Newsweek: Steroids and Teens

Toxic Strength

The headlines about illegal steroids have focused on professional and Olympic athletes. But the most vulnerable users may be kids in your neighborhood, high-schoolers who are risking an array of frightful side effects that can lead to death.

By Jerry Adler
Newsweek

Dec. 20 - It can take years to hit bottom with many drugs, decades with alcohol. But on steroids Chris Wash managed it in just 12 months, starting with a dream of playing for a top college basketball team and winding up on a highway overpass, waiting for the moment to jump. In that time Wash, a 6-foot-2 guard on the Plano West High School team in Plano, Texas, went from a rangy 180 pounds to a hulking 230, with shoulders so big he could barely pull on his backpack in the morning. And he developed a whole new personality to match that intimidating physique: depressed, aggressive and volatile.

After a series of fights in his junior year his coach threw him off the team, but by then building muscles had become an end in itself. He switched from pills to injecting himself with steroids in the buttocks, often with a couple of friends, including a promising high-school baseball player named Taylor Hooton. That went on for several months, until one day Hooton was found dangling from his belt in his bedroom, an apparent suicide. Frightened, Wash gathered up his vials and syringes and threw them down the sewer. But an insidious thing about steroids is that stopping them abruptly can lead to depression. A few weeks later Wash drove to a bridge across a Dallas freeway and walked to the middle, looking down at the rushing traffic.

Major League Baseball will no doubt eventually solve, or at least paper over, the explosive charges involving steroid use, and the athletes will live with the consequences to their reputations and their health, cushioned by their eight- figure contracts. But their examples have placed a generation of teenage athletes at risk for the same mistakes, which could end their careers—if not their lives—long before they reach the big time. An authority on youth sports, Dr. Jordan D. Metzl of the Hospital for Special Surgery in New York, calls steroid use "a burgeoning epidemic." The annual "Monitoring the Future" survey by the University of Michigan's Institute for Social Research suggests that the rate of steroid use by high-school students increased throughout the 1990s before dropping off slightly in 2003; a NEWSWEEK analysis of the data indicates that last year more than 300,000 students between the eighth and 12th grades used steroids. And they were not all jocks; as many as one third were girls, and experts say there is a growing problem of steroid use by boys whose heroes aren't baseball sluggers but the sinewy, rock-jawed models glowering from the pages of the Abercrombie & Fitch catalog. This development led to the recent introduction of a new psychological diagnosis, muscle dysmorphia (sometimes called "reverse anorexia"). For teenagers who use steroids, the side effects may begin with severe acne and run through hair loss, infertility, male breast development, violent mood swings and paranoia. And, in an unpleasant irony, steroids can stunt growth and cause injuries that could end the very career they were intended to enhance.

And they don't even get you high, at least not in the way most drug addicts would recognize. Consequently, steroid users don't consider themselves addicts, even those whose dependency is obvious, usually in retrospect. "He'd say, 'Pop, I'd never do drugs'," recalls Donald Hooton Sr., the father of Wash's friend Taylor. "I sincerely believe he didn't see steroids as a drug. None of these kids do." But steroids have their own seductions. "They make you pumped, aggressive, hypersexual, and that's going to feel good to a lot of these kids," says Dr. Kirk Brower, an addiction-treatment specialist at the University of Michigan. You can still hear the rueful note of pride in Wash's recollection of how the other boys would steer clear as he swaggered down the hallway—"They'd say, 'Don't fool with that kid'"—and how his girlfriend admired the rocklike consistency of his biceps. Athletes who train on steroids can gain muscle mass at phenomenal rates, as much as two pounds a week. Training for strength and speed is grueling work, pitting your muscles against the whole mass of the Earth, with only the unforgiving clock or weight stack to measure your progress. Suddenly, a pill appears and what seemed agonizingly impossible is within your grasp.

Joshua Dupont, a star running back at a Southern California high school and a highly ranked wrestler, began taking steroids in the summer before his junior year because he was jealous of the praise a stronger, faster teammate was getting from the coaches. He began seeing results, he claims, within three days: "I could spend the entire day at the gym and just keep pumping iron, working the same muscle without fatigue. After a week of taking this stuff, I went from 4.7 seconds to 4.6 [in the 40-yard dash]. It was incredible." For those who can tolerate, or have yet to experience, the side effects of steroids, there isn't much motivation to give them up. "If you're big and muscular and people admire you for that, why would you seek treatment to become smaller?" asks Harrison Pope Jr., a psychiatrist and addiction specialist at Harvard-affiliated McLean Hospital in Belmont, Mass. "I could count on both hands the number of patients who have sought treatment from me for [addiction to] steroids."

