ADOLESCENTS AND  STEROIDS:  
A USER PERSPECWE  
RICHARD P. KUSSEROW 
INSPECTOR GENERAL 
OEI-06-90-01081  AUGUST 1990   MECUTNE SUMMARY  
PURPOSE 
To describe adolescent steroid use from a user point of view; this includes use patterns 
and trends, motivations and influences, effects, and awareness of health risks. 
BACKGROUND 
Anabolic-androgenic steroids ("steroids") are synthetic derivatives of the natural male 
hormone testosterone. They were first used non-medically by elite athletes seeking to 
improve performance. More recently, however, steroid use has filtered down to high 
school and junior high school levels. 
OEI contracted three experts1 in the field of steroids to conduct confidential 
structured interviews with former and current steroid users. They interviewed 67 
respondents who began using steroids before leaving high school, and were not over 
the age of 25 at the time of the interview. These plus five anonymous telephone 
interviews completed by OEI resulted in a total of 72 interviews. The findings below 
are based on this non-random sample of 72 steroid users. 
FINDINGS 
More Adolescents Are Using Steroids 
Nearly all users say more senior high school students are using steroids now than when 
they started. Male competitive athletes are the primary users. 
Users Start Young and Continue Using for a Long Time 
Over one-half of the respondents started using steroids by age 16. Nearly one-third of 
the current users interviewed have been using steroids for five years or longer; on 
average they started over three years ago. 
1 See Appendix C: Acknowledgments.  Former Users Quit Because of Bad Effects They Experienced, Fear of Bad Effects, 
and New Goals. 
Former users (17) gave a number of reasons for quitting (some mentioning more than 
one): eight experienced undesirable physical or psychological effects which they 
attribute to steroids; eight were concerned about possible health risks; seven noted a 
life change, such as not competing (or working out) any more, a change in goals, or a 
job-related decision. 
Prafiles Show Many Users Are Mainstream Students? 
Because many steroid users are pursuing socially acceptable goals, they do not stand 
out as belonging to a "drug subc~lture!~As  one interviewer reports, "By looking at 
them you wouldn't know they were steroid users; in fact, if I didn't know, they look 
like the kind of guys I'd like my daughter to date." This, plus the secretive nature of 
steroid use, means that parents, coaches, peers, and even teammates may not know 
that someone close to them is a user. As one user notes, "When I started I thought I 
was the only one at my school, but once I got bigger others started talking about it! '
2 See Appendix k. Selected User Profiles for profiles of eight users. 
iii  TABLE OF CONTENTS  
......................................... 
EXECUTIVE SUMMARY  i-iii  
............................................... 
INTRODUCTJON  1  
........................................ 
PURPOSE  1  
.......................................... 
BACKGROUND  1  
......................................... 
MEMODOLOGY  1  
................................................... 
FINDINGS  2  
.......................... 
More Adolescents Are Using Steroids  2  
............ 
Users Start Young and Continue Using for a Long Time  2  
Adolescent Users Combine Steroids. Take Large Doses. and Use  
.............................. 
More intensely Over Tme  3  
....... 
Users Buy Steroids and Get Information from Several Sources  5  
..................... 
Typical Adolescent Concerns Motivate Users  6  
............................ 
Resutts Encourage Continued Use  8  
Users Report Psychological and Physical Changes After Starting  
..
........... 
Steroids, But Most Discount Warnings About Risks  10  
....... 
Current Users Show Signs of Denial; Some Appear Dependent  12  
Former Users Quit Because of Bad Effects They Experienced. Fear of  
....-........................ 
Bad Effects. and New Goals  13  
............... 
Prafiles Show Many Users Are Mainstream Students  13  
.......................... 
APPENDIX A:  SELECTED USER PROFILES  A-1  
............................ 
APPENDIX B: USER CHARACERISTICS  B-1  
............................... 
APPENDIX C: ACKNOWLEDGMENTS  C-1   INTRODUCTION  
PURPOSE 
To describe adolescent steroid use from a user point of view; this includes use patterns 
and trends, motivations and influences, effects, and awareness of health risks. 
