    [House Hearing, 109 Congress]
    [From the U.S. Government Publishing Office]

      ERADICATING STEROID USE, PART IV: EXAMINING THE USE OF STEROIDS BY
           YOUNG WOMEN TO ENHANCE ATHLETIC PERFORMANCE AND BODY IMAGE

    =======================================================================

                                    HEARING

                                   before the

                                  COMMITTEE ON
                               GOVERNMENT REFORM

                            HOUSE OF REPRESENTATIVES

                           ONE HUNDRED NINTH CONGRESS

                                 FIRST SESSION

                                   __________

                                 JUNE 15, 2005

                                   __________

                               Serial No. 109-38

                                   __________

           Printed for the use of the Committee on Government Reform

      Available via the World Wide Web: http://www.gpo.gov/congress/house
                          http://www.house.gov/reform

                     U.S. GOVERNMENT PRINTING OFFICE

    22-241                 WASHINGTON : 2005
    _________________________________________________________________
    For sale by the Superintendent of Documents, U.S. Government
    Printing  Office Internet: bookstore.gpo.gov  Phone: toll free
    (866) 512-1800; DC area (202) 512-1800 Fax: (202) 512-2250 Mail:
    Stop SSOP, Washington, DC 20402-0001

                         COMMITTEE ON GOVERNMENT REFORM

                         TOM DAVIS, Virginia, Chairman
    CHRISTOPHER SHAYS, Connecticut       HENRY A. WAXMAN, California
    DAN BURTON, Indiana                  TOM LANTOS, California
    ILEANA ROS-LEHTINEN, Florida         MAJOR R. OWENS, New York
    JOHN M. McHUGH, New York             EDOLPHUS TOWNS, New York
    JOHN L. MICA, Florida                PAUL E. KANJORSKI, Pennsylvania
    GIL GUTKNECHT, Minnesota             CAROLYN B. MALONEY, New York
    MARK E. SOUDER, Indiana              ELIJAH E. CUMMINGS, Maryland
    STEVEN C. LaTOURETTE, Ohio           DENNIS J. KUCINICH, Ohio
    TODD RUSSELL PLATTS, Pennsylvania    DANNY K. DAVIS, Illinois
    CHRIS CANNON, Utah                   WM. LACY CLAY, Missouri
    JOHN J. DUNCAN, Jr., Tennessee       DIANE E. WATSON, California
    CANDICE S. MILLER, Michigan          STEPHEN F. LYNCH, Massachusetts
    MICHAEL R. TURNER, Ohio              CHRIS VAN HOLLEN, Maryland
    DARRELL E. ISSA, California          LINDA T. SANCHEZ, California
    GINNY BROWN-WAITE, Florida           C.A. DUTCH RUPPERSBERGER, Maryland
    JON C. PORTER, Nevada                BRIAN HIGGINS, New York
    KENNY MARCHANT, Texas                ELEANOR HOLMES NORTON, District of
    LYNN A. WESTMORELAND, Georgia            Columbia
    PATRICK T. McHENRY, North Carolina               ------
    CHARLES W. DENT, Pennsylvania        BERNARD SANDERS, Vermont
    VIRGINIA FOXX, North Carolina            (Independent)
    ------ ------

                        Melissa Wojciak, Staff Director
           David Marin, Deputy Staff Director/Communications Director
                          Rob Borden, Parliamentarian
                           Teresa Austin, Chief Clerk
              Phil Barnett, Minority Chief of Staff/Chief Counsel

                                C O N T E N T S

                                  ----------
                                                                       Page
    Hearing held on June 15, 2005....................................     1
    Statement of:
        Elliot, Dr. Diane, professor of medicine, Oregon Health and
          Science University; Dr. Todd Schlifstein, clinical
          instructor, New York University School of Medicine; Dr.
          Harrison Pope, professor of psychiatry, McLean Hospital,
          Belmont, MA; Dr. Charles Yesalis, professor of health
          policy and administration, the Pennsylvania State
          University; and Dr. Avery Faigenbaum, professor of health
          and exercise science, the College of New Jersey............    48
            Elliot, Dr. Diane........................................    48
            Faigenbaum, Dr. Avery....................................   107
            Pope, Dr. Harrison.......................................    83
            Schlifstein, Dr. Todd....................................    56
            Yesalis, Dr. Charles.....................................   101
        White, Kelli, former World Champion sprinter; and Mari
          Holden, Olympian and World Champion cyclist................    20
            Holden, Mari.............................................    28
            White, Kelli.............................................    20
    Letters, statements, etc., submitted for the record by:
        Cummings, Hon. Elijah E., a Representative in Congress from
          the State of Maryland, prepared statement of...............    15
        Davis, Chairman Tom, a Representative in Congress from the
          State of Virginia, prepared statement of...................     4
        Elliot, Dr. Diane, professor of medicine, Oregon Health and
          Science University, prepared statement of..................    51
        Faigenbaum, Dr. Avery, professor of health and exercise
          science, the College of New Jersey, prepared statement of..   109
        Holden, Mari, Olympian and World Champion cyclist, prepared
          statement of...............................................    31
        Pope, Dr. Harrison, professor of psychiatry, McLean Hospital,
          Belmont, MA, prepared statement of.........................    86
        Porter, Jon C., a Representative in Congress from the State
          of Nevada, prepared statement of...........................   127
        Schlifstein, Dr. Todd, clinical instructor, New York
          University School of Medicine, prepared statement of.......    59
        Waxman, Hon. Henry A., a Representative in Congress from the
          State of California, prepared statement of.................     8
        White, Kelli, former World Champion sprinter, prepared
          statement of...............................................    23
        Yesalis, Dr. Charles, professor of health policy and
          administration, the Pennsylvania State University, prepared
          statement of...............................................   103

      ERADICATING STEROID USE, PART IV: EXAMINING THE USE OF STEROIDS BY
           YOUNG WOMEN TO ENHANCE ATHLETIC PERFORMANCE AND BODY IMAGE

                                  ----------

                            WEDNESDAY, JUNE 15, 2005

                              House of Representatives,
                                Committee on Government Reform,
                                                        Washington, DC.
        The committee met, pursuant to notice, at 10 a.m., in room
    2154, Rayburn House Office Building, Hon. Tom Davis (chairman
    of the committee) presiding.
        Present: Representatives Davis of Virginia, Shays,
    Gutknecht, Duncan, Porter, Dent, Waxman, Maloney, Cummings,
    Kucinich, Davis of Illinois, Clay, Watson, Lynch,
    Ruppersberger, Higgins, and Norton.
        Staff present: Melissa Wojciak, staff director; David
    Marin, deputy staff director/communications director; Jennifer
    Safavian, chief counsel for oversight and investigations; Howie
    Denis and Anne Marie Turner, counsels; Rob White, press
    secretary; Drew Crockett, deputy director of communications;
    Susie Schulte, professional staff member; Teresa Austin, chief
    clerk; Sarah D'Orsie, deputy clerk; Kristina Sherry,
    legislative correspondent; Corinne Zaccagnini, chief
    information officer; Leneal Scott, computer systems manager;
    Phil Schiliro, minority chief of staff; Kristin Amerling,
    minority general counsel; Karen Lightfoot, minority
    communications director/senior policy advisor; Brian Cohen,
    minority senior investigator and policy advisor; Early Green,
    minority chief clerk; and Jean Gosa, minority assistant clerk.
        Chairman Tom Davis. The committee will come to order. Good
    morning and welcome to today's hearing on the use of steroids
    by young women to enhance athletic performance and body image.
        This is the fourth hearing the committee has had on the use
    of steroids, a public health crisis, that reaches from the
    highest levels of professional sports down to ball fields and
    school yards across the country.
        Throughout our inquiry, we have sounded a familiar theme:
    The culture of steroid use among professional athletes, while
    troubling by itself, is also worrisome in its trickle-down
    effect. In the absence of strong testing regimes, pro athletes
    use performance-enhancing drugs to stay ahead of the
    competition. College athletes feel pressure to use steroids to
    get drafted. High school kids believe steroids are the ticket
    to bigger, faster bodies that will attract the attention of
    scouts and college coaches, and maybe lead to a scholarship.
        And the cycle goes on and on. These pressure are real and
    they sometimes have tragic consequences, as we have heard from
    the Hooten and Garibaldi families during the first hearing.
    Their sons killed themselves after slipping into depression
    that their families believe was fueled by anabolic steroids.
        Today we fix our gaze on a disturbing piece of the steroid
    puzzle. Studies have shown that growing numbers of young girls
    are beginning to use steroids. Some of this use is attributed
    to the desire to improve athletic performance, but some is
    because girls are looking for a way to get thinner, to reduce
    body fat, to conform to an idea of beauty they feel pressured
    to emulate.
        That is why we are here. Young lives continue to be
    destroyed or lost due to the illegal use of steroids. That is
    why I have introduced, along with Ranking Member Henry Waxman
    and other members of the committee, legislation to require
    tougher testing standards for performance-enhancing drugs.
        The deeper we get into this issue, the more certain I am of
    the need for Federal legislation to address this dangerous,
    deadly, public health crisis. Our legislation specifically
    addresses professional sports, because that is the public face
    of this vicious cycle. That is where it starts, that is where
    we need to begin to stop it. But we now know that the use of
    illegal performance-enhancing drugs extends to places once
    thought impossible.
        For example, a survey of high school students conducted by
    the Center for Disease Control and Prevention indicated that 5
    percent of high school girls and 7 percent of ninth grade
    girls, had abused steroids without a doctor's prescription.
        Dr. Linn Goldberg, who testified at the committee's April
    30th hearing, and researchers at Oregon Health and Science
    University, Dr. Diane Elliott, will be testifying today,
    reported an increased use in anabolic steroids among high
    school nonathletes. Young women appear to be resorting to
    steroids use as a means of weight control and body fat
    reduction; that is, losing fat and gaining lean muscle.
        The use of steroids for this purpose often goes hand in
    hand with eating disorders, not to mention the abuse of other
    drugs in order to stay thin. At first glance, it may seem odd
    to associate the use of steroids with the desire to stay thin.
    Our mental image of a steroid user is an over-muscled jock. But
    as we will hear today, some steroids are thought to act as an
    appetite suppressant or to burn fat at a faster rate. Sadly,
    females suffer particularly devastating health consequences
    from steroid use.
        Adverse side effects include but are not limited to
    excessive growth of body hair, masculization, premature
    arrested bone development, resulting in stunted growth,
    irritability, delusion, and depression.
        Today we will hear from several medical experts, some of
    whom believe steroid use by young women is an underreported
    problem, and all of whom agree more research and scientific
    evidence are needed to more accurately quantify how large a
    problem we face.
        I look forward to a robust discussion on the extent of the
    problem, what the numbers tell us, and what information we may
    be lacking in understanding the whole picture.
        Dr. Elliott will also discuss her success with a prevention
    program called ATHENA, Athletes Targeting Healthy Exercise and
    Nutrition Alternatives, which is specifically designed for
    middle and high school-age girls.
        Additionally, we are very pleased to have with us Kelli
    White, a former world champion sprinter, who has come clean
    about her decision to use steroids and about her subsequent
    regrets; and Mari Holden, a world-class cyclist, who will
    discuss the pressures clean athletes face in competing in an
    environment where their rivals may be taking performance-
    enhancing drugs.
        [The prepared statement of Chairman Tom Davis follows:]

