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PEDIATRIC PERSPECTIVE

Honesty is the best policy in educating youths about steroids

A few years ago, I helped care for a teenager with cystic fibrosis, a chronic lung disease often causing malnutrition. Such patients are usually quite thin. But this young man was suspiciously muscular, and when asked, admitted to using anabolic steroids. He said he needed the look to be an actor someday.

Once used to help bulk up concentration camp survivors, anabolic steroids can be helpful in a variety of wasting conditions, such as cystic fibrosis and AIDS, to normalize weight. But my patient didn't settle for normal. Like many teenagers using steroids, he wanted to be more muscular than average.

Nationally, about one in 20 healthy males have used anabolic steroids at some time; surprisingly, so have many females. As Newsweek reported last month, 300,000 American teenagers abuse steroids every year. In a Massachusetts-based 1998 survey, published in the journal Pediatrics, 3 percent of middle school students had used them. Many were athletes but, like my patient, 40 percent used steroids for purely cosmetic reasons.

Of course, steroids are dangerous. Numerous side effects can occur, including gonad shrinkage, disfiguring acne, aggressiveness (so-called ''roid rage"), hair growth in girls, and breast growth in boys. Numerous groups, such as the American Academy of Pediatrics, National Football League, and the NCAA, discourage steroid abuse. But, according to the federal Monitoring the Future Study released last month, teenage use hasn't dropped much over the past 10 years.

Why can't parents and health authorities stop this epidemic? The answer is that our attitudes on these drugs are often hypocritical.

The inconsistencies begin with our culture. On one hand, authorities promote an ''abstinence-only" approach to performance-enhancing drugs by encouraging teenagers and athletes to ''just say no." The perception is that steroids confer unfair advantages.

But teenagers see just the opposite around them. Students without hyperactivity problems pop Ritalin to try to enhance concentration, healthy men take Cialis to improve sexual performance, and normal-looking women get surgical makeovers regularly on television.

Furthermore -- and this is a painful acknowlegement -- some of these drugs actually work.

The first serious study of the effects of anabolic steroids wasn't done until 1996. Then, the New England Journal of Medicine reported that, after 10 weeks, healthy men given anabolic steroids gained 10 pounds of muscle mass and could bench press an extra 20 pounds without any weight training. The differences were even greater when weight training was added. The brief study showed no adverse affects, and no change in mood or behavior.

Secret East German studies that recently came to light show that anabolic steroids allow athletes to toss javelins up to 45 extra feet, and cut 10 seconds off a 1,500-meter run.

In 1990, the US Food and Drug Administration began regulating steroid sales. But that changed in 1994 when lawmakers passed the Dietary Supplement and Health Education Act. Among other changes, the law created a semantic distinction between certain anabolic steroid ''drugs," like Dianabol and Winstrol, and other steroid-like ''supplements," like DHEA and Tetrabol -- and stripped the FDA's authority to regulate the latter.

Local Vitamin Worlds and GNCs now legally stock numerous hormonally active pills. Here and there a dietary ''supplement" is pulled (the FDA last year halted sales of ''Andro," which baseball player Mark McGwire used in 1998 when he hit a then-record 70 home runs), but next-generation supplements are continuously released. Today, about half of 12th-graders say steroids are ''easy to get."

Schools and parents continue to send unmistakable messages about the importance of physical achievement. According to USA Today, towns in the Dallas area alone are spending $180 million building high school football stadiums, a trend by no means confined to Texas.

In a survey of potential Olympic athletes, 98 percent said they'd take a performance-enhancing drug if it were undetectable and assured victory. More than half said they'd still take the drugs if it guaranteed victories for five years but then caused death.

When I was a medical resident, I counseled the young man with cystic fibrosis about the dangers of steroid use, the lack of evidence that they worked, and the importance of inner rather than outer attractiveness. In retrospect, my well-intentioned but ignorant approach probably did no good.

Today, many parents wonder how to help youths avoid steroids. One pilot curriculum in Oregon, called ATLAS, targets male high school athletes for antidoping education by coaches and peer counselors, but shows only modest positive effects. This program is just a start. We must begin with consistent honesty at the level of families, schools, and government if we hope to capture respect from teenagers.

Dr. Darshak Sanghavi, a clinical fellow at Children's Hospital and Harvard Medical School, can be reached at sanghavi@post.harvard.edu. 

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