Steroids now often used for slimming, not just sports

During the two months of its wide-ranging inquiry into steroid abuse, Congress has come a long way from slugger Mark McGwire. When lawmakers opened a fourth hearing on the subject Wednesday, they were talking not about the batting averages and biceps of professional ballplayers, but the waistlines and weight of teenage girls.

It was an attempt to explore the growing concern nationwide about steroid abuse among young women. Yet in the process, it also laid bare perhaps a deeper and more overlooked trend in steroid abuse - one that goes beyond sport or sex. Many steroid users - both men and women - take the drug not to run faster, jump higher, or throw harder, but simply to look better.

Among boys, it has been called the "Adonis Complex" - a desire for the perfect body, as old as ancient Greece, now abetted by chemical means. Among girls, it is seen as part of a disorder akin to anorexia - a pathological desire to get the fit, toned figure of modern fashion. Indeed, to a growing number of scientists, steroids are no longer linked only to sports, but to a society fixated by the shape and size of the human body.

"There is a consensus that the problem is real," says Gary Wadler, a doctor of sports medicine and a member of the World Anti-Doping Agency. "[Steroid abuse] is not just about making the team, ...It goes significantly beyond that."

Getting a handle on the scope and nature of steroid abuse has long been difficult. Most scientists agree that surveys prove that a problem exists, even if researchers disagree on the numbers. One survey by the Centers for Disease Control and Prevention, for example, suggests that 5 percent of high school girls have abused steroids - findings that in many ways led to Wednesday's hearings.

Although at least one panelist took issue with those numbers, suggesting they are high, there is convincing evidence - both statistical and anecdotal - that a significant percentage of those who do abuse steroids are not athletes. A survey of 13 high schools in Oregon found that, among boys, 4.5 percent of nonathletes took steroids. The figure is in the same ballpark as the one for athletes: 6.5 percent.

The data for girls were even more revealing. Some 2.1 percent of nonathletes took steroids, compared with 1 percent of athletes. For girls in particular, the trend is an outgrowth of the increased stakes of women's sports in the Title IX era, as well as shifting perceptions of what is considered to be physical perfection. In a rebellion against the waifish looks of past generations, today's girl power has increasingly embraced raw power and the more robust look that goes with it.

"It used to be bulimia was the fad choice, and most college women would go through it," says Amanda Gruber, a psychiatrist at Harvard University's McLean Hospital in Belmont, Mass. "This is the new thing.... Now it's attractive to be thin and toned."

In Wednesday's congressional hearing US sprinter Kelli White, who testified to her use of performance enhancing drugs to win races, also admitted to being seduced by the the glamorous effect the drugs had on her body.

"There are a lot of pressures to look a certain way," said Ms. White. "We need to teach women how to be comfortable with their bodies."

Clinicians certainly don't wish to discourage physical fitness. But any trend can be taken too far. One study by Dr. Gruber found some women so obsessed about maintaining their appearance that they "refused to eat out at restaurants or at friends' houses because of their need to be certain that they were ingesting the precise amounts of calories, protein, fat, and carbohydrates that they believed necessary to maintain their physique."

In this context, steroids can become just another tool in the chemical arsenal - like diet pills or protein shakes. "It's the easiest way for a woman to decrease body fat," adds Gruber. "No matter how much you diet, for many women to reach these increasing aesthetic ideals, they need to do something like take steroids."

To scientists, this represents a failure to adequately convey the serious medical side effects of steroid abuse for women and men - such as heart and liver damage. The percentage of people who feel that steroids are dangerous drugs fell from 71 percent in 1992 to 56 percent in 2004, according to a report by Monitoring the Future.

"That translates into a risk for increased usage," says Dr. Wadler. "If we get glib with this, then it is sowing the seeds for problems down the road, as we found out with the East Germans."

One response has been ATLAS and ATHENA, two gender-specific programs devised by the Oregon Health and Science University to counter the pressure from peers and coaches to turn to steroids and other body-shaping drugs.

"You don't talk about calories or unhealthy behavior," says Linn Goldberg, co-principal investigator for the programs. "You talk about what's healthy, and what you need."