BACKGROUND 
Anabolic-androgenic steroids ("steroids") are synthetic derivatives of the natural male 
hormone testosterone. They were first used non-medically by elite athletes seeking to 
improve performance. More recently, however, their use has filtered down to high 
school and junior high school levels. For more detail, including a literature review, 
expert interviews, statistics from the National Institute on Drug Abuse (NIDA), and 
comparisons of the following findings with published studies, see the companion report 
entitled Adolescent Steroid Use, OEI 06-90-01080. 
OEI contracted three experts' in the field of steroids to conduct confidential 
structured interviews with former and current steroid users. They interviewed 67 
respondents who began using steroids before leaving high school, and were not over 
the age of 25 at the time of the interview. These plus five anonymous telephone 
interviews completed by OEI resulted in a total of 72 interviews. The findings below 
are based on this non-random sample of 72 steroid users. 
Interviewees came from ten states. Sixty-six respondents (92%) were male and six 
were female. Fifty-five (76%) were current users and 17 former users. Twenty-six 
(36%) were 18years old or younger at the time of the interview. The average current 
age of the respondents was 2OO2 
See Appendix C: Acknowledgments. 
2 See Appendix B: User Characteristics for more detail. 
1  Adolescent Users Combine Steroids, Take Large Dases, and Use More Intensely 
Over mme. 
Neariy all users take more than one stemid at a time. 
Only two respondents did not "stack" (combine two or more) steroids during their last 
"cycle" (episode of use). Eighty-two percent combined three or more steroids, while 30 
percent used seven-or more. On average respondents used five steroids during their 
last cycle. 
Table 1: Steroids Used by 10 or Mote Users DuringTheir Last Cyde 
DepTestosterone  testosterone cypionate  injectable 
DecaDurabolin  nandrolone decanoate  injectable 
Anadrol  oxymetholone  oral 
Winstrsl V  stanozolol  veterinary, injectable 
Dianabol  methandrostenolone  oral 
Equipoise  boldenone undecyclenate  veterinary, injecteble 
Anavar  oxandrolone  oral 
Sustanon 250  testosterone  injectable 
Primobolan  methenolone  oral 
Dianabol  methandrostenolone  injectable 
Nearfy all use injectable stem* 
All but one respondent used injectable steroids. In addition, 91 percent used oral 
steroids. 
Users take dcnres many timesn o d th em@  la,& 
Some users took nearly 30 
times the maximum 
Doses Far Exceed Therapeutic Levels 
therapeutic dose of Deca- 
1,400 
Durabolin (nandrolone 
decanoate) during their last  1,200 
-
cycle. Depo-Testosterone is  X 
g 1,OOo 
s 
the most popular drug, 
$800 
reported by 44 users, 
$ 
followed by Deca-Durabolin 
with 43 users. Both of these  -I3)
are injectable steroids. Many  =f   400 
also used veterinary products  200 
during their last cycle, as 
0 
shown in Table 1above.  I 
W Maximum Therapeutic  Median User  Highest User  Users Buy Steroids and Get Information from Several Sources. 
C o ~ g y m r p l aay rolefw  a majority of urers. 
Users report one to five sources when asked about their current/most recent source of 
steroids, averaging 2.2 sources per respondent. Commercial-gym-related sources were 
mentioned by 63 percent of the respondents. Table 3 shows the main sources of 
purchased steroids. 
--
Table 3: Sources d Pmhased Steroids 
Where  Who  -by* 
Oneormorrrgym-bead#ures  45  (83%) 
friendlathiete  26  (37%) 
a 'gym dealer'  17  (24%) 
gym personnel  8  (11%) 
Heelth plohhmk  O n e o r m o r e h e a n h ~   27  (38%) 
pharmacist  22  (31%) 
veterinarian  10  (14%) 
personal doctor  3  (4%) 
Mail order  20 
Schod-related-  Oneormorerchodrelstedaourw  16  Ca%) 
school friendheammate  15  (21%) 
school coach or team physician  1 
Other drug dealer  8  (11%) 
Percentagesbased on the 71 respondents who answered this question. 
One-quarter of all respondents sold steroids themselves at some time. 
Users mrely receivefiee s&.micis on an ongoing baris. 
Four respondents say they received free steroids on an ongoing basis. Three former 
users each reported one source: school alumni, a school coach or trainer, and a gym 
friendlathlete. One current user receives free steroids from a relative who is a 
physician. 
