Doping substance use among young people

21 February 2024

Young adult males are the most common group of users of doping substances. Unlike with alcohol and drugs, people often experiment with doping substances for the first time in early adulthood. The most common age of use is between 20 and 35 years. Typically, a user of doping substances who submits a question to Dopinglinkki’s Health Advice Service is a male with vocational training aged between 25 and 34. [1, 2]

Drug experimentation among young people often starts much earlier, between the ages of 10–15 [3, 4]. The use of doping substances often starts a little later, around the age of 20. However, doping substance use by underaged people does also occur. The prevalence of doping substance use among adolescents, especially the use of anabolic steroids, is around 1–3%, depending on the study. The use of doping substances is more common among boys, but there is little information, for example, on the use of weight-loss medicine among girls. The use of doping substances is often accompanied by other risky behaviour and drug and alcohol use. The motives for doping substance use are often centred around appearance. [2]

Body image and eating behaviours among Finnish young people

According to surveys conducted between 1998 and 2018, problems with body image and eating behaviours among Finnish young people (13–15-year-olds) have remained stable or have even decreased. Girls’ body image in particular has seen positive developments. However, girls still have more body image and eating problems than boys. Almost 70% of girls and just under 40% of boys sometimes feel dissatisfied with their bodies. [5]

However, significant changes have occurred since the survey, such as the COVID-19 pandemic and the rise of visual social media, which may have changed things for the worse.  There are a great deal of workout videos and other content on social media that can lead young people to compare themselves to others and negatively affect their body image and self-esteem. International studies have linked heavy use of social media, particularly visual social media, to symptoms of depression, more negative body image and increased use of dietary supplements and anabolic steroids. [6, 7, 8]

Prevalence of use in Finland and related factors

There is no recent data on the prevalence of doping substance use among young people in Finland. Between 1991 and 2005, Finnish adolescents aged 12–18 years (n=22,519) were asked about their use of anabolic steroids. Of the boys and girls surveyed, 0.5% and 0.2% respectively had used anabolic steroids at least once in their lives. For boys, the risk factors for use of anabolic steroids were drinking alcohol for the sake of intoxication and their friends’ drug abuse. [9]

In a survey conducted between 2001 and 2007, 0.9% of conscripts reported having used anabolic steroids at least once in their lives. Anabolic steroid use was particularly associated with strength training, low degree of education and weekly drinking for the sake of intoxication. [10]

According to the Finnish University Student Health Survey 2012, 1.6% of men and 0.4% of women had used doping substances at least once in their lives. Among male students of social work, health care and physical exercise in universities of applied sciences, 11% had used doping substances at least once. [11]

International prevalence

According to ESPAD Report 2019 – Results from the European School Survey Project on Alcohol and Other Drugs (n=9967), about 1% of the respondents had used anabolic steroids at least once in their lives [12]. According to a systematic review and meta-analysis, 9% of people under the age of 18 worldwide have used slimming tablets for weight loss at some point in their lives. The use of weight loss tablets seems to be on the rise and is more common among girls than boys. [13]

In a Norwegian survey published in 2018 (n=77,572, respondents aged 13–19 years), 1.3% of all respondents reported having used anabolic steroids at least once. Boys were twice as likely as girls to use anabolic steroids. The results showed that anabolic steroid use was clearly associated with problem behaviours such as violence and the use of alcohol and drugs. [14]

In an Icelandic survey of upper secondary school students (n=10,259, age 17.3 years), 1.6% of the respondents reported having used anabolic steroids at least once. These students had more anger management problems, anxiety, depression and lower self-esteem. 30% of anabolic steroid users had attempted suicide, compared to 10% of non-users. [15]

Of the young people (n=11,162) surveyed in Spain, 3.3% reported having used anabolic steroids at least once. Of these users, 86% were boys.  Anabolic steroid users were more likely to engage in drug and alcohol abuse than young people who had never used anabolic steroids. [16]

