Performance-Enhancing Supplements

Pros and Cons of Performance-Enhancing Supplements for Sports

Youth sports used to mean kids going outside, organizing their own teams, creating their own rules, and playing until mom called them in for dinner. Today, the nature of youth sports has changed drastically. The ever-professionalized landscape of professional and collegiate sports has swallowed up youth sports so that the focus is no longer on strictly playing for the sake of playing. The focus has turned to a win-at-all-costs competitive mentality (1), turning most youth sports programs into no more than mini versions of adult programs. Just as the competitive nature of professional sports has led to athletes doing whatever they can to give themselves an edge, sometimes putting their health at risk in the process, it has also led to a trickled down affect in youth sports. Evidence shows that performance-enhancing supplements are being used by youth athletes, some as young as 13-14, in order to improve their performance (2). This should be seen as problematic for parents, coaches, and league administrators.

Most Common Performance-Enhancing Supplements

This discussion of performance-enhancing supplements will focus primarily around two of the most common supplements, creatine and steroids, but you will also find links to sites that give information on other types of supplements. Before we begin our discussion, there are a few things you should know about performance-enhancing supplements.

Ergogenic Aid

First, performance-enhancing supplements are a type of ergogenic aid. An ergogenic aid is simply any aid that is taken, put on, or performed to enhance performance. According to Powers and Howley (3), ergogenic aids can be any of the following: nutrients, drugs, blood doping, oxygen breathing, warm-up exercises, stress management and even hypnosis. There is concern about the fairness regarding ergogenic aids, especially supplements, because using them gives the athlete an unfair advantage. This violates the spirit of fair play in athletics. The American Academy of Pediatrics (AAP) (4) says, “The intentional use of any substance for performance enhancement is unfair and, therefore, morally and ethically indefensible” (p. 2).

Unregulated and Unproven Supplements

Second, the Food and Drug Administration (FDA) does not regulate supplements sold over the counter. This allows the manufactures to put whatever claim they want on their bottle, regardless of whether or not the product really does what it claims to do. According to the AAP, the lack of any regulations may ultimately pose a health risk to anyone using these products (4), not to mention the fact that they are expensive and most are a waste of money.

Sports Supplements and Nutrition

Third, the AAP cautions that using supplements may undermine proper nutrition, coaching and training (4). If someone can take a supplement, they may think it is OK to use that instead of good old sweat and hard work. This sends the wrong message to kids.

Finally, as a parent or coach it is important that you realize what your role regarding supplement use is. Kids are being sent mixed messages by society. Too often they are also being sent mixed messages by their parents and coaches as well. In an article from The Physician and Sportsmedicine Online (5), epidemiologist and professor of health and human development Charles Yesalis is quoted as saying, “Steroid use is consistent with two societal values: winning and improved physical appearance. ‘We have to give kids a clear message that taking steroids is cheating and harmful’” (p. 2). It is parents and coaches who need to take an active role in sending that clear message to kids. The AAP has several recommendations to discourage supplement use (4). Regarding parents, they recommend, “Parents should take a strong stand against the use of performance-enhancing substances and, whenever possible, demand that coaches be educated about the adverse health effects of performance-enhancing substances” (p. 5). As for coaches, they recommend, “Coaches at all levels, including youth sports, should encourage wholesome and fair competition by emphasizing healthy nutrition and training practices, taking a strong stand against cheating, and avoiding the ‘win-at-all-costs’ philosophy” (p. 5).

With that said, we now turn to a more in depth look at two popular performance-enhancing supplements: creatine and steroids.


What is creatine?

Creatine is a substance, which the body uses to produce energy. It is necessary for high intensity activities. Creatine comes from two sources. It is naturally produced in the body, and it also comes from foods such as red meats and fish. The combination of diet and the natural production in the body generally satisfies the body’s requirement of 2 grams per day (6). Some athletes have chosen to ingest additional creatine in the form of a supplement. Creatine supplementation is thought to aid athletes involved in high power and high intensity sports, but not aerobic sports. The added creatine is thought to allow the athlete to perform repeated training bouts at a higher intensity due to the fact that the energy supply from the CK system (one of three main ways in which the body produces energy) is not as diminished (7). Being able to perform at a higher intensity allows for the muscles to be pushed harder and requires them to subsequently adapt and gain strength.