Usersget information on dmp and dosages from  their stemid sowws and fiom printed 
i&?mm 
Commercial-gym-related people are a source of steroid information for nearly three- 
quarters of the respondents. Many users also read printed information on steroids to 
decide what and how much to take.  Respondents also gave several reasons relating to selfkteem and appvaljbm others 
which may be related to performance, appearance or both: 
53%  generally like self betterbe happier 
35%  friends were using 
18%  be more successful with the opposite sex 
11%  receive more approval from parents 
Other (apparent) performance-related reasons for use: 
44%  competitors were using 
29%  improve ability to train harderlendurance 
24%  increase chances for a college athletic scholarship 
15%  be more aggressive 
15%  receive more approval from coachesltrainers 
6%  prevent injuries 
3%  recover from injuries 
Eighty-five percent are influenced or motivated to use steroids by school 
friendslteammates, gym friendslathletes, or other friends. In most cases the friend is a 
user who has achieved the kind of results the respondent desires. In some instances 
only the friend's advice is mentioned. The (commercial) gym friend may be an older 
role model and not a peer in age. Respondents were free to mention more than one 
influence. The personal influences mentioned by four or more users were: 
53%  gym friendlathlete  8%  brotherlsister 
40%  school friendlteammate  6%  other friends 
15%  non-school coacwtrainer  6%  personal doctor 
11%  gym personnel  6%  school coacwtrainer 
Famous role modelr also injhme adokcem 
Users also believe that many high-level athletes have used steroids, and say this 
influenced them to start using.  While 25 percent do not identify influences outside of 
people they know personally, 57percent point to "muscle" magazines, 42 percent to 
famous athletes who (they believe) use, and seven percent to entertainment 
personalities. 
Users also give several indications that social acceptance and societal values are 
reinforcing their motivations to use steroids. (See "Sxkty..."  below, page 9.)  seeking, nearly all (97%) say those positive effects encouraged them to continue using 
steroids. Many users report tremendous gains in weight, muscle mass, strength, muscle 
definition and athletic accomplishment. 
Some get very powerfd unqxctd "benejk" 
Forty-three percent (31 of 72) report unexpected "benefits" from taking steroids. 
Society rewadi mers for the results they achieve; a&uhs  of  peers and coachesfail to 
b u m g es temid use. 
Many current users agree with the following ~tatements:~ 
93%  "Overall, people like the effects steroids have had on me." 
83%  'The improvements I achieved by using steroids made me more 
popular." 
76%  "My friends, who don't use steroids, don't  care if I use! '
52%  "My parents probably lcnow that I use steroids." 
37%  "At my school winning is more important than good grades." 
Sixty-one percent disagree with the statement, "My coaches really believe that steroid 
use is a bad idea" (of 41 having coaches). For current users still of high school age 
9 of 24 (38%) disagree. 
Usersnoted both positive and neg&  social change5 sinceusing stem& 
Of the 24 current users who say they had more arguments or physical fights, half also 
say they got along better with others; 21 are more satisfied with their life; 17 say 
girlslguys liked them a lot more. Some note fights occur because others want to test 
3 Percentages taken from the total respondents who answered each question, varying from 54 to 55. 
9   Further, when asked about the physical changes a strong majority of users say each 
reported change is a direct resuIt of taking steroids. 
Usersare somewhatawareof risks cited by e;r;pelts. 
When asked if they can tell what experts say about steroids and health problems, 
respondents most frequently volunteer the following: 
71%  liver disease  45%  death 
56%  heart disease  44%  sterility 
50%  cancer  38%  kidney disease 
49%  shrinking of the testicles  38%  blood pressure problems 
49%  adverse personality changes  36%  stunted growth 
Nowevet, 82pcmt ofall  usersdisagree with epm&aboutpotmtkdhedh 
aurenf 
problems associa&  with &mi&.In sharp w  m 16 of 17fonner users agree with 
ezperl;r. 
Most urers base theiropinions about hedh risks on &&personal  expieme or on that 
of others they know. 
