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ERADICATING STEROID USE, PART IV: EXAMINING

THE USE OF STEROIDS BY YOUNG WOMEN TO

ENHANCE ATHLETIC PERFORMANCE AND BODY

IMAGE

HEARING

BEFORE THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

JUNE 15, 2005

Serial No. 109–38

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpo.gov/congress/house

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

CHRISTOPHER SHAYS, Connecticut

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

GIL GUTKNECHT, Minnesota

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

CANDICE S. MILLER, Michigan

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

GINNY BROWN-WAITE, Florida

JON C. PORTER, Nevada

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

CHARLES W. DENT, Pennsylvania

VIRGINIA FOXX, North Carolina

——— ———

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

BRIAN HIGGINS, New York

ELEANOR HOLMES NORTON, District of

Columbia

———

BERNARD SANDERS, Vermont

(Independent)

MELISSA WOJCIAK, Staff Director

DAVID MARIN, Deputy Staff Director/Communications Director

ROB BORDEN, Parliamentarian

TERESA AUSTIN, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

(III)

C O N T E N T S

Page

Hearing held on June 15, 2005 ............................................................................... 1

Statement of:

Elliot, Dr. Diane, professor of medicine, Oregon Health and Science University; Dr. Todd Schlifstein, clinical instructor, New York University

School of Medicine; Dr. Harrison Pope, professor of psychiatry, McLean

Hospital, Belmont, MA; Dr. Charles Yesalis, professor of health policy

and administration, the Pennsylvania State University; and Dr. Avery

Faigenbaum, professor of health and exercise science, the College of

New Jersey .................................................................................................... 48

Elliot, Dr. Diane ........................................................................................ 48

Faigenbaum, Dr. Avery ............................................................................. 107

Pope, Dr. Harrison .................................................................................... 83

Schlifstein, Dr. Todd ................................................................................. 56

Yesalis, Dr. Charles .................................................................................. 101

White, Kelli, former World Champion sprinter; and Mari Holden, Olympian and World Champion cyclist ................................................................ 20

Holden, Mari .............................................................................................. 28

White, Kelli ................................................................................................ 20

Letters, statements, etc., submitted for the record by:

Cummings, Hon. Elijah E., a Representative in Congress from the State

of Maryland, prepared statement of ............................................................ 15

Davis, Chairman Tom, a Representative in Congress from the State of

Virginia, prepared statement of ................................................................... 4

Elliot, Dr. Diane, professor of medicine, Oregon Health and Science University, prepared statement of ..................................................................... 51

Faigenbaum, Dr. Avery, professor of health and exercise science, the

College of New Jersey, prepared statement of ........................................... 109

Holden, Mari, Olympian and World Champion cyclist, prepared statement

of ..................................................................................................................... 31

Pope, Dr. Harrison, professor of psychiatry, McLean Hospital, Belmont,

MA, prepared statement of .......................................................................... 86

Porter, Jon C., a Representative in Congress from the State of Nevada,

prepared statement of ................................................................................... 127

Schlifstein, Dr. Todd, clinical instructor, New York University School

of Medicine, prepared statement of ............................................................. 59

Waxman, Hon. Henry A., a Representative in Congress from the State

of California, prepared statement of ........................................................... 8

White, Kelli, former World Champion sprinter, prepared statement of ...... 23

Yesalis, Dr. Charles, professor of health policy and administration, the

Pennsylvania State University, prepared statement of ............................. 103

(1)

ERADICATING STEROID USE, PART IV: EXAMINING THE USE OF STEROIDS BY YOUNG

WOMEN TO ENHANCE ATHLETIC PERFORMANCE AND BODY IMAGE

WEDNESDAY, JUNE 15, 2005

HOUSE OF REPRESENTATIVES,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The committee met, pursuant to notice, at 10 a.m., in room 2154,

Rayburn House Office Building, Hon. Tom Davis (chairman of the

committee) presiding.

Present: Representatives Davis of Virginia, Shays, Gutknecht,

Duncan, Porter, Dent, Waxman, Maloney, Cummings, Kucinich,

Davis of Illinois, Clay, Watson, Lynch, Ruppersberger, Higgins, and

Norton.

Staff present: Melissa Wojciak, staff director; David Marin, deputy staff director/communications director; Jennifer Safavian, chief

counsel for oversight and investigations; Howie Denis and Anne

Marie Turner, counsels; Rob White, press secretary; Drew Crockett,

deputy director of communications; Susie Schulte, professional staff

member; Teresa Austin, chief clerk; Sarah D’Orsie, deputy clerk;

Kristina Sherry, legislative correspondent; Corinne Zaccagnini,

chief information officer; Leneal Scott, computer systems manager;

Phil Schiliro, minority chief of staff; Kristin Amerling, minority

general counsel; Karen Lightfoot, minority communications director/senior policy advisor; Brian Cohen, minority senior investigator

and policy advisor; Early Green, minority chief clerk; and Jean

Gosa, minority assistant clerk.

Chairman TOM DAVIS. The committee will come to order. Good

morning and welcome to today’s hearing on the use of steroids by

young women to enhance athletic performance and body image.

This is the fourth hearing the committee has had on the use of

steroids, a public health crisis, that reaches from the highest levels

of professional sports down to ball fields and school yards across

the country.

Throughout our inquiry, we have sounded a familiar theme: The

culture of steroid use among professional athletes, while troubling

by itself, is also worrisome in its trickle-down effect. In the absence

of strong testing regimes, pro athletes use performance-enhancing

drugs to stay ahead of the competition. College athletes feel pressure to use steroids to get drafted. High school kids believe steroids

are the ticket to bigger, faster bodies that will attract the attention

of scouts and college coaches, and maybe lead to a scholarship.

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And the cycle goes on and on. These pressure are real and they

sometimes have tragic consequences, as we have heard from the

Hooten and Garibaldi families during the first hearing. Their sons

killed themselves after slipping into depression that their families

believe was fueled by anabolic steroids.

Today we fix our gaze on a disturbing piece of the steroid puzzle.

Studies have shown that growing numbers of young girls are beginning to use steroids. Some of this use is attributed to the desire to

improve athletic performance, but some is because girls are looking

for a way to get thinner, to reduce body fat, to conform to an idea

of beauty they feel pressured to emulate.

That is why we are here. Young lives continue to be destroyed

or lost due to the illegal use of steroids. That is why I have introduced, along with Ranking Member Henry Waxman and other

members of the committee, legislation to require tougher testing

standards for performance-enhancing drugs.

The deeper we get into this issue, the more certain I am of the

need for Federal legislation to address this dangerous, deadly, public health crisis. Our legislation specifically addresses professional

sports, because that is the public face of this vicious cycle. That is

where it starts, that is where we need to begin to stop it. But we

now know that the use of illegal performance-enhancing drugs extends to places once thought impossible.

For example, a survey of high school students conducted by the

Center for Disease Control and Prevention indicated that 5 percent

of high school girls and 7 percent of ninth grade girls, had abused

steroids without a doctor’s prescription.

Dr. Linn Goldberg, who testified at the committee’s April 30th

hearing, and researchers at Oregon Health and Science University,

Dr. Diane Elliott, will be testifying today, reported an increased

use in anabolic steroids among high school nonathletes. Young

women appear to be resorting to steroids use as a means of weight

control and body fat reduction; that is, losing fat and gaining lean

muscle.

The use of steroids for this purpose often goes hand in hand with

eating disorders, not to mention the abuse of other drugs in order

to stay thin. At first glance, it may seem odd to associate the use

of steroids with the desire to stay thin. Our mental image of a steroid user is an over-muscled jock. But as we will hear today, some

steroids are thought to act as an appetite suppressant or to burn

fat at a faster rate. Sadly, females suffer particularly devastating

health consequences from steroid use.

Adverse side effects include but are not limited to excessive

growth of body hair, masculization, premature arrested bone development, resulting in stunted growth, irritability, delusion, and depression.

Today we will hear from several medical experts, some of whom

believe steroid use by young women is an underreported problem,

and all of whom agree more research and scientific evidence are

needed to more accurately quantify how large a problem we face.

I look forward to a robust discussion on the extent of the problem, what the numbers tell us, and what information we may be

lacking in understanding the whole picture.

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Dr. Elliott will also discuss her success with a prevention program called ATHENA, Athletes Targeting Healthy Exercise and

Nutrition Alternatives, which is specifically designed for middle

and high school-age girls.

Additionally, we are very pleased to have with us Kelli White, a

former world champion sprinter, who has come clean about her decision to use steroids and about her subsequent regrets; and Mari

Holden, a world-class cyclist, who will discuss the pressures clean

athletes face in competing in an environment where their rivals

may be taking performance-enhancing drugs.

[The prepared statement of Chairman Tom Davis follows:]

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Chairman TOM DAVIS. I now recognize the distinguished ranking

member, Mr. Waxman, for an opening statement.

Mr. WAXMAN. Thank you very much, Mr. Chairman. I want to

thank you for holding this hearing today. We have already held

three hearings on the issue of steroids, and this is our fourth hearing on steroid use.

But in these first three hearings, we focused on male professional

athletes and the impact of their steroids use in athletics, especially

in professional athletics. Today we are examining whether steroids

are a problem for young women as well.

In April, about the time we were holding a hearing on the NFL,

several newspaper stories focused on a potentially new issue, the

use of steroids by young women. These stories pointed out that the

Centers for Disease Control survey data showed that 5 percent of

high school women had reported using steroids, and, according to

experts, the women using these drugs are not just high school and

college athletes looking for a competitive advantage, but girls with

body image problems hoping to achieve a lean and muscular look.

These stories got our attention in part because they suggest that

the pressure to use these drugs illegally extends beyond locker

rooms and playing fields where we have been focusing our inquiry.

Steroid use among female athletes is unfortunately nothing new.

We all recall the images of East German female athletes in the

1970’s and 1980’s.

But it seems to me that if young women today are taking

steroids at high rates, and taking them not just to improve their

athletic abilities and performance but to meet a socially expected

standard of how they should look, then perhaps the steroid problem

is even bigger than we had thought.

Our hearing today will examine the use of steroids by young

women. First we will hear from two athletes, Kelli White, former

world champion sprinter, currently serving a 2-year ban for steroid

use. And to her credit, she has been speaking out about the mistakes that she has made. We will hear from her today about the

pressures on young women athletes to use steroids. We will also

hear from Mari Holden, a world champion cyclist, who has been

able to do it without drugs. I know that young women can learn

from both examples, especially the idea that they can compete and

win at the highest level of sports without resorting to illegal steroid

use.

I want to thank both of you for being here today. Our second

panel will be consisting of five medical experts. And they will help

us examine what I think is the most important question of this

hearing: How big is the problem of high school women and girls

using steroids?

CDC survey data shows that over 5 percent have used steroids.

Separate data from the National Institute of Drug Abuse shows

lower usage among women. In both cases, the government data

shows a disturbing trend, with reported steroid use among women

and girls increasing four fold over the last decade. It is low now,

but it looks like a trend to growing use.

We will hear from at least one expert today who thinks that

these government figures dramatically overstate the problem of

steroid use among women, which he calls an illusion; and we will

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hear from a number of others who may be skeptical of the highend estimates, but have little doubt that steroid use among women

is growing and represents a serious public health problem.

While I hope we can get to the bottom of these issues today and

learn from the hearing, we do not need to walk out of this room

with a precise figure on the extent of steroid use by young women,

but I hope we can determine if it is a serious problem, serious

health issue, and, if so, what we can do about it.

Our legislation, the Clean Sports Act, will help solve some of

these problems. We will hear from our witnesses today how society’s attitude toward steroids and the professional athletes who use

them impacts young women.

By making it clear that steroid use is unacceptable for elite athletes, our legislation will send a strong message to both the male

and female high school and college athletes who use these competitors, these stars as role models, but it may be that we need to do

more.

Our witnesses today will give us broader insight into the extent

of steroid use by young women, the reasons for this use, and the

ways to stop it.

Mr. Chairman, I thank you for your continued attention to the

problem of steroid use, and I look forward to the hearing today.

[The prepared statement of Hon. Henry A. Waxman follows:]

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Chairman TOM DAVIS. Thank you very much.

Mr. Cummings.

Mr. CUMMINGS. Thank you very much, Mr. Chairman.

Mr. Chairman, I too thank you for holding this hearing. And let

me note from the very beginning that, Mr. Chairman, when we addressed the use of steroids in professional sports a few weeks ago,

the lines were very long outside. You could hardly get into the

room.

Cameras were all over the place. Reporters were breaking their

necks to get to the table over there. And now we have a situation

where, when we address the issue with regard to women, the room

is not so packed. But the fact is, it is still a significant problem.

The ranking member and the chairman have gone over very

carefully the statistics, based upon research, and certainly there

may be differing views on that from different organizations. Certainly there may be some who will come before us today and say

that it is no big deal.

Well, as one Member of Congress, the father of two daughters,

I consider it a very, very, very big deal. When you think about

health problems that often result from using illegal steroids—like

abnormalities of the sexual characteristics, cardiovascular disease,

liver and kidney complications, and serious psychiatric side effects,

including acute depression and even suicide, we are talking

about—if one person, if one young lady uses illegal steroids, it is

one too many.

One of the things that I have often seen, Mr. Chairman, in my

district, is I run into people who use illegal drugs; not these types

of drugs but others. And one thing that they often tell me, even

when they have recovered and they are on the mend and they have

been off the drugs for a long time, they will tell me that I can forgive myself, but my body will not forgive me.

And that is a very, very powerful statement. I can forgive myself,

but my body does not forgive me. With this in mind, Congress

added certain anabolic steroids to Schedule III, the Controlled Substances Act. Individuals possessing such drugs without a valid prescription are liable for a misdemeanor, while persons convicted of

distributing, dispensing, or selling those drugs are subject to a 5-

year sentence for a first offense. In clear and plain terms, illegitimate steroid use is a crime. And we need to keep that in focus:

It is a crime.

As the ranking member of the Subcommittee on Criminal Justice, Drug Policy, and Human Resources, I routinely work on issues

related to U.S. drug control policy and public health. Although the

primary focus of our oversight is Schedule I substances, I am particularly concerned that the abuse of steroids by female athletes

and female nonathletes may be underreported and require further

study.

As the title of this hearing conveys, this committee is driven by

a commitment to eradicate illegitimate steroid use regardless of

whether they are abused on or off the playing field. Today we are

united in the belief that the health and safety of our communities

and generations yet unborn are too important to pursue any lesser

goal.

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This demands that we not only embrace successful education and

prevention programs that address steroid abuse by young girls and

women, but continue to examine unresolved questions regarding

steroid abuse within this population.

And so I thank all of our witnesses for coming here today. I

thank you for sharing your opinions. I thank you for sharing your

stories. This is our watch. As a Congress, this is our watch. When

issues come before us, we try to do our best to address them, not

just for you, but for generations yet unborn.

And with that, Mr. Chairman, I yield back.

Chairman TOM DAVIS. Thank you very much.

[The prepared statement of Hon. Elijah E. Cummings follows:]

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Chairman TOM DAVIS. Mr. Gutknecht, any opening statement?

Mr. GUTKNECHT. No.

Chairman TOM DAVIS. Ms. Norton, any opening statement?

Ms. NORTON. Thank you, Mr. Chairman. I may be the only

woman on the dais, but I can assure you that this is a concern of

this entire committee, and I want to thank Chairman Davis for his

follow-through after the previous hearings. With all of that muscle

at the microphone in the original hearings, with many famous professional athletes in the room, the original motivation for our hearings could easily get swamped.

