As a personal trainer, I come into contact with young men who appear to be on anabolic steroids, typically taken to increase muscle mass and improve athletic performance. What are the signs they are using steroids? For starters, they exhibit muscle mass that seems to be beyond “normal,” and they exhibit aggressive behavior. Other signs of steroid use in boys include:
- Stunted growth
- Accelerated puberty
- Shrinking of the testicles
- Development of breasts
- Bruising or marks from injection sites (shoulders, thighs, buttocks etc.)
But steroid use isn’t just for men. Girls and young women use them, as well, says Scott Weiss, DPT, owner of Bodhizone Physical Therapy and Wellness in New York City.
The use of anabolic steroids by teens has been monitored by the Institute for Social Research at the University of Michigan since 1989 and reported in their Monitoring the Future study, funded by the National Institute on Drug Abuse (NIDA). According to their 2018 study of steroid use by high school seniors, about .5% of girls report having used anabolic steroids in the last 12 months, which is about one-third the rate of use by their male counterparts. “Female signs of steroid use include changes in or cessation of the menstrual cycle, enlargement of the clitoris and a permanently deepened voice,” notes Weiss. Girls can also experience excessive body hair and male-pattern baldness.
How Can You Tell?
Some of the signs of steroid use mimic typical adolescence, especially in boys, such as acne, moodiness, and increased muscle mass. How can a parent tell the difference between normal developmental changes and signs of steroid use?
The speed at which these changes are occurring, says Weiss, is a big clue for parents. “Vertical growth can take place over a summer,” he explains, “but muscular growth takes years. Acne can greatly worsen and occur in more places on the body. Stretch marks may appear from the sudden muscle growth, especially across the chest and hips. The mood swings can be violent and they are the aggressor in many altercations. And obviously hair loss is not normal during puberty.”
Longer term effects of anabolic steroid use include shortened stature, tendon rupture (from the sudden muscular growth), liver cancer and hepatitis, infertility, and cardiovascular problems, including higher LDL (bad) cholesterol, lower HDL (good) cholesterol, high blood pressure, and even heart attack. One study showed that anabolic steroids weaken the heart even more than previously thought. So ironically, while steroids are taken to increase muscle mass and strength, they actually weaken the most important muscle in the body. And in a study on liver injury and supplements in the journal Hepatology, researchers reported that the most common source of liver toxicity was found with use of anabolic steroids. About one-third of cases in a U.S. registry that documents drug-induced liver injury were due to steroids. Anabolic steroids have been shown to cause liver injury because they interfere with the production of bile, a fluid produced by the liver that aids in digestion.
Anabolic steroids differ from corticosteroids, often given for conditions such as asthma and allergies. “Corticosteroids are medications that have effects on inflammation in the body,” explains Shannon Safier MD, Clinical AssociateProfessor in the Department of Pediatrics at Drexel University College of Medicine in Philadelphia. “They are often used to reduce inflammation. Corticosteroids can be immunosuppressive and decrease the activity of the immune system, as well.”
How Common Is Steroid Use?
Statistics vary in steroid use among all populations. This is in part due to the fact that anabolic steroids are not commonly included when participants are surveyed about drug abuse. However, the 2018 Monitoring the Future study notes that rates of steroid use among teens have been up and down since the research began in 1989, with a decline in recent years. The report states that twelfth graders’ past year use in 2001 was 2.4%, then declined to 1.7% in 2005, stayed fairly level from 2005 through 2015 (1.7%), and then declined in 2016 to 1.1% and held steady in 2018. Similarly, in 2006, 2% of all students in grades eight through 12 reported that they had tried anabolic steroids at least once in their lifetime. By 2018 that number was reduced to 1.3% among students in those grades. Other studies show similar results, while a University of Minnesota study showed a higher incidence of steroid use: Out of 2,793 students surveyed with an average age around 14, 5.9% had used steroids.
While data may conflict, trends do tend to go up and down. One thing that has been shown to aid in the downward trend is education. According to a study published in The Sport Journal, “less than two-thirds of the athletes had the effects of anabolic steroids explained to them, and less than half of them have received their knowledge from an adult (parent, coach, teacher, athletic trainer, etc.).”
According to NIDA, simply giving students information about steroids’ adverse effects is not enough to convince them to avoid the drugs. “Presenting both the risks and benefits of anabolic steroid use is more effective in convincing adolescents about steroids’ negative effects, apparently because the students find a balanced approach more credible.” This makes sense. When you tell a teen to avoid something, what is he or she likely to do?
Which Teens Are Drawn to Steroids?
As with any other drug, there is a certain population that is more likely to abuse anabolic steroids. “Teen boys who are feeling vulnerable or inadequate to cope with the demands of teen life are more likely to use steroids to try to make themselves look and feel more powerful,” explains Carole Lieberman, MD, Beverly Hills psychiatrist and author. “This includes teen boys who are being bullied, abused or rejected by teen girls.”
A study in the Journal of Adolescent Health echoes this assessment: “In males, steroid use was associated with poorer self-esteem and higher rates of depressed mood and attempted suicide, poorer knowledge and attitudes about health, greater participation in sports that emphasize weight and shape, greater parental concern about weight, and higher rates of disordered eating and substance use. Among females, steroid use was less consistent in its associations with other variables, although overall, a similar pattern of results emerged.”
If you suspect your teen may be using anabolic steroids, a trip to the doctor is in order, notes Dr. Lieberman. “Parents can bring their teen in to their family doctor for a blood or urine test to look for steroids,” she says. “Most importantly, if parents suspect their teens may be using steroids, they should bring them to a psychiatrist for an evaluation, because even if the teen is not actually using steroids, the behavior that became worrisome to the parent needs an evaluation. Whether it is teen rebellion or maladjustment or the beginnings of a mental illness, the teen needs help.”
There are also home urine tests that will detect many of the common anabolic steroids used today, and these can be found online or at your community drug store.
If you have any concerns that your teen may be using anabolic steroids, experts recommend that you have an honest conversation with your child and provide the information and support he or she needs.
Steroids and Other Appearance and Performance Enhancing Drugs (National Institute on Drug Abuse)
Anabolic Steroids and Pre-Adolescent Athletes: Prevalence, Knowledge, and Attitudes (United States Sports Academy, The Sport Journal)
Steroid use among adolescents: findings from Project EAT (PubMed.gov, National Institutes of Health)
Anabolic Androgenic Steroid Use in Teens: Prevalence, Demographics and Perception of Effects (Journal of Child & Adolescent Substance Abuse, Volume 20, Issue 4, 2011)
Good Source for Your Teens
Drug facts: Anabolic Steroids NIDA for Teens (National Institute on Drug Abuse)