        Chairman Tom Davis. I now recognize the distinguished
    ranking member, Mr. Waxman, for an opening statement.
        Mr. Waxman. Thank you very much, Mr. Chairman. I want to
    thank you for holding this hearing today. We have already held
    three hearings on the issue of steroids, and this is our fourth
    hearing on steroid use.
        But in these first three hearings, we focused on male
    professional athletes and the impact of their steroids use in
    athletics, especially in professional athletics. Today we are
    examining whether steroids are a problem for young women as
    well.
        In April, about the time we were holding a hearing on the
    NFL, several newspaper stories focused on a potentially new
    issue, the use of steroids by young women. These stories
    pointed out that the Centers for Disease Control survey data
    showed that 5 percent of high school women had reported using
    steroids, and, according to experts, the women using these
    drugs are not just high school and college athletes looking for
    a competitive advantage, but girls with body image problems
    hoping to achieve a lean and muscular look.
        These stories got our attention in part because they
    suggest that the pressure to use these drugs illegally extends
    beyond locker rooms and playing fields where we have been
    focusing our inquiry. Steroid use among female athletes is
    unfortunately nothing new. We all recall the images of East
    German female athletes in the 1970's and 1980's.
        But it seems to me that if young women today are taking
    steroids at high rates, and taking them not just to improve
    their athletic abilities and performance but to meet a socially
    expected standard of how they should look, then perhaps the
    steroid problem is even bigger than we had thought.
        Our hearing today will examine the use of steroids by young
    women. First we will hear from two athletes, Kelli White,
    former world champion sprinter, currently serving a 2-year ban
    for steroid use. And to her credit, she has been speaking out
    about the mistakes that she has made. We will hear from her
    today about the pressures on young women athletes to use
    steroids. We will also hear from Mari Holden, a world champion
    cyclist, who has been able to do it without drugs. I know that
    young women can learn from both examples, especially the idea
    that they can compete and win at the highest level of sports
    without resorting to illegal steroid use.
        I want to thank both of you for being here today. Our
    second panel will be consisting of five medical experts. And
    they will help us examine what I think is the most important
    question of this hearing: How big is the problem of high school
    women and girls using steroids?
        CDC survey data shows that over 5 percent have used
    steroids. Separate data from the National Institute of Drug
    Abuse shows lower usage among women. In both cases, the
    government data shows a disturbing trend, with reported steroid
    use among women and girls increasing four fold over the last
    decade. It is low now, but it looks like a trend to growing
    use.
        We will hear from at least one expert today who thinks that
    these government figures dramatically overstate the problem of
    steroid use among women, which he calls an illusion; and we
    will hear from a number of others who may be skeptical of the
    high-end estimates, but have little doubt that steroid use
    among women is growing and represents a serious public health
    problem.
        While I hope we can get to the bottom of these issues today
    and learn from the hearing, we do not need to walk out of this
    room with a precise figure on the extent of steroid use by
    young women, but I hope we can determine if it is a serious
    problem, serious health issue, and, if so, what we can do about
    it.
        Our legislation, the Clean Sports Act, will help solve some
    of these problems. We will hear from our witnesses today how
    society's attitude toward steroids and the professional
    athletes who use them impacts young women.
        By making it clear that steroid use is unacceptable for
    elite athletes, our legislation will send a strong message to
    both the male and female high school and college athletes who
    use these competitors, these stars as role models, but it may
    be that we need to do more.
        Our witnesses today will give us broader insight into the
    extent of steroid use by young women, the reasons for this use,
    and the ways to stop it.
        Mr. Chairman, I thank you for your continued attention to
    the problem of steroid use, and I look forward to the hearing
    today.
        [The prepared statement of Hon. Henry A. Waxman follows:]

        Chairman Tom Davis. Thank you very much.
        Mr. Cummings.
        Mr. Cummings. Thank you very much, Mr. Chairman.
        Mr. Chairman, I too thank you for holding this hearing. And
    let me note from the very beginning that, Mr. Chairman, when we
    addressed the use of steroids in professional sports a few
    weeks ago, the lines were very long outside. You could hardly
    get into the room.
        Cameras were all over the place. Reporters were breaking
    their necks to get to the table over there. And now we have a
    situation where, when we address the issue with regard to
    women, the room is not so packed. But the fact is, it is still
    a significant problem.
        The ranking member and the chairman have gone over very
    carefully the statistics, based upon research, and certainly
    there may be differing views on that from different
    organizations. Certainly there may be some who will come before
    us today and say that it is no big deal.
        Well, as one Member of Congress, the father of two
    daughters, I consider it a very, very, very big deal. When you
    think about health problems that often result from using
    illegal steroids--like abnormalities of the sexual
    characteristics, cardiovascular disease, liver and kidney
    complications, and serious psychiatric side effects, including
    acute depression and even suicide, we are talking about--if one
    person, if one young lady uses illegal steroids, it is one too
    many.
        One of the things that I have often seen, Mr. Chairman, in
    my district, is I run into people who use illegal drugs; not
    these types of drugs but others. And one thing that they often
    tell me, even when they have recovered and they are on the mend
    and they have been off the drugs for a long time, they will
    tell me that I can forgive myself, but my body will not forgive
    me.
        And that is a very, very powerful statement. I can forgive
    myself, but my body does not forgive me. With this in mind,
    Congress added certain anabolic steroids to Schedule III, the
    Controlled Substances Act. Individuals possessing such drugs
    without a valid prescription are liable for a misdemeanor,
    while persons convicted of distributing, dispensing, or selling
    those drugs are subject to a 5-year sentence for a first
    offense. In clear and plain terms, illegitimate steroid use is
    a crime. And we need to keep that in focus: It is a crime.
        As the ranking member of the Subcommittee on Criminal
    Justice, Drug Policy, and Human Resources, I routinely work on
    issues related to U.S. drug control policy and public health.
    Although the primary focus of our oversight is Schedule I
    substances, I am particularly concerned that the abuse of
    steroids by female athletes and female nonathletes may be
    underreported and require further study.
        As the title of this hearing conveys, this committee is
    driven by a commitment to eradicate illegitimate steroid use
    regardless of whether they are abused on or off the playing
    field. Today we are united in the belief that the health and
    safety of our communities and generations yet unborn are too
    important to pursue any lesser goal.
        This demands that we not only embrace successful education
    and prevention programs that address steroid abuse by young
    girls and women, but continue to examine unresolved questions
    regarding steroid abuse within this population.
        And so I thank all of our witnesses for coming here today.
    I thank you for sharing your opinions. I thank you for sharing
    your stories. This is our watch. As a Congress, this is our
    watch. When issues come before us, we try to do our best to
    address them, not just for you, but for generations yet unborn.
        And with that, Mr. Chairman, I yield back.
        Chairman Tom Davis. Thank you very much.
        [The prepared statement of Hon. Elijah E. Cummings
    follows:]

        Chairman Tom Davis. Mr. Gutknecht, any opening statement?
        Mr. Gutknecht. No.
        Chairman Tom Davis. Ms. Norton, any opening statement?
        Ms. Norton. Thank you, Mr. Chairman. I may be the only
    woman on the dais, but I can assure you that this is a concern
    of this entire committee, and I want to thank Chairman Davis
    for his follow-through after the previous hearings. With all of
    that muscle at the microphone in the original hearings, with
    many famous professional athletes in the room, the original
    motivation for our hearings could easily get swamped.
        There were indeed a number of motivations. The huge ethical
    problems in organized sports tended to grab the headlines,
    especially when everybody in the country knew it was happening
    and nobody was doing anything about it. But the fact is that
    from the beginning, these hearings have been motivated--and on
    the record we have said so--by the growth in the use of
    steroids among children, and that means girls and boys.
        The importance of focusing on children is what we know
    about what steroids can do when adults use them. Mr. Cummings
    has indicated some of the documented results of use of steroids
    by adults, indeed athletes. Imagine how much more serious the
    consequences will be for people who start using steroids when
    they are children. The only analogy I can think of is smoking.
        I mean, if you start smoking when you are a teenager, you
    are going to have a much greater chance of having all of the
    associated illnesses than if you are foolish enough to start
    when you are an adult. So focusing in on young people is
    important, because inevitably they focus in on athletes, and on
    the most successful athletes. The real rock stars of this
    generation are athletes. You know, not everybody can sing and
    play, but they all think that they can take a turn at some
    sport or the other if they get good enough, and getting good
    enough has come to mean, for professional athletes, cheating.
        So we were both teaching cheating to young people and
    teaching something just as serious: how to destroy your health
    at a very young age. Now, I am aware, have read about the
    controversy concerning just how many girls use or do not use
    steroids. I recognize the difficulty of pinning that down in
    this population. I do not regard the controversy as serious,
    because even assuming that girls are using steroids in fairly
    sparse numbers, there is no question that unless we begin to
    focus on what this does for young people, they will do--they
    will finally do what boys do. We see it happening in sports all
    of the time. Indeed in Title IX we tell them that you can play
    anything boys can play. You can do anything boys can do. There
    may be a deterrent to a girl using steroids, if they think they
    are going to look muscle-bound as opposed to simply looking
    slightly more muscular. Given how important looks are to
    teenage girls, perhaps it has not ballooned yet.
        But if all we are doing is sending out the message of
    prevention to parents about girls, that is doing what I wish we
    had done when it came to boys who apparently may be using
    steroids in very large numbers. So this hearing, I think,
    brings us back full circle to where we began. The reason for
    these hearings is to make sure that this terrible problem does
    not become a mass problem for our children; yes, and even for
    girls who may be less inclined, but will surely march up the
    same road if we do not continue to focus on them.
        And therefore, Mr. Chairman, I appreciate that you have not
    dropped the ball, but have kept the ball moving on our kids.
    Thank you very much.
        Chairman Tom Davis. Thank you very much.
        We have our first panel today, and it is a distinguished
    panel. We have Kelli White, the former world champion sprinter,
    and Mari Holden the Olympian and world champion cyclist. It is
    a great privilege to have both of you here today. If you would
    please rise and raise your right hands, it is our policy that
    we swear you in before you testify.
        [Witnesses sworn.]
        Chairman Tom Davis. Thank you. Please be seated.
        Ms. White, we will start with you. We have--your total
    written statement is in the record. Questions will be based on
    that.
        We appreciate having you here today. Thank you. Kelli.