Steroids are hormones, and for body-building purposes the ones of interest are "anabolic" steroids—a number of related compounds that mimic the effects of testosterone, the male hormone secreted by the testes. (There are several other classes of steroids, including the female hormone estrogen and the drugs called corticosteroids, which are used to treat inflammation and asthma; neither of these builds muscle, and their side effects are very different.) Anabolic steroids build strength by entering a muscle cell and switching on the genes that manufacture muscle proteins. Weightlifting amplifies the effect by stressing the muscles. "If you just took steroids by themselves, you'd gain some muscle protein, but not nearly as much as if you do it with exercise," says Dr. Alan Rogol, a pediatric endocrinologist at the University of Virginia. "The combination can make a skinny Pittsburgh Pirate into a San Francisco Giant who hits 73 home runs, but we won't mention any names."

Testosterone and its relatives are controlled substances, approved to treat only a few, uncommon medical conditions—although any doctor can legally prescribe them for so-called off-label use to anyone. Some body-builders do obtain them that way, but most traffic in a bewildering black market of pills, gels and injectable solutions purchased over the counter in countries such as Mexico, on the Internet or from a guy at the gym whose cousin knows a batboy. Since the market is unregulated, products claiming to be steroids might in fact be almost anything, in concentrations that can only be guessed at by anyone without an analytical lab at his disposal.

Until now, teenage body-builders have been able to get around the obstacles to obtaining steroids by substituting androstenedione, a chemical "precursor" that is converted to testosterone in the body. In fact, says Dr. Gary Wadler of the New York University School of Medicine and a member of the World Anti-Doping Agency, andro has virtually the same effects, and side effects, as steroids, although it requires a much higher dosage. It was the enhancer of choice for Mark McGwire the year his coconut-size biceps propelled 70 home runs over outfield walls. Andro has been sold legally in nutrition stores and on the Internet for years. (Although a California law made it illegal to sell to minors, Dupont says he had no trouble buying it over the counter as a high-school student.) Congress closed that loophole only this October—the change takes effect in January—by adding andro to the list of Schedule III drugs, with "medium" potential for abuse. Wadler notes, though, that the law does not affect a compound known as DHEA, which is sold over the counter as an anti-aging drug. DHEA, as it happens, is converted in the body to ... androstenedione.

And this does not begin to exhaust the list of performance-enhancing drugs in circulation. Human-growth hormone, thyroid hormones and compounds to enhance the oxygen-carrying capacity of blood are all available, albeit illegally, to professional and Olympic athletes; soon, gene therapy may make its mark on the record books. There's not much evidence that high-school athletes have access to these. They do, however, legally obtain, and often use in prodigious amounts, a product known as creatine phosphate, which doesn't build muscle, but is believed to boost athletic performance by enhancing cellular-energy production. Most researchers believe that creatine is essentially harmless for adults, but it hasn't been studied much in children. At least one survey found it was being used by sixth graders—a result Dr. Eric Small, the chairman of the sports-medicine committee of the American Academy of Pediatrics, calls "scary."

Moreover, since the sale of "dietary supplements" like creatine is essentially unregulated, "you don't know what's in them," says Dr. Douglas McKeag, who heads the Indiana University Center for Sports Medicine. "You've got somebody saying, 'Well, my trainer gave me this'," says McKeag, who once analyzed a "protein supplement" one of his students had bought at the gym, and found it contained a cocktail of steroids, plus the poison strychnine, none of them listed on the label.

Anabolic steroids are inherently dangerous, though, no matter what else the pills may contain. The average adult male produces 35 to 50 milligrams of testosterone a week in his testes; athletes may inject 300 to 1,000 milligrams or more. That induces a kind of hypermasculinity, like adolescence on, well, steroids. Users may develop "horrific" acne, Wadler says, and can suffer an early onset of male-pattern baldness. Women are at risk for a whole set of masculinizing changes including body hair, enlargement of the clitoris and a deepened voice.

