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On Tuesday, July 13, 2004, the Senate Caucus on International Narcotic Control of the United States Senate began a hearing on the abuse of anabolic steroids and their precursors by adolescent athletes. The purpose of the hearing is to highlight the easy availability, wide spread abuse, and inherent dangers of performance-enhancing drugs to adolescent athletes. The American College of Sports Medicine (ACSM) was invited to submit, for the record, a written statement. That statement follows:

The American College of Sports Medicine (ACSM) is the world’s largest sports medicine and exercise science organization and is widely regarded as the world leader in the field. More than 20,000 members in some 80 countries worldwide advance and integrate scientific research to provide educational and practical applications of exercise science and sports medicine. ACSM endeavors to increase sports participation as well as to ensure sports safety, and to promote physical activity as an important strategy to address the global pandemic of rising rates of obesity and related chronic diseases attributable to inactive lifestyles.

ACSM has a decades-long history of strong opposition to the use of steroids and other performance enhancing drugs in sports or in recreational settings. Over the years, ACSM has published many authoritative scientific statements on this topic. These statements include the official ACSM Position Stand: The Use of Anabolic-Androgenic Steroids in Sports. The main points of ACSM’s official position on the use of anabolic steroids are summarized as follows:

1. The use of steroids by athletes is contrary to the rules and ethical principles of athletic competition as set forth by many sports governing bodies. The American College of Sports Medicine supports these ethical principles and deplores the use of anabolic-androgenic steroids by athletes.

2. Anabolic-androgenic steroids in the presence of an adequate diet can contribute to increases in body weight and lean body mass.

3. The gains in muscular strength achieved through steroid use at doses beyond those utilized in clinical medicine improve performance and seem to increase aerobic power or capacity for muscular exercise, giving an unfair advantage to those who are willing to risk the potential side effects to achieve gains in athletic performance.

4. Steroids have been associated with adverse effects on the liver, cardiovascular system, reproductive system, and psychological status in therapeutic trials and in limited research on athletes.

ACSM recognizes that the use of drugs to enhance strength and endurance has been observed for thousands of years. Today, many individuals, including adolescents, continue to employ a variety of drugs, such as anabolic steroids, to improve their athletic performance and appearance. The appetite for these drugs has been created predominantly by our societal fixations on winning and physical appearance. There are physiological concerns associated with steroid use, however, including drug dependence and increased aggression.

Perhaps most alarming are the severe health risks associated with steroid use and abuse. These have been well-documented in the medical literature and are a function of the specific steroid used, the dose and duration of use, as well as the route of administration. Anabolic steroid use has been implicated in early heart disease, including sudden death, changes in blood cholesterol profile (increased LDL, lower HDL) resulting in increased risk of coronary artery disease, an increase in tendon injuries, liver tumors, testicular atrophy, gynecomastia (abnormal enlargement of breasts in males), male pattern baldness, severe acne, premature closure of growth plates in adolescents, emotional disturbances, and other significant health risks.

Some of the adverse effects are a function of the user’s age and sex. Particularly those adverse effects affecting secondary sex characteristics are quite predictable. Other somatic (unrelated to secondary sex characteristics) adverse effects related to steroid use and abuse, such as their effects on the cardiovascular system, blood clotting, liver function, and cholesterol metabolism, are less predictable and may occur from months to years subsequent to their use. The psychiatric effects of steroids are well known and in the extreme have been referred to as “Roid Rage.” Anabolic steroid abuse has been associated with a dependency syndrome and suicide has been noted upon cessation of use.

More recently, shameful attempts have been made to develop and mask “designer steroids,” meaning substances that are undetectable through the use of existing testing procedures. ACSM also considers these chemicals, such as the recently identified Tetrahydrogestrinone (THG) as serious threats to the health and safety of athletes, as well as detriments to the principle of fair play in sports. Any effort to veil or disguise steroid use in sports through stealth, designer, or precursor means, puts elite, amateur, and even recreational athletes, at risk. The health risks of designer steroids compared to or beyond symptoms of anabolic steroid use are not currently known.

Anabolic steroids are synthetic versions of the primary male sex hormone, testosterone. Testosterone, produced primarily by the testes, is responsible for the masculinization and muscle growth during male adolescence. Anabolic steroids are administered primarily in oral and injectable forms, and needle sharing has been reported, especially among adolescents. The latter method of administration, of course, means the risk of transmission of a variety of life-threatening, blood-borne diseases is an additional serious concern. These drugs are usually obtained from black market sources, which often include distributors of other illegal drugs. Beyond the dangers associated with anabolic steroid use, the purity and quality control of ‘black market’ sources may be an additional concern.

Individuals who use anabolic steroids, particularly those experienced in weight training, will experience increases in strength and muscle significantly beyond those observed from training alone. Many adolescents who use anabolic steroids do not participate in school-sponsored sports, but instead are using the drug to improve appearance. Adolescent steroid users are considered particularly susceptible to potentially serious health problems during the physically and emotionally vulnerable period when their own hormonal cycles are changing.

In females, anabolic steroids have been associated with a number of adverse effects, some of which appear to be permanent even when drug use is stopped. These include menstrual abnormalities, deepening of voice, shrinkage of breasts, male-pattern baldness, and increases in sex drive, acne, body hair, and clitoris size. Younger steroid users, both male and female, are at risk of permanently closing their growth plates and halting their linear growth, which results in shorter stature than nature had intended.

Anabolic steroid use is not just confined to collegiate, professional and Olympic athletes. Use among students in ninth to 12th grades is increasing at an alarming rate, indicating the critical need for action and intervention by policymakers. According to trend data tracked by the Youth Risk and Behavior Surveillance System at the Centers for Disease Control and Prevention, in just a four year time span, from 1999 to 2003, the percentage of students who reported that they had taken steroid pills or shots without a doctor's prescription one or more times during their life jumped 65 percent from 3.7 percent to 6.1 percent. If this trend continues, more than one out of every ten American students will have used illegal steroids at least once, by the turn of the next decade. The rise in use among females is even more alarming. Just four years ago, 2.2 percent of females in the survey reported use. By 2003, it was 5.3 percent – a 140 percent increase.

Also of concern to ACSM is the availability and use of anabolic steroid precursors. Thousands of over-the-counter products contain steroid precursors that metabolize in the body into anabolic steroids. In many cases, these are being sold as dietary supplements that provide "safe" steroid equivalents. Because these products are metabolized by the body into anabolic steroids, the side-effects are thought to be the same as the side-effects resulting from steroid use. ACSM recently commended the United States House of Representatives for passing the Anabolic Steroid Control Act of 2004 (HR 3866) and urged members of the Senate to promptly support and adopt similar legislation. HR 3866 would prohibit over-the-counter sales of anabolic steroid precursors by requiring a prescription from a doctor. Final passage would significantly limit access to substances such as androstenedione, commonly known as “andro,” and its derivatives. The legislation effectively reclassifies these products as controlled substances. They are currently considered supplements. Under federal law, controlled substances are the most highly regulated drugs in the United States.

The American College of Sports Medicine strongly urges lawmakers to take immediate, definitive, and lasting action to prevent the use of anabolic steroids and steroid precursors; with appropriate penalties for those involved in the medically inappropriate production, prescription, distribution and use of these agents. We thank you for the opportunity to contribute to this discussion.