Reasons for disagreeing  
Eighty-seven percent of 
F$m4  
those who disagree with  
experts say they are not  
experiencing health problems 
Strongly Agree  
themselves, and 80 percent  
say other users they know  
are not experiencing  
problems. Only nine percent  
qualify their answer by saying  Digree  
that they are not  
experiencing "serious" 
Strongly Disagree  
problems themselves, and  
only four percent qualify  0  5  10  15  20  25  30  35  
their answers similarly for  Number of Respondents (n=72)  
others.  Fifty-four percent  
cite a lack of hard evidence,  
and 39 percent suspect scare tactics on the part of experts. Over one-quarter point out  
that experts were wrong before in saying that steroids didn't work.   Former Users Quit Because of Bad Effects They Experienced, Fear of Bad Effects, 
and New Goals. 
Former users (17) gave a number of reasons for quitting (some mentioning more than 
one): 
8  experienced undesirable physical or psychological effects which they attribute to 
steroids 
8  were concerned about possible health risks 
8  noted a life change: not competing (or working out) any more, a change in 
goals, or a job-related decision 
7  feared becoming dependent 
5  said steroids cost too much 
3  failed to achieve the results they had hoped for 
2  feared being caught. 
Disapproval of coaches and disapproval of parents were each mentioned by one 
former user. One said steroids were difficult to get, and one quit because he was 
"bored." 
Profiles Show Many Users Are Mainstream student^.^ 
Because many steroid users are pursuing socially acceptable goals, they do not stand 
out as belonging to a "drug subculture." As one interviewer reports, "By looking at 
them you wouldn't  know they were steroid users; in fact, if I didn't know, they look 
like the kind of guys I'd  like my daughter to date." This, plus the secretive nature of 
steroid use, means that parents, coaches, peers and even teammates may not know 
that someone close to them is a user. As one user notes, "When I started I thought I 
was the only one at my school, but once I got bigger others started talking about it." 
4 See Appendix A: Selected User Profiles for profiles of eight users.  APPENDIX A 
SELECTED USER PROFILES 
The following are actual profiles of individuals interviewed for this project. They are 
drawn from seven states. The names used are fictitious. 
All-American Guy 
Phil was into football, and his successes would be the envy of many of his peers. At 15 
he saw the progression of size, strength, and athletic ability (plus the scholarship 
offers) of guys at the gym where he worked out. A friend there felt that steroids had 
contributed a great deal to his improvements, so Phil started too. 
Phil gained 25 lbs. in his sophomore year, his first year of use, and he displaced older 
students for first string linebacker on the football team. He was bigger, faster, more 
aggressive, and much stronger. He could bench press 185 in tenth grade, and 335 
(strict form) by the end of high school. Phil says his grades improved, he gets along 
better with others, he is more satisfied with life, he is more popular, and the girls like 
him a lot more. Finally, he got a scholarship to college. 
Phil's behavior has been strongly reinforced. He feels that winning was more important 
than good grades at his school, and he doesn't believe that his coaches really thought 
steroids were a bad idea. He also believes that steroid use is widespread, even 
universal (at least at some time), among famous football players. He doesn't consider 
his side effects (acne, bloated appearance, breast development, shrinking testicles) to 
be serious, and disagrees with what experts say about the risks of steroids, though he's 
not sure. At 19, he has no plans to stop, even if others do. He says he would stop if 
you could convince him that steroids were really bad for him, but for now he believes 
that he made a good decision when he started. 
"Living Proof (So Far)" 
Steve had measured his gains in inches: 6" on his neck, 3" on each arm, 12"on his 
chest. Now he says, "I'm living (so far) proof of the addictive nature. I was chemically 
dependent as an adolescent, and 'roids are just as addictive!'  Steve started using 
steroids at 17, and used for about 23 cycles. In his heaviest cycle he combined 9 
steroids, five of those injectable. Before steroids he had used alcohol, marijuana and 
"uppers." He later added "downers," recreational drugs, estrogen inhibitors, blood 
pressure regulators, and Human Growth Hormone. He experienced increased acne,  He did a lot of research on steroids before starting, "reading everything about it. I 
weighed the good and the bad, and decided the bad wasn't all that bad if I didn't 
abuse it." He has completed four seven-week cycles, using one oral and two injectables 
during his last cycle. He went from about 160 (with training) up to 215 lbs. at 16 years 
old after adding steroids. He had some trouble with aggressiveness at first, but once he 
realized what was happening he said he could consciously keep it under control. 
