Usage and Perceived Benefits of Anabolic Steroids for Increased Sports Performance

Usage and perceived benefits of Anabolic steroids for Increased Sports Performance

Introduction and Literature Review:

Since the beginning of sports, athletes have found ways to enhance their performance to gain a competitive advantage over their competitors. Records indicated that as early as 77l BC athletes have been attempting to use substances to enhance their performance. The Greek Olympians ingested various substances such as dried figs, mushrooms, sheep testicles and strychnine to improve their performance (Calfee and Fadale, 2006). Through the years these performance-enhancing drugs gained its acceptance and became a feasible solution for many athletes who wanted to achieve personal goals. In the past three decades, steroids have become a serious problem, more than ever in the athletic field. It is reported that over 3 million athletes and bodybuilders alone have used anabolic steroids. Eventually anabolic steroids extended its reach to high school athletes by 1959 (Calfee and Fadale, 2006).
The definition of “Anabolic Steroids” includes any synthetic substance that mimics the male sex hormone testosterone and all other substances listed in the Anabolic Steroid Control Act of 2004 (Calfee and Fadale, 2006). Since the 1980’s studies show increasing number of adolescent athletes resort to supplementation to enhance their athletic performance. Today studies indicate between 1-3 million American adolescent have either experimented with anabolic steroids in the past or are currently using them Evan, 2004; Faigenbaum et al., 1998; DuRant et al., 1995). Anabolic steroid use by adolescent athletes is regrettably poorly understood and is limited to small number of studies. Recent evidence suggests that steroid use has extended to children as young as 10 years old (Evans, 2004; Faigenbaum et al., 1998; Gaa et al., 1994; Calfee and Fadale, 2006; Stilger and Yesalis, 1999; Yesalis and Bahrke, 2000). Children at younger ages are continually scouted by coaches in schools and placed under the media spotlight, which adds pressure to excel in their performance.
Studies show that anabolic steroid use among high school athletes and even non-athletes have been growing in popularity and athletes at even younger ages are experimenting with their usage (Evans, 2004; Faigenbaum et al., 1998; Gaa et al. 1994; Calfee and Fadale, 2006; Stilger and Yesalis, 1999; Yesalis and Bahrke, 2000). Among young athletes evidence indicated that high school football players and wrestlers have reported higher rates of anabolic steroid use than any other sporting group (Evans, 2004; Faigenbaum et al., 1998; Gaa et al. 1994; Calfee and Fadale, 2006; Stilger and Yesalis, 1999; Yesalis and Bahrke, 2000). Statistics show that anabolic steroid use peaks in early teens aging 11 to 14 (Faigenbaum et al., 1998;, Stilger and Yesalis, 1999; Gaa et al., 1994). It is often difficult to convince adolescents of the real dangers associated with anabolic steroids due to the lack of scientific evidence to show the possible long-term effects. A notion that is driven into these athletes’ heads are that usage of steroids will give them a competitive edge. Committee on Sports Medicine and Fitness (1997) lists the desirable effects adolescents associated with anabolic steroids as being: increased muscle mass, increased strength, increasing ones appearance decreased recovery time, increased aggression, promote healing of injuries, maintaining the same ‘advantage’ as one’s opponent and for obtaining a competitive edge. Steroids are proven to increase both power and strength and decrease recovery time needed between heavy workouts but the fact that it does not make your better athlete is often overlooked.
The potential dangers associated with steroids include increased acne, gynecomastia, testicular atrophy, toxic effects on the liver and kidneys, and negative effects to the cardiovascular system and for females additional risks such as deepening of voice, clitoris hypertrophy and male-pattern baldness, these are just a few of the known risks (Committee on Sports Medicine and Fitness, 1997; Evans, 2004). The most common method of using steroids appears to be through self-administering inter-muscular injections. According to Evans (2004) between 76%-96% of anabolic steroid users injects steroids. Since quite often needles are shared between users this adds another dangerous dimension to steroid use, which is the increased risk of infection but also of spreading diseases, particularly HIV or AIDS (Melia, Pipe and Greenberg, 1996). In the study of anabolic steroid use by high school football players Stilger and Yesalis (1999) stated that the use of injectable steroids indicated an increased level of commitment to this drug behavior. ‘Stacking’ describes the use of two of more anabolic steroids at the same time, and is usually thought to produce better results, which is a very common method used to attain extremely high doses of anabolic steroids. Studies indicate that a steroid user will inject 10 to 100 times the amount that a prescribed user would take as a medical dosage (Committee on Sports Medicine and Fitness, 1997; Stilger and Yesalis, 1999).
