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Anabolic Steroid Use in Female Adolescents
Feb. 21, 2011
Anabolic steroids and the complications involved have received much press in recent years. Unfortunately, the majority of the focus has been centered on athletes’ use of the drugs. A much more sensitive portion of the population is at risk, however. Some young teenage girls are beginning to find the promise of a perfectly sculpted body irresistible. For many reasons, this is a very dangerous cycle to get trapped in at so young an age. Furthermore, it is not necessarily the use of these steroids that is most distressing, but the root of the problem itself. These teenage girls have such a skewed view of their body in reality, striving constantly to reach their ideal body and fearing without end reaching a size or shape they see as worthy of despite. This type of obsession has recently been clinically labelled as body dysmorphic disorder. According to the DSM IV, people with BDD suffer from a “preoccupation with an imagine defect in appearance” (Schlundt, 2011). More specifically, users of anabolic steroids often suffer from Muscle Dysmorphic Disorder. This usually results in obsessive exercising and, more often than not, the use of ergogenic aids like anabolic steroids (Schlundt, 2011). The consequences for these teenage girls are frightening, and the struggles they will continue to face for a lifetime are haunting. This paper seeks to answer the question of the prevalence of female adolescent steroid use, asses possible causes of such use, outline the dangers of this, and suggest solutions for this problem.
Before discussing possible causes or solutions, it is important to assess how severe this problem really is. In 1989, the American College of Sports Medicine conducted a survey of high school students in both affluent districts and districts in lower socioeconomic areas. The questionnaires were given to head coaches at ten different high schools, 1,010 in total. The head coaches, in turn, were asked to distribute these surveys to males, females, athletes, and non-athletes evenly. Students filled out the surveys anonymously and independently, and only if willing. These students’ ages ranged from 13-21 overall. These students were in some of the most critical years of their growing lives. Of all the high school students surveyed, three percent admitted to using anabolic steroids. The vast majority of these users also admitted to receiving these drugs from a non physician source. Though most users were male, a still significant 1.4% of all female students admitted to consuming anabolic steroids. This particular study was the first to assess the number of high school students using steroids delineated by sex. It is clear that many more female teenagers are using these drugs illegally than would be expected (Windsor, 1989).
More recently, further studies have been conducted surveying students of an even younger age. The Department of Human Performance and Fitness at the University of Massachusetts surveyed middle school students in the area, male and female. This study, conducted in 1997, discovered that 2.7% of all middle school students reported the use of steroids. Surprisingly, 2.6% of users were male, and 2.8% were females (Faigenbaum, 1997). This same report also cites that anywhere between .5% and 2.9% of female adolescents in the United States have used steroids for the purpose of sports performance enhancement and body altering. It is clear that more females use steroids than would be expected - and at a younger age than would be expected. For example, Tanner et al collected data showing that 54% of teenage steroid users began before the age of 14. Other studies cited in this report have found results to show that a growing number of female adolescents are using these dangerous substances for non-medical purposes, regardless of a spreading awareness of their dangers (Faigenbaum, 1997).
A further study conducted in 2007 examined the prevalence of anabolic steroid use by females across the country as a whole, discovering trends overall. This study documented a doubling and quadrupling of the use of steroids by adolescent girls in the 1990’s. In 2004, the Centers for Disease Control and Prevention found that over 7% of ninth grade girls admitted to using steroids at one time. This number surpasses the amount of male adolescent users in some areas. This cross sectional study used results from many similar sources to find a nationally representative sample of US adolescents - specifically high school students. According to this study, 5.3% of female high school students reported steroid use, and a portion of the females surveyed refused to answer the question regarding anabolic steroids. Once again, an even more recent study has shown that the number of teenage girls using steroids is only increasing, nationwide (Elliot, 2007).
Figure showing the prevalence among female adolescent steroid users (Elliot, 2007).
Determining the cause of these girl’s use of non-prescribed drugs is certainly not an exact science. However, from the three studies already mentioned, certain trends and correlations can be found in users of anabolic steroids. The comorbidity of steroid use and other dangerous habits and behaviors seems to be clear. Whether these tendencies cause the growing use of steroids or simply accompany them is not so clear. For example, most adolescent female users tend to abuse multiple substances, be more sexually active, carry weapons, or participate in reckless activities. Once again, it is difficult to determine whether these stem from, cause, or simply accompany the use of steroids in female adolescents. There are, however, some clear characteristics that seem directly proportional to the use of anabolic steroids (Elliot, 2007).
The most significant related factor is concern about weight loss and body shape. According to a 2007 survey by the American Medical Association, two thirds of all female adolescent subjects tried had made attempts to lose weight, but those who admitted to using steroids also admitted to extreme means of doing so. As an example of this, the survey asked users and nonusers alike whether they had used vomiting or laxatives as a method of compensating for high calorie intake. Only 6.8% of the nonusers admitted to doing so in the last thirty days. A significant 28.7% of users admitted the same. Clearly a significant portion of the female adolescents who use anabolic steroids do so in an attempt to achieve their ideal body shape (Elliot, 2007).
A second accompanying factor of anabolic steroid use is that of depression. While it isn’t necessarily a cause, it cannot be disregarded. From the same 2007 study, data was collected showing that only 10% of female high school students who didn’t use steroids had attempted suicide, whereas 43.6% of users had done so. A vast majority of the steroid users reported consistent feelings of sadness and hopelessness. This depression could be related to the self image issues that accompany the attempts to shape their bodies. It could also be a response to unmet expectations of a perfect body after steroid use. Finally, this correlation could mean that depression is a cause of steroid use in female adolescents (Elliot, 2007).
