Tuesday, 7 May 2013

Steroids and supplements: Are they an issue for school-based young men?

 
The story of two secondary school students caught with steroids at a private boys school in Queensland last week received national attention. Details of what they were selling and/or using have not been made public but what made this story particularly interesting is that it is the first time in my memory that performance and image enhancing drugs (PIEDs) have been seized in a school setting.

The principal responded swiftly and when you go to the school website there is a message from him that acknowledges that the "... incident, while serious, highlights the issues associated with body image for young men." He goes on to write that the "... College will continue its drug education program throughout the pastoral care program with a renewed interest and effort around body enhancing drugs and supplements."

So should we be worried about PIEDs and supplements? What does the evidence say and is use increasing amongst secondary school students?

Unfortunately we don't know much. Trying to find out anything about the use of these type of substances has always been difficult, even the excellent National Drug Strategy Household Survey (NDSHS), which provides us with most information on the alcohol and other drug use of the Australian population sheds little light on how many people have actually ever used steroids (it doesn't ask questions on any other PIEDs or supplements). According to the 2010 NDSHS there were only 0.4% of the Australian population who have ever used steroids for non-medical purposes and just 0.1% who used these drugs in the past year! This just doesn't make any sense and realistically just proves that this is an extremely difficult group to access and is what we call a 'hidden population'. They simply are not captured effectively in this type of population-wide survey.

When you look at the 2011 ASSAD survey that provides information on secondary school students' alcohol and other drug use, the questions are based around "using steroids without a doctor's prescription in an attempt to improve sporting ability, increase muscle size or improve appearance". The numbers are small, but still significant, with 2.4% of 12-17 males and 1.5% females reporting ever using steroids - the highest rate of use was amongst 15 year old males at 3.1%.

For many years we have talked about body image issues for young women but increasingly there is more discussion about the pressures that young men face in this area. If you watch any movie, TV show or advertisement, it is becomingly rare to see any young man who does not have the 'V shape' of broad shoulders, a tiny waist and 'washboard abs'. Like young women who try desperately to achieve the waif-like figures of catwalk models, many young men attempt to reach the often unachievable lean, muscular bodies of high-profile actors and sportsmen.

A study of PIEDs use in NSW conducted a number of years ago reinforced the importance of body image as the major motivation for PIEDs use, particularly the desirable effects on physique. The reported benefits of PIEDs use included: muscle definition, increased size, increased weight, increased strength, improved self-esteem, increased confidence and positive feedback from others. When you look at those 'benefits' it's not surprising that some young men going through that difficult time called adolescence see PIEDs use as a way of 'helping them through a little'.

Supplements like Creatine Monohydrate are incredibly popular at schools across the country, with coaches at some schools actively promoting the product. Let me make it clear at this stage that I'm not suggesting there is anything particularly wrong with this product but once you start promoting any supplement, it's not necessarily a huge leap to start using others, some of which may be more problematic, particularly for adolescents who have not completed their growth spurt. So what is creatine?
 
Creatine is normally obtained from the foods we eat and put simply supplies energy to the muscles. It is also believed that it increases the volume of muscles by pulling water molecules into muscle cells.  The highest sources of naturally-occurring creatine are meat and fish. Creatine Monohydrate, the substance that you buy at the health food store, is the synthetic form of naturally-occurring creatine. I have met many young men in schools across the country who use creatine, some who have been doing so for some time. Few of these knew very much about the product they were using and when I asked them why they chose creatine as a supplement, the usual response was that someone had told them that it 'worked'! That attitude worries me ...

I really have no idea how many school-based young men are using steroids or supplements. I certainly don't think there is an 'epidemic', but it's certainly happening and little quality education is currently provided to those are who may potentially use this wide range of substances. There is certainly great pressure on young men to look a certain way and, for some, PIEDs and supplements offer what appears to be an 'easier way' to achieve that goal. With the recent media coverage of elite sportsmen being supplied with a range of products by their club to give them the competitive edge, there has never been a better time to discuss how we should deal with this issue as far as school-based young people are concerned. 

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