Coaches play a major role in helping the increasing number of adolescent athletes who are turning to anabolic steroids. Stilger and Yesalis (1999) found that coaches play a crucial role in peer advice. Faigenbaum et al. (1998) suggests in their study that coaches should be made aware of anabolic steroid incidence rates during early adolescents. Studies indicate that the method used to educate athletes about anabolic steroids is another important element in helping to prevent steroid usage by adolescents. In situations such as this, old method such “scare tactics” do not work; this might even in turn dare adolescents to experiment with anabolic steroids (Faigenbaum et al., 1998; Committee on Sports Medicine and Fitness, 1997; Stilger and Yesalis, 1999). Prevention programs that typically failed in the past are the “Just Say No” campaigns, knowledge-only programs and pamphlets, “one size” fits all not specifically focused on an age or gender and programs that used primarily adult lecturers. A better method is to present both the positive benefits an athlete will gain by using anabolic steroids like the increase in body weight or the increase in lean body mass and strength, and then present the negative effects associated with the use of steroids, such as higher risk of cancer, increased risk of testing positive for HIV, etc. Studies have shown that 12th grade students [since 1993] increasing believe that occasional steroid use can lead to serious health risks (Calfee and Fadale, 2006). Gaa et al. (1994) and Stilger and Yesalis (1999) suggest that anabolic steroid education might also be more effective if it begin at younger ages when students are in elementary and junior high instead of waiting until these athletes have already entered high school.
A program titled Athletes Training and Learning to Avoid Steroids (ATLAS) mainly for males and Athletes Targeting Healthy Exercise and Nutritional Alternatives (ATHENA) mainly for females has shown consistently high levels of success among adolescents (Calfee and Fadale, 2006; Goldberg et al, 200). According to Goldberg (2006) it is a multi-component school-based drug and alcohol program for athletes aged 13- 19 years old. The program attempts to prevent the use of various drugs and supplements by educating students about sound nutritional and exercise practices. It concentrates on some of the more immediate consequences associated with anabolic steroid use instead of the possible long-term effects. An ATHENA curriculum facilitated by a coach for example contains eight weekly 45 min sessions starting with “proper nutrition for sport performance, negative effects of use of body shaping substances, disordered eating, how to enhance self-efficacy for healthy eating through achievable weekly goals, deconstruct messages in advertisements of supplements and diet pills to reverse beliefs in deceptive norms portrayed in advertisements etc.” (Goldberg, 2006). Athletes are presented with the most resent information pertaining to nutrition; strengthen training, in addition to receiving various teaching and informational workbooks (Goldberg, 2006). Collectively the above research confirms the hypothesis that adolescent athletes use and perceive anabolic steroids as beneficial to enhance their sports performance.
In conclusion, steroids have a great impact on one 's body. Steroids help the body put on muscle and add strength in the short term. In the long run, steroids can have numerous negative effects on the body and can even cause death. This has been proven over and over again that it is the safest and most efficient way of getting healthy. Further, there are now questions as to the validity of the testing procedure used to examine the potency of the anabolic steroids presently on the market shelves. This would suggest that the anabolic steroids may have but a fraction of their reported protein anabolic activity giving further support to the idea that improved nutrition may be the major cause of the observed effects of these steroids.
Methods:
Current literature will be presented that establishes a link between the use of anabolic steroids and its perceived benefits among adolescent athletes. This is of interest to the researcher because adolescents are at a particular risk as steroids can lead to a variety of damaging side effects.
