Hormone abuse in adolescents and adults: A review of current knowledge

Abuse of hormones by adolescents and adults is increasing. Controversy exists about detection, factors that influence use, effects on athletic performance, and effectiveness of deterrence programs. The purpose of this study is to summarize data on hormone abuse, including prevalence, performance enhancement, adverse effects, and interventions. MEDLINE and LexisNexis databases searches between 1975 and June 2004 using the terms "adolescent/adolescence" or "student" or "athlete" combined with "anabolic," "steroid," "dietary supplements," "erythropoietin," or "growth hormone," and "prevalence," "epidemiology," "adverse effects," "doping in sports," or "substance abuse detection" were performed. A total of 1174 citations were identified and 514 were retrieved for analysis based on relevance. National surveys since 1991 show anabolic steroid use increasing in high school students, particularly females. Use is highest among athletes and clusters with abuse of other drugs. Short-term use of low to moderate doses of anabolic steroids increases muscle strength in trained athletes; studies evaluating higher dose regimens have not been conducted. Low doses of anabolic steroid precursors, like androstenedione and dehydroepiandrosterone, variably alter testosterone levels in males but increase levels in women. Although erythropoietin clearly enhances aerobic performance, there is little research on human growth hormones' effects on strength or physical performance. Newer drug prevention programs appear promising in reducing performance enhancing substance use. Illicit anabolic-androgenic steroid use is increasing in adolescents and adults, and team-centered, peer-led interventions appear to be effective in deterrence. A successful nationwide approach will require focused educational efforts, additional research, and legislation to limit availability of anabolic steroid precursors.