DR. WORNIK: Even though anabolic steroids are illegal drugs, the teens who use them don’t generally fit the stereotype of those who use other recreational drugs. Teens don’t try steroids at a party on a whim; instead, they start with a plan to improve their appearance or performance. Many have done extensive online research, finding active communities of bodybuilders who offer access, information, and support. Because these patients are already familiar with the risks and rewards, it can be difficult for doctors to get through to them… especially if the doctors themselves are unfamiliar or uncomfortable with the topic.
Counter to stereotypes, steroid use is not limited to competitive athletes. Steroids are most common among teens -- boys and girls -- who hit the gym to look fit and toned, to the point that just using a commercial gym can be considered a risk factor. And these teens, like those with eating disorders, often suffer from body image distortion or body dysmorphia, conditions which cause them to seek the “perfect body,” sometimes taking drastic action like starvation, surgery, or drugs.
And, along with the unrealistic body standards that drive these behaviors, steroids have made a deep impact in our schools.
Studies find that around 7% of high school seniors have tried anabolic steroids, while 11% have tried using human growth hormone for athletic gains. And those numbers may be underreported. Yet these drugs are dangerous, and can be much worse for growing teens than for adults. Were you aware that:
Steroids cause irreversible side effects in children, such as fusing their growth plates so they never reach adult height.
Illegal steroids can be much stronger than those that are medically prescribed.
Because most “street” steroids are produced overseas without testing or oversight, it’s impossible to know what’s really in them.
By strengthening muscles beyond the capacity of tendonds, steroids greatly increase risk of musculoskeletal injuries, especially tendon ruptures.
People using injectible steroids often share needles, putting them at risk for HIV and other diseases.
There are many common warning signs of steroid use:
Steroids can have different effects on men and women. Here are some warning signs specific to men:
And signs specific to women:
When several of these symptoms appear together, especially in someone who exercises heavily or has frequent injuries, it’s a good idea to try to find out if the patient is using steroids. But it isn’t easy to diagnose and treat steroid use. Not only do patients not want to admit what they’re using, but medical science has yet to catch up to this problem, leaving few agreed-upon protocols for helping a patient quit safely.
One thing we do know: coming off steroids is not as simple as just quitting. The sudden withdrawal of artificial testosterone can trigger depression and even suicide in some patients. Teens who want to quit will need a full team to address the psychological and medical challenges, including specialists like psychiatrists, addiction counselors, endocrinologists, or sports-medicine doctors.Let’s look at one more case study. Cody is seventeen and was overweight until two years ago, when he began working out at a local gym. In the past year, Cody has put on 30 pounds of muscle and he has acne on his back and shoulders. His parents brought him in because they’re worried about his mood swings and violent rages. A physical exam found he has low testicular volume.
As Cody’s doctor, Dr. Denke’s job is to confirm if Cody is using steroids, and warn him about the dangers of continuing. If Cody admits to using and wants to stop, Dr. Denke should help him develop a safe plan to wean off. But remember, teens can be extremely defensive about steroid use. He’ll have the most success if he respects Cody’s knowledge and experiences, uses Ask-Tell-Ask to provide information, and approaches his questions indirectly -- if Dr. Denke sends Cody into a rage, he’ll never be willing to listen.