The literature review regarding anabolic steroid use among adolescent athletes involved several steps. The ADA evidence analysis library was first utilized to find resources but unfortunately the researcher was unable to find any evidence-based analysis on adolescent athletes. Research was then conducted such that the researcher entered keywords, terms and phrases into the Syracuse University library database mainly SCOPUS and ProQuest to generate studies that would increase knowledge on the topic of usage and perceived benefits of anabolic steroids for increased sports performance, to assist in defining specific problems. Key words included but were not limited to: “adolescents athletes + steroid use” “anabolic steroids” “prevention interventions for steroid use” “ATLAS” “ATHENA” “ergogenic drugs”. So I decided to use the Syracuse University Library database mainly Scopus to find literature that would enlarge my knowledge about this topic.
Articles that were unbiased and valid were compiled. Further exclusions were made based on specificity and relevance of the topic. Excluded topics included: steroid use among the adult population, dietary supplement use among young athletes, antioxidant status and protein modification in adolescent athletes etc. Results were then limited to research articles dealing specifically with anabolic steroids use among adolescents and adolescent athletes. The most relevant articles were selected for export to RefWorks (reference management tool).
Once sufficient amount of literature was gathered, the researcher read the articles in full and scanned for a formulated problem or issue. The articles were read more than once to get a sense of the topics discussed and also to note the recurring topics in this area of research (i.e. prevalence estimates of other health related behavior associated with steroid use, common perceived benefits, mediation analysis of intervention programs).
Literature was organized into sections of emerging themes and trends, which were synthesized and evaluated according to the guided concept of my topic. The researcher created three categories, which each article was placed into. The categories are: 1) Facts about steroids 2) Anabolic steroid use studies and 3) Prevention interventions. The results of the studies were synthesized into a summary of what is known and what is not. Areas of controversy and further research in the literature were identified. Conclusions of the studies were reviewed to see if they were validly based upon data and analysis. The studies were then assessed for their strengths and weakness. A total of 31 articles were used in this literature review.
Primary Research Articles:
I. Cross-sectional Study of Female Students Reporting Anabolic Steroid Use (Elliot et al, 2007).
This study aimed to determine the characteristics of female US high school students self-reporting anabolic steroid use and compare that with other health-related behaviors and sports participation.
The participants were 7544 adolescent females in grades 9 though 12. This study used cross-sectional assessment as their research design. Data was collected using the 2003 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey database. The survey is a 95-item survey administered biannually to the US high school students assessing demographics variables and priority health risk behaviors relating to subsequent social problems, morbidity, disability, and mortality. In schools that administered the survey, the overall student response rate was 83%. All the female respondents (1.3%) who were missing a response to the question concerning anabolic use were excluded from the analysis. The results reported that prior or ongoing anabolic steroid use was reported by 5.3% of female US high school students. Of these students 37.8% of the girls participated in team sports, yet participating in team sports was negatively related to anabolic steroid use. This could be because the members of the sports teams were less likely to self-report prior or ongoing anabolic steroid use. When compared with the students in the 12th grade, those in 9th and 10th grades reported a higher anabolic steroid use. The results confirmed that adolescent girls reporting anabolic steroid use had significantly more other health-harming behaviors such as use of cigarettes in the past 30-days, marijuana and cocaine, more sexual activity before the age of 13, drinking and driving, past use of vomiting, laxative use, and diet pills, depressed feelings etc. This study concluded that self-reported anabolic steroid use is not confined to adolescent girls in competitive athletics. The study also found a direct correlation between anabolic steroid use and increase of other health-harming behaviors.
This study has several noteworthy strengths and some limitations, which must be addressed when making recommendations and suggesting avenues for future research. A particular strength of this study is that it represents a large sample size for us to generalize that health-harming actions among adolescent girls include anabolic steroid use. Perhaps the greatest strength of this study was that the findings were gender specific through all high school grades. As a result their work contributes a great deal of knowledge on performance enhancing effects and consequences on girls.
This study has its limitations. The cross-sectional data set does not allow insight into temporal relationships or underlying mechanisms of this study. Also since the data was collected though self-reported anabolic steroid use, the results were insignificant among adolescent athletes because they were less likely to report their use. Also researchers need to devise methodologies that effectively target adolescent girls for future research. Since this is a sensitive topic, focus groups can be implemented to alleviate some stress regarding self-reported steroid use. Despite these limitations, the findings provide concerning information about adolescent girls with self-reported prior or ongoing anabolic steroid use for further research. Further Study is also needed to develop effective interventions for this population.
