– It’s not just pro athletes any more

WASHINGTON — A dozen years ago, Congress held widely-publicized hearings to lambaste Major League Baseball stars for using steroids and similar performance-enhancing substances, which were filtering down to youth sports in part because of their role modeling. Down the street here Thursday afternoon, providers and advocates conveyed a different message about these substances. “It’s not a sports issue anymore,” Neil Romano, a public health consultant, said to a group of journalists and others gathered at the National Press Club. “We are not addressing the real issue.” Use of performance-enhancers such as anabolic steroids, weight-loss products, and dietary supplements is actually a “major unrecognized public health problem,” said Shalender Bhasin, MD, an endocrinologist with Brigham and Women’s Hospital. Most users are non-athletes, with men ages 15-34 the most likely, and use among men in their late 30’s and women is emerging as well. Yet most people are unaware of what speakers here called a crisis — including most providers. “We need doctors to understand the problem,” Bhasin said, which includes socio-cultural aspects in addition to physical. Organizers’ overarching goal Thursday was to launch public awareness of this as a public health issue, Romano said, not just a mere sports problem. “We’re trying to move that conversation,” he said. “It’s also now an American issue and an epidemic at every level of our society.” Scientific sessions and medical society statements have not done enough, Michele LaBotz, MD, a sports medicine physician in Maine, said.”The trick isn’t developing information. The trick is dissemination.” “We need a Marshall Plan” to save the aforementioned generation of young men, said Bhasin, lead author of such a 2013 Endocrine Society statement. It should include preventative education for both men and providers, as well as new studies funded by the likes of the Department of Defense and National Institutes of Health. Another possible link: Exercise dependence, Hildebrandt said, adding: “We can’t ignore that exercise can be a catalyst.” Users typically get the substances from online pharmacies and supplement stores. That’s a problem because many online products contain contaminants, said Brian Jordan, of NSF International, a Michigan-based certification company, and products sold at stores often do not have detailed enough labels. The industry “has a hard time regulating itself,” Jordan said. There are not enough “good people to where it can protect public health.” Jordan suggested standardized, third-party product testing be mandated. If denied by providers or upstanding sellers, “kids will look elsewhere,” he said. “The only way you can truly protect them is to provide strict requirements.” Many users don’t seek medical help, often because they are ashamed to talk to their doctors about it, Bhasin and Hildebrandt said. They also know more about the substances then their providers, LaBotz said. Users take these substances to chase goals and not for recreation, LaBotz said, so providers must learn to treat the drug itself and “push kids towards something else.” Labotz suggested pediatric providers check out Artificial Perfection, a platform co-developed by the American Academy of Pediatrics to help discuss PED’s with patients and their families. Providers should also avoid a stigma against helping users, Hildebrandt said, who are sometimes viewed as sports cheaters — not sufferers. Few MLB players are cheaters anymore, speakers said, after the league cleaned up following the embarrassing 2005 hearing. The Taylor Hooton Foundation recently created PSA’s conveying that message, hoping to set a better example for modern teens. The foundation was named for Taylor Hooton, a teen who died in 2003 after using anabolic steroids, (a new book about him and Rob Girabaldi was on sale in the back of the room.). Their stories are even more tragic because “we still do not have the medical protocols in place,” to protect the Taylor Hooton’s and Rob Girabaldi of today, Romano said. “And we have to change that.” One place to start: Many users get get educated about these substances in the gym or online, Hooton said. “We need to counter that education with real positive, accurate information … Think beyond sports.” https://www.medpagetoday.com/publichealthpolicy/publichealth/64917