There were indeed a number of motivations. The huge ethical

problems in organized sports tended to grab the headlines, especially when everybody in the country knew it was happening and

nobody was doing anything about it. But the fact is that from the

beginning, these hearings have been motivated—and on the record

we have said so—by the growth in the use of steroids among children, and that means girls and boys.

The importance of focusing on children is what we know about

what steroids can do when adults use them. Mr. Cummings has indicated some of the documented results of use of steroids by adults,

indeed athletes. Imagine how much more serious the consequences

will be for people who start using steroids when they are children.

The only analogy I can think of is smoking.

I mean, if you start smoking when you are a teenager, you are

going to have a much greater chance of having all of the associated

illnesses than if you are foolish enough to start when you are an

adult. So focusing in on young people is important, because inevitably they focus in on athletes, and on the most successful athletes.

The real rock stars of this generation are athletes. You know, not

everybody can sing and play, but they all think that they can take

a turn at some sport or the other if they get good enough, and getting good enough has come to mean, for professional athletes,

cheating.

So we were both teaching cheating to young people and teaching

something just as serious: how to destroy your health at a very

young age. Now, I am aware, have read about the controversy concerning just how many girls use or do not use steroids. I recognize

the difficulty of pinning that down in this population. I do not regard the controversy as serious, because even assuming that girls

are using steroids in fairly sparse numbers, there is no question

that unless we begin to focus on what this does for young people,

they will do—they will finally do what boys do. We see it happening in sports all of the time. Indeed in Title IX we tell them that

you can play anything boys can play. You can do anything boys can

do. There may be a deterrent to a girl using steroids, if they think

they are going to look muscle-bound as opposed to simply looking

slightly more muscular. Given how important looks are to teenage

girls, perhaps it has not ballooned yet.

But if all we are doing is sending out the message of prevention

to parents about girls, that is doing what I wish we had done when

it came to boys who apparently may be using steroids in very large

numbers. So this hearing, I think, brings us back full circle to

where we began. The reason for these hearings is to make sure

that this terrible problem does not become a mass problem for our

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children; yes, and even for girls who may be less inclined, but will

surely march up the same road if we do not continue to focus on

them.

And therefore, Mr. Chairman, I appreciate that you have not

dropped the ball, but have kept the ball moving on our kids. Thank

you very much.

Chairman TOM DAVIS. Thank you very much.

We have our first panel today, and it is a distinguished panel.

We have Kelli White, the former world champion sprinter, and

Mari Holden the Olympian and world champion cyclist. It is a

great privilege to have both of you here today. If you would please

rise and raise your right hands, it is our policy that we swear you

in before you testify.

[Witnesses sworn.]

Chairman TOM DAVIS. Thank you. Please be seated.

Ms. White, we will start with you. We have—your total written

statement is in the record. Questions will be based on that.

We appreciate having you here today. Thank you. Kelli.

STATEMENTS OF KELLI WHITE, FORMER WORLD CHAMPION

SPRINTER; AND MARI HOLDEN, OLYMPIAN AND WORLD

CHAMPION CYCLIST

STATEMENT OF KELLI WHITE

Ms. WHITE. Thank you, Mr. Chairman, and esteemed members

of the committee. I want to thank you very much for allowing me

the opportunity to appear today before this very prestigious group.

My name is Kelli White. And I appear here today having made the

regrettable mistake of using steroids and other performance-enhancing drugs during my athletic career as a sprinter.

With my experience and knowledge regarding the use of performance-enhancing drugs, I welcome the opportunity to assist in the

efforts to remove doping from sport. By way of background, I competed in track and field for most of my life, having begun at the

age of 10. In my early teen years, I began working with renowned

Remi Korchemny, who would remain a significant figure in my life

over the next decade and a half.

I went on to compete collegiately and graduated from the University of Tennessee before turning professional in the year 2000. At

that time, I returned home to the San Francisco Bay area and

began training full time with Mr. Korchemny. Shortly thereafter,

in December 2000, my coach introduced me to BALCO founder,

Victor Conte. Conte initially gave me a package containing both

legal supplements as well as substances—a substance which later

became known as the clear or the designer steroid THG.

At the time, I was unaware that anything I received from Mr.

Conte was a prohibited performance-enhancing substance, as I was

told by both my coach and Mr. Conte that the vial they had given

me contained flaxseed oil.

A few weeks later, Mr. Conte admitted to me that the substance

he had given me was indeed not flaxseed oil, but rather a prohibited substance that if not taken properly could yield a positive drug

test. I immediately ceased using the liquid, because at that time in

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my career I did not believe it was necessary to take performanceenhancing drugs to be competitive.

I competed over the next 2 years without the use of any performance substances, despite being constantly urged to do so. I was continuously being told by my advisers that the use of performanceenhancing substances was necessary to be competitive because everyone else was doing so.

My 2002 season was very difficult, as I struggled with injuries

for most of the year. I had a great deal of uncertainty regarding

my status as I entered the 2003 season. And I did not want to miss

it. I failed to make the 2003 indoor world team, and was receiving

more pressure to start a performance-enhancing drug regime.

My advisers were pointing to other performances of athletes and

saying I needed to do what they were doing in order to compete on

that level. In March 2003, I made a choice that I will forever regret. I visited Mr. Conte at his lab which was near my home, and

we sat down and devised a program to utilize performance-enhancing drugs in my training and competition.

At that time I began taking EPO, the clear, or what is now called

THG, the cream, and other stimulants. I remained on this program

over the course of 4 months, and with the help of Mr. Conte, I was

able to pass 17 drug tests, both in and out of competition, while

utilizing these performance-enhancing substances.

In a relatively short time period, I had gone from being a very

competitive sprinter to being the fastest woman in the world. In

June 2003, I captured both the 100 and 200-meters U.S. Championships, and followed that by winning the same event in the

World Championships in August in Paris.

Although I crossed the finish line first in all those events, I knew

in my heart it was accomplished partially because of the other line

I had crossed. Instead of what should have been the high point of

my career and a tremendous accomplishment in my life, I was

ashamed of the choices I had made.

In addition to enhancing my performance on the track, there

were other physical effects I encountered while taking this mix of

substances. My blood pressure was elevated, and I also experienced

an acne problem, increased menstrual cycle, and slight vocal cord

problems.

The first and only failed drug test I experienced was following

the World Championship meet in Paris, when a stimulant known

as Modafinil was discovered in my urine sample. But the penalty

for that substance would not have been a suspension from track

and field.

A few weeks after the World Championships, the FBI and other

law enforcement agencies raided the BALCO Laboratory. A few

months later, I admitted to the U.S. Anti-Doping Agency officials

what I had done, as I have outlined for you today. I received a 2-

year ban from competition for my actions as well as loss of results

from my previous 4 years of competition.

I also agreed to assist USADA in its mission to clean up the

sport, and now offer to be of service to this committee in any way

you see fit. I believe athletes who use performance-enhancing drugs

are hurting themselves, cheating the public and betraying our

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youth. I believe it is important that you understand the reasons

that I made the choice, in essence to cheat.

I strongly feel the use of steroids and other prohibited performance-enhancing drugs are wrong and there is no place for them in

sports or society in general. However, athletes who have made the

choice are not necessarily bad people. In my own situation, there

are many factors contributing to my poor decision I made, which

include the influence of a longtime trusted coach, but, most importantly, I began using these substances not to give me an advantage, but because I became convinced that I needed to use them to

level the playing field with my competitors.

It is a very troubling situation when you have trained to compete

in a sport at the highest level, and you feel those with which you

are competing have an unfair advantage. I make neither any excuse nor justification for my horrible choice. I merely hope to lend

some understanding to this committee as to how someone who

loved her sport and who trained cleanly for most of her life got involved in this awful abuse.

My attorney, Jerrold Colton, and I have worked with assisting

USADA as well as the World Anti-Doping Agency in their efforts,

and we believe this committee should further support USADA in

the fight, as this fight is a very difficult one.

Being mindful that my use of steroids and other performance-enhancing drugs was not detected through the extensive testing I received, USADA needs the resources to go further in its fight to detect the people who are breaking the rules. I am certainly most appreciative of this opportunity to appear here today to discuss the

relationship of women and steroids. This is a problem that is not

gender specific, and affects people across all gender and racial

lines.

As an athlete, I am very aware of the opportunities which advanced for women in sports during my lifetime and just hope the

committee takes note that the pressures and considerations pertain

equally to men and women.

I hope there are further studies as to the physiological and

health impact people face when choosing to use these substances.

Further, the roles of some national governing bodies involved in

sports and the coaches which either assist in the wrongdoing or

turn their backs on what they see must have some responsibility,

culpability, and penalty for their role in making sport unclean.

The fight against drugs in sports is an extremely difficult battle.

I am sorry that I cheated myself, my competitors, my sport, my

family, and the public for the choices that I made in the past.

As athletes we know we are role models, but I betrayed my responsibility as such. Please feel free to call on me to play any role

I can in assisting your committee and anyone else you see fit in

this very important matter. I hope in doing so, I will help the sport

I love more by what I do off the track than anything I could have

ever done on it.

Thank you very much for your kind attention and for allowing

me to appear here today.

Chairman TOM DAVIS. Well, thank you very much for that testimony.

[The prepared statement of Ms. White follows:]

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Chairman TOM DAVIS. Mari.

STATEMENT OF MARI HOLDEN

Ms. HOLDEN. Mr. Chairman, members of the committee, good

morning. My name is Mari Holden. And I am a 2000 Olympic silver

medalist and 2000 World Champion in the sport of cycling. I want

to thank the committee for its interest in this important subject,

and the invitation to testify.

I have been competing as a professional cyclist at the international level since 1993, and have firsthand experience of the effects of drug use in sport. I have never used steroids or other performance-enhancing drugs, but I have had my hard work, dedication, and victory compromised by other athletes who have.

It is important for you to hear from clean athletes who have had

to work against those who rob all of us of the values sport should

represent. Unfortunately, much of what is in the news is the opinion of athletes who have achieved success by using performance-enhancing substances and are now getting caught.

While we should commend those who have the courage to accept

responsibility for their mistakes, far too little has been heard from

the athletes who strive to participate in the sport, using the right

substances; namely, personal accountability, commitment, hard

work, and integrity.

As a young girl growing up in southern California, I saw the

magic of the Olympics in my own back yard when Los Angeles

hosted the 1984 Olympic Games. I dreamed of being an Olympian

and representing the United States in athletic competition.

I even went so far as to practice standing on a makeshift podium

and singing the national anthem. As a kid my dreams seemed

straightforward and similar to most people’s American dream: If

you train and work hard, dedicate yourself to your goals and play

by the rules, you can become a winner.

When I was 12 on my first bike, I just wanted to go fast. And

for me it was a matter of seeing how far I could ride or how fast

I could go on a descent. The rules were the rules and no questions

asked. We all played by the simple philosophy that winners never

cheat and cheaters never win.

Most 12-year-olds today can recite that sacred adage. It seems so

simple. The reason that winners never cheat is that winners recognize the important life lessons taught by sport, which are far greater than any title, record or price. True champions recognize that

sportsmanship exists not only in winning but in winning with integrity.

Sport is valued in part because it builds character, self esteem,

and confidence. These are the skills that create success on the athletic field or in the boardrooms across America. And as I transition

from athlete to businesswoman, I cling to the lessons I have

learned over the past 17 years.

Being a young girl in today’s society is not always easy. All

around there are messages that they need to be thin, and how they

look is more important than who they are. Sports teach young girls

and young women that it is our commitment and the core within

and not just our outer layer that is valued and respected.

29

I first realized the magnitude drug use can have on my career

when I went to race in Europe, widely considered the pinnacle of

professional cycling. I knew that in order to be the best in the

world I needed to race in Europe full time and push myself harder

than I had in the United States. Despite winning several National

Championships titles, I was barely making enough money to cover

my phone bills back home.

Women’s sports generally do not have the money that other

sports have. But I was not racing to become rich; I just wanted to

see how good I could be. For some of my fellow competitors, cycling

was their only means of supporting a family back home. Regardless

of whether the athletes were competing solely for the money or

glory, the temptation to win at all costs was prevalent. Athletes

need a support system that supports their choice to compete clean.

I made a decision early on in my career not to take shortcuts to

success by doping. And I was fortunate to have a support group,

including my parents, coach and husband, who backed my belief

that the only accomplishments worth attaining were the ones that

I earned on my own.

Sometimes it is hard to think straight when you are exhausted

from a 10-day race, and we know that some people out there are

cheating. Personally, I have always tried to take the high road and

tell myself that I was a better sportsman because I was successful

without drugs.

Of course, disappointment sets in when you know that someone

who is not clean beats you and takes away your result. In the past

it did seem that much of the time the cheaters were one step ahead

of the testers. The people who cheat are also the ones who are willing to use every scientific and legal loophole to ensure that they do

not get caught.

Fortunately for clean athletes, this has changed with the World

Anti-Doping Agency and the U.S. Anti-Doping Agency. A few years

ago when I told some foreign teammates that 1 day they too would

be subject to unannounced testing, they did not believe me.

Now that time is here and more people are starting to get caught

for drugs that they never would have had in their systems before.

Looking back on my career, I can smile knowing I did it in the

right way. I have an Olympic medal and earning it was one of the

greatest achievements in my life. The medal is only a symbol, but

standing on the podium and hearing Anita De Frantz, a USOC and

IOC board member, tell me that my country was proud was the

moment I had imagined since I stood on the podium in my back

yard. It was a feeling that I had overcome the odds and had done

it without compromising my values.

There were so many opportunities to take the easy way that I

will never look at my medal and feel anything but pride.

I am here because I want to make sure that the clean athletes

of today and tomorrow have a voice. Our children need to have a

level playing field and the use of drugs for sport or looks should

be deterred at all levels. As a clean athlete, I want you to test me

so the world knows that when I win, I win fair and square. I believe all clean athletes feel the same when given a chance to speak

freely about these issues.

30

Frankly, it is the same simple rule we all followed as children

on the playground, and which our children hopefully still follow

today, that cheaters never win and winners never cheat.

[The prepared statement of Ms. Holden follows:]

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32

33

34

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Chairman TOM DAVIS. Thank you both for the very strong, compelling testimony.

Ms. White, how were you able to elude the USADA and WADA

testing during the time you were taking steroids?

Ms. WHITE. Along with the steroid that we were taking, we also

had a masking agent that we would use. We also knew who was

testing at which competitions, and we knew what we could and

could not take.

Chairman TOM DAVIS. Were steroids prevalent during your years

competing in NCAA athletics?

Ms. WHITE. I do not think so.

Chairman TOM DAVIS. You do not talk about it with anybody

else?

Ms. WHITE. No. I did not personally think so then. I would have

never thought it.

Chairman TOM DAVIS. What is your opinion of the steroid testing

that you received during college? Was it rigorous enough?

Ms. WHITE. No.

Chairman TOM DAVIS. OK.

Ms. Holden, what direct experience have you had with the other

female cyclists taking steroids?

Ms. HOLDEN. With steroids, I have been beaten by someone who

was caught for doping, but it was for a diuretic, which would be

a masking agent. So indirectly I would say yes; and that was I received second in that event, and received my award later.

Chairman TOM DAVIS. It is clear that designer steroids can elude

the testing. Do you think cyclists are still using steroids for international competitions like the Olympics? Do you have any idea?