    STATEMENTS OF KELLI WHITE, FORMER WORLD CHAMPION SPRINTER; AND
            MARI HOLDEN, OLYMPIAN AND WORLD CHAMPION CYCLIST

                        STATEMENT OF KELLI WHITE

        Ms. White. Thank you, Mr. Chairman, and esteemed members of
    the committee. I want to thank you very much for allowing me
    the opportunity to appear today before this very prestigious
    group. My name is Kelli White. And I appear here today having
    made the regrettable mistake of using steroids and other
    performance-enhancing drugs during my athletic career as a
    sprinter.
        With my experience and knowledge regarding the use of
    performance-enhancing drugs, I welcome the opportunity to
    assist in the efforts to remove doping from sport. By way of
    background, I competed in track and field for most of my life,
    having begun at the age of 10. In my early teen years, I began
    working with renowned Remi Korchemny, who would remain a
    significant figure in my life over the next decade and a half.
        I went on to compete collegiately and graduated from the
    University of Tennessee before turning professional in the year
    2000. At that time, I returned home to the San Francisco Bay
    area and began training full time with Mr. Korchemny. Shortly
    thereafter, in December 2000, my coach introduced me to BALCO
    founder, Victor Conte. Conte initially gave me a package
    containing both legal supplements as well as substances--a
    substance which later became known as the clear or the designer
    steroid THG.
        At the time, I was unaware that anything I received from
    Mr. Conte was a prohibited performance-enhancing substance, as
    I was told by both my coach and Mr. Conte that the vial they
    had given me contained flaxseed oil.
        A few weeks later, Mr. Conte admitted to me that the
    substance he had given me was indeed not flaxseed oil, but
    rather a prohibited substance that if not taken properly could
    yield a positive drug test. I immediately ceased using the
    liquid, because at that time in my career I did not believe it
    was necessary to take performance-enhancing drugs to be
    competitive.
        I competed over the next 2 years without the use of any
    performance substances, despite being constantly urged to do
    so. I was continuously being told by my advisers that the use
    of performance-enhancing substances was necessary to be
    competitive because everyone else was doing so.
        My 2002 season was very difficult, as I struggled with
    injuries for most of the year. I had a great deal of
    uncertainty regarding my status as I entered the 2003 season.
    And I did not want to miss it. I failed to make the 2003 indoor
    world team, and was receiving more pressure to start a
    performance-enhancing drug regime.
        My advisers were pointing to other performances of athletes
    and saying I needed to do what they were doing in order to
    compete on that level. In March 2003, I made a choice that I
    will forever regret. I visited Mr. Conte at his lab which was
    near my home, and we sat down and devised a program to utilize
    performance-enhancing drugs in my training and competition.
        At that time I began taking EPO, the clear, or what is now
    called THG, the cream, and other stimulants. I remained on this
    program over the course of 4 months, and with the help of Mr.
    Conte, I was able to pass 17 drug tests, both in and out of
    competition, while utilizing these performance-enhancing
    substances.
        In a relatively short time period, I had gone from being a
    very competitive sprinter to being the fastest woman in the
    world. In June 2003, I captured both the 100 and 200-meters
    U.S. Championships, and followed that by winning the same event
    in the World Championships in August in Paris.
        Although I crossed the finish line first in all those
    events, I knew in my heart it was accomplished partially
    because of the other line I had crossed. Instead of what should
    have been the high point of my career and a tremendous
    accomplishment in my life, I was ashamed of the choices I had
    made.
        In addition to enhancing my performance on the track, there
    were other physical effects I encountered while taking this mix
    of substances. My blood pressure was elevated, and I also
    experienced an acne problem, increased menstrual cycle, and
    slight vocal cord problems.
        The first and only failed drug test I experienced was
    following the World Championship meet in Paris, when a
    stimulant known as Modafinil was discovered in my urine sample.
    But the penalty for that substance would not have been a
    suspension from track and field.
        A few weeks after the World Championships, the FBI and
    other law enforcement agencies raided the BALCO Laboratory. A
    few months later, I admitted to the U.S. Anti-Doping Agency
    officials what I had done, as I have outlined for you today. I
    received a 2-year ban from competition for my actions as well
    as loss of results from my previous 4 years of competition.
        I also agreed to assist USADA in its mission to clean up
    the sport, and now offer to be of service to this committee in
    any way you see fit. I believe athletes who use performance-
    enhancing drugs are hurting themselves, cheating the public and
    betraying our youth. I believe it is important that you
    understand the reasons that I made the choice, in essence to
    cheat.
        I strongly feel the use of steroids and other prohibited
    performance-enhancing drugs are wrong and there is no place for
    them in sports or society in general. However, athletes who
    have made the choice are not necessarily bad people. In my own
    situation, there are many factors contributing to my poor
    decision I made, which include the influence of a longtime
    trusted coach, but, most importantly, I began using these
    substances not to give me an advantage, but because I became
    convinced that I needed to use them to level the playing field
    with my competitors.
        It is a very troubling situation when you have trained to
    compete in a sport at the highest level, and you feel those
    with which you are competing have an unfair advantage. I make
    neither any excuse nor justification for my horrible choice. I
    merely hope to lend some understanding to this committee as to
    how someone who loved her sport and who trained cleanly for
    most of her life got involved in this awful abuse.
        My attorney, Jerrold Colton, and I have worked with
    assisting USADA as well as the World Anti-Doping Agency in
    their efforts, and we believe this committee should further
    support USADA in the fight, as this fight is a very difficult
    one.
        Being mindful that my use of steroids and other
    performance-enhancing drugs was not detected through the
    extensive testing I received, USADA needs the resources to go
    further in its fight to detect the people who are breaking the
    rules. I am certainly most appreciative of this opportunity to
    appear here today to discuss the relationship of women and
    steroids. This is a problem that is not gender specific, and
    affects people across all gender and racial lines.
        As an athlete, I am very aware of the opportunities which
    advanced for women in sports during my lifetime and just hope
    the committee takes note that the pressures and considerations
    pertain equally to men and women.
        I hope there are further studies as to the physiological
    and health impact people face when choosing to use these
    substances. Further, the roles of some national governing
    bodies involved in sports and the coaches which either assist
    in the wrongdoing or turn their backs on what they see must
    have some responsibility, culpability, and penalty for their
    role in making sport unclean.
        The fight against drugs in sports is an extremely difficult
    battle. I am sorry that I cheated myself, my competitors, my
    sport, my family, and the public for the choices that I made in
    the past.
        As athletes we know we are role models, but I betrayed my
    responsibility as such. Please feel free to call on me to play
    any role I can in assisting your committee and anyone else you
    see fit in this very important matter. I hope in doing so, I
    will help the sport I love more by what I do off the track than
    anything I could have ever done on it.
        Thank you very much for your kind attention and for
    allowing me to appear here today.
        Chairman Tom Davis. Well, thank you very much for that
    testimony.
        [The prepared statement of Ms. White follows:]

        Chairman Tom Davis. Mari.

                        STATEMENT OF MARI HOLDEN

        Ms. Holden. Mr. Chairman, members of the committee, good
    morning. My name is Mari Holden. And I am a 2000 Olympic silver
    medalist and 2000 World Champion in the sport of cycling. I
    want to thank the committee for its interest in this important
    subject, and the invitation to testify.
        I have been competing as a professional cyclist at the
    international level since 1993, and have firsthand experience
    of the effects of drug use in sport. I have never used steroids
    or other performance-enhancing drugs, but I have had my hard
    work, dedication, and victory compromised by other athletes who
    have.
        It is important for you to hear from clean athletes who
    have had to work against those who rob all of us of the values
    sport should represent. Unfortunately, much of what is in the
    news is the opinion of athletes who have achieved success by
    using performance-enhancing substances and are now getting
    caught.
        While we should commend those who have the courage to
    accept responsibility for their mistakes, far too little has
    been heard from the athletes who strive to participate in the
    sport, using the right substances; namely, personal
    accountability, commitment, hard work, and integrity.
        As a young girl growing up in southern California, I saw
    the magic of the Olympics in my own back yard when Los Angeles
    hosted the 1984 Olympic Games. I dreamed of being an Olympian
    and representing the United States in athletic competition.
        I even went so far as to practice standing on a makeshift
    podium and singing the national anthem. As a kid my dreams
    seemed straightforward and similar to most people's American
    dream: If you train and work hard, dedicate yourself to your
    goals and play by the rules, you can become a winner.
        When I was 12 on my first bike, I just wanted to go fast.
    And for me it was a matter of seeing how far I could ride or
    how fast I could go on a descent. The rules were the rules and
    no questions asked. We all played by the simple philosophy that
    winners never cheat and cheaters never win.
        Most 12-year-olds today can recite that sacred adage. It
    seems so simple. The reason that winners never cheat is that
    winners recognize the important life lessons taught by sport,
    which are far greater than any title, record or price. True
    champions recognize that sportsmanship exists not only in
    winning but in winning with integrity.
        Sport is valued in part because it builds character, self
    esteem, and confidence. These are the skills that create
    success on the athletic field or in the boardrooms across
    America. And as I transition from athlete to businesswoman, I
    cling to the lessons I have learned over the past 17 years.
        Being a young girl in today's society is not always easy.
    All around there are messages that they need to be thin, and
    how they look is more important than who they are. Sports teach
    young girls and young women that it is our commitment and the
    core within and not just our outer layer that is valued and
    respected.
        I first realized the magnitude drug use can have on my
    career when I went to race in Europe, widely considered the
    pinnacle of professional cycling. I knew that in order to be
    the best in the world I needed to race in Europe full time and
    push myself harder than I had in the United States. Despite
    winning several National Championships titles, I was barely
    making enough money to cover my phone bills back home.
        Women's sports generally do not have the money that other
    sports have. But I was not racing to become rich; I just wanted
    to see how good I could be. For some of my fellow competitors,
    cycling was their only means of supporting a family back home.
    Regardless of whether the athletes were competing solely for
    the money or glory, the temptation to win at all costs was
    prevalent. Athletes need a support system that supports their
    choice to compete clean.
        I made a decision early on in my career not to take
    shortcuts to success by doping. And I was fortunate to have a
    support group, including my parents, coach and husband, who
    backed my belief that the only accomplishments worth attaining
    were the ones that I earned on my own.
        Sometimes it is hard to think straight when you are
    exhausted from a 10-day race, and we know that some people out
    there are cheating. Personally, I have always tried to take the
    high road and tell myself that I was a better sportsman because
    I was successful without drugs.
        Of course, disappointment sets in when you know that
    someone who is not clean beats you and takes away your result.
    In the past it did seem that much of the time the cheaters were
    one step ahead of the testers. The people who cheat are also
    the ones who are willing to use every scientific and legal
    loophole to ensure that they do not get caught.
        Fortunately for clean athletes, this has changed with the
    World Anti-Doping Agency and the U.S. Anti-Doping Agency. A few
    years ago when I told some foreign teammates that 1 day they
    too would be subject to unannounced testing, they did not
    believe me.
        Now that time is here and more people are starting to get
    caught for drugs that they never would have had in their
    systems before. Looking back on my career, I can smile knowing
    I did it in the right way. I have an Olympic medal and earning
    it was one of the greatest achievements in my life. The medal
    is only a symbol, but standing on the podium and hearing Anita
    De Frantz, a USOC and IOC board member, tell me that my country
    was proud was the moment I had imagined since I stood on the
    podium in my back yard. It was a feeling that I had overcome
    the odds and had done it without compromising my values.
        There were so many opportunities to take the easy way that
    I will never look at my medal and feel anything but pride.
        I am here because I want to make sure that the clean
    athletes of today and tomorrow have a voice. Our children need
    to have a level playing field and the use of drugs for sport or
    looks should be deterred at all levels. As a clean athlete, I
    want you to test me so the world knows that when I win, I win
    fair and square. I believe all clean athletes feel the same
    when given a chance to speak freely about these issues.
        Frankly, it is the same simple rule we all followed as
    children on the playground, and which our children hopefully
    still follow today, that cheaters never win and winners never
    cheat.
        [The prepared statement of Ms. Holden follows:]

