Walk through the halls of any high school and you might not see much in common among
the jocks, beauty queens and geeks. But all three groups are at risk for using appearance-
and performance-enhancing substances (APES).
In the past, the focus was on athletes who used substances to build muscularity and
improve sports performance and those looking for an academic edge. Now, there is greater
awareness that nonathletes are using substances in the hopes of looking better.
“We’re recognizing in adolescents the drive for improved appearance is just as strong
if not a stronger motivator for use of a lot of these things than strictly for athletic
or cognitive performance enhancement,” said Michele LaBotz, MD, FAAP, a member of
the AAP Council on Sports Medicine and Fitness and a sports medicine physician at
InterMed in Portland, Maine.
Dr. LaBotz will discuss how to screen for and address the use of APES among adolescents
during a session titled “Performance Enhancement: Not Just for Athletes Anymore (F4046).”
The session will be held from 9:30-10:15 am Tuesday in McCormick Place West, W190
Among the substances she will cover are anabolic steroids, creatine, protein supplements,
stimulants and selective androgen receptor modulators (SARMs). She also will review
data that have come out since the AAP clinical report Use of Performance Enhancing Substanceswas published in 2016.
Pediatricians may be adept at screening for performance-enhancing substances during
sports physicals. However, they also should consider screening other high-risk groups
such as those with poor body image.
“The kid who is coming (into the office) and he is a little overweight, and he’s not
happy with how he’s looking — that’s a kid who is worthy of screening as well,” said
Dr. LaBotz, co-author of the clinical report.
Since there are no specific screening tools for ergogenic agents or performance-enhancers,
Dr. LaBotz suggests taking a developmental approach to screening and counseling patients.
Prepubescent youths, for example, will use substances to try to speed up the clock.
These patients should be counseled that no matter how hard they train and no matter
what substances they take, changes in appearance and performance will be limited until
their endogenous hormones kick in, she said.
Counseling also should focus on the dangers of substances, which many view as innocuous.
Protein and creatine supplements, for example, are readily available on store shelves,
but they are not regulated by the Food and Drug Administration, Dr. LaBotz said. Studies
have shown almost universal contamination of protein supplements with small amounts
of heavy metals, and 25%-60% of creatine supplements contained anabolic agents.
“You’re walking down the grocery store aisle, and these supplements are intermingled
with the food, but you don’t have the same safety assurances,” she said.
SARMS are a newer class of substances on the scene. They were developed to treat hypogonadism
and testosterone-sensitive tumors, Dr. LaBotz said, but recently captured the attention
of those looking to get the same benefits as anabolic steroids without the risks.
Dr. LaBotz also will discuss the use of stimulants to improve cognitive performance
among those who haven’t been diagnosed with attention-deficit/hyperactivity disorder.
Recent data show the rates of nonmedical use of stimulants among eighth- through 12th-graders
are double that of opioids like oxycodone.
“I think it (illicit use of stimulants) is a hidden epidemic that is being overshadowed
by the opioid epidemic but is still of significant consequence,” Dr. LaBotz said.