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Performance Enhancing Substances in Student Athletes

Andrea Meadows, M.D., Lexington Clinic Pediatrics            

In the last few years, the use of performance enhancing substances (PES) has made headlines due to their popularity among professional athletes. The apparent widespread use of PES and the associated media coverage raises questions to me as a pediatrician taking care of student athletes. Are my patients (your children) also using these substances? If so, what can I (we) do about it?  

The American Academy of Pediatrics (AAP) defines PES as “any substance taken specifically for the purpose of improving sports performance”. These products include protein shakes, creatine, amino acids, steroids and growth hormone. Several recent studies have estimated the use among high school athletes to be between 5-20%.  

The most widely used PES is protein supplementation, either in the form of shakes or bars. These supplements provide 20-35 g of protein per serving and are either whey (milk) or soy based. Athletes use protein shakes to help build lean muscle mass and increase strength. Protein supplementation appears to be safe when not used excessively and has been shown to improve performance when used appropriately.  

The second most widely used substance is creatine, which is a naturally occurring substance found in our body that muscles use as a source of energy. It is more popular among older athletes, with its use being estimated at 44% in senior high school students.  Athletes use it because it improves performance in “burst” activities such as sprinting; research has not shown it to improve performance in endurance sports.  


One of the side effects of creatine use is weight gain – on average 2-5 pounds for most individuals. Other side effects include gastric upset, elevation of blood pressure, kidney disease and increased risk of heat related illness and muscle cramping. Despite its popularity among athletes and its relative safety, the AAP and the American College of Sports Medicine (ACSM) does not recommend use in athletes under 18.    

Commonly used steroid-like supplements include androstenedione and DHEA, which are both precursors our body uses to make testosterone. Androstenedione and DHEA are marketed as dietary supplements and are not regulated by the FDA, although the use of both mimics the use of anabolic steroids. Androstenedione is currently banned by the International Olympic Committee (IOC), NCAA and the majority of professional sports. Side effects of these supplements include lipid abnormalities, liver damage, mood changes, increased risk of some cancers, enlarged breast tissue and increased masculine features in female athletes.   


If you know your athlete is using any of these substances, let your pediatrician know about it at their annual sports physical. Counseling on the use of these substances can go a long way to keeping your child safe.