Performance–enhancing drug usage and adolescent athletes–identifying

Question 1

What is the most common performance-enhancing drug used by adolescent athletes?

Answer 1

Anabolic steroids for the most common type of PED

Question 2

What are some of the common reasons for using performance-enhancing drugs?

Answer 2

To improve physical appearance and athletic performance.

Question 3

What are some of the positive benefits of anabolic steroids?

Answer 3

They increase lean body mass and decrease body fat composition.

Question 4

What are the 5 major organ systems in which side effects occur from anabolic steroids?

Answer 4

1. Cardiovasculer
2. Hematologic
3. Neuropsychiatric
4. Reproductive
5. Other

Question 5

What are some of the cardiovascular side effects and how common are they?

Answer 5

Sporadic case reports of sudden death in athletes taking anabolic steroids with no family history or medical history of sudden death. The case reports include cardiac hypertrophy or myocarditis and there have been reports of left ventricular hypertrophy.

Question 6

What are the hematologic side effects of anabolic steroids?

Answer 6

1.Use of androgenic steroids can activate the hemostatic system which increases thrombin–Antithrombin complexes, prothrombin fragment 1, Antithrombin III, and protein S. It can also decrease tissue plasminogen activator and its inhibitor. It is unsure if it increases incidence of thrombosis.
2. Erythropoiesis: Exogenous testosterone and GnRH agonist can increased hemoglobin hematocrit by stimulating erythropoiesis.

Question 7

What are some of the neuropsychiatric side effects of anabolic steroid use?

Answer 7

They include mood disorders and aggressive/violent behaviors. Females also have reported experiencing symptoms of hypomania and depression.

Question 8

What are some of the reproductive side effects effects in both females and males?

Answer 8

Females receiving exogenous androgens can have increased acne, hirsutism, male pattern balding, clitorimegaly, and a deeper voice.
Males receiving exogenous androgens can cause hypergonadism due to prolonged gonadotropin suppression which then results in decreased spermatogenesis & infertility. Exogenous testosterone can be aromatized to estradiol leading to gynecomastia.

Question 9

What are the 4 “other” areas that can be negatively affected by anabolic steroids?

Answer 9

1 infection from local abscess and septic arthritis from injecting steroids, sharing needles can be risky for developing HIV, hepatitis B and hepatitis C.
2. Tendon rupture triceps and biceps tendons rupture risk increases
3. Epiphyseal closure: Testosterone can aromatize to estradiol which can cause earlier epiphyseal closure in the skeletal immature athlete
4. Hepatic: Oral 17 hydroxy alkylated androgens can cause elevated liver function enzymes and cholestatic jaundice.

Question 10

When should a provider suspect performance-enhancing drug use in an adolescent?

Answer 10

They are most commonly used in competitive sports such as swimming, cycling, football, and baseball, etc.

Question 11

What are the common signs and symptoms suspect exogenous androgen use?

Answer 11

1. Behavioral changes such as irritability, aggression and depression
2. Rapid increase in muscle mass and strength
3. Acne
4. Elevated hematocrit, low LH, low sex hormone binding globulin SHBG
5. Males with hypogonadism, gynecomastia, decreased sperm count, or tendon ruptures.
6. Females with irregular menses, hirsutism, breast atrophy, temporary balding, clitorimegaly, and deepening of the voice
7. Early puberty, premature epiphyseal closure and final height shorter than predicted.