Creatine Health Risks

Creatine is not recommended for teens or adolescents. The studies conducted on creatine use so far have all used adult subjects to gather information on short-term creatine supplementation. To date only one study of creatine use has been conducted with adolescents (7), and no studies have examined the long-term consequences of use. The safety and effectiveness of long-term use cannot be guaranteed, especially among adolescents. Therefore, the risks to adolescent users are unknown, and creatine use for this population should be discouraged. While not definitively proven, some studies on adults have suggested high doses of creatine may cause kidney damage or result in the body ceasing to make it’s own creatine.  A survey of teen athletes found that teens take higher doses than recommended during loading and maintenance phases of creatine use and therefore are not recommended to take creatine (14). Creatine use should be monitored by a physician.

Creatine Benefits For Adults

In adult populations, creatine use has been shown to enhance the ability of the muscle to exert force and power, especially in bouts of repeated high-intensity movements (7). In addition, it is not banned by the NCAA. However, the NCAA cautions that since over the counter supplements are not regulated by the FDA, they may contain substances that could result in a positive drug test. (8)

Despite the apparent benefit of creatine supplementation for adult athletes involved in high intensity sports, caution is advised in using this supplement. There have been reports of creatine use being associated with short-term side effects such as nausea, vomiting, diarrhea, cramping, heat exhaustion, hypertension, kidney problems, and liver problems. But according to the American College of Sports Medicine, there is insufficient evidence to directly link these problems to creatine use (7). In addition, the effects of long-term use are unknown. Steroids were once thought relatively safe and acceptable in the 1960s and 70s. Twenty years later the link between steroids and cancer became clear (9).

What is the rate of creatine use among adolescents?

Creatine is one of the more popular performance-enhancing supplements used by adolescents. A national survey by the National Institute on Drug Abuse found in 2004 that the annual use rate among 8th, 10th and 12th grade boys, respectively, was 3%, 10% and 16%. This means that one-in-six 12th grade boys used creatine at least once in the prior 12 months. The annual rate among 8th, 10th, and 12th grade girls was 0.6%, 0.9%, and 1.0% (10).


What are steroids?

When talking about steroids there are three main categories you should be aware of: anabolic steroids, testosterone, and prohormones. Anabolic steroids are synthetic steroids that were designed to promote muscle growth in patients suffering from muscular atrophy. Unfortunately, they made their way into the athletic arena where they are sometimes taken in extremely large amounts, up to 100 times larger than the recommended dosage (3). Testosterone is a hormone naturally occurring in males and females that promotes muscle growth. Since it occurs naturally, it is harder to detect. Prohormones are precursors to testosterone and comes in a variety of forms. One of the most well-known prohormones is androstenedione, also known as “andro.” Since they are precursors to testosterone, users hope that once in the body these prohormones will increase testosterone levels. This does not appear to be the case. Maughan, King and Lea (11) reported in the Journal of Sports Sciences that “’testosterone prohormones’ taken orally do not significantly raise blood testosterone in young men and do not increase muscle size or strength.”

What are the risks of using steroids?

The risks of using steroids far outweigh any strength benefit that might be gained. The sale, purchase, or possession of many forms of steroids is illegal. In 2004, congress passed the Anabolic Steroid Control Act, making andro supplements illegal after January, 2005. Steroid use also comes with huge health risks. Some of the adverse effects of steroid use include: disrupted blood clotting, atherosclerosis, hypertension, increased sex drive, acne, frequent nose bleeds, sleeplessness, rapid weight increase, stretch marks, increased irritability, violent behavior, and suicidal behavior. In males, steroid use has been shown to lead to tumors, testicular atrophy, enlargement of the breasts, and premature closure of the growth plate in adolescents. In females, steroid use can lead to abnormal hairiness, deepening of the voice, alopecia, clitoral enlargement and menstrual irregularities (12).

What is the rate of steroid use among adolescents?

The prevalence of steroid use in adolescent males has been reported between 5% and 11%, while the prevalence rate in females is as high as 2.5% (13). The National Institute on Drug Abuse estimated that in 2004, 2.2%, 3.1% and 5.3% of boys in 8th, 10th and 12th grades, respectively, used either andro or steroids in the past year. In addition, steroid use among 12th graders has increased by 1.4% from 1992 to 2004. (10). While these percentages may seem small, given the harmful side effects of steroid use and the fact that use is on the rise, it is not a problem that should be ignored.

