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Understanding Performance-Enhancing Drug Use DAVID WANG MD, MS ABSTRACT—Performance-enhancing drug use is a prevalent problem in sports. It is a problem that has captured the world's attention as the media highlights story after story of athletes who have transformed their bodies over a short period of time, those who have simply defíed the aging process in an attempt to prolong a career and those whose ca- reers have been tarnished because of drug use. The baseball investigations and the Mitchell Report* of 2007 opened our eyes and gave us a glimpse of a secretive underground world. This "world" is much more intelligent and sophisticated than it is given credit for. It is the goal of this article to increase the awareness of the medical provider about the types of steroids and other medications used, the influence these substances have on the athletes, and how and why they use them. DAVID WANG,MD,MS,EliteSportsMedidne, Connecticut Children's Medical Center. D RUG use is an area in sports medicine that is crucial to recognize and is poorly studied, largely because the use of performance-enhancing substances are illegal and therefore rarely, if ever, reported. It is an area difficult to gather scientific data about, but with the severity of consequences from the use of these substances it is imperative that the prudent practitioner is familiar enough with the substances and practices that red flags would be recognized and an open and honest discussion with the patient on the wrong path could occur. During the course of a 20-year practice of sports medicine and I have encountered the use of these substances by athletes of all sorts. I have spent time in a smaller gym populated by serious bodybuilders and witnessed practices most would not know existed. Through con- versations with these bodybuilders, and I have learned of the countless steroids that are "stacked" and the myriad of other medications used to achieve their desired results or to manage side effects. The medical community is well aware of the existence of anabolic-androgenic steroids and human growth hormone ( H G H ) and their use for performance enhancement. However, most practitioners are often not well versed on the specific types of steroids and other medications that are used in combination with these ergogenic aids. It is the "other" medications that are responsible for much of the morbidity and mortal- ity within this population. When these athletes die it is often due to narcotic addiction and, to a much lesser degree, anabolic steroids and growth hormone use. Al- though the exact number of deaths is unknown, I have seen and heard of several. In my experience and I have witnessed or cared for several tragic deaths in training and competition. The number of deaths witnessed from drug use equals those observed from congenital heart disease and head injury. VOLUME 76, NO. 8 487 Initially our contact with an athlete can take place during the preparticipation screeni ...

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