Performance-Enhancing Substances: Should we be worried?

Performance-Enhancing Substances (PES) are used by children, teens, and adults to improve their athletic performance and for appearance changes. These can be dietary supplements, legal and illegal drugs, such as anabolic steroids, human growth hormone, creatinine, and stimulants.

Which are common PES? What do they do and how do they harm our children or us?

1. Anabolic steroids
   Used to increase muscle mass and strength.
   The main anabolic from our body is Testosterone.  Many athletes take a synthetic modification of testosterone. 
   A particularly dangerous class of anabolic steroids are the so-called designer drugs. These are synthetic steroids that have been illicitly created to be undetectable by current drug tests.
   Risks:
   -Male: prominent breasts, shrunken testicles, infertility and prostate enlargement.
   -Female: baldness (could be irreversible), deeper voice, enlarged clitoris, increased body hair, irregular periods.
   -Male and female: severe acne, high blood pressure, aggressive behavior, liver abnormalities and tumors, changes in cholesterol, psychiatric disorder (depression), drug dependence.
   -Taking anabolic steroids is prohibited by must sports organizations and it is illegal. 
2. Human Growth Hormone (HGH)
   Human growth hormone has an anabolic effect. Athletes take it to improve their muscle mass and performance. It is available with a prescription and administered by injection.
   Adverse effects: muscle weakness, fluid retention, joint pain, diabetes, vision changes, carpal tunnel syndrome, enlargement in heart and high blood pressure.
3. Creatine
   Creatine is a naturally occurring compound produced by your body that helps your muscles release energy. Creatine appears to help muscles make more adenosine triphosphate (ATP), which stores and transports energy in cells, and is used for quick bursts of activity, such as weightlifting or sprinting. It is available over-the-counter as a supplement.
   Adverse effects: abdominal pain, muscle cramps, weight gain.
   It appears safe if used at the recommended dose, but there are no long-term studies.
4. Stimulants
   Common stimulants include caffeine and amphetamines. Cold remedies often contain the stimulants ephedrine or pseudoephedrine hydrochloride. Energy drinks contain high doses of caffeine and other stimulants. The street drugs cocaine and methamphetamine are also stimulants.
   Stimulants can improve endurance, reduce fatigue, decrease appetite, and increase concentration.
   Adverse effects: irritability, insomnia, dehydration, heatstroke, dependence or addiction, palpitations, heart rhythm abnormalities, weight loss, high blood pressure, stroke, hallucinations, and heart attack.

What can we do as parents?

The American Academy of Pediatrics recommends the following to parents:

Guidance for Parents with Concerns About PES Use: 

1. Get involved...
   •  Be aware of new pressures as athletes progress through different levels of  participation and competition
   •  Emphasize the basics of hard work, pushing limits, teamwork, respect for competitors 
   •  Give options for alternative ways to achieve peak performance
   •  Monitor any use of supplements or shakes
   •  Do not hesitate to ask directly about supplement use
   •  Provide a counterpoint for prodrug and prosupplement messages
   •  Become knowledgeable about PES
   •  Be persistent 
2. Stay connected and create a strong partnership with your child's coach...
   • Get to know the team rules
   • Keep coach informed of any pertinent issues that may be occurring in    athlete's life
   • Respect role of coach
   • Talk to coach before or after practice, avoid sensitive discussions on game days
3. Keep lines of communication open with the athlete...
   • a. Emphasize the importance of good health
   • b. Use the news as a starting point for discussions on PES use 
   • c. Emphasize that there are no shortcuts to peak performance 
4. Engage health care providers if you are concerned about PES use...
   • Call provider before check-up and request that possibility of PES use be addressed during examination.
5. Know the warning signs of PES use, which include the following:
• Rapid changes in body shape
• Aggressive behavior or atypical mood swings 
• Extreme hair growth or acne
• Excessive time in weight room
• Voice changes (especially for girls) 
6. If you discover that your child is using PES...
   • Keep lines of communication open
   • Seek outside help

Should our children use PES?

Some athletes may appear to improve their performance with certain supplements or drugs, but at what cost? The list of side effects is very extensive, and some are irreversible. The short-term benefits are evident in some cases, but with a risk that outweighs the benefit. Doping is prohibited by most sports organizations. Taking performance-enhancing substances is very risky.

If you have any questions about performance-enhancing substances, please log into your account and send us your question. We are here to help.

Valerie C. Hines, MD, FAAP