        Chairman Tom Davis. Thank you both for the very strong,
    compelling testimony.
        Ms. White, how were you able to elude the USADA and WADA
    testing during the time you were taking steroids?
        Ms. White. Along with the steroid that we were taking, we
    also had a masking agent that we would use. We also knew who
    was testing at which competitions, and we knew what we could
    and could not take.
        Chairman Tom Davis. Were steroids prevalent during your
    years competing in NCAA athletics?
        Ms. White. I do not think so.
        Chairman Tom Davis. You do not talk about it with anybody
    else?
        Ms. White. No. I did not personally think so then. I would
    have never thought it.
        Chairman Tom Davis. What is your opinion of the steroid
    testing that you received during college? Was it rigorous
    enough?
        Ms. White. No.
        Chairman Tom Davis. OK.
        Ms. Holden, what direct experience have you had with the
    other female cyclists taking steroids?
        Ms. Holden. With steroids, I have been beaten by someone
    who was caught for doping, but it was for a diuretic, which
    would be a masking agent. So indirectly I would say yes; and
    that was I received second in that event, and received my award
    later.
        Chairman Tom Davis. It is clear that designer steroids can
    elude the testing. Do you think cyclists are still using
    steroids for international competitions like the Olympics? Do
    you have any idea?
        Ms. Holden. I don't think that cycling is different than
    any other sport. There are going to be people out there who are
    trying to beat the system. That is, I believe that they need to
    have more money for the research, to try and catch these
    designer steroids and designer drugs, because we need to stay
    one step ahead of the game instead of one step behind, which is
    how I have always thought it has been.
        Chairman Tom Davis. Ms. White, did you get any physical or
    psychological side effects from using steroids?
        Ms. White. Yeah, the voice changing, the increased
    menstrual cycle, high blood pressure. It came on very quickly
    too.
        Chairman Tom Davis. Was it pretty pronounced? It was very
    clear that this was affecting----
        Ms. White. Correct.
        Chairman Tom Davis. Well, thank you very much.
        Mr. Waxman.
        Mr. Waxman. Well, I want to thank both of you. You have
    given us an insight into the culture of competitive athletics
    from your respective sports.
        Ms. Holden, you seem to think that there is a lot of
    performance-enhancing drugs used by people in your sport, but
    Ms. Kelli, you do not think so--I mean, Ms. White, you do not
    think that there is much going on? Is that an accurate
    statement for both of you?
        Ms. Holden. I would not say there is a high percentage. I
    do think that it is happening out there. I do not know the
    exact percentage. But it is something that concerns me, and I
    want to try and help make it better out there for future
    cyclists, future athletes in general.
        Mr. Waxman. If you thought of course it was happening out
    there, that would be a pressure on you to use some kind of
    drugs as well in order to be able to compete. You did not
    succumb to that pressure.
        Ms. Holden. No. Personally I would rather not win than to
    cheat that way.
        Mr. Waxman. Ms. White, did you--you seemed to indicate you
    did not think--you knew of people using these drugs when you
    were using them. Do you think that there are other people now
    using steroids and other performance-enhancing drugs in order
    to enhance their performance?
        Ms. White. Yeah, I think so. If you look at the second
    place and the third place at the World Championships in the 200
    meters, they have also tested positive for different
    substances. So they are having 2-year bans also. So in my sport
    it kind of tends to be a big problem. I wish that I could
    really give an answer on how we can decrease the numbers or
    make it stop and go away altogether.
        Mr. Waxman. Well, do you think stricter penalties that they
    have for the Olympics is playing a role to discourage people
    from using those drugs?
        Ms. White. Personally I think that the punishment is a
    little bit harsh. Two years out of a career is very harsh.
    Stricter punishment, I don't think that would resolve it. I
    think there are other athletes that are being caught, and they
    are not being outed as I have been outed. I think being outed
    is a big deterrent. It is embarrassing and it really does go
    with your character, it hurts you in the long run. And I think
    that if we do out people, it could be a deterrent.
        Mr. Waxman. Is there a reason for us to be discouraged that
    even while we have testing, there are people who are looking
    for ways to get through the testing by masking the fact that
    they have been using these drugs?
        Ms. White. I do not think that should be a deterrent,
    because it not only affects professional athletes like we are
    talking about here today, it affects people underneath us.
        I think that if we continue to push forward, regardless of
    what we as professional athletes may ignore, I don't think that
    it is being ignored by other parents and children, you know,
    younger than me.
        Mr. Waxman. Ms. Holden, what do you think about that? Do
    you think that in order to compete, there are--women are
    looking at using these steroids and other performance-enhancing
    drugs, knowing it is the wrong thing to do, knowing that it
    could hurt them if they get caught, and they are willing to
    spend extra effort to see if they can mask it?
        Are the penalties enough to deter them, and what else do
    you think we can do to change the mindset about the use of
    those drugs?
        Ms. Holden. I think that the temptation is probably great
    to go out and cheat, because I think it is taking an easy way
    to a big result. And I personally do not believe that the
    punishment should be any less. In fact, I think that when
    someone cheats and takes away a result from somebody who is
    working hard and doing it clean, that they should be given a
    harsh punishment.
        They are taking away someone else's dreams, and, you know,
    the hard work that someone else has put into it. And so they
    should be punished fully for it. I don't have a problem with a
    2-year bar for someone who is caught for steroids. I think it
    is appropriate. You are robbing someone else of their
    opportunity to see what they can do.
        I mean, the second place person may think that they could
    not win, or the person who got fourth and did not get on the
    podium. I think that is what gets forgotten a lot of times is
    we are hearing, we are hearing about the people who are winning
    who may have had, you know, given in to temptation or
    something; but what about the person who is fourth and who did
    not get to stand on the podium? That person deserves something
    too.
        Mr. Waxman. Ms. White, as you look back on your mistake,
    you knew it was cheating, you knew maybe that it was illegal,
    you knew you didn't want to get caught, because getting caught
    would deprive you of the award.
        What do you think more could have been done to have
    discouraged you from doing this? So we can learn for others. As
    you look at it retrospectively, what more might have had an
    influence on you not to take these drugs?
        Ms. White. You know, I have had that question asked a lot.
    I have been going over it. I can't think of much of anything
    that would have discouraged me at that time. I was at such a
    low point, that there is nothing else but being healthy--I am
    talking with all of the injuries, that I wanted to get rid of
    the injuries--so nothing else would have discouraged me from
    doing it at the time.
        The only thing, like I said, there were other people that I
    knew who were doing the same thing. Maybe had they been caught
    right before me, I would have been like, no, but in considering
    that THG had been around for years prior to my use.
        Seeing others get caught and pay a price for it, that would
    be something. You see someone you know with cancer and dying,
    seeing people tends to make you look at it differently. And it
    is the same thing with my situation.
        Mr. Waxman. Thank you.
        Chairman Tom Davis. Mr. Gutknecht.
        Mr. Gutknecht. Thank you, Mr. Chairman. And I echo those
    remarks. Thank you for just this unbelievable testimony. It has
    been very, very eye-opening, I think, to all of us. Just a
    couple of very quick questions.
        First of all, did you notice, you said you saw your body
    respond to these drugs very quickly. When you quit taking them,
    did you see your body respond sort of in that way; did the
    effect go away that quickly as well?
        Ms. White. The blood pressure took a little while to go
    away, with the increased menstrual cycle that--we changed the
    dosage I had been taking and that changed right away also. And
    the acne, that went away. That took a little while to go away
    also.
        Mr. Gutknecht. You also mentioned with not getting into the
    names, but there was a particular individual that you went to.
    Is it fair to assume that individual was consulting with other
    people as well?
        Ms. White. I am sorry?
        Mr. Gutknecht. I guess the point is, you went to a
    particular individual to get these agents, these drugs?
        Ms. White. Right.
        Mr. Gutknecht. It could be fair to assume that individual
    was consulting with other athletes?
        Ms. White. Yes.
        Mr. Gutknecht. It strikes me that it is not enough to do
    testing, there needs to be some level of enforcement for those
    people who are serving as a consult/physicians whatever. I
    mean, there must be a limited number of people who do that.
        Ms. White. I have always had that question asked also; how
    many people are out there doing this? But they are hard to
    find. And a lot of them are introduced to these people through
    coaches. And, it is--you do not usually find people directly.
    So that would be a very hard thing to do.
        Mr. Gutknecht. Well, it strikes me that might be a
    responsibility that we have here at the Federal level, either
    through the FBI or the Drug Enforcement Agency or somebody who
    ought to be trying to track down who these people are who
    become the conduit or purveyors in these kind of drugs.
        I think, perhaps, Mr. Chairman, at some future point we
    ought to consider how we track down these individuals who are
    really the dealers of these kinds of drugs?
        Thank you very much. I yield back.
        Chairman Tom Davis. Thank you very much. Mr. Cummings.
        Mr. Cummings. Thank you very much, Mr. Chairman. I thank
    both of you for your testimony. I want to go to you, Ms. White.
    You said something that was very interesting. First of all, let
    me say this, Ms. White. That you, I think what concerns me
    about--first of all, I am glad you testified.
        We had a Major League Baseball player here who could not
    admit that using steroids was cheating, and could not even get
    the words out of his mouth that he would plead the fifth
    amendment rights. And so I thank you for at least coming
    forward and trying to make a difference.
        Your testimony makes me wonder, though, about--you said
    some of the folks get caught but they do not get outed. What
    does that mean?
        Ms. White. I know of at least six athletes who tested
    positive, and we have not heard anything about that. Quietly
    they are banned. And, in that response, now that one gets
    caught, and it seems as if that can be OK to keep going on with
    the same behavior of these performance-enhancing drugs.
        Mr. Cummings. Do you think when Mr. Waxman asked you if
    there was anything that could have been done or anything that
    you would have seen that would have caused you not to do what
    you did, you said that you couldn't think of anything. That
    leads me to wonder, then, when you said during your testimony
    that you were working with your lawyer and others to talk about
    your story.
        And I am wondering, do you believe that your story then has
    an effect on other people that may find themselves similarly
    situated where you were? And I understand that you are a young
    woman, there are decisions sometimes, you know, maybe are a
    little difficult, and the lights seem a little hazy and there
    is a lot of pressure. But I am just saying there are a whole
    lot of women out there, just like Ms. Holden, who may employ
    one route; but I am just wondering, do you think that will have
    some impact when you do not think it would have affected you?
        I may be saying that improperly, but correct me if I'm
    wrong.
        Ms. White. Well, I can add a couple of things to that. One
    thing I wish I could change is that when I was approached with
    it in 2000, I wish I would have made the decision then to leave
    my coach. That really would have been the best decision,
    because he continued to urge me to use the drugs. And I think
    that with my story, and in talking about how painful it is to
    go through something like this, so that others will not go
    through this. I also believe that a lot of the pressures do
    come from not only what we see around us, but the people that
    we do spend most of our day with.
        I spent at least 6 or 7 hours a day with my coach. That is
    somebody that I have been working with since I was 12. So you
    tend to trust those people. And I think that we need to educate