Paradoxically, steroids can also cause feminizing changes in men. The pituitary gland, which regulates hormone production in the body, responds to an oversupply of testosterone by signaling the testes to shut down, causing them to shrink. Another way the body deals with excess testosterone is by converting some of it to estrogen, which can cause men to grow breasts. Admittedly these effects are unusual, and sophisticated users try to manage them by taking the drugs in cycles of four to 20 weeks, timed to their training regimen. At any gym in the country you can find people who claim to have been using steroids for years with minimal problems, says Pope. But there's an enormous range of variability in how people respond to steroids—and some of the effects are permanent.

There are other risks as well. Adolescence signals the beginning of the end of skeletal growth, and steroids can hasten this process, shutting down growth prematurely. Steroids cause muscles to grow without a compensating strengthening of the tendons that attach them to the bones, a disproportion that increases the risk of crippling injuries. Steroids lower levels of so-called good cholesterol and raise the bad kind, sometimes to alarming levels, and they can be toxic to the liver. And there are the infamous psychological effects of volatile aggressiveness—the " 'roid rage" that cost Wash his position on the team, and have landed other users in jail or in the hospital. "When I was hitting someone, I couldn't stop," says Mike Bauch, an 18-year-old former high-school wrestler who has been off and on andro and steroids since seventh grade. Yet when a heavy user stops taking steroids, his testosterone level can drop practically to zero for weeks until his testes resume production—producing the opposite syndrome, a devastating depression.

Unfortunately, explaining cholesterol ratios to a 15-year-old who's just been cut from the baseball team and thinks his life is over anyway may not have the desired effect. "You have to understand high-school kids," McKeag says. "They think they're immortal." In any case, the message doesn't seem to be getting through as well as it could: the proportion of high-school seniors who consider steroids a "great risk" to their health actually dropped from 68 to 55 percent over the past five years, according to the University of Michigan study. In talking to young athletes who did take steroids, it's striking how little notice their parents and coaches took of the Gargantua taking shape before their eyes. Other than his brother, "nobody knew" he was taking steroids, says Bauch, even after he added what he claims was 30 pounds of muscle last summer. "Coaches are oblivious to it," says California state Sen. Jackie Speier, who sponsored a bill to crack down on sales of dangerous supplements to minors, "some out of lack of knowledge, others because they don't want to know." Speier's bill was vetoed by Gov. Arnold Schwarzenegger—who has admitted using steroids in his own body-building career—on the ground that dietary supplements were best left to the FDA.

Testing might help, of course, but only about 13 percent of school districts test athletes for drugs at all, and virtually none for steroids; it would cost $50 to $100 for each test, compared with $10 to $30 for the standard urine sample for substances like marijuana. In the largest high-school steroid scandal in memory, which led to the suspension of 10 varsity-football players in Buckeye, Ariz., coach Bobby Barnes—who had coached the team for only nine weeks—was as surprised as anyone when the police swept down on the practice field one day in September 2003. "This is the first time in all my years of coaching it had come up," Barnes told NEWSWEEK. "It wasn't something coaches were looking for."

And even if they were looking for it, they would miss the increasing number of cases of steroid use that don't involve athletes at all, but students who simply believe they don't measure up to what an American boy ought to look like—an image they probably formed playing with their G.I. Joe action figures, around the same time their sisters got their idea of female body shape from their Barbies. "Much like the anorexic never feels thin enough, men with muscle dysmorphia never feel big enough," says Roberto Olivardia, a clinical psychologist at Harvard and coauthor with Pope of "The Adonis Complex: The Secret Crisis of Male Body Obsession."

Could it really be that decades of education aimed at boosting the self-esteem of normal teenage girls has just transferred the body-image problem to boys? Or is vanity simply too deeply ingrained in human nature to eradicate, merely shifting its form and locus with the times? For answers, we turn to Charlie Hyvarinen, a 15-year-old aspiring football player from a suburb of Cleveland, who insists he would never take steroids. "Those are fake muscles, and it's cheating, and it's bad for you," he says. "The ones who use it are really a bunch of losers. But man," he adds wistfully, "for a little while, they're really something."

Oops, sorry, that's not the answer we were looking for. Let's hear instead from Chris Wash, who stepped back from the railing and called his mother to come get him, and after intensive therapy is now free of steroids—but after losing months of classes transferred out of Plano West and is now finishing up at an alternative high school for troubled kids that has no basketball team. "I could have had a scholarship to play ball in college," he muses. "Basketball was my life. It's who I was."

With Anne Underwood, Julie Scelfo and Vanessa Juarez in New York, Dirk Johnson and Hilary Shenfeld in Illinois, Jamie Reno, Andrew Murr and Karen Breslau in California and Joan Raymond in Ohio