It was always supposed to be about protecting the kids.
That aspect of the Great Steroid Scandal of 2005 seems to have been forgotten amid the political spectacle of last spring's congressional hearings and the "what did he shoot and when did he shoot it" parlor game focusing on some of the nation's leading sports figures. The imbalance is pointed up by a database search of major newspaper articles in the last month. "Steroids and Rafael Palmeiro," the Baltimore Orioles baseball player who recently tested positive for a banned substance, generated more than 1,000 citations. "High school and steroids" produced just over 100.
As both houses of Congress push for legislation that would up the ante for professional athletes found to have abused banned substances, those interested in the welfare of young people may be left with more questions than answers. For all the heat, relatively little light has been shed on such basic questions as: Is there really an epidemic of steroid abuse among young people? Are they as bad for kids as they are made out to be? How do they do their harm?
And, not least, what is being done about it?
Figures on steroid abuse among high school students in the Washington area are difficult to come by. But local school sports officials say there is little reason to believe that prevalence here is out of line with the national rate, which some surveys place as low as 3 percent. But leading steroids researcher Charles Yesalis, professor of health policy and administration and exercise and sport at Pennsylvania State University, argues that the national rate is much higher, 7 or 8 percent. With more than 300,000 students attending secondary schools in the Washington region, Yesalis's estimate would mean that more than 20,000 local kids are abusing steroids.
A number of states, including Virginia, have enacted legislation that would sideline high school athletes found to have abused steroids and, at least in the case of Virginia, revoke the certification of teachers, coaches and other school personnel found to have condoned such abuse.
The legislation, sponsored by Del. Robert G. Marshall of Manassas, sets up a framework for punishing violators but does not call for testing athletes for steroid abuse.
Bruce Patrick, assistant director of the Virginia High School League, says there is no reason to believe steroids abuse is more or less common among Virginia student-athletes than elsewhere in the country. The legislation should be seen merely as an additional deterrent, he said.
"It certainly can't do us any harm to make sure that our kids are getting the same message" that is being delivered to professional athletes, Patrick said.
He is hopeful that a nationwide educational campaign starting soon can help. Under a program called "Make the Right Choice," the National Federation of State High School Associations is distributing brochures, posters and DVDs -- one to be shown to students, another for parents -- in all 50 states and the District of Columbia.
The DVDs include interviews with Indianapolis Colts head coach Tony Dungy and Kansas City Chiefs quarterback Trent Green. They also include the story of Taylor Hooton, a Texas high school baseball pitcher who committed suicide while suffering from depression following steroid abuse. The brochures include medical information about anabolic steroids, including quick facts and side effects, as well as measures that parents and coaches can use.
Ned Sparks, executive director of the Maryland Public Secondary Schools Athletic Association, says he expects that coaches will show the video to athletes during team meetings and that parents will have an opportunity to view the one designed for them during preseason sessions that most schools hold for parents.
Sparks, who, like Virginia's Patrick, does not believe steroid abuse is a widespread problem in his state, welcomes the campaign but worries that it will not be sufficiently persuasive.
"Adolescents are difficult," Sparks said. "I mean, how long have we been bombarding them with stuff about not smoking and not doing drugs and drinking?"
What Are They On?
Anabolic-androgenic steroids, as they are properly known, are synthetic compounds -- there are more than 100 in all -- that mimic the effects of the hormone testosterone, which males (and females to a lesser extent) produce naturally.
They have three mechanisms of action: They help metabolize ingested proteins; they induce synthesis of skeletal muscle; and they produce a state of euphoria and decreased fatigue that enables athletes to work out harder and longer.
When given in therapeutic doses in a medical setting -- as they might be to a child with delayed puberty or a man with reproductive dysfunction -- these drugs enable the body to perform as it would with a normal level of testosterone. The drugs are increasingly used to prevent muscle wasting in people with AIDS and certain types of cancer.