    our coaches and others.
        Mr. Cummings. We do not need to educate our coaches, they
    need to understand that they ought to have integrity. That is
    what we need. That is the problem.
        And as I sat here and I thought about my little episodes
    with sports--never was a great basketball player, but I was
    pretty good at football--the coach becomes like a father. So if
    someone has a father-type figure that is saying do this, do
    this, do this, and it is not like you are some 45-year-old
    person, you are a young person, and the coach is saying do
    this, I think that is another type of pressure that--I mean we
    have to look at some of these coaches.
        And I am not trying the take the responsibility off of you,
    but that is extremely alarming that somebody who has a lot more
    experience in life than you, who was supposed to be guiding you
    in the right direction, would say something like that. I would
    have hoped that they would have said something like what Ms.
    Holden said; look, we are going to do this the right way or we
    are not going to do it at all.
        But anyway, you go ahead. I am sorry. Were you finished?
        Ms. White. Yes.
        Mr. Cummings. You said that you felt that the 2-year ban
    was not necessarily fair. Is that because you believe that some
    people have not been, as you say, outed; or do you believe that
    is just totally unnecessary, when you have admitted that it is
    cheating, when you have admitted that--I think you did--that it
    is unfair to other people, and when you have admitted that it
    is wrong? You know, this committee has taken a position almost
    that you should be thrown out of sports completely.
        But go ahead. I am just wondering what your response to
    that is.
        Ms. White. I would have to say that 2 years is pretty harsh
    in a sport. I think that even 1 year is a lesson learned. I
    learned it pretty quickly. It did not take me very long. So I
    think 2 years is very harsh. Because if you look at other
    sports, they are allowed to pay a fine, they are allowed to
    miss a game or two. So I do believe that our lessons are
    learned quickly. I do not think it takes 2 years to correct
    that mistake and to go back and compete clean again.
        Mr. Cummings. I see my time is up. Thank you, Mr. Chairman.
        Chairman Tom Davis. Thank you very much. Mr. Porter.
        Mr. Porter. Thank you, Mr. Chairman, and thank you, Ms.
    White, for being here. You have set such a great example for
    other young folks and other athletes around the country.
        And based on your experience, if there was just a few
    things that you could say to young women that would be under
    similar pressures, what would be your advice to them today, as
    they face similar challenges that you have through the years?
        Ms. White. I would definitely have to say that if you feel
    it is not right deep down in your heart, if someone comes to
    you with something that you feel is just not right, to talk to
    somebody about it, and to walk away from the situation.
        I wish I would have walked away a long time ago, even
    before the usage. And just looking at my mistake, I have paid
    greatly for it, and I will always be looked at differently. And
    I don't believe that is the person that I am deep down, and it
    has changed how people look at me, and I wish that I can go
    back and change that.
        Mr. Porter. Thank you.
        Chairman Tom Davis. Mr. Lynch.
        Mr. Lynch. Thank you, Mr. Chairman, and Ranking Member
    Waxman. I appreciate your focus on this issue. I want to thank
    both of our panelists for coming forward. It takes a lot of
    courage I think in both of your instances.
        I have a 5-year-old daughter and a 10-year-old at home, and
    I worry about whether they are going to face the temptation and
    the same difficulty that you girls have, you women have.
        And I am just curious, in your testimony, Ms. White, you
    said that you had passed 17 drug tests, even though you had
    been taking illegal steroids. Seventeen times. With all of the
    time that you are focusing on training and doing all that you
    have to do to compete, you must have had fairly close--I think
    Ms. Holden referred to it as tutoring, from either Mr. Conte or
    someone else to give you what you needed to enhance your
    performance and then to mask it.
        How did that all happen? I mean, are these people just
    waiting out there to corrupt young athletes such as yourself?
        Ms. White. I do not think it has to do with them waiting to
    do that. Like I said before, I was introduced to him by my
    coach. And it was--it is a service. You basically pay for that
    service. And that is why I really did not have, you know, much
    worry about being caught, because I knew that I was paying for
    a good service.
        And it is a very complicated system that--to do this. It is
    very complicated. And the problem that the drug testers have is
    that the drug makers are far, far ahead of the drug testers.
    And they need to figure out how they can make the gap smaller.
        Mr. Lynch. Now, I understand you received a 2-year ban. Did
    you know that was pretty widely publicized that was the
    consequence for someone who tested positive, a 2-year ban?
        Ms. White. Yes.
        Mr. Lynch. So you knew that? What about Mr. Conte? What
    about people in his situation, where, if he was selling heroin
    or something like that and destroying lives and careers by
    doing that, he would be away for a long, long time; what are
    the consequences for people in that position who corrupt young
    athletes?
        Ms. White. Nothing.
        Mr. Lynch. Nothing. Well, that is something we might need
    to look at.
        Ms. Holden, do you see anything out there that could
    undermine the culture that you fought? You are an Olympic
    Champion, and you have every right to be proud of that.
    Certainly your country is very proud. Is there something that
    you would see that would be readily available to undermine the
    culture; because it has to be starting at a lower level; people
    do not all of a sudden get up one morning and say, OK, I am
    going to take steroids to compete. There has to be some
    acceptability or some receptivity in the younger athletes to
    get them to take that step, to cross that line, as Ms. White
    said.
        Ms. Holden. Well, I think that all sports should be held to
    the same accountability level that Olympic sports are held to.
    I think that would go a long ways into showing younger
    generations that they cannot cheat in order to win. You know,
    it is no signal to our youth if we have professional sports not
    giving strict punishments on doping offenses.
        And it should be standard across the board. I think that
    would be a huge deterrent. If they thought that they could
    maybe not get their scholarship to college because they tested
    positive, or continue on into professional sports because they
    had to sit out too long and they couldn't proceed with their
    training or whatever, I think that would be huge.
        Mr. Lynch. Those are great suggestions. I want to thank you
    both again for your willingness to help this committee with its
    work.
        Thank you. I yield back.
        Chairman Tom Davis. Thank you very much.
        Mr. Shays.
        Mr. Shays. It is so refreshing to be at a hearing like this
    and to hear two very articulate young and fine people give such
    candid testimony. And I contrast it to not just the baseball
    players who were with us, but the players' representatives, the
    commissioners of baseball, you put them--both of you put them
    to shame. And I just want to thank you for being so candid.
    You're helping us understand something that we don't
    experience. We don't know what it's like to be a celebrity, we
    don't know what it's like to seek this kind of success.
        Ms. Holden, you come across in a very strong way, which is
    the way I would want my daughter to; but I'm just wondering, do
    you feel like you were ever tempted? I mean, do you feel like
    were you faced with the same kind of temptations that Ms. White
    may have had with her own coach doing that? Did you have your
    own coaches saying you need to do this and so on?
        Ms. Holden. I was very fortunate in the sense that my
    support group was really positive in backing my wanting to do
    sports without drugs. It sounds to me like Kelli's support
    group wasn't as strong as mine was in the sense of wanting to
    stay clean. And in that sense, I was able to go to Europe with
    that in mind and know where my boundaries were. And you could
    get the sense that someone was trying to offer you something;
    once they realized that you weren't going to do anything, that
    was pretty much where the end of it was for me. Like I was not
    approached in the same way, constantly prodded to do any
    doping.
        I think that people knew my stand on being clean, and it
    was never a problem for me.
        Mr. Shays. Ms. White, I think almost everyone makes
    mistakes they regret, but the mistakes that I might have made I
    made when I was 7 or 8 years old. And my dad--I don't want to
    say beat the hell out of me--but he got my attention. And what
    I'm interested to know is, I'm interested to know when you were
    caught, what did your coach say to you?
        Ms. White. The first thing he said was, it's no problem;
    we'll train for the next 2 years. And that was it.
        Mr. Shays. Has he--you felt--I read an article that said
    you've lost your friends. And I would weep to think that you
    would lose any friends. I would like to think that, given what
    you've learned at an older age, that you would have gained
    friends. But what has been, as far as you're aware, the penalty
    that the coaches paid?
        Ms. White. None. None at all.
        Mr. Shays. Is he still coaching?
        Ms. White. Yes.
        Mr. Shays. He's still out there; he still has people he's
    training. And this was someone that basically was encouraging
    you to take drugs?
        Ms. White. Correct.
        Mr. Shays. Mr. Chairman, it seems to me that's an area that
    this committee--Mr. Cummings, you alluded to this and others--
    that's an area that we need to spend a tremendous amount of
    time on.
        You know, when you hear good testimony, sometimes you don't
    need to ask a lot more questions. And I just--I appreciate no
    excuses, and I appreciate--I get a sense that--well, let me
    just ask this point.
        Ms. Holden, when you were racing against people that you
    believed were using drugs, was it almost like feeling like you
    were competing against a machine? I mean, somebody who was
    basically--and tell me the emotion. I'd like to hear it.
        Ms. Holden. Well, I mean, not necessarily like you were
    racing against a machine, because there are a lot of other
    factors that go into racing besides just being strong----
        Mr. Shays. I guess the question I'm asking is, was that a
    hurdle that you had to overcome? I'm just trying to think, if
    I'm racing against someone and it's pretty close and I want to
    beat them, I'm still thinking, my God, this person has an
    advantage that I don't. Did you find yourself, even during the
    competition, thinking it; or once you were in competition, you
    put it out of your mind?
        Ms. Holden. I tried to put it out of my mind when we were
    in competition, because personally I just felt like I knew
    where my mind was; I wasn't willing to do any drugs, so this
    was the hand that I was dealt competing against these women.
    And I still felt confident that given the right day, the right
    training, and having everything come together, you could still
    get a good result in a 1-day race. So I just went out there and
    did the best I could and just tried not to think about it,
    because I figured that if they weren't getting caught, maybe
    they would get caught at some point. And it did happen, so----
        Mr. Shays. Ms. White, I appreciate your comment that when
    you were winning, you didn't feel like you were winning. And
    the message that you have given other people who are competing
    is that they realize that for you that wasn't success, even
    when you were succeeding. And that's a nice thing, I think, to
    make sure that young kids know. Thank you.
        Ms. White. Thank you.
        Chairman Tom Davis. Thank you very much.
        Ms. Watson.
        Ms. Watson. Mr. Chairman, thank you very much.
        I want to say to Ms. White and Ms. Holden, it takes a lot
    of courage to come in front of a congressional committee. You
    know, we sit on high; if you notice, we're elevated and you sit
    down in the pit and we question you. So I want to thank you for
    your courage in coming forward.
        Both of you have risen to the top of your sports, and are
    admired globally for your physical accomplishments. Children in
    particular look at you as role models. And I'm very, very
    worried that the adult athletes who have cheated are held in
    high esteem.
        As a child, I used to think of being a sportsperson as
    something to ascend to, and sports were the way people should
    live their lives, in a sportsman-like fashion--sportswoman,
    sportsperson. I see a culture out there, not only in sports but
    on the streets, a drug culture.
        And so what I want to do is to look at the two of you, and
    first start with Ms. Holden. What was it that led you away from
    cheating?
        And, Ms. White, what was it that led you into the use of
    steroids? What is in our culture; what is it that we don't do