He says hell stop taking steroids when he's through with competitive bodybuilding, 
confident hell "do just fine without them." At the time of the interview he was busy 
mowing lawns around the neighborhood to earn enough money for his next cycle. 
Hooked? 
Mike is a competitive bodybuilder who started using at 18. He was convinced to start 
by a user at a commercial gym:"Once I saw him I thought, 'Here's  the way to put 
some size on."'  Mike got the results he was after; he's gained 75 lbs. in the four years 
since he started using, and has increased his bench press to 450 lbs. He says people 
like the effects steroids have had on him, and that girls like him a lot more. He 
strongly disagrees with experts' warnings about steroids, saying that he hasn't  had 
health problems and neither have other users whom he knows. Evidently Mike doesn't 
feel that any of the physical changes he reported are "problems": acne, bloated 
appearance, bone or joint pain, muscle pain, frequent urge to urinate, difficulty 
sleeping, impotence, breast development and shrinking testicles. (He believes that any 
bad effects of steroids go away when you stop using them.) Mike also reports 
sometimes feeling very sad, and that he has seriously considered suicide since starting 
to use steroids. 
Mike is not without his doubts: he now feels that he did not make a good decision 
when he started steroids. But he has no plans to stop, and in fact has decided to quit 
using them before, only to start again. He says that if you could convince him that 
steroids are really bad that he'd quit. 
The 98-Pound Weakling 
Joe was very serious about getting bigger. At 16, he's  been taking steroids since he was 
14. He's already completed 10 cycles. The last one was 16 weeks long, and he 
"stackedt' three oral and six injectable steroids. He's continuing despite a number of 
side effects, including emergency room treatment for high blood pressure. 
Has it been worth it? Joe went from 98 lbs. to 185 lbs. in six months. He says that he's 
definitely more popular and more satisfied with his life now. He participates in 
football, swimming/diving, soccer, and competitive bodybuilding. He tried to quit using 
steroids once but "couldn't." He now has no plans to stop.  APPENDIX B 
User Characteristics 
Respondents Were From 10 States 
Current Age of Respondents 
15yrS old 
0  2  4  6  8  10   12 
Number of Respondents  Number of Drugs in Reported Cycle  
-
3 Steroids  14 
-
8-10 Steroids 
-
7 Steroids  8 
Sports or Training Programs 
Listed by Respondents 
(Some respondents listed more than one.) 
Number  Percent 
Weightlifting **  39  56.5% 
Football  32  46.4% 
Bodybuilding *  15  21.7% 
Track and Field  12  17.4% 
Wrestling  11  15.9% 
Swirnming/Diiing  10  14.5% 
Powerlifting  10  14.5% 
BaseballISoftball  5  7.2% 
Soccer  5  7.2% 
Basketball  3  4.3% 
Gymnastics  3  4.3% 
Cycling  2  2.9% 
Hockey  2  2.9% 
SkiingISkating  1  1.4% 
TennisBadminton  1  1.4% 
Competitive 
** Nontompetitiie  ACKNOWLEDGMENTS 
For revMving the discmion guides: 
Drs. Linn Goldbe% Douglas McKeag, James Wright and Charles Yesalis reviewed the 
user discussion guides and offered many helpful suggestions. 
For wnhcthg b&n&wm 
The following individuals conducted interviews with steroid users using the structured 
discussion guides prepared by OEI. We appreciate their many hours of work. 
Neil Carolan  Mr. Carolan has extensive counseling experience 
Vice President for Chemical  with adolescent steroid users. 
Dependency Programs 
Bry Lin Hospital 
1263 Delaware Ave. 
Buffalo, NY 14209 
Mark Humbert, PhD.  Dr. Humbert wrote his dissertation on the 
3351 East "G" Street, #19 E  psychological effects of steroid use. He is 
Ontario, CA 91764  presently a staff psychologist for the Youth 
Training School at Chino. He is also a 
competitive bodybuilder. 
James E Wright, PhD.  Dr. Wright has been a prominent researcher and 
.. 
9001 Eames Street  writer in the field of steroids for many years. 
Northridge, CA 91324