Ms. HOLDEN. I don’t think that cycling is different than any

other sport. There are going to be people out there who are trying

to beat the system. That is, I believe that they need to have more

money for the research, to try and catch these designer steroids

and designer drugs, because we need to stay one step ahead of the

game instead of one step behind, which is how I have always

thought it has been.

Chairman TOM DAVIS. Ms. White, did you get any physical or

psychological side effects from using steroids?

Ms. WHITE. Yeah, the voice changing, the increased menstrual

cycle, high blood pressure. It came on very quickly too.

Chairman TOM DAVIS. Was it pretty pronounced? It was very

clear that this was affecting——

Ms. WHITE. Correct.

Chairman TOM DAVIS. Well, thank you very much.

Mr. Waxman.

Mr. WAXMAN. Well, I want to thank both of you. You have given

us an insight into the culture of competitive athletics from your respective sports.

Ms. Holden, you seem to think that there is a lot of performanceenhancing drugs used by people in your sport, but Ms. Kelli, you

do not think so—I mean, Ms. White, you do not think that there

is much going on? Is that an accurate statement for both of you?

Ms. HOLDEN. I would not say there is a high percentage. I do

think that it is happening out there. I do not know the exact percentage. But it is something that concerns me, and I want to try

36

and help make it better out there for future cyclists, future athletes

in general.

Mr. WAXMAN. If you thought of course it was happening out

there, that would be a pressure on you to use some kind of drugs

as well in order to be able to compete. You did not succumb to that

pressure.

Ms. HOLDEN. No. Personally I would rather not win than to

cheat that way.

Mr. WAXMAN. Ms. White, did you—you seemed to indicate you

did not think—you knew of people using these drugs when you

were using them. Do you think that there are other people now

using steroids and other performance-enhancing drugs in order to

enhance their performance?

Ms. WHITE. Yeah, I think so. If you look at the second place and

the third place at the World Championships in the 200 meters,

they have also tested positive for different substances. So they are

having 2-year bans also. So in my sport it kind of tends to be a

big problem. I wish that I could really give an answer on how we

can decrease the numbers or make it stop and go away altogether.

Mr. WAXMAN. Well, do you think stricter penalties that they have

for the Olympics is playing a role to discourage people from using

those drugs?

Ms. WHITE. Personally I think that the punishment is a little bit

harsh. Two years out of a career is very harsh. Stricter punishment, I don’t think that would resolve it. I think there are other

athletes that are being caught, and they are not being outed as I

have been outed. I think being outed is a big deterrent. It is embarrassing and it really does go with your character, it hurts you in

the long run. And I think that if we do out people, it could be a

deterrent.

Mr. WAXMAN. Is there a reason for us to be discouraged that

even while we have testing, there are people who are looking for

ways to get through the testing by masking the fact that they have

been using these drugs?

Ms. WHITE. I do not think that should be a deterrent, because

it not only affects professional athletes like we are talking about

here today, it affects people underneath us.

I think that if we continue to push forward, regardless of what

we as professional athletes may ignore, I don’t think that it is

being ignored by other parents and children, you know, younger

than me.

Mr. WAXMAN. Ms. Holden, what do you think about that? Do you

think that in order to compete, there are—women are looking at

using these steroids and other performance-enhancing drugs, knowing it is the wrong thing to do, knowing that it could hurt them

if they get caught, and they are willing to spend extra effort to see

if they can mask it?

Are the penalties enough to deter them, and what else do you

think we can do to change the mindset about the use of those

drugs?

Ms. HOLDEN. I think that the temptation is probably great to go

out and cheat, because I think it is taking an easy way to a big

result. And I personally do not believe that the punishment should

be any less. In fact, I think that when someone cheats and takes

37

away a result from somebody who is working hard and doing it

clean, that they should be given a harsh punishment.

They are taking away someone else’s dreams, and, you know, the

hard work that someone else has put into it. And so they should

be punished fully for it. I don’t have a problem with a 2-year bar

for someone who is caught for steroids. I think it is appropriate.

You are robbing someone else of their opportunity to see what they

can do.

I mean, the second place person may think that they could not

win, or the person who got fourth and did not get on the podium.

I think that is what gets forgotten a lot of times is we are hearing,

we are hearing about the people who are winning who may have

had, you know, given in to temptation or something; but what

about the person who is fourth and who did not get to stand on the

podium? That person deserves something too.

Mr. WAXMAN. Ms. White, as you look back on your mistake, you

knew it was cheating, you knew maybe that it was illegal, you

knew you didn’t want to get caught, because getting caught would

deprive you of the award.

What do you think more could have been done to have discouraged you from doing this? So we can learn for others. As you look

at it retrospectively, what more might have had an influence on

you not to take these drugs?

Ms. WHITE. You know, I have had that question asked a lot. I

have been going over it. I can’t think of much of anything that

would have discouraged me at that time. I was at such a low point,

that there is nothing else but being healthy—I am talking with all

of the injuries, that I wanted to get rid of the injuries—so nothing

else would have discouraged me from doing it at the time.

The only thing, like I said, there were other people that I knew

who were doing the same thing. Maybe had they been caught right

before me, I would have been like, no, but in considering that THG

had been around for years prior to my use.

Seeing others get caught and pay a price for it, that would be

something. You see someone you know with cancer and dying, seeing people tends to make you look at it differently. And it is the

same thing with my situation.

Mr. WAXMAN. Thank you.

Chairman TOM DAVIS. Mr. Gutknecht.

Mr. GUTKNECHT. Thank you, Mr. Chairman. And I echo those remarks. Thank you for just this unbelievable testimony. It has been

very, very eye-opening, I think, to all of us. Just a couple of very

quick questions.

First of all, did you notice, you said you saw your body respond

to these drugs very quickly. When you quit taking them, did you

see your body respond sort of in that way; did the effect go away

that quickly as well?

Ms. WHITE. The blood pressure took a little while to go away,

with the increased menstrual cycle that—we changed the dosage I

had been taking and that changed right away also. And the acne,

that went away. That took a little while to go away also.

Mr. GUTKNECHT. You also mentioned with not getting into the

names, but there was a particular individual that you went to. Is

38

it fair to assume that individual was consulting with other people

as well?

Ms. WHITE. I am sorry?

Mr. GUTKNECHT. I guess the point is, you went to a particular

individual to get these agents, these drugs?

Ms. WHITE. Right.

Mr. GUTKNECHT. It could be fair to assume that individual was

consulting with other athletes?

Ms. WHITE. Yes.

Mr. GUTKNECHT. It strikes me that it is not enough to do testing,

there needs to be some level of enforcement for those people who

are serving as a consult/physicians whatever. I mean, there must

be a limited number of people who do that.

Ms. WHITE. I have always had that question asked also; how

many people are out there doing this? But they are hard to find.

And a lot of them are introduced to these people through coaches.

And, it is—you do not usually find people directly. So that would

be a very hard thing to do.

Mr. GUTKNECHT. Well, it strikes me that might be a responsibility that we have here at the Federal level, either through the FBI

or the Drug Enforcement Agency or somebody who ought to be trying to track down who these people are who become the conduit or

purveyors in these kind of drugs.

I think, perhaps, Mr. Chairman, at some future point we ought

to consider how we track down these individuals who are really the

dealers of these kinds of drugs?

Thank you very much. I yield back.

Chairman TOM DAVIS. Thank you very much. Mr. Cummings.

Mr. CUMMINGS. Thank you very much, Mr. Chairman. I thank

both of you for your testimony. I want to go to you, Ms. White. You

said something that was very interesting. First of all, let me say

this, Ms. White. That you, I think what concerns me about—first

of all, I am glad you testified.

We had a Major League Baseball player here who could not

admit that using steroids was cheating, and could not even get the

words out of his mouth that he would plead the fifth amendment

rights. And so I thank you for at least coming forward and trying

to make a difference.

Your testimony makes me wonder, though, about—you said some

of the folks get caught but they do not get outed. What does that

mean?

Ms. WHITE. I know of at least six athletes who tested positive,

and we have not heard anything about that. Quietly they are

banned. And, in that response, now that one gets caught, and it

seems as if that can be OK to keep going on with the same behavior of these performance-enhancing drugs.

Mr. CUMMINGS. Do you think when Mr. Waxman asked you if

there was anything that could have been done or anything that you

would have seen that would have caused you not to do what you

did, you said that you couldn’t think of anything. That leads me to

wonder, then, when you said during your testimony that you were

working with your lawyer and others to talk about your story.

And I am wondering, do you believe that your story then has an

effect on other people that may find themselves similarly situated

39

where you were? And I understand that you are a young woman,

there are decisions sometimes, you know, maybe are a little difficult, and the lights seem a little hazy and there is a lot of pressure. But I am just saying there are a whole lot of women out

there, just like Ms. Holden, who may employ one route; but I am

just wondering, do you think that will have some impact when you

do not think it would have affected you?

I may be saying that improperly, but correct me if I’m wrong.

Ms. WHITE. Well, I can add a couple of things to that. One thing

I wish I could change is that when I was approached with it in

2000, I wish I would have made the decision then to leave my

coach. That really would have been the best decision, because he

continued to urge me to use the drugs. And I think that with my

story, and in talking about how painful it is to go through something like this, so that others will not go through this. I also believe that a lot of the pressures do come from not only what we see

around us, but the people that we do spend most of our day with.

I spent at least 6 or 7 hours a day with my coach. That is somebody that I have been working with since I was 12. So you tend

to trust those people. And I think that we need to educate our

coaches and others.

Mr. CUMMINGS. We do not need to educate our coaches, they

need to understand that they ought to have integrity. That is what

we need. That is the problem.

And as I sat here and I thought about my little episodes with

sports—never was a great basketball player, but I was pretty good

at football—the coach becomes like a father. So if someone has a

father-type figure that is saying do this, do this, do this, and it is

not like you are some 45-year-old person, you are a young person,

and the coach is saying do this, I think that is another type of pressure that—I mean we have to look at some of these coaches.

And I am not trying the take the responsibility off of you, but

that is extremely alarming that somebody who has a lot more experience in life than you, who was supposed to be guiding you in the

right direction, would say something like that. I would have hoped

that they would have said something like what Ms. Holden said;

look, we are going to do this the right way or we are not going to

do it at all.

But anyway, you go ahead. I am sorry. Were you finished?

Ms. WHITE. Yes.

Mr. CUMMINGS. You said that you felt that the 2-year ban was

not necessarily fair. Is that because you believe that some people

have not been, as you say, outed; or do you believe that is just totally unnecessary, when you have admitted that it is cheating,

when you have admitted that—I think you did—that it is unfair to

other people, and when you have admitted that it is wrong? You

know, this committee has taken a position almost that you should

be thrown out of sports completely.

But go ahead. I am just wondering what your response to that

is.

Ms. WHITE. I would have to say that 2 years is pretty harsh in

a sport. I think that even 1 year is a lesson learned. I learned it

pretty quickly. It did not take me very long. So I think 2 years is

very harsh. Because if you look at other sports, they are allowed

40

to pay a fine, they are allowed to miss a game or two. So I do believe that our lessons are learned quickly. I do not think it takes

2 years to correct that mistake and to go back and compete clean

again.

Mr. CUMMINGS. I see my time is up. Thank you, Mr. Chairman.

Chairman TOM DAVIS. Thank you very much. Mr. Porter.

Mr. PORTER. Thank you, Mr. Chairman, and thank you, Ms.

White, for being here. You have set such a great example for other

young folks and other athletes around the country.

And based on your experience, if there was just a few things that

you could say to young women that would be under similar pressures, what would be your advice to them today, as they face similar challenges that you have through the years?

Ms. WHITE. I would definitely have to say that if you feel it is

not right deep down in your heart, if someone comes to you with

something that you feel is just not right, to talk to somebody about

it, and to walk away from the situation.

I wish I would have walked away a long time ago, even before

the usage. And just looking at my mistake, I have paid greatly for

it, and I will always be looked at differently. And I don’t believe

that is the person that I am deep down, and it has changed how

people look at me, and I wish that I can go back and change that.

Mr. PORTER. Thank you.

Chairman TOM DAVIS. Mr. Lynch.

Mr. LYNCH. Thank you, Mr. Chairman, and Ranking Member

Waxman. I appreciate your focus on this issue. I want to thank

both of our panelists for coming forward. It takes a lot of courage

I think in both of your instances.

I have a 5-year-old daughter and a 10-year-old at home, and I

worry about whether they are going to face the temptation and the

same difficulty that you girls have, you women have.

And I am just curious, in your testimony, Ms. White, you said

that you had passed 17 drug tests, even though you had been taking illegal steroids. Seventeen times. With all of the time that you

are focusing on training and doing all that you have to do to compete, you must have had fairly close—I think Ms. Holden referred

to it as tutoring, from either Mr. Conte or someone else to give you

what you needed to enhance your performance and then to mask

it.

How did that all happen? I mean, are these people just waiting

out there to corrupt young athletes such as yourself?

Ms. WHITE. I do not think it has to do with them waiting to do

that. Like I said before, I was introduced to him by my coach. And

it was—it is a service. You basically pay for that service. And that

is why I really did not have, you know, much worry about being

caught, because I knew that I was paying for a good service.

And it is a very complicated system that—to do this. It is very

complicated. And the problem that the drug testers have is that the

drug makers are far, far ahead of the drug testers. And they need

to figure out how they can make the gap smaller.

Mr. LYNCH. Now, I understand you received a 2-year ban. Did

you know that was pretty widely publicized that was the consequence for someone who tested positive, a 2-year ban?

Ms. WHITE. Yes.

41

Mr. LYNCH. So you knew that? What about Mr. Conte? What

about people in his situation, where, if he was selling heroin or

something like that and destroying lives and careers by doing that,

he would be away for a long, long time; what are the consequences

for people in that position who corrupt young athletes?

Ms. WHITE. Nothing.

Mr. LYNCH. Nothing. Well, that is something we might need to

look at.

Ms. Holden, do you see anything out there that could undermine

the culture that you fought? You are an Olympic Champion, and

you have every right to be proud of that. Certainly your country

is very proud. Is there something that you would see that would

be readily available to undermine the culture; because it has to be

starting at a lower level; people do not all of a sudden get up one

morning and say, OK, I am going to take steroids to compete.

There has to be some acceptability or some receptivity in the

younger athletes to get them to take that step, to cross that line,

as Ms. White said.

Ms. HOLDEN. Well, I think that all sports should be held to the

same accountability level that Olympic sports are held to. I think

that would go a long ways into showing younger generations that

they cannot cheat in order to win. You know, it is no signal to our

youth if we have professional sports not giving strict punishments

on doping offenses.

And it should be standard across the board. I think that would

be a huge deterrent. If they thought that they could maybe not get

their scholarship to college because they tested positive, or continue

on into professional sports because they had to sit out too long and

they couldn’t proceed with their training or whatever, I think that

would be huge.

Mr. LYNCH. Those are great suggestions. I want to thank you

both again for your willingness to help this committee with its

work.

Thank you. I yield back.

Chairman TOM DAVIS. Thank you very much.

Mr. Shays.

Mr. SHAYS. It is so refreshing to be at a hearing like this and

to hear two very articulate young and fine people give such candid

testimony. And I contrast it to not just the baseball players who

were with us, but the players’ representatives, the commissioners

of baseball, you put them—both of you put them to shame. And I

just want to thank you for being so candid. You’re helping us understand something that we don’t experience. We don’t know what

it’s like to be a celebrity, we don’t know what it’s like to seek this

kind of success.