    that we should do so that we won't have this occurring? Because
    behind you come millions and millions of young people who want
    to succeed just like the two of you have. So what can we put
    into the culture and into education, into training, that would
    stop the shortcuts and look down the road to your physical
    best, your excellence in whatever you pursue?
        Ms. Holden, what kept you clean?
        Ms. Holden. Well, I think a lot of it is what Kelli was
    talking about, with how bad she felt that she had cheated after
    it. I guess I always thought about that, and I knew I wasn't
    willing to look at my results in that way. I wanted to make
    sure that when I looked at them, I could show them to my kids.
    I could take out any medal I might get, or something, and be
    able to tell them about how I earned it, the things that I went
    through in order to get there. Those are the things that I
    treasure almost more than the medal itself, is being able to
    look my parents in the face and tell them--you know, be excited
    about a result.
        I think it's unfortunate that so many people want to take
    shortcuts, because I think you miss out on a lot of the lessons
    that you want to get out of it along the way. And I think that
    by succumbing to doping or cheating, you're taking away the
    opportunity for them to get the self-confidence and everything
    that should be coming out of sports and just undermining
    yourself.
        Ms. Watson. I heard you use the word ``confidence.'' Your
    confidence was built how; your self-confidence?
        Ms. Holden. Well, a lot of my confidence has been built
    through my trials and tribulations through sports.
        Ms. Watson. Your family?
        Ms. Holden. My family was a big part of it, always backing
    me on everything that I wanted to do. My coach stood behind me
    and helped me get through situations when I felt like I
    couldn't succeed. There are always points when you're worried
    and you don't know if you can make it.
        I don't know how many times I wanted to quit during my
    career, but I think that my not quitting and going forward and
    trying to do it in the right way, you become self-confident,
    you get self-esteem. And I think these are the things that are
    so important that you get out of sport, that are especially
    important to young women who are growing up.
        Ms. Watson. What can we do in our schools?
        Ms. Holden. I think what's going on now in schools is
    great. I think there are more opportunities for women in
    sports. Unfortunately with that opportunity, if women have more
    professional sports, I think there are going to be more
    problems with doping coming up in the future, because with
    increased money, you have increased pressure. And so I think
    it's important for groups, for USADA especially, to have the
    funding to try and combat doping, because I think that those
    things that we're learning from sports are so important.
        Ms. Watson. Ms. White.
        Ms. White. Mari said in her testimony that there should be
    a support system for athletes who compete clean, and I think
    that there is. I think that we glorify winning more than
    anything. And I think that we should also look at what comes
    along with that, how to do that properly and with integrity. I
    don't think that's emphasized at all, and it should be. And I
    think that's where--it made me come forward with my story as to
    how horrible I felt about what I had done. And I don't ever
    want someone else to go through the same thing that I did at
    all. It was just something that I really do regret.
        Ms. Watson. At what age----
        Chairman Tom Davis. The gentlelady's time has expired.
        Ms. Watson. I'm out of time?
        Chairman Tom Davis. Yes. Thank you.
        Ms. Watson. Let me end by saying, as you respond to others
    you might want to indicate at what age, what stage, did you
    feel you needed some supplements.
        Thank you, Mr. Chairman.
        Chairman Tom Davis. I think in her written statement it
    does talk about how she got into this, at length. But thank you
    for your questions.
        Mr. Dent.
        Mr. Dent. Thank you, Mr. Chairman. I would like to yield my
    time to the gentleman from Connecticut, Mr. Shays.
        Mr. Shays. Just for this question that I want to ask both
    of you, because we asked the baseball players this.
        If you saw someone cheating I want to know how you would
    react to it and what you would do, first, if it was a member of
    your own team, or maybe someone that you were competing with
    that wasn't part of your own team.
        I'm going to start with you, Ms. White. Someone is
    cheating, you know they're cheating, what are you going to do
    about it?
        Ms. White. You mean now, or what would I have done then?
        Mr. Shays. I want to know what you should do about it, what
    you would tell any athlete to do about it. You're aware that
    someone--let's just say you're part of the Olympics and this is
    your team. How would you deal with that? If you want a chance
    to think about it, I'll ask Ms. Holden, but I want to know how
    you would deal with that. Would you ignore it? Would you speak
    to the person? Would you go to the coach? Would you speak with
    the person, and, if you didn't get a good answer, go to the
    coach? The person is cheating, right?
        Ms. White. Right. And now--now I would definitely say
    something to them. I don't--I probably wouldn't take it outside
    of that. I think if--from my experience, I think what I would
    have to say to them would be so strong that they probably
    really would reconsider it, just from my experience. It was
    just--it's just a hard battle. It's been a 2-year nightmare,
    and going on 3, so I would have to just talk to them about
    that.
        Mr. Shays. What happens if you were aware that there was a
    coach, a trainer, that was getting people to cheat; what would
    you do in that case?
        Ms. White. That is a different situation. I would go over
    their heads, because they affect more people than just that one
    person that is taking the drug. That's just them, really. But
    the trainer, coaches, they--it affects many more lives and
    people, so I would definitely go over their heads to make sure
    that the problem doesn't spread.
        Mr. Shays. Ms. Holden.
        Ms. Holden. If I hadn't actually seen them cheating or----
        Mr. Shays. You saw someone cheat, there is no question they
    were cheating.
        Ms. Holden. There was no question.
        Mr. Shays. No question.
        Ms. Holden. Well, then I would say something about it. I
    would first tell them and give them the opportunity to go turn
    themselves in; and then I would say something, too, if you knew
    they were cheating. The problem is, is that people don't cheat
    right in front of you, so you don't want to label yourself as
    someone who's, you know, going out and telling on everyone. So
    I mean, it's hard to have direct proof of doping unless someone
    fails a doping test.
        Mr. Shays. I think that's fair, and that's why it's a
    hypothetical question. But I think, Ms. White, given your
    experience, if you saw someone cheating, and you're saying all
    the things that you've said, that you would need to speak to
    them. And if they didn't respond, I think you would have to do
    what Ms. Holden did; you would have to say to them--and you
    know they've done it, it's not a question, I think you have to
    do more than that, frankly. Maybe it's a little more difficult
    for you to do that, because you feel maybe a little more
    hypocritical, since you've been there. So I'd cut you a little
    slack there.
        Thank you. And thank the gentleman for yielding.
        Chairman Tom Davis. Thank you.
        Mrs. Maloney.
        Mrs. Maloney. Thank you, Mr. Chairman. And I want to thank
    all of my colleagues in the Government Reform Committee for
    lifting the veil of secrecy that has hidden the steroid use in
    professional sports for far too long. And I thank the panelists
    for your courage in coming forward today.
        I have received countless calls from constituents who are
    eager to see American athletes return to their fundamental
    values of integrity and honest competition. As a mother of two
    children, I am particularly--two young girls--I am particularly
    disturbed to learn that steroid use is increasing, especially
    by young women, and it is being used not only to enhance their
    athletic performance but to attain a near impossible standard
    of beauty.
        This statistic I find startling, and I'm sharing it with my
    colleagues, that the Centers for Disease Control reports that
    5.3 percent of girls between 9 and 12 have used steroid pills.
    And the rate of teenage young women using steroids has nearly
    tripled in the last decade alone. And obviously we have to
    approach this problem from treatment--from two angles:
    treatment and intervention. But the problem also has to be
    attacked at the level of family, community, and schools.
        But I believe it is also a problem that must be approached
    on a cultural level. And my question to our two panelists is,
    really, the effect of messages from our media industry and what
    these messages send to young women for near impossible body
    looks and so forth.
        And it's very troubling. Obviously every athlete is a role
    model to other young men and women, and if one is using
    steroids, it obviously encourages others to do so. So it's
    very, very troubling.
        And, basically, how many young women will have to struggle
    with cancer or liver damage or masculinization of their bodies
    before we take a real honest look at the cultural influences on
    young women? And I'd like you to comment on it, the impact of
    the media and the media industry and the messages that they are
    sending to young women that may influence them to take
    steroids.
        Ms. Holden. I think that the media is actually giving a
    better body image than they did a few years ago, in part
    because women's sports are becoming more popular and a little
    bit more realistic than the stick-thin models of the past.
        As far as the steroids abuse in young women, that--I can't
    really speak to them wanting to masculinize their bodies, and I
    hope that the over-muscular women aren't the ones that they're
    trying to become like.
        Ms. White. It is a very disturbing thing to find out that
    there are nonathletic women taking steroids, because I didn't
    realize that you can actually get an effect from not working
    out with them. I thought that you had to be doing something
    with them to be taking any effect.
        And I think the media, it is kind of--they do play a role
    in the image of what women should look like. And I've also even
    fallen into it a little bit just in the glamorization of myself
    and looking at different TV shows of plastic surgery shows and
    things like that.
        So there are a lot of pressures to look a certain way, but
    I think that's why we should also encourage the flip side to
    that and teach women how to be comfortable with their bodies,
    in what they have been given in themselves.
        Mrs. Maloney. How do we teach them to be comfortable with
    themselves?
        Ms. White. The same way that we tell them that it's OK to
    change their body if you feel like it. We should also in school
    teach--as we teach any other subject--a confidence course. I
    don't know; I mean, I think men need it also because----
        Mrs. Maloney. Do you believe that young athletes may be
    more likely to use steroids because some professional athletes
    may have used steroids during their careers, successful
    athletes, that comes after using steroids? Do you think that
    younger athletes are thereby encouraged to use them?
        Ms. White. I don't think that comes from just the
    professional realm, just the pressure. It goes even further
    down, to making it just to the next level, from high school to
    college, from college to the professional arena. I don't think
    it necessarily comes directly from a certain person. I just
    think the pressures from those around us are just a little
    bit--are high.
        Mrs. Maloney. My time is up. Thank you.
        Chairman Tom Davis. Well, I just want to thank this panel.
    It has been very, very helpful to the committee. We appreciate
    very much you taking your time today in each of your cases,
    from different perspectives, coming out with your stories. It's
    been very helpful. So I dismiss this panel.
        We will take a 3-minute recess while we get the next panel.
    Thank you very much.
        [Recess.]
        Chairman Tom Davis. Thank you very much for your patience.
    We had a great first panel, and we have now a very
    distinguished second panel as well.
        We have Dr. Diane Elliott, professor of medicine at Oregon
    Health and Science University, and thank you for being with us
    today; Dr. Todd Schlifstein, clinical instructor at the New
    York University School of Medicine; Dr. Harrison Pope,
    professor of psychiatry at the McLean Hospital in Belmont, MA
    and Harvard Medical School; Dr. Charles Yesalis, professor of
    health policy and administration at Penn State; and Dr. Avery
    Faigenbaum, professor of health and exercise science at the
    College of New Jersey.
        Thank you all for being with us. It's our policy we swear
    people in before they testify, so if you would just rise with
    me and raise your right hands.
        [Witnesses sworn.]
        Chairman Tom Davis. Dr. Elliot, we'll start with you. Thank
    you for being with us.

