Performance-Enhancing Drugs

Christopher Dandoy; Rani S. Gereige

doi:10.1542/pir.33-6-265

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Christopher Dandoy, MD*
Rani S. Gereige, MD, MPH^†

^*Pediatric Hematology/Oncology, Fellow, Cincinnati Children’s Hospital, Cincinnati, OH.
^†Clinical Professor of Pediatrics–Florida International University, Miami Children’s Hospital, Miami, FL.

Author Disclosure
Drs Dandoy and Gereige have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

AAS:: anabolic-androgenic steroid
DHEA:: dehydroepiandosterone
EPO:: erythropoietin
hGH:: human growth hormone
PED:: performance-enhancing drug

Educational Gap

Performance-enhancing drug (PED) use by children and teenagers rose sharply in the past decade. One study shows 3.3% of high school students admit anabolic steroid use; another finds 8% of girls and 12% of boys report using products to improve appearance, muscle mass, or strength. Pediatrics clinicians must monitor PED usage trends, screen perceptively, and offer anticipatory guidance.

Objectives

After completing this article, readers should be able to:

Recognize the signs and symptoms of the use of anabolic steroids and growth hormone.
Know how to diagnose the use of anabolic steroids and growth hormone by data collection (history, physical examination, and laboratory evaluation).
Know the side effects of anabolic steroids.

Introduction

The use of performance-enhancing drugs (PEDs) by preteenagers and teenagers has increased tremendously over the past decade. This trend is driven by multiple factors, including the decrease in the age of participation in competitive sports; the increase in popularity of team/competitive sports; the focus of the media on thinness in females and muscular bodies in males; pressure from parents and coaches; the age-related characteristics of taking risks and feeling invincible; and the availability of various PEDs in many forms and shapes.

The pediatric clinician must be aware of the use of performance-enhancing substances by pediatric patients; be prepared to identify risk factors, signs, and symptoms; ask screening questions; and offer anticipatory guidance related to their use. Table 1 lists the common classes of PEDs. This review will focus on a select group of commonly used PEDs. The reader should know that anabolic steroids are synthetic substances derived from testosterone and are also called anabolic-androgenic steroids (AASs) or just “steroids.” Steroid precursors also …