania, ADHD, or anxiety.
Psychiatrists should be aware of behavioral or physical changes in
high-risk populations like athletes or bodybuilders.
Withdrawal can be difficult and produces its own set of symptoms: mood
lability, depression, anxiety, insomnia, anorexia, headache, decreased libido,
muscle or joint pain, a craving for steroids, and suicidality.
Patients trying to withdraw from these drugs feel weaker and more
vulnerable than when they were using, and so they need psychosocial support to
persevere, said Gaffney. An endocrine consult may be needed to deal with
"Symptomatic treatment may call for neuroleptics to manage psychosis,
mood stabilizers, or SSRIs, but there is almost no research in this
area," he said.
Given the pressures to excel at every level of athletics, persuading young
people to avoid these drugs isn't easy.
Every avenue of society pushes performance-enhancing drugs, said Hooton.
Advertisers for cars and other power-associated products idealize"
steroids" as a metaphor for strength or better performance. That
diffuses the idea that they are dangerous, illegal drugs. Slugger Mark
McGwire's admission to using androstenedione (a prohormone then unregulated in
professional baseball) sparked a 10-fold increase in sales, he said."
It's hard to argue that steroids are bad if all their heroes use
Adults who play important roles in the lives of children must take more
responsibility, said Gaffney. "Behind the elite athletes are trainers,
coaches, and physicians—our colleagues."
Gary Gaffney's blog "Steroid Nation" can be accessed at<http://grg51.typepad.com/steroid_nation>.▪