The following was written by Dr. Laurence E. Mermelstein, M.D.

There are a fair amount of people who continue to remain ambivalent regarding athletes like Lance Armstrong  and Alex Rodriguez and their involvement with performance enhancing drugs (PED’s).  Many fans feel that whatever the professional athletes want to put in their bodies is their business.  Besides, all those home runs make for exciting baseball. In addition, the major league organizations have been equally ambivalent.  It is only recently that there is a firm anti-steroid policy in baseball with significant penalties in both the major and minor leagues.  Performance enhancing drug use is not limited to athletes.  These drugs have been touted by media personalities, police and military personnel and by “anti-aging clinics” to build strength, endurance and to “look and feel younger”.

Currently, the most commonly used drugs to enhance musculoskeletal performance are testosterone, androstenedione, anabolic steroids, and human growth hormone.  Beyond the obvious importance of eradicating these drugs to provide a “level playing field”, we need to avoid exposure of our young athletes to these very powerful and dangerous drugs. 


There are many substance considered to be “performing enhancing”. According to the US Anti-Doping Agency (, the list includes many drugs which have otherwise legitimate medical uses. This list includes:

More than 50 types of anabolic androgenic steroids, including androstanediol, stanozol, and testosterone and its various derivatives

More than 30 types of stimulants, including amphetamine and its analogs, ephedrine, and related substances

Human growth hormone (HGH)

Insulin-like growth factors

Erythropoietin and related compounds


  • Acne
  • Liver Dysfunction
  • Damage to brain tissue (neurons)
  • Premature closure of the growth centers of long bones (in adolescents) which may result in stunted growth
  • Increased aggressiveness & sexual appetite, sometimes resulting in aberrant sexual and criminal behavior
  • Impotence with chronic or repeated use
  • Testicular shrinkage (testicular atrophy)
  • Breast enlargement (gynecomastia)
  • Enlargement of prostate gland
  • Reduction of sperm production (cessation of spermatogenesis)
  • Male pattern baldness
  • Masculinization (in girls)
  • Excessive hair growth on the face and body
  • Deepening of the voice
  • Enlargement of the clitoris
  • Abnormal menstrual cycles (suppression of ovarian function and menstruation)


When looking at the statistics of PED use in this country, the magnitude of the problem is truly disturbing.  If you think that high school steroid use is a non-issue, think again.  A 2013 study by the Partners for Drug Free Kids reported that 7percent of high school students had used steroids and 11% had used HGH.  All one has to do is Google “buy anabolic steroids” and the search will turn up over 5 million web sites.  Some shocking data points include:

15 MILLION the number of Americans who use performance-enhancing drugs, according to one estimate

1 BILLION plus the amount of money spent annually in the United States on legal (prescribed) human growth hormone (HGH)

2.4 MILLION the number of prescriptions for testosterone filled by U.S pharmacies in 2004

3 million-the number of Americans who use anabolic steroids

750,000 the estimated number of children who have uses steroids and HGH


The main reason that there needs to be a firm anti-doping policy in ALL major league sports is to prevent aspiring young athletes from feeling the pressure to use these drugs in order to compete.  We need to protect the integrity of the games as well as the players who have made the choice not to use these drugs.

Enforcement of anti-doping policies up until 2005 had been non-existent at the high school level.  In California, the state’s interscholastic athletic governing board only requires every high school athlete to sign a pledge that he or she will not use performance enhancing drugs.  In addition, every coach must attend a course on recognizing the symptoms of steroid use and its prevention.  Many schools are requiring that parents and athletes attend a similar course.

But what about stronger deterrents? Many feel that education is only part of a successful program to eradicate steroid use.  Strong punishments for steroid use need to be implemented to eliminate the cheaters, or the “honest athletes” would potentially find themselves at a disadvantage.  With over 7 million active high school athletes, testing even a percentage of these athletes would be potentially cost prohibitive.

In 2005, New Jersey became the first state to begin testing its high school athletes.  Testing was only performed at post-season games and then only a random sampling of students were tested.  Even this limited amount of testing is estimated to cost over $100,000. Over the course of 2013-14, 495 New Jersey athletes were tested – 3 students tested positive.


Starting in 2007, Texas embarked on the most comprehensive high school testing. But  8 years  and  $10 million later, the state is considering scraping the system altogether. Due to what many call gaping loopholes in the testing process, only 2 positive tests out of 2,633 tests in 2013-14 were found. Testers had to tell school officials ahead of time when they would be on campus and were not allowed to physically watch the collection of urine samples.  In addition, only a fraction of the available steroids and other PED’s were tested for.

Florida’s testing program was dumped in 2009 leaving only Illinois, Texas  and New Jersey with active programs.

State Sen. Andrew Lanza, a Republican from Staten Island, introduced legislation in 2006 calling for secondary schools to test male and female student-athletes for the performance-enhancing drugs. Borrowing wording from legislation passed in Texas, which enacted the country’s most comprehensive program, the bill would require 30% of all high schools to screen for anabolic steroids, with 3% of athletes at designated schools to submit urine samples at least once a year.  Students would be required to sign a pledge to be drug-free and agree to random testing, and parents would have to sign a waiver acknowledging state laws regarding steroid possession and distribution, as a condition of athletic eligibility.

We as healthcare professionals, parents, coaches and school officials need to step forward in this state and demand and support such a stringent testing program.  This mandate needs to come down from the state level, as the successes of other states’ programs have relied on this legal pressure.  Enacting such legislation in New York State with significant punishments for even first time offenders will be an important step forward in cleaning up high school sports. 

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