With the 2004 Summer Olympic Games coming up this August, illegal steroid use will probably be in the news once again. Athletes hoping for a competitive advantage use anabolic steroids to build muscle mass and improve their athletic performance.

Though anabolic steroids are illegal except when prescribed for rare medical cases, their use is common all across the United States. Not just professional athletes, but college, high school and middle school-aged athletes are attracted by the lure of improved performance and increased body size. Even some non-athletes use steroids because they believe this will improve their physical appearance.

Anabolic steroids mimic the male hormone testosterone, which plays a key role in increasing muscle mass and improving strength and endurance.

Most anabolic steroids are taken in pill form. Some types are injected with a needle, putting users at risk for HIV and Hepatitis B infection if needles are shared with others.

There are at least 100 different types of steroids, which are sometimes taken in combination. Some users mix steroids with other drugs such as stimulants and painkillers.

Because anabolic steroids act like hormones, they cause changes in sexual characteristics and the reproductive systems of users. Side effects in males can include shrinking of the testicles, impotence (inability to have an erection), low sperm count, baldness, prostate enlargement and breast development.

Women taking anabolic steroids may have increased facial hair, decreased breast size, enlargement of the clitoris, menstrual cycle changes and deepening of the voice.

For all users, steroids can make acne worse. High blood pressure, heart attacks and liver damage are other risks. Adolescents who start taking steroids before they have reached their full adult height may stop growing prematurely.

The psychological side effects of anabolic steroid use can be the most obvious and frightening sign that someone is using these drugs. Mood swings, personality changes, increased aggressiveness, violent behavior, paranoia and depression are all well-known side effects.

Anabolic steroids are manufactured overseas or made in illegal labs in this country. These smuggled drugs are completely unregulated, so it is impossible to know what they contain. The black market value for these steroids is thought to be about $400 million each year.

The possession or distribution of anabolic steroids for non-medical reasons is a federal offense. They are considered Schedule III drugs, so possession is punishable by up to five years in prison for a first offense, and 10 years for a second offense.

Anabolic steroids are sold in gyms, schools and over the Internet. Type "buy steroids" into a search engine and over half a million Web sites appear. Most claim their products are effective and safe. In reality, these distributors have no way of knowing whether these steroids are pure and contain the listed ingredients. With no oversight by the Food and Drug Administration or other quality control agencies, underground steroid producers have no incentives to produce quality steroids.

Even athletes who wisely stay away from steroids may try various other supplements in an attempt to build up muscle mass. Creatine, DHEA, protein and amino acid supplements, HMB and others are widely available, sold over the counter. None of these are regulated by the FDA and all can have serious side effects, especially at high doses.

Parents, teachers and coaches should teach children that the use of any bodybuilding substance can be dangerous and that steroids are illegal. Children should be encouraged to pursue sports that suit their body type. The old-fashioned ways to get strong and excel at sports are still the best: hard training, plenty of rest and an excellent diet.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send ideas to kbbrown@eastoregonian.com.

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