Ms. Holden, you come across in a very strong way, which is the

way I would want my daughter to; but I’m just wondering, do you

feel like you were ever tempted? I mean, do you feel like were you

faced with the same kind of temptations that Ms. White may have

had with her own coach doing that? Did you have your own coaches

saying you need to do this and so on?

Ms. HOLDEN. I was very fortunate in the sense that my support

group was really positive in backing my wanting to do sports without drugs. It sounds to me like Kelli’s support group wasn’t as

42

strong as mine was in the sense of wanting to stay clean. And in

that sense, I was able to go to Europe with that in mind and know

where my boundaries were. And you could get the sense that someone was trying to offer you something; once they realized that you

weren’t going to do anything, that was pretty much where the end

of it was for me. Like I was not approached in the same way, constantly prodded to do any doping.

I think that people knew my stand on being clean, and it was

never a problem for me.

Mr. SHAYS. Ms. White, I think almost everyone makes mistakes

they regret, but the mistakes that I might have made I made when

I was 7 or 8 years old. And my dad—I don’t want to say beat the

hell out of me—but he got my attention. And what I’m interested

to know is, I’m interested to know when you were caught, what did

your coach say to you?

Ms. WHITE. The first thing he said was, it’s no problem; we’ll

train for the next 2 years. And that was it.

Mr. SHAYS. Has he—you felt—I read an article that said you’ve

lost your friends. And I would weep to think that you would lose

any friends. I would like to think that, given what you’ve learned

at an older age, that you would have gained friends. But what has

been, as far as you’re aware, the penalty that the coaches paid?

Ms. WHITE. None. None at all.

Mr. SHAYS. Is he still coaching?

Ms. WHITE. Yes.

Mr. SHAYS. He’s still out there; he still has people he’s training.

And this was someone that basically was encouraging you to take

drugs?

Ms. WHITE. Correct.

Mr. SHAYS. Mr. Chairman, it seems to me that’s an area that

this committee—Mr. Cummings, you alluded to this and others—

that’s an area that we need to spend a tremendous amount of time

on.

You know, when you hear good testimony, sometimes you don’t

need to ask a lot more questions. And I just—I appreciate no excuses, and I appreciate—I get a sense that—well, let me just ask

this point.

Ms. Holden, when you were racing against people that you believed were using drugs, was it almost like feeling like you were

competing against a machine? I mean, somebody who was basically—and tell me the emotion. I’d like to hear it.

Ms. HOLDEN. Well, I mean, not necessarily like you were racing

against a machine, because there are a lot of other factors that go

into racing besides just being strong——

Mr. SHAYS. I guess the question I’m asking is, was that a hurdle

that you had to overcome? I’m just trying to think, if I’m racing

against someone and it’s pretty close and I want to beat them, I’m

still thinking, my God, this person has an advantage that I don’t.

Did you find yourself, even during the competition, thinking it; or

once you were in competition, you put it out of your mind?

Ms. HOLDEN. I tried to put it out of my mind when we were in

competition, because personally I just felt like I knew where my

mind was; I wasn’t willing to do any drugs, so this was the hand

that I was dealt competing against these women. And I still felt

43

confident that given the right day, the right training, and having

everything come together, you could still get a good result in a 1-

day race. So I just went out there and did the best I could and just

tried not to think about it, because I figured that if they weren’t

getting caught, maybe they would get caught at some point. And

it did happen, so——

Mr. SHAYS. Ms. White, I appreciate your comment that when you

were winning, you didn’t feel like you were winning. And the message that you have given other people who are competing is that

they realize that for you that wasn’t success, even when you were

succeeding. And that’s a nice thing, I think, to make sure that

young kids know. Thank you.

Ms. WHITE. Thank you.

Chairman TOM DAVIS. Thank you very much.

Ms. Watson.

Ms. WATSON. Mr. Chairman, thank you very much.

I want to say to Ms. White and Ms. Holden, it takes a lot of courage to come in front of a congressional committee. You know, we

sit on high; if you notice, we’re elevated and you sit down in the

pit and we question you. So I want to thank you for your courage

in coming forward.

Both of you have risen to the top of your sports, and are admired

globally for your physical accomplishments. Children in particular

look at you as role models. And I’m very, very worried that the

adult athletes who have cheated are held in high esteem.

As a child, I used to think of being a sportsperson as something

to ascend to, and sports were the way people should live their lives,

in a sportsman-like fashion—sportswoman, sportsperson. I see a

culture out there, not only in sports but on the streets, a drug culture.

And so what I want to do is to look at the two of you, and first

start with Ms. Holden. What was it that led you away from cheating?

And, Ms. White, what was it that led you into the use of

steroids? What is in our culture; what is it that we don’t do that

we should do so that we won’t have this occurring? Because behind

you come millions and millions of young people who want to succeed just like the two of you have. So what can we put into the culture and into education, into training, that would stop the shortcuts and look down the road to your physical best, your excellence

in whatever you pursue?

Ms. Holden, what kept you clean?

Ms. HOLDEN. Well, I think a lot of it is what Kelli was talking

about, with how bad she felt that she had cheated after it. I guess

I always thought about that, and I knew I wasn’t willing to look

at my results in that way. I wanted to make sure that when I

looked at them, I could show them to my kids. I could take out any

medal I might get, or something, and be able to tell them about

how I earned it, the things that I went through in order to get

there. Those are the things that I treasure almost more than the

medal itself, is being able to look my parents in the face and tell

them—you know, be excited about a result.

I think it’s unfortunate that so many people want to take shortcuts, because I think you miss out on a lot of the lessons that you

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want to get out of it along the way. And I think that by succumbing to doping or cheating, you’re taking away the opportunity for

them to get the self-confidence and everything that should be coming out of sports and just undermining yourself.

Ms. WATSON. I heard you use the word ‘‘confidence.’’ Your confidence was built how; your self-confidence?

Ms. HOLDEN. Well, a lot of my confidence has been built through

my trials and tribulations through sports.

Ms. WATSON. Your family?

Ms. HOLDEN. My family was a big part of it, always backing me

on everything that I wanted to do. My coach stood behind me and

helped me get through situations when I felt like I couldn’t succeed. There are always points when you’re worried and you don’t

know if you can make it.

I don’t know how many times I wanted to quit during my career,

but I think that my not quitting and going forward and trying to

do it in the right way, you become self-confident, you get self-esteem. And I think these are the things that are so important that

you get out of sport, that are especially important to young women

who are growing up.

Ms. WATSON. What can we do in our schools?

Ms. HOLDEN. I think what’s going on now in schools is great. I

think there are more opportunities for women in sports. Unfortunately with that opportunity, if women have more professional

sports, I think there are going to be more problems with doping

coming up in the future, because with increased money, you have

increased pressure. And so I think it’s important for groups, for

USADA especially, to have the funding to try and combat doping,

because I think that those things that we’re learning from sports

are so important.

Ms. WATSON. Ms. White.

Ms. WHITE. Mari said in her testimony that there should be a

support system for athletes who compete clean, and I think that

there is. I think that we glorify winning more than anything. And

I think that we should also look at what comes along with that,

how to do that properly and with integrity. I don’t think that’s emphasized at all, and it should be. And I think that’s where—it made

me come forward with my story as to how horrible I felt about

what I had done. And I don’t ever want someone else to go through

the same thing that I did at all. It was just something that I really

do regret.

Ms. WATSON. At what age——

Chairman TOM DAVIS. The gentlelady’s time has expired.

Ms. WATSON. I’m out of time?

Chairman TOM DAVIS. Yes. Thank you.

Ms. WATSON. Let me end by saying, as you respond to others you

might want to indicate at what age, what stage, did you feel you

needed some supplements.

Thank you, Mr. Chairman.

Chairman TOM DAVIS. I think in her written statement it does

talk about how she got into this, at length. But thank you for your

questions.

Mr. Dent.

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Mr. DENT. Thank you, Mr. Chairman. I would like to yield my

time to the gentleman from Connecticut, Mr. Shays.

Mr. SHAYS. Just for this question that I want to ask both of you,

because we asked the baseball players this.

If you saw someone cheating I want to know how you would

react to it and what you would do, first, if it was a member of your

own team, or maybe someone that you were competing with that

wasn’t part of your own team.

I’m going to start with you, Ms. White. Someone is cheating, you

know they’re cheating, what are you going to do about it?

Ms. WHITE. You mean now, or what would I have done then?

Mr. SHAYS. I want to know what you should do about it, what

you would tell any athlete to do about it. You’re aware that someone—let’s just say you’re part of the Olympics and this is your

team. How would you deal with that? If you want a chance to think

about it, I’ll ask Ms. Holden, but I want to know how you would

deal with that. Would you ignore it? Would you speak to the person? Would you go to the coach? Would you speak with the person,

and, if you didn’t get a good answer, go to the coach? The person

is cheating, right?

Ms. WHITE. Right. And now—now I would definitely say something to them. I don’t—I probably wouldn’t take it outside of that.

I think if—from my experience, I think what I would have to say

to them would be so strong that they probably really would reconsider it, just from my experience. It was just—it’s just a hard battle. It’s been a 2-year nightmare, and going on 3, so I would have

to just talk to them about that.

Mr. SHAYS. What happens if you were aware that there was a

coach, a trainer, that was getting people to cheat; what would you

do in that case?

Ms. WHITE. That is a different situation. I would go over their

heads, because they affect more people than just that one person

that is taking the drug. That’s just them, really. But the trainer,

coaches, they—it affects many more lives and people, so I would

definitely go over their heads to make sure that the problem

doesn’t spread.

Mr. SHAYS. Ms. Holden.

Ms. HOLDEN. If I hadn’t actually seen them cheating or——

Mr. SHAYS. You saw someone cheat, there is no question they

were cheating.

Ms. HOLDEN. There was no question.

Mr. SHAYS. No question.

Ms. HOLDEN. Well, then I would say something about it. I would

first tell them and give them the opportunity to go turn themselves

in; and then I would say something, too, if you knew they were

cheating. The problem is, is that people don’t cheat right in front

of you, so you don’t want to label yourself as someone who’s, you

know, going out and telling on everyone. So I mean, it’s hard to

have direct proof of doping unless someone fails a doping test.

Mr. SHAYS. I think that’s fair, and that’s why it’s a hypothetical

question. But I think, Ms. White, given your experience, if you saw

someone cheating, and you’re saying all the things that you’ve said,

that you would need to speak to them. And if they didn’t respond,

I think you would have to do what Ms. Holden did; you would have

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to say to them—and you know they’ve done it, it’s not a question,

I think you have to do more than that, frankly. Maybe it’s a little

more difficult for you to do that, because you feel maybe a little

more hypocritical, since you’ve been there. So I’d cut you a little

slack there.

Thank you. And thank the gentleman for yielding.

Chairman TOM DAVIS. Thank you.

Mrs. Maloney.

Mrs. MALONEY. Thank you, Mr. Chairman. And I want to thank

all of my colleagues in the Government Reform Committee for lifting the veil of secrecy that has hidden the steroid use in professional sports for far too long. And I thank the panelists for your

courage in coming forward today.

I have received countless calls from constituents who are eager

to see American athletes return to their fundamental values of integrity and honest competition. As a mother of two children, I am

particularly—two young girls—I am particularly disturbed to learn

that steroid use is increasing, especially by young women, and it

is being used not only to enhance their athletic performance but to

attain a near impossible standard of beauty.

This statistic I find startling, and I’m sharing it with my colleagues, that the Centers for Disease Control reports that 5.3 percent of girls between 9 and 12 have used steroid pills. And the rate

of teenage young women using steroids has nearly tripled in the

last decade alone. And obviously we have to approach this problem

from treatment—from two angles: treatment and intervention. But

the problem also has to be attacked at the level of family, community, and schools.

But I believe it is also a problem that must be approached on a

cultural level. And my question to our two panelists is, really, the

effect of messages from our media industry and what these messages send to young women for near impossible body looks and so

forth.

And it’s very troubling. Obviously every athlete is a role model

to other young men and women, and if one is using steroids, it obviously encourages others to do so. So it’s very, very troubling.

And, basically, how many young women will have to struggle

with cancer or liver damage or masculinization of their bodies before we take a real honest look at the cultural influences on young

women? And I’d like you to comment on it, the impact of the media

and the media industry and the messages that they are sending to

young women that may influence them to take steroids.

Ms. HOLDEN. I think that the media is actually giving a better

body image than they did a few years ago, in part because women’s

sports are becoming more popular and a little bit more realistic

than the stick-thin models of the past.

As far as the steroids abuse in young women, that—I can’t really

speak to them wanting to masculinize their bodies, and I hope that

the over-muscular women aren’t the ones that they’re trying to become like.

Ms. WHITE. It is a very disturbing thing to find out that there

are nonathletic women taking steroids, because I didn’t realize that

you can actually get an effect from not working out with them. I

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thought that you had to be doing something with them to be taking

any effect.

And I think the media, it is kind of—they do play a role in the

image of what women should look like. And I’ve also even fallen

into it a little bit just in the glamorization of myself and looking

at different TV shows of plastic surgery shows and things like that.

So there are a lot of pressures to look a certain way, but I think

that’s why we should also encourage the flip side to that and teach

women how to be comfortable with their bodies, in what they have

been given in themselves.

Mrs. MALONEY. How do we teach them to be comfortable with

themselves?

Ms. WHITE. The same way that we tell them that it’s OK to

change their body if you feel like it. We should also in school

teach—as we teach any other subject—a confidence course. I don’t

know; I mean, I think men need it also because——

Mrs. MALONEY. Do you believe that young athletes may be more

likely to use steroids because some professional athletes may have

used steroids during their careers, successful athletes, that comes

after using steroids? Do you think that younger athletes are thereby encouraged to use them?

Ms. WHITE. I don’t think that comes from just the professional

realm, just the pressure. It goes even further down, to making it

just to the next level, from high school to college, from college to

the professional arena. I don’t think it necessarily comes directly

from a certain person. I just think the pressures from those around

us are just a little bit—are high.

Mrs. MALONEY. My time is up. Thank you.

Chairman TOM DAVIS. Well, I just want to thank this panel. It

has been very, very helpful to the committee. We appreciate very

much you taking your time today in each of your cases, from different perspectives, coming out with your stories. It’s been very

helpful. So I dismiss this panel.

We will take a 3-minute recess while we get the next panel.

Thank you very much.

[Recess.]

Chairman TOM DAVIS. Thank you very much for your patience.

We had a great first panel, and we have now a very distinguished

second panel as well.

We have Dr. Diane Elliott, professor of medicine at Oregon

Health and Science University, and thank you for being with us

today; Dr. Todd Schlifstein, clinical instructor at the New York

University School of Medicine; Dr. Harrison Pope, professor of psychiatry at the McLean Hospital in Belmont, MA and Harvard Medical School; Dr. Charles Yesalis, professor of health policy and administration at Penn State; and Dr. Avery Faigenbaum, professor

of health and exercise science at the College of New Jersey.

Thank you all for being with us. It’s our policy we swear people

in before they testify, so if you would just rise with me and raise

your right hands.

[Witnesses sworn.]

Chairman TOM DAVIS. Dr. Elliot, we’ll start with you. Thank you

for being with us.

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STATEMENTS OF DR. DIANE ELLIOT, PROFESSOR OF MEDICINE, OREGON HEALTH AND SCIENCE UNIVERSITY; DR.

