Toxic Strength

It can take years to hit bottom with many drugs, decades with alcohol. But on steroids Chris Wash managed it in just 12 months, starting with a dream of playing for a top college basketball team and winding up on a highway overpass, waiting for the moment to jump. In that time Wash, a 1.88-meter guard on the Plano West High School team in Plano, Texas, went from a rangy 82 kilograms to a hulking 104, with shoulders so big he could barely pull on his backpack in the morning. And he developed a whole new personality to match that intimidating physique: depressed, aggressive and volatile.

After a series of fights in his junior year his coach threw him off the team, but by then building muscles had become an end in itself. He switched from pills to injecting himself with steroids in the buttocks, often with a couple of friends, including a promising high-school baseball player named Taylor Hooton. That went on for several months, until one day Hooton was found dangling from his belt in his bedroom, an apparent suicide. Frightened, Wash gathered up his vials and syringes and threw them down the sewer. But an insidious thing about steroids is that stopping them abruptly can lead to depression. A few weeks later Wash drove to a bridge across a Dallas freeway and walked to the middle, looking down at the rushing traffic.

America's professional baseball league will no doubt eventually solve, or at least paper over, the explosive charges involving steroid use by some of its biggest stars, and the athletes will live with the consequences to their reputations and their health, cushioned by their eight-figure contracts. But their examples have placed a generation of teenage athletes at risk for the same mistakes, which could end their careers--if not their lives--long before they reach the big time. An authority on youth sports, Dr. Jordan D. Metzl of the Hospital for Special Surgery in New York City, calls steroid use "a burgeoning epidemic" in the United States.

The annual "Monitoring the Future" survey by the University of Michigan's Institute for Social Research suggests that the rate of steroid use by U.S. high-school students increased throughout the 1990s before dropping off slightly in 2003; a NEWSWEEK analysis of the data indicates that last year more than 300,000 students between the eighth and 12th grades used steroids. And they were not all jocks; as many as one third were girls, and experts say there is a growing problem of steroid use by boys whose heroes aren't baseball sluggers but the sinewy, rock-jawed models glowering from the pages of the Abercrombie & Fitch catalog. This development led to the recent introduction of a new psychological diagnosis, muscle dysmorphia (sometimes called "reverse anorexia"). For teenagers who use steroids, the side effects may begin with severe acne and run through hair loss, infertility, male breast development, violent mood swings and paranoia. And, in an unpleasant irony, steroids can stunt growth and cause injuries that could end the very career they were intended to enhance.

And they don't even get you high, at least not in the way most drug addicts would recognize. Consequently, steroid users don't consider themselves addicts, even those whose dependency is obvious, usually in retrospect. But steroids have their own seductions. "They make you pumped, aggressive, hypersexual, and that's going to feel good to a lot of these kids," says Dr. Kirk Brower, an addiction-treatment specialist at the University of Michigan. Athletes who train on steroids can gain muscle mass at phenomenal rates, nearly a kilogram a week. Training for strength and speed is grueling work, pitting your muscles against the whole mass of the Earth, with only the clock or weight stack to measure your progress. Suddenly, a pill appears and what seemed impossible is within your grasp.

Joshua Dupont, a star athlete at a Southern California high school, began taking steroids because he was jealous of the praise a stronger, faster teammate was getting from the coaches. He began seeing results, he claims, within three days: "I could spend the entire day at the gym and just keep pumping iron, working the same muscle without fatigue." Steroids are hormones, and for body-building purposes the ones of interest are "anabolic" steroids--a number of related compounds that mimic the effects of testosterone, the male hormone secreted by the testes. (There are several other classes of steroids, including the female hormone estrogen and the drugs called corticosteroids, which are used to treat inflammation and asthma; neither of these builds muscle, and their side effects are very different.) Anabolic steroids build strength by entering a muscle cell and switching on the genes that manufacture muscle proteins. Weight lifting amplifies the effect by stressing the muscles. "If you just took steroids by themselves, you'd gain some muscle protein, but not nearly as much as if you do it with exercise," says Dr. Alan Rogol, an endocrinologist at the University of Virginia.

Testosterone and its relatives are controlled substances, approved to treat only a few, uncommon medical conditions. Some body-builders obtain them from their doctors, but most traffic in a bewildering black market of pills, gels and injectable solutions purchased over the counter in countries such as Mexico, on the Internet or from a guy at the gym whose cousin knows a batboy. Since the market is unregulated, products claiming to be steroids might in fact be almost anything, in concentrations that can only be guessed at by anyone without an analytical lab at his disposal.