Steroid abusers essentially attempt to magnify the known effects by "stacking" or "pyramiding" doses totaling 10 to 100 times the amount used in a clinical setting. Because clinical trials of such large doses are ethically infeasible, evidence of their benefits and adverse reactions is largely anecdotal or assumed from known problems associated with therapeutic amounts.
While little science can verify the effects of illegal steroids, the case of Jeff Rutstein, a personal trainer, author and a self-described recovering steroid addict, illustrates them. He gained 20 pounds in the first six weeks after starting anabolic steroids as a teenager in the 1980s. Before steroids, he was able to bench press 175 pounds; after six weeks he was able to bench press 225. He was also able to work out for long periods without stopping.
But when he stopped taking the drugs, he lost whatever muscle mass he'd gained and went into depression, which seems to result from the sharp drop in testosterone.
The litany of health hazards associated with abuse of anabolic steroids, according to the National Institute on Drug Abuse, include liver and kidney tumors, jaundice, fluid retention, high blood pressure, heightened "bad" cholesterol and lowered "good" cholesterol, as well as severe acne.
According to the Drug Enforcement Administration, steroids -- which are illegally diverted onto the black market from U.S. pharmacies or produced in underground laboratories -- are sold in gyms, at competitions, by mail and via the Internet. They are relatively inexpensive drugs; a price check for anadrol from a large U.S. mail order pharmacy puts the cost at less than $1 per 50 milligram tablet. Costs for abusers are multiplied by the fact that they use such high doses and typically acquire them on the black market.
In any event, anabolic steroids rank fairly low among American teenagers' drugs of choice. According to figures for 2004 from an ongoing survey by the University of Michigan's Institute for Social Research, only 1.6 percent of 12th-graders reported having used steroids within the last 30 days at the time they were surveyed, and 3.4 percent reported ever having used them. Even if prevalence is as high as the 7 or 8 percent cited by Yesalis, steroid abuse would fall well behind alcohol, tobacco and marijuana, ranking instead in the same neighborhood as ecstasy, LSD and cocaine.
And if educational efforts aren't enough to make major progress against abuse of other illicit drugs, the battle against steroids faces an additional obstacle in that abusers see them as providing a genuine benefit.
"These drugs are far too seductive, and the rewards for using them are far too great for us to think that education will stop it," said Yesalis, who advocates across-the-board steroid testing for high school athletes. "My answer to those people [who insist that testing is too expensive] is, 'Then get used to it. Shut up and get used to kids using them.' "
Perhaps the most prominent anti-steroid effort directed at young people in the scandal's aftermath is a collaborative campaign of Major League Baseball and the Partnership for a Drug-Free America. It features the "Statue" public service advertisement being shown during baseball broadcasts this season.
The commercial, which shows a statue of a classic Roman athlete crumbling as a voice-over narration outlines the damaging effects of steroid abuse, is a fairly conventional anti-drug message, in that it emphasizes the potential harms while paying little attention to what it is that attracts people to the substance.
A campaign against steroid abuse that looks only at the harm the drugs can do is more likely to be ignored by young people inclined to use them because it "flies in the face of the reality" that they see on television, at the gym or in school, suggests David Baron, chair of the department of psychiatry and behavioral health sciences at Temple University Hospital and School of Medicine in Philadelphia.
"The medical community has lost some of our credibility in the past when we've made claims that we really didn't have the data to make and used them as quasi-scare tactics," said Baron, who has been a U.S. Olympic Committee doping control officer since 1982. "I can remember during my medical education, people saying, 'Well, they don't really help you bulk up,' and that was total nonsense and every athlete knew that."
The need for the medical community to be more forthright and eschew scare tactics was a point of emphasis in an American Academy of Pediatrics policy statement on the use of performance-enhancing drugs, issued earlier this year. The statement urged pediatricians to ask about use of performance-enhancing substances as a part of every health maintenance visit with adolescents. It also urged doctors to develop an understanding of the incentives for using the drugs, a comprehensive definition of performance-enhancing drugs and familiarity with strategies for preventing their use.
