The prevalence of anabolic steroid use among teens has attracted mainstream media attention since the mid 1980s, when reports began to surface that high school students were using the drugs. Available over the clandestine black market since the 1960s, anabolic steroids have been linked with various adverse health effects, especially when taken non-medically by adolescents or in very high dosages. News headlines typically inform the public that adolescent steroid use is a rising epidemic, alarming American parents from coast to coast.
Various surveys have attempted to examine non-medical steroid use among adolescents, with lifetime use estimates ranging widely from 4 percent to 12 percent for boys and from 0.5 percent to 2.9 percent for girls. The higher numbers are likely attributed to methodological problems in study design, as reviewed in Interventions for Addiction Vol. 3 (Peter M. Miller ed., Elsevier 2013), in which I coauthored Chapter 84 on performance-enhancing drug use by adolescents and college students.
The gold standard national studies are the Monitoring the Future (MTF) surveys, which are funded by the National Institute on Drug Abuse and administered by the Inter-university Consortium for Political and Social Research (ICPSR) at the University of Michigan. The ongoing MTF study annually surveys a total of about 50,000 students in the 8th, 10th and 12th grades about the use of a wide variety of drugs. The questionnaires ask for information about anabolic steroid use and steroid availability. Respondents are asked: “Steroids, or anabolic steroids, are sometimes prescribed by doctors to promote healing from certain types of injuries. Some athletes, and others, have used them to try to increase muscle development. On how many occasions (if any) have you taken steroids on your own―that is, without a doctor telling you to take them . . . ?” In 2006 the question text was changed slightly in some questionnaire forms―the phrase “to promote healing from certain types of injuries” was replaced by “to treat certain conditions” (the resulting data didn’t show any effect from this rewording and in 2007 the remaining forms were changed in the same manner).
This month, the latest MTF statistics (2016) on adolescent use of anabolic steroids were released. For grades 8, 10 and 12 combined, the percentage of youths reporting having used steroids at least once in their lives is now 1.3%. That’s down from 1.5% last year. In fact, the percentage has been either 1.5% or 1.4% since 2009, and was 1.6% in 2008. Prior to that, it was never less than 1.8% in the 26-year history of the surveys.
The highest overall rates of non-medical teen steroid usage were during the years 1999-2004: jumping to 2.8% in 1999, hitting 3.0% in 2000 and 2003, peaking at 3.3% in 2001 and 2002, and remaining elevated at 2.5% in 2004 before dropping back down. What accounts for this inflated rate during those years? The answer, I suggest, has nothing to do with the clandestine black market at all. Rather, during those years a subcategory of products called “prohormones” was being openly marketed under the guise of dietary supplements. Widely sold online and in health food stores, the ingredients in these products were steroids or steroidal precursors. The first prohormone product, androstenedione, was brought to market in 1998. It was followed by many other “designer steroids” between 1999 and 2004. While many of these products failed to conform to the criteria necessary for sale as dietary supplements, they were not illegal under the Controlled Substances Act due to the poor craftsmanship of the law at that time. Prohormones were a significant segment of the sports nutrition market until Congress amended the law to explicitly criminalize most of the prohormone products then in the marketplace. The new law, effective in January 2005, added 26 new compounds to the list of anabolic steroids and forced the discontinuation of scores of products.
The prohormone market continued to some extent even after the effective change in the law in 2005, and was ultimately eviscerated by yet another law change in late 2014 targeting “designer steroids.” Whether this even stricter law against prohormone products accounts for the further drop in usage rates today is open to question. What isn’t open to question, based on the most reliable data we have, is that teen steroid use is at an all-time low.
Obviously, any non-medical adolescent steroid use is a problem; so is adolescent use of cigarettes (18.2%) and alcohol (41.9%). But we can view the 1.3% use prevalence for steroids in favorable comparison to usage rates for other drugs: cocaine (2.3%), ecstasy (3.1%) and amphetamines (8.1%). And stepping back for an even broader picture, the most important and positive news is that use of all of these drugs has dropped to the lowest levels in the entire history of the MTF surveys. As the MTF 2016 press release points out, the “overall percentage of teens using any of the illicit drugs other than marijuana has been in a gradual, long-term decline since the last half of the 1990s, when their peak rates reached 13 percent, 18 percent and 21 percent, respectively.”
Good news - particularly surrounding teen drug abuse and, more specifically, non-medical teen steroid use - rarely garners the mainstream headlines it deserves. But the latest MTF survey is a reassuring report for all American parents.