Until now, teenage body-builders have been able to get around the obstacles to obtaining steroids by substituting andro-stenedione, a chemical "precursor" that is converted to testosterone in the body. In fact, says Dr. Gary Wadler of the New York University School of Medicine and a member of the World Anti-Doping Agency, andro has virtually the same effects, and side effects, as steroids, although it requires a much higher dosage. In the United States andro has been sold legally in nutrition stores and on the Internet for years, though the U.S. Congress closed that loophole in October. The law, however, does not affect a compound known as DHEA, which is sold over the counter as an anti-aging drug. DHEA, as it happens, is converted in the body to... androstenedione.

And this does not begin to exhaust the list of performance-enhancing drugs in circulation. Human-growth hormone, thyroid hormones and compounds to enhance the oxygen-carrying capacity of blood are all available, albeit illegally, to professional and Olympic athletes; soon, gene therapy may make its mark on the record books. There's not much evidence that high-school athletes have access to these. They can, however, legally obtain a product known as creatine phosphate, which doesn't build muscle, but is believed to boost athletic performance by enhancing cellular-energy production. Most researchers believe that creatine is harmless for adults, but it hasn't been studied much in children. At least one survey found it was being used by sixth graders--a result Dr. Eric Small, chairman of the sports-medicine committee of the American Academy of Pediatrics, calls "scary."

Anabolic steroids are inherently dangerous, no matter what else the pills may contain. The average adult male produces 35 to 50 milligrams of testosterone a week in his testes; athletes may inject 300 to 1,000 milligrams or more. That induces a kind of hypermasculinity, like adolescence on, well, steroids. Users may develop "horrific" acne, Wadler says, and can suffer an early onset of male-pattern baldness. Women are at risk for a whole set of masculinizing changes including body hair, enlargement of the clitoris and a deepened voice.

Paradoxically, steroids can also cause feminizing changes in men. The pituitary gland, which regulates hormone production in the body, responds to an oversupply of testosterone by signaling the testes to shut down, causing them to shrink. Another way the body deals with excess testosterone is by converting some of it to estrogen, which can cause men to grow breasts. Admittedly these effects are unusual, and sophisticated users try to manage them by taking the drugs in cycles of four to 20 weeks, timed to their training regimen. Many people claim to have been using steroids for years with minimal problems, says Pope. But there's an enormous range of variability in how people respond to steroids--and some of the effects are permanent.

There are other risks as well. Adolescence signals the beginning of the end of skeletal growth, and steroids can hasten this process, shutting down growth prematurely. Steroids cause muscles to grow without a compensating strengthening of the tendons that attach them to the bones, an imbalance that increases the risk of crippling injuries. Steroids lower levels of so-called good cholesterol and raise the bad kind, sometimes to alarming levels, and they can be toxic to the liver. And there are the infamous psychological effects of volatile aggressiveness--the " ' roid rage" that cost Wash his position on the team, and have landed other users in jail or in the hospital. "When I was hitting someone, I couldn't stop," says Mike Bauch, an 18-year-old former high-school wrestler who has been off and on andro and steroids since seventh grade.

Unfortunately, explaining cholesterol ratios to a 15-year-old who's just been cut from the baseball team and thinks his life is over anyway may not have the desired effect. "You have to understand high-school kids," says Dr. Douglas McKeag, who heads the Indiana University Center for Sports Medicine. "They think they're immortal." In talking to young athletes who did take steroids, it's striking how little notice parents and coaches took of the Gargantua taking shape before their eyes. Other than his brother, "nobody knew" he was taking steroids, says Bauch, even after he added what he claims was 14 kilograms of muscle last summer. A congressional committee is considering proposing a steroids policy for all U.S. athletes, from high school to the pros.

Even if coaches looked for steroid abuse, they would miss the increasing number of cases that don't involve athletes at all, but students who simply believe they don't measure up to what an American boy ought to look like. Could it really be that decades of education aimed at boosting the self-esteem of normal teenage girls has just transferred the body-image problem to boys? Or is vanity too deeply ingrained in human nature to eradicate, merely shifting its form and locus with the times? For answers, we turn to Charlie Hyvarinen, a 15-year-old aspiring football player from a suburb of Cleveland, who insists he would never take steroids. "Those are fake muscles, and it's cheating, and it's bad for you," he says. "The ones who use it are really a bunch of losers. But man," he adds wistfully, "for a little while, they're really something."

Oops, sorry, that's not the answer we were looking for. Let's hear instead from Chris Wash, who stepped back from the railing and called his mother to come get him, and after therapy is now free of steroids--but is now finishing up at a high school for troubled kids that has no basketball team. "I could have had a scholarship to play ball in college," he muses. "Basketball was my life. It's who I was."