In a Polish survey, 5.8% of young people aged 15–22 (n=1175) reported having used doping substances at least once. Almost 10% of the male respondents had used them at least once. Of vocational college students, 11% had used them at least once. Use typically started between the ages of 16 and 17, but the youngest age for starting was 11.  The main reason for using doping substances was a desire to improve one’s appearance. [17]

According to the 2017 National Youth Risk Behavior Survey in the USA, 3.5% of the male and 2.4% of the female high school students had used anabolic steroids at least once (n=12,068). Anabolic steroid use was common among adolescents who had used heroin or other intravenous drugs (more than 60%). The study showed that anabolic steroid use was often associated with polydrug use, rather than simply to improve athletic performance. Only 2.15% of the young people who used anabolic steroids did not use alcohol or other intoxicants. [18]

Predictors of doping substance use in young people

The use of doping substances by young people is associated more with problem behaviour and risk behaviour, polydrug use and the pressure to look a certain way than with sporting and athletic performance or simply performance. [18, 19, 20, 21, 22]

Factors that studies have shown to be associated with young people’s use of doping substances or with starting their use later include male sex; strength training; heavy use of dietary supplements, alcohol and drugs; risk and problem behaviours; body dysmorphia and body dissatisfaction.  Sports in which strength and body shape are important may also predispose people to use doping substances. People around the users, such as coaches and friends, can also have an influence on a young person’s decision to start doping. [9, 19, 23, 24, 25, 26] Anabolic steroid use is noticeably more common among boys who perceive themselves as significantly overweight or underweight compared to boys who are satisfied with their weight [27].

Certain psychological factors have been found to increase or decrease the risk of doping. Factors that have been observed to increase the likelihood of anabolic steroid use include the desire to be muscular, perceiving oneself as too thin or too fat, competitiveness, comparing oneself to others, low self-esteem, aggression and fear of failure. [24, 26, 28, 29]

Specific psychological traits such as happiness, self-control, moral conviction and good self-esteem may protect people against starting to use doping substances. [24]

Risks of doping among young people

The adverse effects of doping substances are largely the same for young people and adults. They include hormonal changes (such as disorder of the hypothalamic-pituitary-gonadal axis); damage to the heart, liver and kidneys; cholesterol and blood pressure changes; acne, and effects on mood. [30] However, there are specific risks related to doping for young people. Because of the ethical considerations involved in studying the adverse effects of doping among young people, research on the subject is relatively scarce.

As puberty and adolescence are hormonally sensitive periods of development, anabolic steroids and other hormone preparations used during these years may have considerable adverse effects. The body’s own hormones, such as growth hormone, insulin-like growth factor (IGF-1) and sex hormones, are vital for normal growth and development. Any external hormones disrupt this delicate growth phase. Luteinising hormone (LH) and follicle-stimulating hormone (FSH) naturally increase the body’s production of sex hormones such as oestrogen and testosterone. An external testosterone or anabolic steroid interferes with this production and depresses the production of LH and FSH. Male hormones used during puberty may affect, for example, brain development, and the adverse effects may be long-term or even permanent and may still manifest themselves in the person’s behaviour when they are an adult. [2, 31, 32, 33, 34] The use of anabolic steroids and testosterone during adolescence may cause premature epiphyseal closure, which alters the normal longitudinal growth of bones, and may negatively affect the user’s growth in height. In girls, even small amounts of male hormones can cause hair loss, affect the menstrual cycle and cause masculine features. For boys, puberty may come earlier or it may progress quicker. [30, 35]

In human and animal studies, anabolic steroids taken at a young age have been found to alter normal brain remodelling, including structural changes and neurotransmitter function. The most commonly observed behavioural effect is an increase in aggression. Anabolic steroid use during adolescence may increase the risk of maladaptive behaviours and neurological disorders. [36] Animal studies have also shown that the use of anabolic steroids started at a young age increases the risk of cardiovascular diseases [37].

Joni Askola, Master of Health Sciences, Dopinglinkki