II. A Mediation Analysis of the ATHENA Intervention for Female Athletes: Prevention of Athletic-Enhancing Substance Use and Unhealthy Weight Loss Behaviors (Ranby et al, 2009)
ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternative) is a primary prevention and health promotions intervention designed to deter unhealthy body shaping behaviors among female high school athletes. The intervention consists of eight weekly 45 min sessions facilitated by the coach and integrated into usual team activities. Majority of activities were peer-led and involved group participation. The objective of this intervention was to explain through mediation analyses, the mechanisms by which ATHENA produced immediate changes in intentions for unhealthy weight loss and steroid/creatine use, and to examine the link to long-term follow-up intentions and behaviors. A randomized trial of 1668 female athletes at 18 high schools in the Northwest was conducted. Intervention participants completed coach-led peer-facilitated sessions during their sport season. Participants provided pre-test, immediate post-test, and 9-month follow-up assessments. Majority of the participants were white and in 9th and 10th grades. Schools were matched in pairs based on size, average socioeconomic status, and student demographics.
The study resulted that ATHENA decreased intentions for steroid/creatine use and intentions for unhealthy weight loss behaviors at post-test. These effects were most strongly mediated by social norms and self-efficacy for healthy eating. These low post-test intentions were maintained 9 months later. The survey question format used by ATHENA researchers have been shown to have acceptable levels of reliability and validity. Most individual items had face validity, and the fact that several measures were impacted similarly by the intervention lends support for their validity. Intervention fidelity was ensured through the use of training manuals with standardized scripts, lesson plans, workbooks, leader training and checklist. The female-only, peer –led format can further lead to increased participants’ self-esteem, assertiveness, and social skills. The strategy of matching schools and type of team was strength to the design.
Although the intervention presented here is informative, there are weaknesses to the studies in question, which need to be addressed. Since the data was self-reported, it is vulnerable to biases. Data measuring alcohol and other drug use were dichotomized based on frequency cutoffs that appeared arbitrary. In addition, the authors point out that alcohol and other drug use in this age group can be influenced by any number of factors that were not assessed in the study. Clustering by schools and teams was no longer taken into account in the follow-up analyses, even though these effects may have been significant.
The component that paired information about nutrition and sport performance with concrete behavioral strategies employed to deliver the intervention may provide useful approaches for practitioners. Future study is needed on long-term behaviors and intentions of steroid use by implementing this intervention at an earlier age (e.g. elementary or middle school grades).
References:

1. Beaver, K., Vaughn, M., & DeLisi, M. (2008). Anabolic-androgenic steroid use and involvement in violent behavior in a nationally representative sample of young adult males in the united states. American Journal of Public Health, , 2185.
2. Braun, Hans, Karsten Koehler, and Hans Geyer. "Dietary Supplement use among Elite Young German Athletes." International Journal of Sport Nutrition and Exercise Metabolism (2009): 97. Print.
3. Calfee, Ryan, and Paul Fadale. "Popular Ergogenic Drugs and Supplements in Young Athletes." Pediatrics 117.3 (2006): E577. Print.
4. Carlsohn, Anja, Sascha Rohn, and Frank Mayer. "Physical Activity, Antioxidant Status, and Protein Modification in Adolescent Athletes." Medicine and science in sports and exercise (2010): 1131. Print.
5. Committee on Sports Medicine and Fitness. 1997, Adolescents and anabolic steroids: a subject review. Pediatrics. 99, 904-908.
6. "Curbing Risky Behaviors in Adolescent Athletes." Journal of Physical Education, Recreation Dance (2009): 10. Print.
7. de Sousa, Eliene, Teresa H. M. Da Costa, and Julia A. D. Nogueira. "Assessment of Nutrient and Water Intake among Adolescents from Sports Federations in the Federal District, Brazil." British journal of nutrition (2008): 1275. Print.
8. DuRant, R. and Escobedo, L. Heath, G. 1995, Anabolic-steroid use, strength training, and multiple drug use among adolescents in the United States. Pediatrics. 96, (1) 23-28.
9. Elliot, D., Cheong, J., Moe, E., & Goldberg, L. (2007). Cross-sectional study of female students reporting anabolic steroid use. Archives of Pediatrics Adolescent Medicine, 161(6), 572.
