"Three years ago, my son's junior varsity high school baseball coach said the 6' 3" star pitcher needed to get bigger if he wanted to make the varsity team," said Don Hooton. He noted that his son, Taylor, "took those instructors very seriously and began to take anabolic steroids. Four months later, my son took his own life. Anabolic steroids played a significant role in the events that led to his suicide."
    Taylor was one of more than a million Americans who use anabolic steroids to bulk up, Hooton said, ranging from major league sports stars to 250,000 ordinary teenagers. Forty percent of Taylor's teammates admitted "juicing," or using steroids. So did half the school football team.
    The boy's parents did not recognize the symptoms of steroid abuse. Neither did his family physician, though he suspected drug use strongly enough to order a battery of standard drug tests.
    "The tests came back negative," Hooton told the American Academy of Family Physicians' Annual Assembly in San Francisco. "Our doctor didn't realize that he had to order a special test for steroids." Hooton didn't specify what special test his doctor might have ordered.
    The physician's inability to spot steroid abuse is no surprise, warned Suraj Achar, MD, assistant clinical professor and education director of the Sports Medicine Fellowship at the University of California San Diego. Between 5% and 6% of high school students have at least tried anabolic steroids. In 2001, 4% of high school students reported using anabolic steroids on a regular basis.
    "That figure is after parents gave consent for the survey," Dr. Achar cautioned. "The actual rate may be considerably higher."
    Depression leading to suicide is a textbook symptom of anabolic steroid use, Dr. Achar said. So are significant weight gain (Taylor put on 30 pounds in four months), bone growth, mood swings, rage, and other psychological symptoms.
    In clinical use, Dr. Achar noted, dosing is typically between 2 mg and 10 mg per cycle. Sports dosing schedules regularly hit 10,000 mg.
    Student athletes, like many of their professional role models, want the increase in bone growth and muscle mass that are typical of high-dose anabolic steroid use. Athletes are willing to accept the psychosocial toll.
    Most do not realize that steroids also increase the size of the heart, liver, and kidneys and reduce sperm count. Mortality is significantly higher among steroid users, not only from suicide related to depression, but also from heart disease and cancers of both liver and kidney.
    Athletes who know the potential for increased morbidity and mortality seem willing to accept the tradeoff.
    In a 1998 poll of US Olympic athletes, Dr. Achar reported, 98% said they would be willing to use steroids if drug use meant they would win their event and they could be assured of not being discovered. When the poll added one further condition, the certainty of death within five years, half of the athletes still said they would choose steroids.
    "The pressure is on," he said.
    Pre-teen athletes have been found using steroids to build size and strength. High school coaches regularly encourage their charges to use steroids, which are freely available at most commercial gyms as well as online.
    Dr. Achar noted that in Iraq, at least one US Army sergeant was found to be giving anabolic steroids to his troops to increase body mass, strength, and aggressiveness. The drugs were originally developed by German researchers to produce the same effects in Nazi soldiers before and during World War II.
    Epoetin is also popular among athletes. Until recently, it was virtually undetectable by blood tests. Human growth hormone is also widely used by athletes, including California Governor Arnold Schwarzenegger during his body building days.
    Gene doping is the next step, Dr. Achar warned. The use of DNA to increase muscle strength is being investigated by a number of researchers as a treatment for muscular dystrophy and other diseases.
    "Athletes are already calling the labs, offering themselves as test subjects," Dr. Achar said. "I don't think anyone would be surprised if it has already happened."