     STATEMENTS OF DR. DIANE ELLIOT, PROFESSOR OF MEDICINE, OREGON
     HEALTH AND SCIENCE UNIVERSITY; DR. TODD SCHLIFSTEIN, CLINICAL
        INSTRUCTOR, NEW YORK UNIVERSITY SCHOOL OF MEDICINE; DR.
       HARRISON POPE, PROFESSOR OF PSYCHIATRY, McLEAN HOSPITAL,
     BELMONT, MA, AND HARVARD MEDICAL SCHOOL; DR. CHARLES YESALIS,
    PROFESSOR OF HEALTH POLICY AND ADMINISTRATION, THE PENNSYLVANIA
    STATE UNIVERSITY; AND DR. AVERY FAIGENBAUM, PROFESSOR OF HEALTH
            AND EXERCISE SCIENCE, THE COLLEGE OF NEW JERSEY

                    STATEMENT OF DIANE ELLIOT, M.D.

        Dr. Elliot. Thank you for inviting me to participate.
        I'm a physician and professor of medicine, and with my
    colleague, Linn Goldberg, and a dedicated team of researchers,
    we have been working with young student athletes for more than
    a decade.
        I know the committee members are becoming experts on
    steroids, and I want to speak to their use among young women.
    You know, your testicles make testosterone, which change boys
    to men, and ovaries produce estrogen, which transforms girls to
    women. The two hormones are closely related, and our cells can
    respond to both in unique ways. Because a woman's testosterone
    level is 2 percent of adult men, lower doses of steroids can
    have marked muscle-building effects and ratchet up a woman's
    muscle size and strength, and they are made to order for
    females wanting to lose body fat and gain muscle. Potential
    additional benefits include making women feel more aggressive
    and powerful.
        Steroids also have masculinizing side effects for women,
    including voice deepening, facial hair growth, acne, clitoral
    lengthening. During adolescence, when our own hormones are
    kicking in, factors affecting drug use and its consequences
    begin to differ for men and women. Women, more so than men, are
    affected by sexual stereotyping and promoting a body that is
    neither healthy nor feasible, which can make a woman feel
    inadequate and motivated to buy clothes, use make-up, and use
    drugs to achieve that end.
        The unrelenting pressure to lower body weight is a factor
    that promotes disordered eating and use of body-shaping drugs
    such as laxatives, diuretics, diet pills and steroids. For
    young female athletes, societal pressures can be compounded by
    the pressures of their sport, the pressure to win, and increase
    their risk for these problems.
        Recent attention has been drawn to young women's anabolic
    steroid use. A 1993 large survey showed an increase in use
    among young women. Every other year, the CDC surveys a national
    sample of 15,000 9th through 12th graders. In the most recent
    2003 data, 7 percent of ninth grade girls reported AS use; 7
    percent using steroids is higher than other national surveys
    and our own data, which are closer to 1 or 2 percent use among
    young women. True rates may be difficult to determine. Women
    who tend to use drugs alone, are better able to conceal drug
    use, and the potential shame and stigma may lead to a bias to
    underreport.
        There appear to be two groups of young women steroid users.
    The first and larger subset use steroids once or a few times,
    and have more disordered eating behaviors and use of other
    weight-loss or other body-shaping drugs. A common misconception
    is that young women with disordered eating are good girls who
    obey all the rules. In general, disordered eating habits
    cluster with other health-harming actions, including drug use.
    The sequence may be that girls have low self-esteem, feel
    depressed, and engage in disordered eating and body-shaping
    drug use, and then progress to use of other drugs and alcohol.
        Girls reporting steroid use also use more alcohol, tobacco,
    marijuana, and other substances. They have greater risk for
    drug use, including more depression, greater perceptions that
    others are using drugs, and fewer rules, explicitly rules
    against their use. Less than half of these girls are in team
    sports.
        My interpretation of the younger girls' use of 7 percent is
    that they're indicating they're using drugs that probably
    aren't steroids. Unlike most drugs, which have an immediate
    effect, steroids take time to see an effect. So after a few
    days of using these drugs nothing is happening, not like when
    you take a diuretic or laxative, and they may stop use. As they
    get older, they recalibrate to what steroids actually are, and
    that's why the use drops among older girls.
        Still, 1 to 2 percent is significant when applied to a
    population and comparable to those using crack or LSD. The
    second group of young women steroid users use them more
    frequently, and they're a unique group. Many carry guns; have
    missed school because they felt unsafe; and half are trying to
    gain, not lose, weight. Depression is common, and almost half
    of these high-end users have attempted suicide in the last 12
    months.
        So for most young women, steroids are not about being great
    athletes; they're markers for problems and clusters of health-
    harming behaviors. In general, for young women and men being in
    sports neither markedly promotes or protects from drug use.
    What being in sports does is provide an ideal solely for
    promoting healthy life-styles and learning skills that will
    deter health-harming behaviors. We took advantage of those
    features with the ATLAS and ATHENA program.
        ATHENA is a program for young women athletes. And while
    both programs share the team setting, the content is specific
    for each sex. During the sports season, the programs are
    incorporated into a team's usual practice activities. Each
    session uses scripted lesson plans for peer-led fun activities.
        With NIDA funding, we studied ATHENA among 40 sport teams
    from 18 high schools in Oregon and Washington. Following the
    program, girls in ATHENA had less new and ongoing diet pill
    use, and less new use of athletic-enhancing substances,
    including steroids, amphetamines, and sport supplements. They
    also had less riding in a car with a drunk driver, less sexual
    activity, and fewer injuries. They ate better and strength
    trained more effectively.
        We continue to follow those young women, and assess them
    again a year after high school graduation. The ATHENA graduates
    reported less use of alcohol, tobacco, and marijuana. Those
    long-term findings show that drug prevention can work, and
    focusing on risk factors and healthy decisionmaking skills can
    have a lasting impact.
        Today, scholarships and even an occasional career in
    professional sports are attainable goals for women. While there
    may be parity in sport participation and college scholarships,
    the financial and career potential of professional sports is
    much less for women. And most people would find it difficult to
    name five active professional women athletes who have not made
    millions.
        Drugs are bad, sports are good. It's commendable the
    committee is showing concern for America's youth and recognizes
    the national significance of drug use. Reducing drug use among
    professional athletes sends a message that steroids and other
    performance-enhancing drugs are not tolerated.
        I'm a doping control officer for USADA because I believe
    athletes should not be pressured to use drugs to compete.
    However, I've outlined the factors that women's drug use and
    drug testing Olympic or professional athletes will not impact
    on those risks.
        It's also unrealistic to think that drug testing
    professional athletes will clean out boys' locker rooms. Ben
    Johnson had his Olympic medal taken away for steroids before
    most adolescent athletes were born. You've heard that the NFL
    has a drug testing program, but recently there has been steroid
    use among high school football players. The steroid genie is
    way out of the bottle and drug testing professional athletes
    won't put it back. Elite athletes are but one influence on
    young males' performance-enhancing drug use. Adolescents know
    anabolic steroids work. They know they're illegal. And they
    know they have side effects. However, when they use steroids,
    most are not thinking about professional careers, or even
    college. They feel invulnerable and want a shortcut for looking
    better next week and playing better next weekend. That's why
    effective education is a critical component.
        Last year Congress passed and President Bush signed the
    Steroid Control Act. It included funding of science-based drug
    use prevention for children and adolescents. To date, those
    funds have not been appropriated. Sports teams have untapped
    potential as settings to positively impact behaviors. Funding
    the Steroid Control Act that you already passed will go a long
    way for giving schools the muscle to get drugs out of youth
    sports and allow programs with proven success to strengthen
    sports' health-enhancing mission.
        Thank you.
        Chairman Tom Davis. Thank you very much.
        [The prepared statement of Dr. Elliot follows:]

        Chairman Tom Davis. Dr. Schlifstein.

                  STATEMENT OF TODD SCHLIFSTEIN, M.D.