Combating the Problem of Supplement Use

Parents and coaches should take an active role in combating the problem of supplement use among adolescents. Fair play and sound nutritional practices should be stressed in youth sports over winning-at-all-costs. Coaches need to educate their players about the harmful side effects of supplements as well as their illegal nature and the unfair advantage that may be derived from using performance-enhancing supplements. Intervention programs using peers to communicate the message have shown promise. For these programs to work, coaches must provide proper nutritional and strength training, enforce a no supplement policy, and de-emphasize scare tactics (5). For an example of an intervention that has shown progress, check out the article “Fortifying students against steroid use” from the Physician and Sportsmedicine Online (5).

Additional Information from The Educated Sports Parent

Pros and Cons of Supplementation and Ergogenic Aids

Pros and Cons of Supplements – Powerpoint Presentation

Additional Information on Other Sites

Detailed chart of various types of performance-enhancing supplements

NCAA List of Banned Drugs

National Federation of High Schools (NFHS) Position Statement on Supplements

Anabolic Steroid Control Act of 2004 – made sale, purchase or possession of andro supplements illegal after Jan 20, 2005

Fortifying Students Against Steroid Use – from The Physician and Sportsmedicine Online, December 1996, Volume 24

Dietary Androgen ‘Supplements’: Separating Substance from Hype – by Conrad P. Earnest, from The Physician and Sportsmedicine Online, May 2001, Volume 29

Nutrition Supplements: Science vs. Hype – by Thomas D. Armsey and Gary A. Green, from The Physician and Sportsmedicine Online, June 1997, Volume 25


(1) White, K. A. (1998). Steroid use among high school girls on rise, study says. Education Week, 17(18), 10. Retrieved November 22, 2005 from Academic Search Premier database.

(2) Johnston, L. D., O’Malley, P. M. & Bachman, J. G. (2003). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings 2002. Retrieved January 15, 2006 from

(3) Powers, S. T. & Howley, E. T. (2004). Exercise Physiology: Theory and Application to Fitness and Performance (5th ed). Boston: McGraw Hill.

(4) American Academy of Pediatrics. (2005). Use of performance-enhancing substances. Pediatrics, 115, 1103-1106. Retrieved November 22, 2005 from Health & Wellness Resource Center database.

(5) Schnirring, L. (1996). Fortifying students against steroid use. The Physician and Sportsmedicine, 24(12), 15. Retrieved November 22, 2005 from ProQuest database.

(6) Cumming, S. & Bartee, T. (2001). The use of creatine supplements in youth sports. Spotlight on Youth Sports, 25(1), 1,3-4.

(7) American College of Sports Medicine. (2000). The physiological and health effects of oral creatine supplementation. Medicine & Science in Sports & Exercise, 32, 706-717.

(8) Meiggs, R. (2004). Committee Continues to Monitor Creatine Use in Sports, Retrieved January 15, 2006 from

(9) Eldridge, J. (2005). University of Texas of the Permian Basin Training & Conditioning Methods Course Notes. Retrieved January 20, 2005 from

(10) Johnston, L. D., O’Malley, P. M., Bachman, J. G. & Schulenberg, J. E. (2004). Monitoring the Future National Survey Results on Drug Use 1975-2004: Volume 1 Secondary School Students. Retrieved January 15, 2006 from

(11) Maughan, R. J., King, D. S. & Lea, T. (2004). Dietary supplements. Journal of Sports Sciences, 22, 95-113. Retrieved January 15, 2006 from Student Resource Center Gold Edition database.

(12) Minelli, M. J., Rapaport, R. J. & Kaiser, D. A. (1992). Preventing steroid use: The role of the health/physical educator. Journal of Physical Education, Recreation & Dance, 63, 68-74. Retrieved November 22, 2005 from ProQuest database.

(13) American Academy of Pediatrics Committee on Sports Medicine and Fitness. (1997). Adolescents and anabolic steroids: A subject review. Pediatrics, 99, 904-908. Retrieved November 22, 2005 from Academic Search Premier database.

(14)  University of Maryland Medical Center (2011) . Creatine. Retrieved from on 5/16/2014

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