TODD SCHLIFSTEIN, CLINICAL INSTRUCTOR, NEW YORK

UNIVERSITY SCHOOL OF MEDICINE; DR. HARRISON POPE,

PROFESSOR OF PSYCHIATRY, McLEAN HOSPITAL, BELMONT,

MA, AND HARVARD MEDICAL SCHOOL; DR. CHARLES

YESALIS, PROFESSOR OF HEALTH POLICY AND ADMINISTRATION, THE PENNSYLVANIA STATE UNIVERSITY; AND DR.

AVERY FAIGENBAUM, PROFESSOR OF HEALTH AND EXERCISE SCIENCE, THE COLLEGE OF NEW JERSEY

STATEMENT OF DIANE ELLIOT, M.D.

Dr. ELLIOT. Thank you for inviting me to participate.

I’m a physician and professor of medicine, and with my colleague, Linn Goldberg, and a dedicated team of researchers, we

have been working with young student athletes for more than a

decade.

I know the committee members are becoming experts on steroids,

and I want to speak to their use among young women. You know,

your testicles make testosterone, which change boys to men, and

ovaries produce estrogen, which transforms girls to women. The

two hormones are closely related, and our cells can respond to both

in unique ways. Because a woman’s testosterone level is 2 percent

of adult men, lower doses of steroids can have marked musclebuilding effects and ratchet up a woman’s muscle size and

strength, and they are made to order for females wanting to lose

body fat and gain muscle. Potential additional benefits include

making women feel more aggressive and powerful.

Steroids also have masculinizing side effects for women, including voice deepening, facial hair growth, acne, clitoral lengthening.

During adolescence, when our own hormones are kicking in, factors

affecting drug use and its consequences begin to differ for men and

women. Women, more so than men, are affected by sexual stereotyping and promoting a body that is neither healthy nor feasible,

which can make a woman feel inadequate and motivated to buy

clothes, use make-up, and use drugs to achieve that end.

The unrelenting pressure to lower body weight is a factor that

promotes disordered eating and use of body-shaping drugs such as

laxatives, diuretics, diet pills and steroids. For young female athletes, societal pressures can be compounded by the pressures of

their sport, the pressure to win, and increase their risk for these

problems.

Recent attention has been drawn to young women’s anabolic steroid use. A 1993 large survey showed an increase in use among

young women. Every other year, the CDC surveys a national sample of 15,000 9th through 12th graders. In the most recent 2003

data, 7 percent of ninth grade girls reported AS use; 7 percent

using steroids is higher than other national surveys and our own

data, which are closer to 1 or 2 percent use among young women.

True rates may be difficult to determine. Women who tend to use

drugs alone, are better able to conceal drug use, and the potential

shame and stigma may lead to a bias to underreport.

There appear to be two groups of young women steroid users.

The first and larger subset use steroids once or a few times, and

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have more disordered eating behaviors and use of other weight-loss

or other body-shaping drugs. A common misconception is that

young women with disordered eating are good girls who obey all

the rules. In general, disordered eating habits cluster with other

health-harming actions, including drug use. The sequence may be

that girls have low self-esteem, feel depressed, and engage in disordered eating and body-shaping drug use, and then progress to

use of other drugs and alcohol.

Girls reporting steroid use also use more alcohol, tobacco, marijuana, and other substances. They have greater risk for drug use,

including more depression, greater perceptions that others are

using drugs, and fewer rules, explicitly rules against their use.

Less than half of these girls are in team sports.

My interpretation of the younger girls’ use of 7 percent is that

they’re indicating they’re using drugs that probably aren’t steroids.

Unlike most drugs, which have an immediate effect, steroids take

time to see an effect. So after a few days of using these drugs nothing is happening, not like when you take a diuretic or laxative, and

they may stop use. As they get older, they recalibrate to what

steroids actually are, and that’s why the use drops among older

girls.

Still, 1 to 2 percent is significant when applied to a population

and comparable to those using crack or LSD. The second group of

young women steroid users use them more frequently, and they’re

a unique group. Many carry guns; have missed school because they

felt unsafe; and half are trying to gain, not lose, weight. Depression

is common, and almost half of these high-end users have attempted

suicide in the last 12 months.

So for most young women, steroids are not about being great athletes; they’re markers for problems and clusters of health-harming

behaviors. In general, for young women and men being in sports

neither markedly promotes or protects from drug use. What being

in sports does is provide an ideal solely for promoting healthy lifestyles and learning skills that will deter health-harming behaviors.

We took advantage of those features with the ATLAS and ATHENA program.

ATHENA is a program for young women athletes. And while

both programs share the team setting, the content is specific for

each sex. During the sports season, the programs are incorporated

into a team’s usual practice activities. Each session uses scripted

lesson plans for peer-led fun activities.

With NIDA funding, we studied ATHENA among 40 sport teams

from 18 high schools in Oregon and Washington. Following the program, girls in ATHENA had less new and ongoing diet pill use, and

less new use of athletic-enhancing substances, including steroids,

amphetamines, and sport supplements. They also had less riding in

a car with a drunk driver, less sexual activity, and fewer injuries.

They ate better and strength trained more effectively.

We continue to follow those young women, and assess them

again a year after high school graduation. The ATHENA graduates

reported less use of alcohol, tobacco, and marijuana. Those longterm findings show that drug prevention can work, and focusing on

risk factors and healthy decisionmaking skills can have a lasting

impact.

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Today, scholarships and even an occasional career in professional

sports are attainable goals for women. While there may be parity

in sport participation and college scholarships, the financial and career potential of professional sports is much less for women. And

most people would find it difficult to name five active professional

women athletes who have not made millions.

Drugs are bad, sports are good. It’s commendable the committee

is showing concern for America’s youth and recognizes the national

significance of drug use. Reducing drug use among professional

athletes sends a message that steroids and other performance-enhancing drugs are not tolerated.

I’m a doping control officer for USADA because I believe athletes

should not be pressured to use drugs to compete. However, I’ve outlined the factors that women’s drug use and drug testing Olympic

or professional athletes will not impact on those risks.

It’s also unrealistic to think that drug testing professional athletes will clean out boys’ locker rooms. Ben Johnson had his Olympic medal taken away for steroids before most adolescent athletes

were born. You’ve heard that the NFL has a drug testing program,

but recently there has been steroid use among high school football

players. The steroid genie is way out of the bottle and drug testing

professional athletes won’t put it back. Elite athletes are but one

influence on young males’ performance-enhancing drug use. Adolescents know anabolic steroids work. They know they’re illegal. And

they know they have side effects. However, when they use steroids,

most are not thinking about professional careers, or even college.

They feel invulnerable and want a shortcut for looking better next

week and playing better next weekend. That’s why effective education is a critical component.

Last year Congress passed and President Bush signed the Steroid Control Act. It included funding of science-based drug use prevention for children and adolescents. To date, those funds have not

been appropriated. Sports teams have untapped potential as settings to positively impact behaviors. Funding the Steroid Control

Act that you already passed will go a long way for giving schools

the muscle to get drugs out of youth sports and allow programs

with proven success to strengthen sports’ health-enhancing mission.

Thank you.

Chairman TOM DAVIS. Thank you very much.

[The prepared statement of Dr. Elliot follows:]

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Chairman TOM DAVIS. Dr. Schlifstein.

STATEMENT OF TODD SCHLIFSTEIN, M.D.

Dr. SCHLIFSTEIN. Thank you. I’m a sports medical physician at

NYU Medical Center. I teach at the School of Medicine on anabolic

steroids. I teach a sports medicine course which lectures on all

types of supplements, including steroids. I go around lecturing to

local high schools about supplements and steroid use. And I also

do the same positions for professional sports, college sports, as well

as do physicals and treat high school athletes as well.

Use of anabolic steroids is coming into the spotlight, especially

over the last several months. Attention has been focused on professional sports. However, the use of steroids in professional sports

may have a large trickle-down effect to college athletes, high school

athletes, and nonathletes.

Recently, new studies have brought evidence of the use of

steroids by females who are both athletic and not athletic.

Anabolic steroids are ergogenic aids. What does that mean? That

means they’re a supplement used to enhance performance. Anabolic

steroids are androgenic derivatives of the male hormone testosterone. There is no pure anabolic compound out there. That is to

say that there is no substance that also has all the androgenic

properties or male hormone effects.

Now, designer steroids are made specifically to increase the anabolic effect while decreasing the androgenic effect in order to get

the maximum benefit with the least side effects. Designer steroids

also came to the highlight because they also were designed not to

be picked up on drug testing; and that is where, for example, THG

came to the forefront.

The incidence rates in young children, adolescents, teenagers,

and especially females, is very difficult to determine. There are several studies that people have been referring to, and you can go

back into the Journal of the American Medical Association back in

1998 where the incidence, even in junior high school, varied from

1 to 11 percent, and in high school as well.

More recently, the Center for Disease Control studies show an incidence of 5 percent of high school girls were using steroids, 7 percent of ninth grade girls were using steroids, all without a prescription. These statistics compel us to look further at the use of

steroids in females. More recently, patients have come to me and

anecdotally discovered that they were taking anabolic steroids—

young females, professional athletes, some not athletes at all, some

professional models, other girls just trying to maintain weight.

The question is, why would a young female put themselves

through the risk of these things, knowing the side effects that there

are? Anabolic steroids are generally used to help increase muscle

mass and strength when combined with appropriate training. Two

or more steroids taken together, stacking, which occurs in 6 to 12-

week cycles, this can increase the level androgenic level 10 to 40

times normal in males. Now, in females, that would be greater

than 100 times the levels tested for. The full benefit of these

androgenic aids is incompletely studied and is very poorly studied

of the hormone levels in females.

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There are several reasons why females, both athletic and not

athletic, may look to anabolic steroids or may look to abuse anabolic steroids. Certain steroids are believed to have appetite suppressant effects. Some of these steroids are supposed to burn fat at

a faster rate. Males normally have a higher percentage of lean body

mass and less percent body fat, and a large effect of this is due to

the male hormone testosterone. Testosterone plays a major role in

the way that weight is distributed through the body and the way

our metabolism works. All these methods may help to control body

weight without having a muscle-bound body; in other words, in

order to change one’s ratio of fat to muscle, to be more lean, and

to lose percent body fat as a way of controlling one’s body weight

by appetite suppression as well as weight control.

Now certain steroids are believed to have certain properties than

other steroids, meaning certain benefits are more anabolically mass

building; other ones may have more appetite suppression effects or

fat suppression or metabolism being accelerated. Clenbuterol,

cytomel, parabolan, phenformin, these are all ones that are believed to have appetite suppressant effects as well as fat burning

effects. So certain ones are more specifically attuned for different

reasons.

Now if one goes on to the Web, one will notice several things.

You can buy these things on line, you can buy them on the Internet, and there are thousands of sites where you can buy these

things. They will also tell you which ones to take. They will tell

you, for girls, if you want to lose weight, if you want to have your

appetite suppressed, they will tell you which ones to take and how

to take it. They will tell you that they can reduce the side effects

by taking it appropriately and not abusing it, and these are largely

found all over the Web. So they’re advertising to these people and

encouraging them to use them and telling them that they can use

them in a safe way.

I’ve talked to other people in Italy, the Italian study that was

going on, and they had a similar incidence rate in high schools that

is comparable to the CDC study. I talked to people in Mexico about

a study they were doing which also had similar rates. Mexico is another problem, as it can be bought over the counter without a prescription, and is very easily accessible. You can call them up and

they will deliver it to your house.

Other problems, on-line ordering and using anabolic steroids, is

that you can make our own steroids. You can buy legal steroids

that are made for cattle or for pigs. You can order it and it will

be delivered to your house. And they will tell you how you can convert it so you can use it as an anabolic steroid. So people order

large quantities of cattle hormones, which I spoke to a police officer

yesterday about and DEA yesterday about, which is perfectly legal;

but obviously this person is not raising cattle in Manhattan, unless

there’s a big supply of cattle in Central Park we’re unaware of—

that is producing mass quantities of anabolic steroids for years.

I don’t have to go over again extensively the major side effects

or problems with anabolic steroids, especially in women and young

adolescents: The closure of the growth plates; you will stop growing. That is not reversible.

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Some other side effects may be reversible: thinning of the hair,

male pattern baldness, thickening of your skin, oily skin, acne,

deepening of your voice. But some of these things may not be reversible. And they still have all the other negative effects from anabolic steroids as well.

I know I’m over the limit. I just want to say one more thing. Also

what this brings to our attention is that not only have I seen numerous patients who I haven’t been looking at previously, who are

young females, not athletic, using it to control weight. Now that

we’re opening our eyes and looking at this, we may be seeing a lot

more of that.

Now, there are no long-term studies that are looking at longterm side effects of steroids, and we don’t know what kind of problems all these people are going to have 10, 15, 20 years from now.

But also with this, we should also look at other substances that are

being abused, other stimulants, amphetamines and other things

that aren’t banned, and should be banned, and are quite often

abused with this. People who abuse steroids tend to be abusing a

lot of other drugs at the same time.

Thank you.

Chairman TOM DAVIS. Thank you.

[The prepared statement of Dr. Schlifstein follows:]

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Chairman TOM DAVIS. Dr. Pope, thank you.

STATEMENT OF HARRISON G. POPE, JR., M.D.

Dr. POPE. Thank you, Mr. Davis.

Let me just preface my remarks by saying that I strongly support the efforts of this committee. I think that steroid use is a

major public health problem here in the United States, both in professional sports and among young men, and also among elite

women athletes, as our first panel so eloquently told us.

And I also, in preface, would like to remind the committee—the

comments by Mr. Cummings, who had to leave us—but even one

case of somebody using anabolic steroids is one too many.

However, if I could have the first slide, please, Scott. Having said

that, let me just turn to the actual strict science here. And I would

argue that as we look at the actual scientific data, that there is no

methodologically sound scientific evidence that there actually is a

serious problem of anabolic steroid use among teenage girls in the

United States. So I’m not denying the severity of the problem, but

specifically among teenage girls there is little evidence to support

a genuine problem.

And I would argue that this is called what we call ‘‘false positive’’

responses on questionnaires. And to explain that, let me just go

through some slides very quickly.

If I could have the next slide.

Here is the much-quoted figure from the CDC that 7.3 percent

of these ninth grade girls stated on an anonymous questionnaire

that they had used lifetime illegal steroids.

But if I could have the next slide.

Let me remind you what we mean by steroids. Anabolic steroids,

the subject of this testimony here, are drugs like testosterone and

its relatives, drugs that are used to gain muscle and lose fat, drugs

that are a serious public health problem among men, and drugs

that are illegal under DEA supervision. However, if a girl answers

yes on an anonymous questionnaire, how can we be sure that she

has used one of these genuine anabolic steroids?

And if I could have the next slide.

The answer is we can’t. We can’t go back and find the girls who

answered yes, and ask them to clarify their answer to make sure

that when they said yes, they were accurate; and that they had

really used genuine anabolic steroids.

Now on the next line, let’s look at the actual question by the

CDC. It simply says: During your life, how many times have you

taken steroid pills or shots without a doctor’s prescription? It

doesn’t specify anabolic steroids, it doesn’t say steroids for muscle

building.

Well, now turning to the next slide.

Suppose a girl has taken steroids from her dermatologist or used

her mother’s steroid skin cream for poison ivy, or she used an asthma inhaler that has steroids? Well, these are not anabolic steroids,

these are corticosteroids. These are drugs that have no musclebuilding abilities, they are not illegal under the DEA, they don’t

have a black market, and they are not drugs of abuse.