What Steroids Do
The essential difference between anabolic steroids and catabolic steroids -- the latter being the kind used in corticosteroid medications, ranging from nasal sprays and eyedrops to the anti-inflammatory drug prednisone -- is that anabolic steroids build tissue while catabolic steroids break it down.
Both types of steroids can produce powerful side effects, and for that reason should only be taken -- and stopped -- under a doctor's supervision. With the illicit use of anabolic steroids, problems are exacerbated by the fact that abusers take such large doses.
And beyond the physical side effects associated with anabolic steroid abuse, there are psychiatric effects, including severe mood swings that can lead to violent behavior, paranoid jealousy and extreme irritability. And while not all of the side effects affect all abusers, adolescents who take steroids can end up with effects precisely the opposite of what they were seeking.
"If you take testosterone before your growth plate is finished growing, you will end up shorter than your projected height. In many ways, I figure that's going to be the most important piece of information to tell adolescent guys," said Rebecca Z. Sokol, professor of medicine and obstetrics and gynecology at the University of Southern California's Keck School of Medicine.
"And you know women take it, too, and they have a whole separate set of bad side effects: You get clitoromegaly, which is enlargement of the clitoris [which can only be repaired surgically]. You get facial hair, you get body hair, you get male-pattern baldness, your voice deepens. And [in women the side effects are] irreversible."
One of the tragic ironies surrounding steroids is that whatever the long-term consequences, the most devastating immediate side effect -- severe depression that has driven some abusers to the brink of suicide or beyond -- occurs when a person abruptly stops taking them.
A Cautionary Tale
For Jeff Rutstein, the road to ruin began at the intersection of poor body image and youthful naivete. Today he counts himself lucky that he has lived to tell his story and to serve as an object lesson on the dangers of steroid abuse.
As an undersized teenager growing up in the Boston area in the 1980s, Rutstein idolized buff sports stars like baseball's Jose Canseco and dreamed of reshaping his body to resemble the bodybuilders whose physiques virtually burst out of the pages of Flex and other muscle magazines he read. When working out on his own and taking protein powders failed to yield the desired effect, he took a fateful step.
"When I was about 18 I started going to a bodybuilding gym, and I kind admired all the big bodybuilders. I felt like their bodies commanded respect," said Rutstein, who is now 40. "Once I got to know some of them, they let me in on their little secret, which turned out to be steroids." Rutstein said he first acquired the drugs through fellow steroid abusers at his gym and later found an unscrupulous physician in the town where he attended college to write prescriptions. To finance his increasingly expensive habit -- which grew to cost "hundreds of dollars" a month -- he eventually took to dealing steroids to his friends and stealing money from his parents.
He spent more than three years cycling steroids -- both pills and injectables -- buoyed on the one hand by the attention his body was attracting and nagged on the other by fact that when he went off the drugs -- which he'd intended to use for only short time -- the muscles quickly disappeared.
His body and his workouts became the center of his life. Schoolwork, friends put off by his newfound aggressiveness and even side effects like the gushing nosebleeds he occasionally experienced were things to be ignored.
When he finally quit, "cold turkey, as a sort of New Year's resolution," he spiraled into a deep depression that left him wishing every day that he wouldn't wake up. With the help of his parents, he got treatment and recovered.
Rutstein thinks too much focus has been placed on the sports stars who have benefited from steroid abuse and not enough attention has been paid to the premature deaths of elite bodybuilders and athletes in their thirties and forties.
"I don't think people really realize how many people it's killed. They aren't saying it's from steroids, but why would a guy who exercises all the time and eats healthy be dying?" said Rutstein, citing the deaths of four leading bodybuilders within a month earlier this year.
"Lot of kids read this 'Underground Steroid Handbook,' " whose author, Dan Duchaine, won a lot of converts by promoting "safe" ways to take anabolic steroids, Rutstein said. "Duchaine died [in 2000] at age 47.
"Of 'natural causes.' "