Finally, a very important factor that causes female adolescents to be more likely to use anabolic steroids is the pressure from peers and adults. “Certainly, the influence of peer pressure during childhood and early adolescence should be considered one of the primary factors associated with the initiation of AS use” (Faigenbaum, 1997). Komorski and Rickert found that friends, family, and other peers are the primary source of anabolic steroids for adolescents. The same studies have shown that adolescents are more likely to use the drugs if they know of a peer who also uses steroids. Furthermore, there is no doubt that many sports push their athletes to maintain a certain weight and build. A study from 1997 examined what percentage of females in various sports use anabolic steroids. Nine percent of weight-training female adolescents admitted to using steroids. Even sports with the lowest percentage of users have a greater percentage than the adolescent population as a whole. Clearly, the pressure from sports and possibly even coaches pushes adolescents to use outside sources to boost performance. In fact, 38% of steroid users state that someone had asked them to take steroids. So much more than just internal strife plays a role in whether an adolescent will fall to the temptation to use anabolic steroids (Faigenbaum, 1997).
(see figure on following page)
Figure showing the comorbidities found in steroid users (Elliot, 2007).
Awareness has certainly been raised regarding the dangers of anabolic steroid use. However, few people could specifically describe what adverse effects actually occur. Far too many problems accompany steroid use, such as glucose intolerance, insulin resistance, increased risk of cardiovascular disease, cerebral problems, injuries, and prostate cancer. And these don’t even include the psychological problems that often result from anabolic steroid intake (Hickson, 1989). Researchers have established a continuum of psychological changes that occur because of steroid use, beginning with changes in mood, an increase in confidence and energy, and a boost in motivation. This first stage also includes a new ability to continue training regardless of pain and unfortunately an increase in irritability and agitation. As people begin to take larger doses for a longer period of time, they reach the second step in the continuum. This involves a decrease in inhibition and judgment, accompanied by mood swings, suspicious thoughts, quarreling, and unrealistic and grand ideas. These users also become impulsive and even more irritable. Finally, the third stage that steroid users reach involves all of the aforementioned qualities, but characterized in antisocial and violent behavior. Hostility from steroid users has been known to result in vandalism, self-injury, divorce, abuse, murder, and even suicide. In extreme cases, users have been found to be suffering from paranoia, schizophrenia, and depression - among others (Hickson, 1989).
There is no doubt whatsoever that steroid intake is risky for all users. However, there are some specific dangers for female adolescents who attempt to alter their body shape by means of the drug. First of all, simply because these teenagers are female puts them in greater danger when using steroids, as the female body is not built in order to receive steroids without adverse effects. Many of the outcomes include a deepening of the voice, increase in body hair, damage to the liver or kidney, skin problems, clitoral enlargement, shrinking of the breasts, and high cholesterol (Women and Steroids). There are also possible risks for adolescents as a whole when steroids become a factor. Some studies have suggested that teenagers using steroids often experience a premature closure of the epiphyseal plate. At a time when these adolescents are doing some of their most vital development, it is dangerous to add anything that could possibly harm this process. (Hoffman, 2006). This compounded with the dangers for women alone makes it obvious that steroid use by female adolescents is an extremely risky lifestyle choice.
Clearly there is a growing population of female adolescents who use anabolic steroids, and it is extremely obvious that there are significant problems with this fact, dangers specific to female teenagers that cannot be avoided. Something must be done. Studies have shown that raising awareness improves drug refusal skills, awareness of individual vulnerability to the dangers of steroid use, and attempts at a healthier lifestyle (Goldberg, 1996). However, it has also been found that “scare tactics” did not effectively sway students away from steroid use. When risks and benefits were presented, students more readily avoided steroids, but when only rare but terrifying outcomes were presented, students did not see the personal dangers and were therefore not persuaded (Goldberg, 1991). Schools and youth centers need to work to develop programs that will raise awareness in this balanced way so that fewer female adolescents fall into the trap of steroid use and abuse.
It has certainly been made clear that there is a growing number of female adolescents who use anabolic steroids for body shaping purposes. Though possible causes can be speculated, at this point it is difficult to tell what truly motivates these girls to use these drugs. Nevertheless, the problem exists and the dangers are clear. The only possible response is intervention. As research for the subject grows, the techniques must be modified. Awareness is certainly important, but as some point the presence of pressure from peers and adults must be eradicated from these teenage girl’s lives. Otherwise, the number of female anabolic steroid users will continue to grow, and the age at which they begin to use these drugs will only become younger.
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Goldberg, L. MD. et al. (1991). Anabolic steroid education and adolescents: do scare
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Goldberg, L. MD. et al. (1996). Effects of a multidimensional anabolic steroid prevention
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Hickson, R. C. et al. (1989). Adverse effects of anabolic steroids. Med Toxicol Adverse
Drug Exp. 4(4), 254-271.
Hoffman, J. R. and Ratamess, N. A. (2006). Medical issues associated with anabolic
steroid use: are they exaggerated? Journal of Sports Science and Medicine. 5,
Schlundt, D. (2011). Muscle dysmorphic disorder. Lecture on February 16, 2011.
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female adolescents. Med icine and Science in Sports and Exercise. 21(5), 494-497.
Women and steroids. Association Against Steroid Abuse.
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