Abstracts & Literature Review 5

Performance-Enhancing Drugs and Today’s Athlete: A Growing Concern.: An Editorial Review. JACO.
2009;6(4).

Seth A. Cheatham, MD; Robert G. Hosey, MD; Darren L. Johnson, MD
Othopedics/ORTHOSuperSite.com;2008; 31(10):1014-1017.
© 2008 Slack Incorporated

JACO Editorial Reviewer: Joyce Miller, BSc, DC, FACO, FCC

Published: December, 2009
Journal of the Academy of Chiropractic Orthopedists
December 2009, Volume 6, Issue 4
Received: October 2009
Accepted: October 2009

The original article copyright belongs to the original publisher. This review is available from: http://www.dcorthoacademy.com © 2009 Miller and the Academy of Chiropractic Orthopedists. This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

JACO Editorial Summary

• The authors did not supply an abstract, only this troubling introduction calling for awareness of this increasingly daunting problem. This article is a short, focused commentary designed to alert clinicians to the growing problem of steroid use among young athletes and to urge their assistance to educate young people on the risks. It is summarized here.
• Epidemiology: Depending on the study, 4-12% of high school boys and 3.3% of girls have used anabolic steroids to enhance performance or recovery from injury. In 9-13 year old children, the rate of usage is 2.7% to 3.8%. Less than 1% of users stated that steroids were hard to get.
• Patterns of use: “Stacking” (the simultaneous use of multiple steroids) and “pyramiding” (increasing the dosage in a cycle) are used to maximize steroid receptor binding. Some also use clomiphen and HCG (human chorionic gonadotropin) to minimize side effects. Over-the-counter products such as Androstenedione (a precursor to testosterone) and DHEA are commonly used but studies show there is no effect on lean muscle mass or muscular strength. There is concern of virilisation in women and gyneocomastia in men after using DHEA.
• Risk Factors: A picture of the most common user has been developed. The user is likey to be male, under-performing in academics and a participant in school athletic programs, especially sports such as football, wrestling, baseball and track and field which require muscle strength and power.
• Adverse Effects: There are 5 categories of adverse effects: hepatic, cardiovascular, reproductive/endocrine, dermatological and psychiatric. Children are the most susceptible to adverse effects with potential elevated lipid profiles, hypertension, cholestasis, hepatic adenomas, severe acne, premature baldness, severe mood changes, early development of secondary sex characteristics and even early closure of growth plates in long bones.
• Conclusion: Health professional who have an understanding of the risks of taking these drugs are in a prime position to educate parents and youngsters in order to decrease the first-time use of these drugs and thus prevent life-long consequences.

Key References:

1. Sjoqvist F, Garle M, Rane A. Use of doping agents, particularly anabolic steroids in sport and society. Lancet. 2008; 371(9627):1872-1882.
2. Casavant MJ, BlakeK, Griffith J, Yates A, Copley LM. Consequences of use of anabolic androgenic steroids. Pediatr Clin North Am. 2007;54(4):677-690.