Adolescent Use of PEDs

Extent of Use

No one disputes the assertion that PEDs of any sort, especially steroids, are very bad business for adolescents. The extensive earlier discussions here about the true side effects of PEDs have all been predicated on the subject being major-league baseball players, which is to say adult professional athletes. The biology of the human body before it completes its adolescent growth is significantly different in many ways from that of adults. (And, while we're at it, so is the biology of even adult females.)

There is not much dispute over the reality of PED use by adolescents, most especially young boys (though some use by girls is reported, too). What there is dispute over (though a lot less dispute than there should be) is the extent of that use. Use rates as high as 8% have been thrown around (see the so-called "Mitchell Report" for an example). But long-term, large-basis scientific studies of the problem just don't match the rhetoric.

The National Institute on Drug Abuse, which surveys about 50 thousand adolescents, in its report "National Results on Adolescent Drug Use: Overview of Key Findings, 2006" stated (with many more accompanying detailed supportive statistics) that:

As confirmation, ProjectEAT: Eating Among Teens, a five-year, longitudinal study of over a thousand youths, reports that:

Those statistics are not unique to this nation; studies in other nations show highly similar rates (for example,"The prevalence of the use of androgenic anabolic steroids by adolescents in a county of Sweden" showed about 1.45% use rate).

Nonetheless, though the use rates were always fairly low and continue to decline, it remains so that any is too much. So let us see why some adolescents use PEDs.

Reasons for Use

The "Role-Model" Claim

To some, "answers" come easy:

That gentle myth, one supposes, is in the tradition of that forlorn waif crying out "Say it ain't so, Joe". The proposition's truth is about the same as that of the tale of the waif.

Aside from meaningless personal estimates and unscientific "surveys" taken by popular media or groups with an obvious axe to grind, there is relatively little in the literature to suggest actual numbers--little, but not nothing.

In a paper entitled "Role Models, Ethnic Identity, and Health-Risk Behaviors in Urban Adolescents" [Arch Pediatr Adolesc Med, Yancey et al. 156 (1): 55], Yancey et al. reported that:

So not even one kid in five today has an athlete as a nominal "role model". And even though in general "role models" have nothing to do with substance abuse, those few who do self-identify as someone with an athlete as a role model--almost entirely male teenagers--are actually slightly cleaner than others with other role models.

Those are the facts as reported from actual studies. But we shouldn't even have needed such information when common sense says the same things. It takes quite a mental broad jump to get from the vague general idea of a "role model" to a belief that those kids having one will try to emulate that person in any and all activities whatever. Common sense suggests that while it's only a hop to the idea that some kids might, oh, wear their baseball caps back to front because they've seen athletes doing it, an awful long running start is needed to jump direct to the conclusion that high-school, or even middle-school, children are going to start a regular regimen of injecting potentially dangerous, certainly illegal, and above all very expensive substances merely on the grounds that "Wul, Doofy Jones does it, an I jus' wanna do everything Doofy does." Come on people: wake up and smell the coffee. And re-read that last paragraph boxed above.

Regrettably, some of those pushing the "misled waifs" line are parents whose children have been injured or even killed. Those bereaved parents, with whom everyone must deeply sympathize, urgently want us to finish the preceding sentence with "by steroids", because their children were using steroids at the time. But sympathy is not agreement. No matter how tragic and heart-rending, anecdotal evidence is just that: personal anecdote. And, as common sense should suggest, bereaved parents are the least likely possible source of reliable information: their child has died, they are confused, frustrated, and angry, and they want something simple and definite to blame for what was almost certainly a complex set of circumstances, possibly involving them.

Fortunately, "common sense" being an oxymoron, we don't have to rely on it unaided. Numerous, comprehensive medical studies have shown the real reasons why the adolescents who use steroids do so. They are, by and large, rather sad. They also, by and large, have nothing to do with "hero worship." Let us review them in roughly the order that researchers have found them to be the priorities of adolescent users ("roughly" because not all causes have well-documented percentages associated).

Appearance

The first and foremost reported reason for use?

Other studies have shown that steroid use by adolescents follows highly similar patterns in all nations. Still, we can get the same analysis closer to home:

But, though they should know, we could still say that that, too, is "anecdotal". So let's turn to some medical experts. Dr. Norman Fost (Princeton A.B., Yale M.D., Harvard M.P.H.), Director of the Program in Medical Ethics at the University of Wisconsin since 1973, past-Chairman of the American Academy of Pediatrics Committee on Bioethics (or, in short, a qualified expert), observed in an interview that:

Numerous other studies report the same finding:

That's it: kids who see themselves as the 98-pound-weakling want to become "babe magnets". If these poor devils have "role models", they are the countless fungible boy toys they see strutting their way through pop magazines (see the quotes above), movies, TV shows, and commercials for everything from cars to hooch. If there is a connection to baseball, it is MLB's fondness for sponsoring ball games with, yes, car and beer ads--among the worst offenders available for setting undesirable male role models.

