PES

Newtown Center Pediatrics

PERFORMANCE ENHANCING DRUGS

In hopes of sparking discussion of a controversial issue, I direct this column to the Board of Education, the Health Department, the Athletic Departments of Newtown High School and Brookfield High School, parents and student athletes.

Approximately one-month ago, I received a phone call from another health professional who had concerns about his patients. He commented that in his many years of caring for adolescents, he has never been more impressed by the extent of facial hair grown by current student-athletes of specific high-school teams in Newtown and Brookfield. His concern was the possible use of anabolic steroids. My larger concern was the possible use of human growth hormone and other performance-enhancing substances (PES). Following my own cursory probe, our suspicions were confirmed. Student-athletes were very much aware of the availability and use of PES in the high schools. If health professionals and students are aware, it seems credible and reasonable that others must be aware: coaches, teachers, administrators, parents. The responsibility is ours—to educate student-athletes and to protect them, sometimes from themselves.

Athletes frequently use PES (steroids, human growth hormone, androgenic hormones) and nutritional supplements (protein drinks, creatine) to facilitate their performance, to gain an edge, to take shortcuts. The heightened level of competition has filtered down age-groups. As a child, we would play baseball in the street, football in the backyard, and bike to the mall. Now children as young as six and seven are being molded and trained to become single-sport super stars. Not surprisingly, the pressure to outperform only worsens with age and has directly led to increases in the use of PES: as high as 5-10% of high school males and 2-3% of females (over 1 million students in 2003) are reported to have used PES.

The following are facts of which parents, coaches, and students should be aware with regard to the more commonly used PES. (Summarized from the American Academy of Pediatrics, Guidelines for PES).

Anabolic steroids, while increasing strength and muscle mass at high doses, have not been proven to improve performance or endurance, and cause: atrophy or shrinkage of the testicles, development of breast tissue in males, facial hair in women, increased blood pressure, cholesterol and risk of heart attacks, liver inflammation and tumors, weakening of tendons and ligaments, stunted growth, “roid rage,” depression, and acne.
Androstenedione (Andro), Dihydroepiandosterone (DHEA) has never been shown to significantly improve strength, muscle mass, or performance but has been shown to carry the same risks as anabolic steroids, including the development of malignant tumors.
Ephedra does act as a stimulant, increasing fat burning, but has often been linked to sudden death, heart attacks, strokes, and seizures.
Creatine may increase the capacity (energy reserve) for weight-lifting and increase water weight, but has never been associated with significant increases in strength or muscle mass. Theoretically, it can lead to dehydration, muscle cramps, and stress on kidney function.
Protein supplements have never been shown to increase muscle strength or mass. Increases in muscle strength and mass are variable and correlate more directly with one’s diet. The side-effects may be similar to those of creatine.
Human growth hormone may decrease body fat, thereby increasing lean body mass. It may also enhance protein synthesis, but has not been demonstrated to increase strength or muscle mass at “standard” doses. At any dose, HGH has been shown to cause acromegaly (Andre the Giant had an over-production of HGH leading to acromegaly), behavioral changes, diabetes, heart disease, and unusual infections.

In addition to these facts, many of these substances, classified as supplements, are not regulated by the FDA. Adolescents with whom I have spoken rarely have any idea what is in the supplements they are taking. Since they are not controlled by the FDA, the distributors may not even know. These substances are advertised as “supplements” and sold legally in health-food stores, and adolescents automatically presume that they are safe. This belief is perpetuated by coaching staffs at the college level where supplements are often provided to athletes.

I hope this column is provocative: as parents, educators, coaches, and health-care providers, we need to educate athletes at an early age, providing them with accurate information. Professional sports associations need to enforce strict rules against drug use. Professional athletes need to recognize that they are role models and that their behaviors are emulated by the youngest of our athletes. As a former weight-lifter, I took pride in knowing that my achievements were from my own efforts and perseverance. The use of PES is cheating. A true sense of pride will never arise from its use. To our student athletes, I ask: “Would you like to be known as a Hank Aaron, Derek Jeter Alex Rodriguez (although he is a Yankee), and/or Manny Ramirez Kevin Youkillis (Go Sox!). Or would you rather be known as a Barry Bonds* or Chris Benoit (May 21, 1967- June 24, 2007)?”