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From the National Athletic Trainers' Association

Pro-Active Approach To Preventing Anabolic-Androgenic Steroid Use Urged

NATA position statement says more study needed to prevent AAS abuse and treating abusers

The National Athletic Trainers' Association (NATA) has issued a valuable new position statement summarizing the best available evidence related to the use of anabolic-androgenic steroids (AAS) and calling for improved understanding of AAS in the sports medicine and athletic communities.

Man picking up dumbbellAnabolic-androgenic steroids* are powerful Schedule III pharmaceuticals that are related to naturally-occurring human hormones. Although the therapeutic use of these synthetic, testosterone-based derivatives can provide specific, limited medical benefits, they are most frequently abused to gain athletic performance advantages, develop physiques and improve body image.  

AAS abuse has been shown to lead to a host of negative health effects on the central nervous system, cardiovascular system, musculoskeletal system, immune system, skin, liver, kidneys and reproductive organs.  Individuals who are abusing these drugs for athletic advantage or image often dangerously rely on questionable information and illegal drug sources, which increases the risk of serious medical consequences.  

Widespread abuse

While most of the public and media attention concerning AAS has been focused on professional athletes, abuse of these powerful drugs is also a serious problem at the high school and collegiate levels of sport, as well as among general fitness enthusiasts.

"Based on recent trend research, we project there are an estimated 750,000 high school AAS abusers in the U.S.," said, Robert Kersey, PhD, ATC, CSCS, lead author of the position statement and director of the athletic training education program at California State University at Fullerton. "Worldwide, AAS abuse is estimated in the tens of millions."

Studies show that males abuse AAS at greater frequency than do females, with a 2009 national Centers for Disease Control and Prevention study of adolescents finding that male teens (4.3%) were almost twice as likely as female teens (2.2%) to abuse AAS.

The statement stresses that identification of the AAS abuser (or potential abuser) by a health care professional is critical to help prevent any negative consequences; and that proper direction, guidance, support and possible referral are essential in assisting those at risk.

Signs and symptoms, active monitoring

"It is vital that health care professionals, coaches, parents, administrators and the athletes themselves know the signs and symptoms of possible AAS abuse so they can educate others with the most current and accurate information," added Kersey. "And, if athletes or others suspect AAS abuse they should bring it to the attention of the athletic trainer or other qualified health care professional."

The statement emphasizes that, because AAS abuse involves a "dynamic, social process," active monitoring for such abuse and "maintaining an open, honest, and evidence-based dialog with all stakeholders, including athletes, coaches, administrators, parents, advisory groups, and others, is vital."  

The signs and symptoms of AAS abuse include the following:

  • Rapid body mass or performance increases
  • Extreme muscular growth
  • Abnormal, excessive or unexpected acne
  • Unexplained hypertension (eg. high blood pressure)
  • Euphoria and irritability
  • Moodiness
  • Aggression
  • Episodic depression
  • Secretive actions
  • Excessive exercise; and
  • Increased obsession with physique and diet 

Prevention difficult

  • Education: Well-designed, properly implemented sex-specific, sport-centered, and coach-facilitated educational programs (such as the ATLAS [Adolescents Training and Learning to Avoid Steroids] for adolescent boys and ATHENA [Athlete Targeting Healthy Exercise and Nutrition Alternatives] for adolescent girls) appears to be effective AAS abuse deterrents for adolescent student-athletes. 
  • Drug testing: Whether drug testing significantly deters AAS abuse remains unclear, says the statement, due to the small number of high-quality studies. The statement says a prospective randomized trials to investigate the deterrent effect of AAS screening is "greatly needed."

Treatment strategies

While the statement recognizes that, to date, no validated management strategies are available for AAS abuse, anecdotal evidence suggests that referral and counseling are "paramount to avoiding possible consequences of AAS abuse."  Because not all health care professionals or educators understand AAS pharmacology, the mentality of athletes and AAS abusers, or common AAS abuse patterns, the NATA recommends that health care professionals develop a referral network to assist them in offering the following kinds of specific support:

  • keeping athletes' self-esteem high with alternatives to AAS, such as evidence-based nutrition and weight-training principles, along with collaboration from conditioning experts and sports nutritionists, among others;
  • building trust with patients, clients, athletes, and coaches through consistent, year-round, evidence-based educational meetings and in-service sessions;
  • avoiding unfounded scare tactics and hype concerning the negative consequences of AAS;
  • being alert for excessive discussion about and focus on supplements and nutrition practices or self-education about AAS (eg, types, stacks, and cycles);
  • not threatening suspected AAS abusers, but instead cautiously stating their suspicions and offering evidence-based information and assistance in order to be an "accessible agent of positive behavioral changes"
  • acknowledging the minimal, short-term (physical) consequences of AAS abuse but stressing education from health, moral and ethical, and legal perspectives;
  • commenting on the negative aspects of AAS abuse, such as increased acne, stunted growth, or jaundice because they are "issues younger adolescents and adults will likely to be concerned about," and being sure not to compliment their physical appearance (eg. muscularity) or strength gaines because it may reinforce or encourage AAS abuse;
  • discussing personal sacrifices that accompany AAS abuse, such as money, time, social experiences, risk of disease and injury, and counterfeit or tainted products, among others; and
  • remaining attentive because AAS abusers typically are secretive and good at not getting caught (i.e. a passed drug screen does not prove AAS nonuse).

The statement notes that athletic trainers are often in a unique position to assess and assist AAS abusers and those who may become AAS abusers, and when necessary, they should call on other qualified health care professionals as referral resources. 

*The NATA's position statement addresses only AAS and does not include human growth hormone, insulin, or other frequently abused pharmaceuticals (including insulin growth factor 1 and selective androgen receptor modulators) or nutritionals (e.g. creatine, amino acids and protein powders).   

For a copy of the complete statement, click here.  

Source: National Athletic Trainers' Association.

1.  Kersey R, Elliott D, et. al. National Athletic Trainers' Association Position Statement: Anabolic-Androgenic Steroids.  J Ath. Train 2012;47(5):567-588 doi:10.4085/1062-6050-47.5.08.

Posted September 26, 2012