Birth control pills, estrogen, and progesterone are technically a

type of steroid, but they’re not drugs of abuse. Then there are the

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so-called adrenal steroids sold legally over the counter, until last

year, in health food and supplement stores. These substances are

not true anabolic steroids. They have at most only weak anabolic

properties, and are not the DEA-controlled anabolic steroids that I

showed on my original slide.

So if a girl answers yes on an anonymous questionnaire, just on

the strength of having used one of these substances that she’s

using a steroid, it is not a real yes; it is an invalid answer.

Now, going to the next slide.

Suppose a girl gets the questionnaire and she has bought something in the health care store that she thinks is a steroid—like creatine or some pill with some name that is meant to sound like a

steroid, like sterol pills, or similar—again, a girl may erroneously

answer that she thinks she has taken real anabolic steroids, when

in fact she has not.

So, on the next slide.

How would we resolve this dilemma? Well, the answer is very

simple. We do a study where we actually go out and interview people in person, get a trained interviewer who will actually see these

people and ask them to clarify and make sure that they really have

used genuine anabolic steroids.

And, on the next slide.

There exists such a study; the federally funded National Household Survey—it’s now called the National Survey on Drug Use and

Health—actually does this. They send trained interviewers to see

about 20,000 Americans and interview them in person about drug

use.

Now, if we look at the data from the next slide.

The National Household Survey, when women were asked in person by a trained interviewer, thereby eliminating or minimizing

this risk of false positives, we find that out of 7,500 women, there

were only 18 women, or 0.2 percent, who took real steroids. Now,

admittedly this is from 1994, but a number of studies in the interval from now until the present—which I can’t stuff into 5 minutes

of testimony—have converged to suggest that once you eliminate

this problem of false positives, that the true rate of real anabolic

steroid use among teenage women is probably only a few tenths of

1 percent.

So, on the next slide.

The bottom line here is be very careful; do not be misled by rates

of so-called steroid use when it’s done by anonymous questionnaires, without confirmation to make sure that the answers were

valid.

And now if I could skip ahead two slides.

Well, how could you prove me right or wrong? Well, it’s easy to

prove me right or wrong. What you do is you go out and you give

the same question that CDC did, except this time you put in a line

at the bottom saying: ‘‘if you answered yes, please name the steroid

that you used.’’ And then we could find out if somebody lists a genuine steroid like testosterone, we know that it’s a genuine yes; if

they list something else, we know that it’s a false positive.

And alternatively—on the last slide—we could put anabolic

steroids back onto the National Household Survey—or what is now

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the National Survey on Drug Use and Health—next year, and have

interviewers ask people directly.

Now, I will submit to you here under oath, on the record, that

if you did this, with care to eliminate false positives in a scientifically rigorous fashion, that the true rate of real anabolic steroid

use among teenage girls is still only a few tenths of 1 percent. And

it’s important for us to concentrate on this science because we’ve

got to know where to apportion our resources in what is really a

genuine problem.

Chairman TOM DAVIS. Thank you very much.

[The prepared statement of Dr. Pope follows:]

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Chairman TOM DAVIS. Dr. Yesalis.

STATEMENT OF CHARLES YESALIS

Mr. YESALIS. Well, I’m going to depart from my prepared remarks to strongly disagree with my long-term colleague, Dr. Pope.

First I want to start by looking at the motives. During the hearing

so far——

Chairman TOM DAVIS. This is the kind of hearing we like. Go

ahead.

Dr. YESALIS. Well, we talked about the benefits, perceived benefits of using anabolic steroids: adulation, financial rewards, scholarships, improved appearance, the competitive pressure on our young

people to use these drugs. I don’t know of any evidence why all

those trends would impact young men greater than young women.

So I think motivation applies equally across the aboard.

Availability. A couple weeks ago I was in New York testifying at

a criminal trial regarding anabolic steroids. I had in my hand a 10-

week supply of human growth hormone, real stuff coming from

Communist China. It cost $1,400. If any of us would have received

this legitimately through a physician, going to a pharmacy, it

would cost $2,500. I had 20,000 Stanozolol pills in my hand, real

stuff from Communist China, that cost $400; 20,000.

Clearly the Internet is out of control, but the point I’m trying to

make is it’s available, and it’s available equally to young boys and

young girls.

Three, effectiveness. These drugs are dramatically more effective

on females than they are males. There is no debate about that. If

you look at the data, not only the CDC’s data but the Monitoring

the Future data conducted by contract through the University of

Michigan, showed, under the Monitoring the Future in 1989, it

went—this is lifetime use—from 0.9 percent to 1.7 percent, approximately doubled. The one out of DSS went from 1989—it just

didn’t pop up to 5.3; it started at 1.2 percent in 1989, it went to

5.3. So this 5.3 just didn’t come out of nowhere; it’s been increasing

steadily.

Also when we’ve done these surveys of children, there have been

reliability studies that kids pretty much tell the truth. Now, you’re

not going to get that same level of candidness from an NFL player,

an MLB player, but kids tend to tell the truth on these surveys.

Surveys do have an advantage—applied surveys, questionnaires, do

have an advantage over face to face. Sometimes when you see

somebody face to face, it intimidates you. So the National Household Survey on Drug Abuse, as it was called back then, is a very

good survey but there is not a consensus that it’s gold standard.

In regard to bias, if I had to—if you asked me where the bias

is, it’s underreporting. Dr. Goldberg, who had testified at previous

hearings, agrees with me on that, along with Dr. Wadler.

And with regard to confusion on this, I would submit if a kid is

confused in that with one of these surveys, I would submit that the

average kid, when it comes to this, has more street smarts than

the majority of the people in this room as to what is really meant

by these drugs.

Well, what should we do? First of all, my background is public

health, I’m an epidemiologist, and I would err on the side of cauVerDate 11-MAY-2000 10:23 Aug 08, 2005 Jkt 000000 PO 00000 Frm 00105 Fmt 6633 Sfmt 6633 D:\DOCS\22241.TXT HGOVREF1 PsN: HGOVREF1
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tion. I’m assuming—I’m going to assume that we have 200,000 to

500,000 young women in this country who have used these drugs

at least once. And what do I mean by used at least once? Nobody

uses one injection or one pill; it would have no impact. And these

drugs are used in cycles which are 6 to 12 weeks or more duration.

I’ve been an educator for going on 30 years. Education isn’t working on this. You need to add to educational efforts, some level of

testing at the high school level, and test—random testing and testing with suspicion. I think that’s imperative.

And, finally, we have to give our kids a real clear message that

steroid use, growth hormone use, and other performance-enhancing

drug use will not be tolerated by their role models, these elite athletes.

And I know that a very good bill has come out of this committee

which would mandate that the WADA—World Anti-Doping Agency—lists the drugs be used, to take amphetamine use out of the

NFL and pro baseball. It would also turn over testing to a disinterested third party so we don’t have the fox guarding the hen

house. And I think that’s imperative; that if you keep letting professional and collegiate organizations do their own testing, you’re

going to give a horrible message to our children, and that has to

be stopped. And a disinterested third party like USADA needs to

take over the testing.

Thank you very much.

Chairman TOM DAVIS. And thank you very much.

[The prepared statement of Mr. Yesalis follows:]

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Chairman THOMAS. Dr. Faigenbaum.

STATEMENT OF AVERY FAIGENBAUM

Mr. FAIGENBAUM. Mr. Chairman and committee members, thank

you for inviting me to participate in this important hearing examining steroid use among young females.

Although anabolic steroids, or, more appropriately, anabolic

androgenic steroids, have traditionally been used by adult strength

and power-athletes, in the United States the use of anabolic

steroids has in fact extended to younger populations.

While the use of anabolic steroids is generally higher in males

than females, the CDC reports that adolescents have used or are

currently using anabolic steroids. Researchers have recently suggested that anabolic steroid use may begin before students enter

high school.

It has been reported that up to 2.8 percent of middle school females report using anabolic steroids. The latest report from the

CDC, as we have heard today, suggests that about 7 percent of

middle school females have tried anabolic steroids at least once.

While it appears that a growing number of young females in the

United States are using anabolic steroids for nonmedical reasons,

I do believe that the possibility of underrecording false negatives

and overreporting false positives needs to be considered. As we

have heard today, it is possible that some children and adolescents

may have confused anabolic steroids with similar medications such

as corticosteroids. On the other hand, it is possible that students

may have underreported anabolic steroid use for fear of punishment or disqualification?

In my opinion, some young females are in fact using anabolic

steroids. The perceived benefits of anabolic steroids are not without

serious consequences, which may include clotting disorders, liver

dysfunction, reproductive abnormalities, and psychological effects,

including uncontrolled aggression.

The use of anabolic steroids by children and adolescents poses

additional concerns because the use of these drugs during this developmental period may result in premature closure of growth

plates that may result in stunted growth.

In my judgment, it is reasonable to conclude that increased pressure in young females to excel in sports, as well as concerns that

some females have about their physical appearance, may result in

a perceived need for chemical interventions to enhance performance or alter body size favorably.

At a time when the number of overweight children and adolescents in the United States continues to increase, it seems that

some middle school and high school athletes and nonathletes may

be tempted to use anabolic steroids for weight control and body fat

reduction. Young females, like adults, want quick results. The CDC

reports that 59 percent of adults and females are currently trying

to lose weight.

While anabolic steroids can in fact favorably alter body composition and enhance strength and power performance, users must participate regularly in a vigorous strength and conditioning program

in order to achieve the desired results. Without the stimulus of

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strength exercise, anabolic steroids will not be ergogenic or performance enhancing.

Findings suggest that children and adolescents are knowledgeable about the potential physiological effects of anabolic steroids as

well as the potential influence of these drugs on physical appearance. However, their knowledge of the potential harmful effects of

anabolic steroids, in my view, seems incomplete. These findings

suggest that proactive interventions are needed, and that positive

messages young females may receive about the use of anabolic

steroids from peers, parents, coaches, and professional athletes are

effective.

In my opinion, the use of anabolic steroids by professional athletes contributes to the belief among some young females that anabolic steroids are not harmful. In my view, comprehensive anabolic

steroid prevention education interventions, supported enthusiastically by health and physical education teachers, should begin before high school.

In addition, our young females need to be provided with

healthier alternatives to anabolic steroids. A well-balanced nutrition plan, combined with a fitness program that includes strength

exercise, is a healthy alternative to harmful behaviors.

In our youth physical activity programs over the past 20 years

for young athletes and nonathletes, our motto is, ‘‘It’s not what you

take, it’s what you do that counts.’’ There is no replacement for a

healthy diet, proper physical training, adequate sleep, and qualified coaching. The best ergogenic aid is, in fact, a well-designed

training program.

It appears that the use of anabolic steroids has, in fact, trickled

down to young females. Health care providers, as well as teachers,

youth coaches, and school administrators, in my view, need to be

part of comprehensive steroid education interventions that are

science-based and promote public media awareness. Additional research is needed.

I also believe that reducing anabolic steroid use by professional

athletes will have a positive impact on boys and girls. Thank you.

[The prepared statement of Mr. Faigenbaum follows:]

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Chairman TOM DAVIS. Well, thank you all very much. Let me

start the questioning.

And Dr. Elliot, you mentioned in your testimony that the ATLAS

and ATHENA programs have been effective and successful in promoting healthy life-styles and preventing steroid use for middle

and high school age females. Do you have any idea how many high

schools are currently implementing ATLAS and ATHENA?

Dr. ELLIOT. I know it’s in 30 States right now; I don’t know how

many kids have gone through.

Chairman TOM DAVIS. Any idea why more schools aren’t using

the program.

Dr. ELLIOT. Well, it’s a new paradigm. It’s health promotion not

in a health class. It’s in a role that coaches aren’t used to; so it

takes some additional effort, like funding the—appropriating funds

to help tip that, to get it to take off, because it is a new way that

coaches aren’t used to doing these peer-led curriculums, even

though the sport team, when you think about it, is certainly an

ideal setting to do that: to teach healthy behaviors, to strengthen

the things that protect girls from drug use, how to prevent depression, insight into the media, to increase their self-esteem, to reduce

the belief that others are doing these things.

Chairman TOM DAVIS. We have heard in some of our previous

panels about how you could identify potential steroid use among

young athletes, because they would bulk up, gain weight quickly.

What are the warning signs that parents and teachers and

coaches would look for in the case of females?

Dr. ELLIOT. I think it is important to remember that steroids

among young women is part of a constellation of health-harming

behaviors, disordered eating behaviors, use of diuretics, laxatives.

I think that it is important that you, as you have heard here, that

parents state clear messages to their kids about not doing these

things, they do things to help increase their self-esteem, that they

reinforce, it is not about winning, that sports is about learning to

be physically active, something you are going to do for life, the enjoyment of being with your teammates.

I had to train myself not to have the first question out of my

mouth is, did you win? It is not supposed to be about winning. And

if they do suspect something, if they see that there is mood

changes, kind of a funk last more than 2 weeks, that they ask the

child about their suspect behaviors, saying, I have a concern about

your behavior.

And because I love you and care more about you and not about

how you look and whether you win, ask them about it directly.

Just in response to what Skip said, in our questionnaire, the

words anabolic steroids are used to gain strength. They are not

corticosteroids used for treatments of asthma or rashes. On how

many occasions have you used anabolic steroids in pill or injectable

form? Don’t count pills you buy in health food stores. That gives

us 1 or 2 percent girls answering positive to that question.

Chairman TOM DAVIS. Thank you. Thank you. Dr. Schlifstein, as

a doctor, do you ever ask patients where they obtain the drugs, and

their knowledge on how to use steroids?

Dr. SCHLIFSTEIN. I always want to know who is giving it them

or how they are getting it. Very rarely are they getting it from a

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physician. Very rarely. Lots of times they are buying it at the gym,

or they are buying it on line, ordering it from other countries.

I have patients that go to Mexico regularly just to pick up anabolic steroids. Other people are making it. They order cattle hormones, and then you can make it yourself, it is very easy to do.

They will tell you how to do it online. You can make mass quantities. It is perfectly legal to buy the hormones.

Chairman TOM DAVIS. You stated that an ergogenic benefit of

steroids is incompletely studied in females. You also state there are

no long-term studies on the side effects.

Do you think that findings from recent surveys will generate a

greater amount of research into female steroid use?

Dr. SCHLIFSTEIN. Hopefully it will generate more research. Certainly on the long-term side effects, no one has really looked at

over a long period of time. We do not know what these people who

have been using steroids for 5, 10, 15 years what is going to happen to these people 10 years down the road.

A lot of the side effects that are well documented are well documented in short term. That just can be the tip of the iceberg. We

do not know what kind of problems they are going to have 15 years

from now. Studies in rats, most of the rats that were on steroids

had at least a 20 percent reduction in life span.

Chairman TOM DAVIS. Thank you. Dr. Pope, I am fascinated by

your study on this, and have done some work on statistics. Let me

ask you this, do you think that the potential shame and the stigma

associated with steroid use could lead to an underreporting of the

problem?

Dr. POPE. Well, that is an issue that was just raised by Chuck.

Maybe if I can ask your indulgence to have one more slide here,

if I could see slide No. 5 from the supplemental ones there.

Chuck raised the reasonable question, if you are in a face-to-face

interview, maybe people are underreporting their steroid use. But

we find that in the national household survey, which is the faceto-face interview, that the rates for other drugs like marijuana, cocaine and other drugs are pretty close to those obtained in anonymous questionnaires. So that would argue that underreporting is

not a major—it may be some factor, but it is not a major statistical

factor in these numbers.

