A swig of coffee and many of us are jolted into the day feeling strong and courageous. That’s why caffeine could technically be considered a “performance-enhancing drug” (PED). When this habit moves to a required herbal-packed energy drink to rev up the day, eyebrows may be raised. The stakes rise even higher when it’s a teenager taking a few pills to lose weight or even bulk up for better athletic performance.

Nebraska’s Youth Risk Behavior Survey (2011) found that 3 percent of high school students reported using PED steroids. While that may seem low, it’s still too high. We talk to our kids about illegal drugs and alcohol, but what about these substances? As many PEDs are sold over the counter with easy access, this conversation is important. Here are four to watch for that are available online, in many health food stores and in pharmacies without needing a prescription.

Creatine

An amino acid that occurs naturally in the body, creatine is also found in meat, milk and fish. It helps create adenosine triphosphate, a coenzyme that makes energy in the body. As a common health food supplement, creatine may improve performance in short, high intensity exercises, like weight lifting, but long term benefits are minimal. Side effects include weight gain, water retention, gastrointestinal cramping, fatigue and diarrhea.

Human Growth Hormone (hGH)

Medically used to treat those with short stature, hGH is currently listed on the World Anti-Doping Agency banned substance list. Researchsuggests that although hGH increases lean body mass in the short term, it does not improve muscle definition, as some young men might think. Measures of improved strength were not found, but hGH did cause high rates of fatigue. Other unwanted effects include joint pain, carpal tunnel syndrome and edema.

Ephedrine

Cough and cold medicines sold over the counter include this decongestant or one of its relatives. Ephedrine covers up feelings of fatigue to improve alertness, so teens will use this before the big test or the big game. While not recommended, some teens may use it as an appetite suppressant. One form of ephedrine, ephedra, was banned by the Food and Drug Administration after it was implicated in several athletes’ deaths. Related drugs (like pseudoephedrine) remain available with similar effects – hypertension, weight loss, insomnia, anxiety, headaches, heart irregularities, strokes and psychosis. Combining ephedrine with caffeine is increasingly popular, which escalates both the effects and the side effects.

Steroid Precursors

Steroid precursors make more naturally-occurring steroids in the body. DHEA (dehydroepiandrosterone) is a readily available example, targeting testosterone, the male hormone associated with increased muscle mass, facial hair, male genital development and aggression. Studies show that these precursors fall short, only mildly affecting the body’s natural hormone system, without desired results. No studies show evidence that steroid precursors lead to increased muscle mass or improved performance. Side effects in girls can include unwanted growth of body hair and a deepened voice. Boys may experience breast enlargement, acne and testicular atrophy. These can occur while taking the steroid precursors or even after discontinuing the drugs.

As we steer our youth away from alcohol, illegal drugs and even misuse of prescription drugs, the conversation about performance-enhancing drugs should be included. With this primer, you’re ready to guide the young men and women in your life to better decisions about their health, particularly when it comes to body image or athletic performance.

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