10. Evans, N. 2004, Current concepts in anabolic-androgenic steroids. The American Journal of Sport Medicine. 32, (2) 534-542.
11. Faigenbaum, A. and Zaichkowsky, L. and Gardner, D. and Micheli, L. 1998, Anabolic steroid use by male and female middle school students. Pediatrics. 101, (5).
12. Gober, Sarita, Paul McCabe, and Malky Klein. "Adolescents and Steroids: What Principals should Know." Principal Leadership Middle Level ed (2006): 11. Print.
13. Goldberg, L. (n.d.). Athletes training and learning to avoid steroids. Retrived November 6, 2006, from http://guide. Helpingamericasyouth.gov/programdetail.cfm?id=592
14. Gaa, G. and Griffith, E. and Cahill, B. and Tuttle, L. 1994, Prevalence of anabolic steroid use among Illinois high school students. Journal of Athletic Training. 29, (3) 216-222.
15. Green, G. and Uryasz, F. and Petr, T. and Bray, C. 2001, NCAA study of substance use and abuse habits of college student-athletes. Journal of Sport Medicine. 11, 51-56.
16. Harmer, A. (2010). Anabolic-androgenic steroid use among young male and female athletes: Is the game to blame? British Journal of Sports Medicine, 44(1), 26
17. Haupt, H. and Rovere, G. 1984, Anabolic steroids: a review of the literature. American Journal of Sports Medicine. 12, (6) 469-484.
18. Hoffman, J., Faigenbaum, A., & Ratamess, N. (2008). Nutritional supplementation and anabolic steroid use in adolescents. Medicine and Science in Sports and Exercise, , 15.
19. Melia, P. and Pipe, A. and Greenberg, L. 1996, The use of anabolic-androgenic steroids by Canadian students. PubMed. 6, (1) 9-14.
20. Metzl, J. and Small, E. and Levine, S. and Gershel, J. 2001, Creatine use among young athletes. Pediatrics. 108, 421-425.
21. NCAA. 1999 NCAA Drug-education and drug-testing survey. Retrieved on November 9, 2006. From National Collegiate Athletic Association.
22. Nilsson, S. 1995, Androgenic anabolic steroid use among male adolescents in Falkenberg. Pharacoepidemiology and Prescription. 48, 9-11.
23. O’Dea, J. and Caputi, P.2000, Assoication between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19- year-old children and adolescents. Health Education Research. 16, 2) 521-532.
24. Steroids, the media, and youth: A Q A with travis tygart.(2009). The Prevention Researcher, , 7.
25. Stilger, V. and Yesalis, C. 1999, Anabolic-androgenic steroid use among high school football players. Journal of Community Health. 24, (2) 131-145.
26. Tanner, S. and Miller, D. and Alongi, C. 1995, Anabolic steroid use by adolescents: prevalence, motives, and knowledge of risks. PubMed. 5, (2), 108-115.
27. Verroken, M. 2000, Drug use and abuse in sport. Bailliere’s Clinical Endocrinology and Metabolism. 14, (1) 1-23
28. Vertalino, M., Eisenberg, M., & Story, M. (2007). Participation in weight-related sports is associated with higher use of unhealthful weight-control behaviors and steroid use. Journal of the American Dietetic Association, , 434..
29. Wichstrom, L. (n.d.), Use of anabolic-androgenic steroids in adolescence: winning, looking good or being bad? Norwegian University of Science and Technology. Retrived November 4, 2006, from Council for Mental Health and Norwegian Confederation of Sports.
30. Yesalis, C. and Barsukiewicz, C. and Kopstein, A. and Bahrke, M. 1997, Trends in anabolic-androgenic steroid use among adolescents. Pediatrics. 151, (12).
31. Yesalis, C. and Bahrke, M. 2000, Doping among adolescent athletes. Bailliere’s Clinical Endocrinology and Metabolism. 14, (1) 25-35.