Chairman TOM DAVIS. All right. Thank you very much. My time

is up. Ms. Watson.

Ms. WATSON. I have several questions. I am going to have to

leave for another meeting. But let me just throw them out real fast.

Dr. Pope, in listening to your testimony and seeing the slides,

you talk about the face-to-face or the paper interview and response.

What about the testing that is done? Has that been factored into

your results?

Dr. POPE. There is very little actual testing, urine testing for

women or, even for that matter, men. On that point, I would side

very strongly with what Chuck Yesalis said. We need targeted testing.

So my answer to your question is, I am all for that, and I wish

there were more of it, but alas, for our purposes in terms of making

estimates we have very little.

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Ms. WATSON. So you are saying that your look at the use, based

on paper and pencil, or face-to-face interviews, indicates that it is

not a widespread problem?

Dr. POPE. Specifically among teen-aged women. Now, remember

I am not questioning that it is a problem among elite women athletes, as we heard from your previous panelists. And I certainly

don’t question the problem among men.

I do not question the fact that body image is a major problem for

young women today. I’m specifically questioning a specific scientific

point here, which is, the use of anabolic steroids by teen-age

women, I believe has been exaggerated by these studies.

Ms. WATSON. So what you are saying is that we need other ways

of testing this theory, or whatever you want to call it out, rather

than giving an estimate, because I did see information that was

prepared for us, that over 500,000 young people in athletics have

used steroids.

And I did not exactly know what the age levels were. So you are

saying, young women below a certain age, not adult women, are

probably not using to the extent that you think.

Dr. POPE. Correct. Now, there are some adult women who have

used steroids. And to my knowledge, the only actual peer-reviewed

scientific study in which investigators actually went out and interviewed real women who had used steroids, to be published in the

last 5 years was published by me in 2000. It was a NIDA grant,

where we spent 2 years aggressively recruiting women steroid

users.

And in the eastern Massachusetts area, despite going to the most

hard-core gyms and other places that we could find, we only located

17 women who had used steroids. And of these 17 women, the

number who had started using their steroids as teenagers was

zero.

By contrast, when we have done studies of male steroid users on

various NIDA-funded grants, we have gotten abundant numbers of

study subjects without any difficulty.

Ms. WATSON. Based on what you know, and what you have found

from your studies, what are your recommendations?

Dr. POPE. I think the first thing we need to do is what was on

my last two slides, which is, to test this in a method designed to

eliminate these so-called false positives, in other words, if you answer yes to the steroid question, fill in on the line below the name

of the steroid that you took.

Or use the national household survey, or as it is now called, the

national survey on drug use and health, to get followup data with

personal interviews, so that we can try to get some scientifically reliable data, up to the minute, on the true levels of steroid use

among young women, so that we can decide how best to apportion

our resources here.

Ms. WATSON. The professor who has my same first name, Elliot,

Dr. Elliot, thank you for being here.

I am kind of troubled by the testimony I heard from Dr. Pope as

to our overestimating. But we do know that our young people are

taking all kinds of drugs. If we delay some other form of testing

so we can come to—we will have the empirical evidence based on

scientific methods, what harmful affect can the taking of all of

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these different drugs, be they anabolic steroids or whatever they

might be, what effect would it have in the long run by the time

they get to be 21, 22, what effect?

Dr. ELLIOT. Well, as I mentioned, it looks like for girls there is

a progression of, in general, girls in adolescence, their self-esteem

goes down. They are putting on weight and they are seeing images

of lean, toned women, and that is not the normal change of adolescence for girls.

They become depressed. They begin having disordered eating behaviors, and using body shaping drugs, one of which is anabolic

steroids. But as I mentioned, it doesn’t have an immediate effect

like a diuretic or a laxative, and so you take it for a few days, nothing is happening, I get a pimple and I think it is a side effect and

I stop it.

I am still using a drug, I still have disordered eating behavior.

You could have prevented that if there had been a program to help

me prevent getting depressed, to increase my self-esteem. Girls are

more quickly addicted to drugs, and then have problems as an

adult, so that disordered eating may progress to use of alcohol and

other drugs.

So it is too late if they had a heart attack. I really need to treat

high blood pressure and get people’s cholesterol down. Because if

I wait until they have real problems, then it becomes a big societal

problem, there is increased drop-out from school, pregnancy, continued problems with other drugs, moving on to other types of addictions.

Today, a girl today, compared to when I was a girl, is 15 times

more likely to become addicted to drugs. It is a problem that can

be prevented. Testing for anabolic steroids is very expensive. Most

drug testing programs in high schools do not test for anabolic

steroids.

Ms. WATSON. I see. I am a former school board member. And I

also sat on the Senate Education Committee for 20 years. I am

very concerned about where we go from here. I think whether we

under or overestimate, we have a problem in this country with

drug use. And you cannot turn on your television, you cannot turn

on your radio, you cannot read a newspaper or magazine that we

are not pushing drugs.

So from the other doctors on the panel, how can we address the

use of drugs of any kind, and, you know, maybe they are not anabolic steroids, but somewhere along the way, as Dr. Eliot just said,

it grows by degrees.

You know, I have a headache. Well, it is a constant headache,

so I need to use something stronger than an aspirin. And how do

we, you as medical professionals, and us as educators and legislators, how can we—what methods, what options do we have to address, regardless of the numbers, Dr. Pope, how can we address

this excessive drug use?

Dr. YESALIS. The old fashioned hearing, I advise people to go

back to basics. You know, in our increasingly secular society, I

don’t think moms and dads are giving constant messages to their

children about appropriate behavior, drug abuse being one of them.

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And I emphasize the word ‘‘constant.’’ They need to get that word

when it comes to performance drugs constantly from the coaches,

with the same amount of energy as a coach gives a half-time talk.

And, look, if our kids do not have well-established moral boundaries that they know not to cross over, all of the education in the

world just isn’t going to cut it. And I think that is where, in my

lifetime, I am 58, that is what I have seen, that we are, more and

more of our children are getting these messages. Well, it is not

cheating if everybody does it, or it is only cheating if you get

caught.

Moral relativism. Situational ethics. That is, in my judgment,

that is root of all of this. And people like us, all we do is try and

repair, the best we can, and I don’t think we are doing a very good

job of it, of the consequences of that.

Chairman TOM DAVIS. Thank you. The gentlewoman’s time has

expired.

Ms. WATSON. Thank you Mr. Chairman.

Chairman TOM DAVIS. Mr. Davis.

Mr. DAVIS OF ILLINOIS. Thank you very much, Mr. Chairman.

Let me thank you for continuing with this series of hearings relative to steroid use in our society.

I think it is important that we try and get at the true nature of

it. And I think one of the most important questions that we have

at this hearing, regards the true extent of steroid use by women.

Now, CDC surveys show that more than 5 percent of women are

using steroids. The NIDA surveys show a lower number, about 1

percent. Dr. Pope’s testimony stated that the phenomena of steroid

use by teen-age girls was an illusion. It noted a number of reasons

why there could be false positives of the CDC tests.

I am trying to get a handle on how big or how small the problem

really is that we are facing. Dr. Yesalis, do you agree with Dr.

Pope’s analysis of the data?

Dr. YESALIS. Well, I said I significantly disagreed with it. Dr.

Pope has contributed a lot of high-quality research to this area,

and I respect him very much. We just, on this particular issue, disagree.

One of the things I look for, is there consistency from one study

to another? Now, Monitoring the Future study, the latest data I

have is 1.7 for 2004, have used, 1.7 girls have used data—anabolic

steroids in the last year. That is yearly prevalence, 1.7 for 12th

grade girls.

Now, lifetime use, common sense tells me it would have to be

higher than that. So if you go with 1.7 you might have a couple

hundred thousand, 150,000, 200,000 young girls. If you go with the

5.3 or the 7 percent figure, you can have up to a half million. As

I said before, I want to err on the side of caution here.

And I have earned my living as a scientist, but there is a time,

you know, you have to say, wait a second, we have to look at the

health of our kids, the betterment of society. So, you know, if you

want to do extra studies, fine, I am not going to have that stop me.

I am going to pursue education and drug testing right now.

Mr. DAVIS OF ILLINOIS. Thank you very much. Dr. Schlifstein, it

is my understanding that you have treated high school girls who

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have taken steroids, and that have you firsthand experience with

many high school athletes. Do you agree with Dr. Pope’s testimony?

Dr. SCHLIFSTEIN. I understand where he is coming from. I don’t

necessarily agree with it. I think, well, first of all, that study he

was commenting on, he was talking about whether there were

missing inhalers or, it specifically says pills or injections. And like

Dr. Yesalis said, you are looking at very different studies of a similar incidence report. When I spoke to people from other countries

as well, they found a similar rate also.

I think if you surveyed girls in their 20’s and looked at it, you

would find a higher number. I think as people become more Internet savvy, and our younger people become older faster, they are

very well educated and knowledgeable about these things, and they

know which ones to take and how often to take it and what the

side effects are.

There is a lot of information available out there. Very easily accessible, and it is so easy to get. And it is going to be helpful, then

they may certainly try it. And it doesn’t mean all of those people

are staying on it. No. It means that they will be trying it as a

weight loss or weight control measure. It is very easy to obtain

these steroids from numerous different sources. It is not difficult.

There is plenty of information out there, that may be also very misleading.

Some of these Web sites will give you information, tell you how

to do it with getting the least amount of side effects, where areas

and Web sites just for women, it says women, what kind of benefits

you will get from it, how to avoid getting the male hormone side

effects, the androgenic side effects.

So I think there is a problem out there. Even if the number is

0.1, if it is not zero, there is a problem.

Mr. DAVIS OF ILLINOIS. Thank you. Dr. Faigenbaum, you have

conducted your own studies of steroid use among young girls. They

found that over 2 percent of middle school girls in Massachusetts

had taken steroids. Do you agree with Dr. Pope’s testimony?

Dr. FAIGENBAUM. I disagree. I think it is important that we look

at the scientific data. And I think there is a need for better scientific data to get out there. I have also worked with physical education teachers, health education teachers, and coaches for the past

15 to 20 years.

I think you would be hard pressed to find a health education

teacher at the middle school or high school level who will say it is

not a problem at all for athletes and nonathletes. So we have the

science, but then we have reality.

And my experience has been, at conferences, seminars, in my

professional work with coaches, physical education teachers and

health education teachers, that it is a real problem among young

female athletes, and nonathletes. I think if a 14-year-old girl is

willing to take laxatives, diuretics and amphetamines to get skinny, I think anabolic steroids might be on her list.

Mr. DAVIS OF ILLINOIS. Dr. Elliot, would you have anything to

add?

Dr. ELLIOT. It is not about steroids by themselves; these kids are

using alcohol, marijuana, other drugs. They are risk-takers, they

drink and drive. So I know that you heard this tragedy of Taylor

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Hooten, but in general, the kids who use steroids are using lots of

other drugs.

You have heard that half of them are not in sports to make them

look better, they are not even in sports. So it is a marker for deviant behavior.

Mr. DAVIS OF ILLINOIS. You know, in conclusion, I think that

some of the estimates for girls may be a bit high, but I am also

thinking that, it seems to me, that female athletics is becoming

more and more competitive.

I mean, it seems to me that there was a time when not as much

emphasis was put on the competitive nature. And as female athletics become more competitive, do you think that we may have a

problem as females compete now more ferociously than perhaps we

have always seen in the past, and we need to do something to head

off this trend that might be developing. I thank you, Mr. Chairman.

Dr. ELLIOT. You are absolutely right. I mean, there were 1 in 27

girls in sports when I was in high school, and now it is 1 in 2.

There is scholarship parity. There are not the lucrative, you know,

obscene salaries that some professional athletes get for young

women, there are no women on the Forbes 50 top paid athletes list.

It is really bringing boys down to where girls are, if they are just

getting caught up with the boys, if that is how they are, it is bringing all of the sports, all of the emphasis on winning down for boys

and girls, so they do not feel this pressure to win, it is about having fun, being physically active, something you are going to continue for life.

Mr. DAVIS OF ILLINOIS. Thank you. Mr. Chairman——

Mr. SHAYS [presiding]. It is just the two of us. So let’s have fun.

You have the floor.

Mr. DAVIS OF ILLINOIS. Go right ahead.

Dr. YESALIS. Well, if you look at some of the NCAA violations,

it is unfortunate that some of the women’s collegiate athletic programs have gone down, or are going down the same road, as far

as violations, as the men’s sport have.

So, you know, I agree with Dr. Faigenbaum. If you use that analogy, or Dr. Elliot I think said, if they are using other drugs or if

they are cheating in other respects, use of steroids is unfortunately

not that big a deal after a certain point.

So I think your point is a good one. Quite clearly women’s sports,

the level of competition, I was a strength coach, in another aspect

of my life, and, I remember in the mid 1970’s, later 1970’s watching female collegiate athletes in the weight room, and they were

going in there with make-up on and jewelry.

About 3 years, 4 years later, they were in there pushing it as

hard at the guys were, just in that short period of time there has

been a significant shift. So the pressure is there. And the temptation is there.

If you do not have that boundary line that you will not cross, if

that is absent, or it is grey, I do not know of any reason why

women won’t cross that line just as quickly as men.

Dr. ELLIOT. You saw the positives were really comparable for

men and women over the last couple of years. It is not confined to

men.

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Dr. POPE. I would have no question that these trends are alarming, and that the increasing pressure on women to excel in sports

it is in things that we should definitely be watching closely. Certainly this engages many risks, the issues of body image and the

pressure to win that has been discussed here.

But I differ a little bit from Chuck Yesalis on this issue of what

is the scientifically conservative approach. I would argue that the

conservative scientific approach would first be to show, in rigorous

scientific fashion, that there is a problem; rather, they assuming

that there is a problem before we have done a rigorous test of the

type that I described.

Mr. DAVIS OF ILLINOIS. Well, thank you very much gentlemen,

lady. And, Mr. Chairman, I have no further questions. I appreciate

your indulgence.

Mr. SHAYS. I thank the gentleman. Gentlemen and lady, this has

been a very, very interesting hearing.

I am struck first by the fact that I am leaving this hearing believing that the temptation for women is almost greater than for

men in the sense that steroid use can have an even greater impact.

Is that a false impression to leave?

So for the record, shaking of heads, no answers, I will assume

that everybody agrees for the record.

I have something that the staff wants, I have some of my own

questions, but the one that the staff wants to put on the record,

Dr. Faigenbaum, could you please elaborate upon your reference to

multi-dimensional school-based approaches?

Is this consistent with programs such as Dr. Elliot’s ATHENA

Program for females.

Dr. FAIGENBAUM. That is exactly the program I am referring to,

the work of Dr. Elliot, which is a multi-faceted program, which

doesn’t simply focus on steroid education.

That kind of multi-faceted program, which is not simply telling

children that steroids are good or bad, but it is a comprehensive

program with a healthy alternative. That is what I am referring to

with a multi-faceted kind of focus.

Dr. YESALIS. I would like to add, one of the Members asked a

question of you, Diane, why your program is not in more schools.

And I, look, Dr. Elliott’s and Dr. Goldberg’s program in my judgment is the best in the Nation by far.

I think it is not in more schools because of this problem of denial.

You know, as I was quoted accurately by the AP several months

ago, if I had $100 for every time a high school principal or coach

told me, Doc, it is a problem, but not in our school, I would have

a Ferrari in my driveway instead of a Corvette.