Team Sports

What may be the number two cause of steroid use is a desire to improve performance in team-sports activities (notably high-school football). Without rolling out yet another laundry list, it appears from the literature that potential adolescent users are informed, though often ill- and under-informed, about steroids, and typically undertake at least some investigation (often from poor sources) about them and other PEDs. That is not "hero-emulation" behavior: it is a calculated attempt to reach a well-defined personal goal.

What is more distressing is that it appears from the evidence that many school coaches, who have a great fiduciary responsibility to these kids, have made it clear, sometimes in a "nudge-nudge-wink-wink" way but too often expressly, that they will look away from, or even implicitly encourage, use of PEDs because "winning is everything". That is sick. But it is certainly not related to "hero worship" unless we consider those coaches "athletic heroes".

Psychological/Psychiatric Problems

This is a major but sorely under-discussed aspect of teen PED use. The kinds of problems involved fall broadly into two classes: irrational body-image and clustered risk-taking.

Adolescent Body-Image Problems

That teenage boys want big muscles may seem somewhere between laughable and sad, but in far too many cases the problem is a lot more serious than wishful fantasizing about "babes". There is a well-recognized condition called "muscle dysmorphia"; it is essentially the exact obverse of anorexia in teenage girls, and is every bit as unfunny and dangerous as anorexia. Both anorexia and muscle dysmorphia can, in extreme cases, lead to death.

The term appears to have originated in a 1997 paper, "Muscle dysmorphia: An underrecognized form of body dysmorphic disorder" [Psychosomatics. 1997 Nov-Dec;38(6):548-57] by Pope et al. The Abstract of that paper states that:

In a subsequent paper, "Muscle dysmorphia in male weightlifters: a case-control study" [Olivardia et al., Am J Psychiatry. 2000 Aug;157(8):1291-6], appearing three years later, we find:

To understand a bit, consider the very name: muscle dys-morphia: dys, ill, abnormal, impaired; morphic, form or shape. As with anorexics, when these people look into a mirror, what they see is not what normal people looking at them see: they, no matter how vigorous or muscular they really are, see an undersized, inadequate body. There is no degree of development (as for anorexics there is no degree of thinness) that will satisfy them.

Again, it is the mass media, and especially advertising--not pro athletes--that seem to dominate influences on muscle-dysmorphic adolescents:

Indeed, one study examined "action-figure" toys intended for young male children and found that over 30 years the toys' body dimensions had wildly inflated, to the point that their apparent musculature had become virtually impossible for real human beings (analogous to the "Barbie doll" phenomenon). My, we start them young.

At any rate, adolescents with muscle dysmorphia or just similar tendencies can scarcely be thought to be "modelling their behavior after prominent athletes"; and those adolescents are probably a good fraction of all adolescent steroid users.

Clustered Risk-Taking Problems in Adolescents

What is probably the lion's share of adolescent steroid use, though, comes from less-specialized psychological problems in adolescence. Study after study shows that teenage steroid users are very frequently also users of other drugs, many quite dangerous; further, those same abusers also almost all engage in many other high-risk behaviors, from violence and alcohol abuse to unprotected sex and weapons.

All too often, even in the scientific literature, we find as a recurring error the inability to distinguish case and effect when PED use shows--as it so very often does--as but one item in a constellation of high-risk behaviors. Indeed, there is actually a name for such a constellation: Jessor's problem-behavior syndrome for adolescents. That name turns up frequently in literature searches for adolescents and steroids.

The significance of the data is that steroids are by no means a cause of any of that behavior: they are just one of the many symptoms of the underlying problem. Here are some representative comments to be found in the literature:

Such clustered-risk behavior has various roots, which adults have been trying to sort out for probably 50,000 years or more; but that they exist and, even in the more extreme forms, are all too common, is scarcely arcane knowledge. Steroids, as they became available, were simply added into the cluster. And, of course--bottom line--none of this has anything whatsoever to do with "modelling behavior after prominent athletes".

Summing the "Role-Model" Claim

To claim "Barry/Roger/Hezekiah made me do it" as a cause for adolescent steroid use gives us a fine chance to air out our vocabularies. From Roget's Thesaurus: babble, balderdash, baloney, bull, bunk, drivel, empty talk, foolery, foolishness, gibberish, hogwash, hooey, hot air, jive, malarkey, mumbo jumbo, palaver, poppycock, prattle, rubbish, silliness, trash.

There: that ought to about cover it.