References: 1. Beaver, K., Vaughn, M., & DeLisi, M. (2008). Anabolic-androgenic steroid use and involvement in violent behavior in a nationally representative sample of young adult males in the united states. American Journal of Public Health, , 2185. 2. Braun, Hans, Karsten Koehler, and Hans Geyer. "Dietary Supplement use among Elite Young German Athletes." International Journal of Sport Nutrition and Exercise Metabolism (2009): 97. Print. 3. Calfee, Ryan, and Paul Fadale. "Popular Ergogenic Drugs and Supplements in Young Athletes." Pediatrics 117.3 (2006): E577. Print. 4. Carlsohn, Anja, Sascha Rohn, and Frank Mayer. "Physical Activity, Antioxidant Status, and Protein Modification in Adolescent Athletes." Medicine and science in sports and exercise (2010): 1131. Print. 5. Committee on Sports Medicine and Fitness. 1997, Adolescents and anabolic steroids: a subject review. Pediatrics. 99, 904-908. 6. "Curbing Risky Behaviors in Adolescent Athletes." Journal of Physical Education, Recreation Dance (2009): 10. Print. 7. de Sousa, Eliene, Teresa H. M. Da Costa, and Julia A. D. Nogueira. "Assessment of Nutrient and Water Intake among Adolescents from Sports Federations in the Federal District, Brazil." British journal of nutrition (2008): 1275. Print. 8. DuRant, R. and Escobedo, L. Heath, G. 1995, Anabolic-steroid use, strength training, and multiple drug use among adolescents in the United States. Pediatrics. 96, (1) 23-28. 9. Elliot, D., Cheong, J., Moe, E., & Goldberg, L. (2007). Cross-sectional study of female students reporting anabolic steroid use. Archives of Pediatrics Adolescent Medicine, 161(6), 572. 10. Evans, N. 2004, Current concepts in anabolic-androgenic steroids. The American Journal of Sport Medicine. 32, (2) 534-542. 11. Faigenbaum, A. and Zaichkowsky, L. and Gardner, D. and Micheli, L. 1998, Anabolic steroid use by male and female middle school students. Pediatrics. 101, (5). 12. Gober, Sarita, Paul McCabe, and Malky Klein. "Adolescents and Steroids: What Principals should Know." Principal Leadership Middle Level ed (2006): 11. Print. 13. Goldberg, L. (n.d.). Athletes training and learning to avoid steroids. Retrived November 6, 2006, from http://guide. Helpingamericasyouth.gov/programdetail.cfm?id=592 14. Gaa, G 15. Green, G. and Uryasz, F. and Petr, T. and Bray, C. 2001, NCAA study of substance use and abuse habits of college student-athletes. Journal of Sport Medicine. 11, 51-56. 16. Harmer, A. (2010). Anabolic-androgenic steroid use among young male and female athletes: Is the game to blame? British Journal of Sports Medicine, 44(1), 26 17. Haupt, H 18. Hoffman, J., Faigenbaum, A., & Ratamess, N. (2008). Nutritional supplementation and anabolic steroid use in adolescents. Medicine and Science in Sports and Exercise, , 15. 19. Melia, P. and Pipe, A. and Greenberg, L. 1996, The use of anabolic-androgenic steroids by Canadian students. PubMed. 6, (1) 9-14. 20. Metzl, J. and Small, E. and Levine, S. and Gershel, J. 2001, Creatine use among young athletes. Pediatrics. 108, 421-425. 21. NCAA 22. Nilsson, S. 1995, Androgenic anabolic steroid use among male adolescents in Falkenberg. Pharacoepidemiology and Prescription. 48, 9-11. 24. Steroids, the media, and youth: A Q A with travis tygart.(2009). The Prevention Researcher, , 7. 25. Stilger, V. and Yesalis, C. 1999, Anabolic-androgenic steroid use among high school football players. Journal of Community Health. 24, (2) 131-145. 26. Tanner, S. and Miller, D. and Alongi, C. 1995, Anabolic steroid use by adolescents: prevalence, motives, and knowledge of risks. PubMed. 5, (2), 108-115. 27. Verroken, M. 2000, Drug use and abuse in sport. Bailliere’s Clinical Endocrinology and Metabolism. 14, (1) 1-23 28. Vertalino, M., Eisenberg, M., & Story, M 31. Yesalis, C. and Bahrke, M. 2000, Doping among adolescent athletes. Bailliere’s Clinical Endocrinology and Metabolism. 14, (1) 25-35.