So, you know, every school district is short of money. That is

what they always argue. So if they deny having a problem, then

they do not have want to spend the time or effort to institute such

a program. That is the big problem that I have seen around the

country.

When we did our steroid study in Massachusetts, 20 randomly

selected middle schools were selected to participate by the Board

of Education in Massachusetts. All 20 school administrators, as we

just heard, denied there was a problem at that school and would

not allow us to administer that survey at that school. It was a

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problem in other schools, but not their school. Therefore, we needed

other methods to administer this survey in Massachusetts.

Mr. SHAYS. That is a good trigger point for me just to comment.

I taught at a private—I didn’t teach, I worked as an administrator

in a private school on a part-time basis. And the school was a

school where the students did not drink or smoke, and, you know,

it was a religious school, and that sex before marriage was just not

condoned. And there was this sense that there was this real high

moral standard.

And the students struck me as being angry. And I couldn’t quite

figure it out, until I realized there was drinking, there was sex, and

there was smoking in the school. And the anger was that none of

us—the students knew it, and we did not. And there was such a

big disconnect between the students and the administrators. And

once we uncovered it, it was stunning how pervasive it was, and

how obvious it was, and frankly how hypocritical it was for us to

have assumed it, and the students were basically living this lie, but

really not aware.

You get my gist. And I am—which leads me, Dr. Pope, I came

to this hearing thinking, give me a break. Not this many people,

students are involved. Then you went through your analysis, and

I thought the exact opposite after you went through your analysis,

because I thought, if I had filled out a questionnaire, and then

someone came back and wanted to know more detail, I would clam

up.

Like, with when I was in the Peace Corps, they wanted to know

how many people were, just tell us how many of you have used

marijuana and everything will be all right. The next thing we

know, we saw a busload of these volunteers leave the first day, who

had volunteered that they had used marijuana. That was, you

know, that was the integrity of that question and that process, I

mean, and nobody wanted to say anything after that point.

I guess my point is, given that it is so easy, given that there is

this network, kids talk to each other, and it is a network under the

radar screen. And I think if a few kids know it, everybody knows

it. If some kids know how to get it, most everyone knows how to

get it. That is my sense of it. I am saying that, because I like to

know how many disagree with what I just said, or how many

agree? And I am going to go right down the line, and tell me where

you disagree.

Dr. Elliot.

Dr. ELLIOT. Well, you are right, that there is a halo effect around

your own kids or coaches for his own team. It is a problem at other

schools. But coaches do care about kids. They really are there for

the kids. They feel pressure from parents and the school to have

a winning season. Too, if a child is using steroids, they are getting

bigger and stronger, they are becoming a better player, unlike

other drugs.

Mr. SHAYS. Do you believe that kids also are aware, maybe not

who is taking it, but aware of how they can get these drugs?

Dr. ELLIOT. The CDC data are that the availability is the same.

I mean, by seniors, most—that there is a high availability and they

don’t believe it is that harmful if you just use it a little bit.

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There is more hits for ‘‘buy steroids’’ on the Internet then there

are for ‘‘buy baseballs’’.

Mr. SHAYS. OK. Anything else you want to add?

Dr. ELLIOT. No, thank you.

Dr. SCHLIFSTEIN. Kids are very knowledgeable. They know how

to get this. And certainly there is a lot of denial from anyone about

their own local school or their own personal problem. But also some

of these people suggested maybe get it from personal trainers, fitness trainers, maybe those are older people, but certainly coaches

and other people are involved, and at the higher competitive levels,

maybe giving access or suggesting the use of some of these supplements as well.

But also, denial is a large part of it, and also there is no testing

in high schools. Less than 4 percent of the U.S. high schools have

done testing for anabolic steroids ever.

Mr. SHAYS. Do you buy the numbers that have been, the number

of kids?

Dr. SCHLIFSTEIN. Yeah, I believe those numbers. I think the

questionnaire was fine. I think it has limitations on it, of course

there are. But, also you have to remember, when you are asking

a 14, 15-year-old girl, are you taking illegal male hormones in

order to make yourself look better, I do not know, even if she has

been doing it her whole life she is probably going to say no. It is

a very hard to answer even on a survey.

Mr. SHAYS. Dr. Pope.

Dr. POPE. I certainly agree with you on your point that these

kids are aware. I wouldn’t quarrel with that for a minute. But, I

would stick very strongly to the scientific precautions that I have

given you about the numbers. And if I could just, you know, tolerate one more slide, if you can just put up No. 4 there. This is the

national household survey, which Chuck Yesalis alluded to. Could

I have No. 4 back, please.

Now, this is a survey also done with anonymous questionnaires

on high school students, 2004, equal time. But instead of 7.3 percent of 9th graders in the CDC study, here we have another federally funded anonymous survey study with the 0.9 percent of 10th

graders. Now, with two large federally funded studies, using identical methods, are getting results of 7.3 and 1 and 0.9 in another,

you know that something has to be wrong.

Mr. SHAYS. Was this the use over the last year or lifetime use?

Dr. POPE. This is used into a lifetime.

Dr. YESALIS. That was last year. That is only the last year. If you

add them up, it would be a lot different.

Dr. POPE. Let me just get the actual numbers here.

I have here table 1, trends in lifetime prevalence of use of various drugs. For 8th, 10th and 12th graders.

Mr. SHAYS. What is the number?

Dr. POPE. For both sections combined, it was 1.9 percent of 8th

graders and 2.4 percent of 10th graders, but remember, the males

outnumber the females.

Mr. SHAYS. This one, though, was for 1 year.

Dr. POPE. No. I am pretty sure those are lifetime rates in females.

Mr. SHAYS. You are under oath here. Let us back up. Slow down.

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Dr. POPE. I am sorry. You are correct. That is an annual rate

that I am quoting.

Mr. SHAYS. And that is not my credit, that is good staff work.

Dr. YESALIS. I feel comfortable that the numbers are somewhere

between 200,000 young women and 500,000 have used these at

least once in their life. I think the kids know about this. I agree

with everything, you know, you stated. And I do have a Corvette.

Dr. FAIGENBAUM. I too believe that children and teenagers are

aware of what anabolic steroids are, how to get them and the potential effects. I also believe that youth coaches are well aware of

the effects of anabolic steroids.

I believe that there are certain performance measures that can

be expected in boys and girls who play sports, those who train with

weights or perform in track and field and other events. And I think

youth coaches are aware of what can be expected, following 8, 12

or 16 weeks of training, and what might be a bit bizarre.

There are some numbers in my mind, when training young athletes that if I see a 10, 20 or a 30 percent gain in a beginner, that

seems rather common. But when working with a 14-year-old or 15-

year-old young athlete, who makes a 30-percent gain in performance in a matter of 6 to 8 weeks, in my eyes, I view that as nearly

physiologically impossible to make that kind of gain.

I think youth coaches are aware of the problem, but as we have

heard today, I think there is a tendency to look the other way.

Mr. SHAYS. OK. Let me, I just have two other areas of questions.

I am leaving this hearing with the belief that you could make a

strong case for using steroids in a controlled and moderate way,

and they could be healthy and helpful to you.

And I do not know if I should leave feeling that way. But, I believe that what I am leaving with is the view that the overuse of

steroids is bad. I am not saying using them in sports is right, I am

not speaking to the rightness or wrongness of using steroids, but

from a medical standpoint, one of the challenges we have is that

you could use steroids in a moderate way, gain some benefits that

would be desirable for some people, and that they would not have

any adverse health affects.

And so therefore, a parent arguing to their kid, don’t do this,

that this smart young kid could say, mom, in moderation it is OK.

That is the way I am leaving. And if I am wrong in that, then tell

me. But if I am right, let us not deny it.

Dr. YESALIS. The anabolic steroids have been, just to give one example, I think you are correct in my judgment, have been, the

World Health Organization has explored their use as a male contraceptive since the mid 1970’s. And it has been shown to be a successful male contraceptive, using doses significantly exceeding

what many track athletes have used.

And these drugs have been used in medicine since 1935 plus. So

I hope we haven’t been killing people, you know, using them. So

they have been used as a prescription drug for all of that time. So,

yeah, I have answered, for years of course they can be used safely,

as any drug. There is no drug that has an absence of side effects.

Mr. SHAYS. And used for beneficial purposes.

Dr. ELLIOT. Would you use amphetamines? They will perk you

up for the game, maybe a handful of Sudafed. It is not really not

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going to probably kill you. I think that the idea is they do have

health effects on young women. It is cheating. It is doing something

unhealthy.

Mr. SHAYS. I am not going down that road right yet. But, it

seems to me, if you do not arm people with the full information,

and you try to distort some information then you lose credibility.

Dr. ELLIOT. Absolutely.

Mr. SHAYS. And some people may take steroids for a shoulder injury. Correct?

Dr. ELLIOT. That is a different kind of steroid. They will inject

you for bursitis with a corticosteroid, that is not an anabolic steroid.

Mr. SHAYS. All right. So one of the points you want to make to

me are, there are steroids and there are steroids.

Dr. ELLIOT. And for women, there are effects that are irreversible. If you start growing hair on your face that does not go away.

Mr. SHAYS. Well, my first attention to this whole issue was when

I saw the East German woman swimming team. And when I saw

them perform, I thought I was seeing men compete against women.

I remember the women, American women, were complaining at the

time that they felt like they were—they were just in a whole different competition.

Dr. ELLIOT. And it has come to light that they were giving these

young women cycles of steroids and ratcheting up their muscle size

and strength with each cycle of use.

Mr. SHAYS. Is it also true that some of those women ultimately

had continued that, in some cases against their will, in some cases,

but had used it so long that they were not comfortable being

women?

Dr. ELLIOT. There is one case of a person who underwent a sex

change. But it generally does not make you develop gender dysphoria or become a transsexual.

Mr. SHAYS. OK. Well, just wanted the real information out here.

Just the last issue then.

Dr. ELLIOT. But let me say, I think your point that you have to

be straight with kids is true. And the underground, if you tell them

something, they will see right through it unless it is true, is right

on.

Mr. SHAYS. So, I mean, in some cases, the message might be, the

problem with this is there is no need to take it. It is, it may be

true that you could take a very moderate amount and not see

harm, but it is the doorway to something that could lead to harm.

Dr. ELLIOT. And a young man’s testosterone level is going up

every day during adolescence. They make their own testosterone.

If they eat right and train right, they can get a lot bigger and

stronger, they do not need to take steroids.

Dr. FAIGENBAUM. I think the point that needs to be noted is that

anabolic steroids need to be combined with a conditioning

agent——

Mr. SHAYS. I am going to have you slow down. I love your testimony, but I am—I have a process problem.

Dr. FAIGENBAUM. Anabolic steroids need to be combined with a

conditioning program for them to have this desired effect, this ripeness that maybe some females are looking for, or an increase in

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muscle mass. One cannot simply take anabolic steroids and expect

to see these desired changes.

I would argue that a 15-year-old girl who follows a reasonable exercise program, makes sensible modifications in her diet, with adequate sleep and such, will be a better athlete, or nonathlete than

a 14 or 15-year-old who ingests anabolic steroids but does not participate in this well-designed kind of program. I do not view them

as a magic bullet.

Mr. SHAYS. I heard Ms. White’s testimony, Kelli White’s testimony. I want to know what your reactions were when you heard

her testimony.

Dr. YESALIS. I agreed with your comment. It was a breath of

fresh air, given the previous hearings that I have either been here

or watched on television, as far as her candidness. So I thought

that was nice.

I was very glad she brought up the fact that she passed 17 drug

tests, even the so-called Olympic standard has giant loopholes in

it. So I thought it was a very good thing that was brought in front

of this committee.

Dr. ELLIOT. There is a paradox. She says she is sorry she used

them. But if I am 14 and I see her, I think she got—she was the

fastest in the world from taking steroids. They work.

Mr. SHAYS. Right. But, she was also good beforehand.

Dr. ELLIOT. Absolutely. From age 10 she was a very gifted athlete.

Mr. SHAYS. She did not take steroids then. So I have my new

Cinderella movie. My new movie would be to see this young lady

compete and show that she could compete without taking steroids

and be very successful.

Dr. ELLIOT. You know, in general, programs that have the recovered personal with an eating disorder come, make the problem

worse. The kids get the message that is, you heard her say, lots

of people were doing it. So they do not always hear the bad consequences. They hear, they feel invulnerable, they think OK, I am

not as talented, and I better take them now.

Mr. SHAYS. That gets me to the last point, that is the coaches

and the trainers. If ever I would want to throw a book against anybody, it would be the trainers and the coaches that would encourage this, and the doctors maybe that encourage it.

I would be eager to go after them every way I could. And yet

they seem to be getting free passes here.

Dr. POPE. I would strongly support you on that position. A coach

or a trainer who very likely is aware of what is going on is exactly

like a bartender serving alcohol to somebody that he knows is 17-

years-old. That is precisely the same problem. It is a point that

should be carefully controlled.

Dr. YESALIS. The notion that elite coaches, whether they be in

the MLB, or NBA, NFL, NCAA, do not know this is happening on

specific individuals, these men and women who are supposed to be

so smart to achieve these positions, can be so ignorant or stupid

in this way baffles me totally. They darn well know what is going

on.

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Mr. SHAYS. You see, I would almost have, you know instead of

one strike and out, I would have no strike. I would have one strike

and you are out.

Dr. YESALIS. For a coach? I agree.

Mr. SHAYS. Anybody want to make——

Dr. ELLIOT. You know, there is really just a few elite coaches.

Most kids’ contact with coaches is not with a coach like Kelli White

had, it is with the soccer coach who is also the science teacher.

Mr. SHAYS. I guess when it comes to track and field, or skating

where you have a personal coach, and they are encouraging it, I

just find that relationship quite strong. At any rate, any comments

you want to put on the record before we adjourn?

Dr. FAIGENBAUM. In response to your comment on coaches, if an

elite coach was to give a 22-year-old female an anabolic steroid,

that is one issue. But if a coach was to give a 12-year-old track and

field star an anabolic steroid, I think that is another issue.

Knowing the side effects and potential consequences of anabolic

steroid use, I wonder if that borders on a kind of child abuse.

Mr. SHAYS. Yeah. It is child abuse.

It is. OK. Any other comment? This is a fascinating hearing. It

is a subject that, courtesy of Major League Baseball, we have gotten into, because they were so arrogant, so obnoxious, so disingenuous, and frankly their testimony before us, in my judgment, was—

almost bordered on perjury. So other than that, I think fondly of

them.

Dr. ELLIOT. Can I say that, I know that you want to harmonize

random drug testing. But if there is a problem with Baseball, why

don’t you just have them get a blood test every 2 weeks, if this is

rampant there, and take it out of this random testing. Let us just

bring them in every 2 weeks, like I would somebody in rehab. You

do not get random tested there, you are given a test every week.

Mr. SHAYS. Well, my response would be, once someone had broken, crossed that line I would do it, but I am not sure I would do

it.

But, you know what, we will think about it, won’t we?

Let me ask unanimous consent that the written testimony from

the Center for Disease Control and Prevention regarding steroid

use among females and the youth risk behaviors surveillance survey system be included in the official hearing record.

Without objection so ordered.

With that this hearing is adjourned.

[Whereupon, at 12:45 p.m., the committee was adjourned.]

[NOTE.—The statement of the American College of Obstetricians

and Gynecologists is on file with the committee.]

[The prepared statement of Hon. Jon C. Porter and additional information submitted for the hearing record follows:]

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