        Dr. Schlifstein. Thank you. I'm a sports medical physician
    at NYU Medical Center. I teach at the School of Medicine on
    anabolic steroids. I teach a sports medicine course which
    lectures on all types of supplements, including steroids. I go
    around lecturing to local high schools about supplements and
    steroid use. And I also do the same positions for professional
    sports, college sports, as well as do physicals and treat high
    school athletes as well.
        Use of anabolic steroids is coming into the spotlight,
    especially over the last several months. Attention has been
    focused on professional sports. However, the use of steroids in
    professional sports may have a large trickle-down effect to
    college athletes, high school athletes, and nonathletes.
        Recently, new studies have brought evidence of the use of
    steroids by females who are both athletic and not athletic.
        Anabolic steroids are ergogenic aids. What does that mean?
    That means they're a supplement used to enhance performance.
    Anabolic steroids are androgenic derivatives of the male
    hormone testosterone. There is no pure anabolic compound out
    there. That is to say that there is no substance that also has
    all the androgenic properties or male hormone effects.
        Now, designer steroids are made specifically to increase
    the anabolic effect while decreasing the androgenic effect in
    order to get the maximum benefit with the least side effects.
    Designer steroids also came to the highlight because they also
    were designed not to be picked up on drug testing; and that is
    where, for example, THG came to the forefront.
        The incidence rates in young children, adolescents,
    teenagers, and especially females, is very difficult to
    determine. There are several studies that people have been
    referring to, and you can go back into the Journal of the
    American Medical Association back in 1998 where the incidence,
    even in junior high school, varied from 1 to 11 percent, and in
    high school as well.
        More recently, the Center for Disease Control studies show
    an incidence of 5 percent of high school girls were using
    steroids, 7 percent of ninth grade girls were using steroids,
    all without a prescription. These statistics compel us to look
    further at the use of steroids in females. More recently,
    patients have come to me and anecdotally discovered that they
    were taking anabolic steroids--young females, professional
    athletes, some not athletes at all, some professional models,
    other girls just trying to maintain weight.
        The question is, why would a young female put themselves
    through the risk of these things, knowing the side effects that
    there are? Anabolic steroids are generally used to help
    increase muscle mass and strength when combined with
    appropriate training. Two or more steroids taken together,
    stacking, which occurs in 6 to 12-week cycles, this can
    increase the level androgenic level 10 to 40 times normal in
    males. Now, in females, that would be greater than 100 times
    the levels tested for. The full benefit of these androgenic
    aids is incompletely studied and is very poorly studied of the
    hormone levels in females.
        There are several reasons why females, both athletic and
    not athletic, may look to anabolic steroids or may look to
    abuse anabolic steroids. Certain steroids are believed to have
    appetite suppressant effects. Some of these steroids are
    supposed to burn fat at a faster rate. Males normally have a
    higher percentage of lean body mass and less percent body fat,
    and a large effect of this is due to the male hormone
    testosterone. Testosterone plays a major role in the way that
    weight is distributed through the body and the way our
    metabolism works. All these methods may help to control body
    weight without having a muscle-bound body; in other words, in
    order to change one's ratio of fat to muscle, to be more lean,
    and to lose percent body fat as a way of controlling one's body
    weight by appetite suppression as well as weight control.
        Now certain steroids are believed to have certain
    properties than other steroids, meaning certain benefits are
    more anabolically mass building; other ones may have more
    appetite suppression effects or fat suppression or metabolism
    being accelerated. Clenbuterol, cytomel, parabolan, phenformin,
    these are all ones that are believed to have appetite
    suppressant effects as well as fat burning effects. So certain
    ones are more specifically attuned for different reasons.
        Now if one goes on to the Web, one will notice several
    things. You can buy these things on line, you can buy them on
    the Internet, and there are thousands of sites where you can
    buy these things. They will also tell you which ones to take.
    They will tell you, for girls, if you want to lose weight, if
    you want to have your appetite suppressed, they will tell you
    which ones to take and how to take it. They will tell you that
    they can reduce the side effects by taking it appropriately and
    not abusing it, and these are largely found all over the Web.
    So they're advertising to these people and encouraging them to
    use them and telling them that they can use them in a safe way.
        I've talked to other people in Italy, the Italian study
    that was going on, and they had a similar incidence rate in
    high schools that is comparable to the CDC study. I talked to
    people in Mexico about a study they were doing which also had
    similar rates. Mexico is another problem, as it can be bought
    over the counter without a prescription, and is very easily
    accessible. You can call them up and they will deliver it to
    your house.
        Other problems, on-line ordering and using anabolic
    steroids, is that you can make our own steroids. You can buy
    legal steroids that are made for cattle or for pigs. You can
    order it and it will be delivered to your house. And they will
    tell you how you can convert it so you can use it as an
    anabolic steroid. So people order large quantities of cattle
    hormones, which I spoke to a police officer yesterday about and
    DEA yesterday about, which is perfectly legal; but obviously
    this person is not raising cattle in Manhattan, unless there's
    a big supply of cattle in Central Park we're unaware of--that
    is producing mass quantities of anabolic steroids for years.
        I don't have to go over again extensively the major side
    effects or problems with anabolic steroids, especially in women
    and young adolescents: The closure of the growth plates; you
    will stop growing. That is not reversible.
        Some other side effects may be reversible: thinning of the
    hair, male pattern baldness, thickening of your skin, oily
    skin, acne, deepening of your voice. But some of these things
    may not be reversible. And they still have all the other
    negative effects from anabolic steroids as well.
        I know I'm over the limit. I just want to say one more
    thing. Also what this brings to our attention is that not only
    have I seen numerous patients who I haven't been looking at
    previously, who are young females, not athletic, using it to
    control weight. Now that we're opening our eyes and looking at
    this, we may be seeing a lot more of that.
        Now, there are no long-term studies that are looking at
    long-term side effects of steroids, and we don't know what kind
    of problems all these people are going to have 10, 15, 20 years
    from now. But also with this, we should also look at other
    substances that are being abused, other stimulants,
    amphetamines and other things that aren't banned, and should be
    banned, and are quite often abused with this. People who abuse
    steroids tend to be abusing a lot of other drugs at the same
    time.
        Thank you.
        Chairman Tom Davis. Thank you.
        [The prepared statement of Dr. Schlifstein follows:]

        Chairman Tom Davis. Dr. Pope, thank you.

                STATEMENT OF HARRISON G. POPE, JR., M.D.

        Dr. Pope. Thank you, Mr. Davis.
        Let me just preface my remarks by saying that I strongly
    support the efforts of this committee. I think that steroid use
    is a major public health problem here in the United States,
    both in professional sports and among young men, and also among
    elite women athletes, as our first panel so eloquently told us.
        And I also, in preface, would like to remind the
    committee--the comments by Mr. Cummings, who had to leave us--
    but even one case of somebody using anabolic steroids is one
    too many.
        However, if I could have the first slide, please, Scott.
    Having said that, let me just turn to the actual strict science
    here. And I would argue that as we look at the actual
    scientific data, that there is no methodologically sound
    scientific evidence that there actually is a serious problem of
    anabolic steroid use among teenage girls in the United States.
    So I'm not denying the severity of the problem, but
    specifically among teenage girls there is little evidence to
    support a genuine problem.
        And I would argue that this is called what we call ``false
    positive'' responses on questionnaires. And to explain that,
    let me just go through some slides very quickly.
        If I could have the next slide.
        Here is the much-quoted figure from the CDC that 7.3
    percent of these ninth grade girls stated on an anonymous
    questionnaire that they had used lifetime illegal steroids.
        But if I could have the next slide.
        Let me remind you what we mean by steroids. Anabolic
    steroids, the subject of this testimony here, are drugs like
    testosterone and its relatives, drugs that are used to gain
    muscle and lose fat, drugs that are a serious public health
    problem among men, and drugs that are illegal under DEA
    supervision. However, if a girl answers yes on an anonymous
    questionnaire, how can we be sure that she has used one of
    these genuine anabolic steroids?
        And if I could have the next slide.
        The answer is we can't. We can't go back and find the girls
    who answered yes, and ask them to clarify their answer to make
    sure that when they said yes, they were accurate; and that they
    had really used genuine anabolic steroids.
        Now on the next line, let's look at the actual question by
    the CDC. It simply says: During your life, how many times have
    you taken steroid pills or shots without a doctor's
    prescription? It doesn't specify anabolic steroids, it doesn't
    say steroids for muscle building.
        Well, now turning to the next slide.
        Suppose a girl has taken steroids from her dermatologist or
    used her mother's steroid skin cream for poison ivy, or she
    used an asthma inhaler that has steroids? Well, these are not
    anabolic steroids, these are corticosteroids. These are drugs
    that have no muscle-building abilities, they are not illegal
    under the DEA, they don't have a black market, and they are not
    drugs of abuse.
        Birth control pills, estrogen, and progesterone are
    technically a type of steroid, but they're not drugs of abuse.
    Then there are the so-called adrenal steroids sold legally over
    the counter, until last year, in health food and supplement
    stores. These substances are not true anabolic steroids. They
    have at most only weak anabolic properties, and are not the
    DEA-controlled anabolic steroids that I showed on my original
    slide.
        So if a girl answers yes on an anonymous questionnaire,
    just on the strength of having used one of these substances
    that she's using a steroid, it is not a real yes; it is an
    invalid answer.
        Now, going to the next slide.
        Suppose a girl gets the questionnaire and she has bought
    something in the health care store that she thinks is a
    steroid--like creatine or some pill with some name that is
    meant to sound like a steroid, like sterol pills, or similar--
    again, a girl may erroneously answer that she thinks she has
    taken real anabolic steroids, when in fact she has not.
        So, on the next slide.
        How would we resolve this dilemma? Well, the answer is very
    simple. We do a study where we actually go out and interview
    people in person, get a trained interviewer who will actually
    see these people and ask them to clarify and make sure that
    they really have used genuine anabolic steroids.
        And, on the next slide.
        There exists such a study; the federally funded National
    Household Survey--it's now called the National Survey on Drug
    Use and Health--actually does this. They send trained
    interviewers to see about 20,000 Americans and interview them
    in person about drug use.
        Now, if we look at the data from the next slide.
        The National Household Survey, when women were asked in
    person by a trained interviewer, thereby eliminating or
    minimizing this risk of false positives, we find that out of
    7,500 women, there were only 18 women, or 0.2 percent, who took
    real steroids. Now, admittedly this is from 1994, but a number
    of studies in the interval from now until the present--which I
    can't stuff into 5 minutes of testimony--have converged to
    suggest that once you eliminate this problem of false
    positives, that the true rate of real anabolic steroid use
    among teenage women is probably only a few tenths of 1 percent.
        So, on the next slide.
        The bottom line here is be very careful; do not be misled
    by rates of so-called steroid use when it's done by anonymous
    questionnaires, without confirmation to make sure that the
    answers were valid.
        And now if I could skip ahead two slides.
        Well, how could you prove me right or wrong? Well, it's
    easy to prove me right or wrong. What you do is you go out and
    you give the same question that CDC did, except this time you
    put in a line at the bottom saying: ``if you answered yes,
    please name the steroid that you used.'' And then we could find
    out if somebody lists a genuine steroid like testosterone, we
    know that it's a genuine yes; if they list something else, we
    know that it's a false positive.
        And alternatively--on the last slide--we could put anabolic
    steroids back onto the National Household Survey--or what is
    now the National Survey on Drug Use and Health--next year, and
    have interviewers ask people directly.
        Now, I will submit to you here under oath, on the record,
    that if you did this, with care to eliminate false positives in
    a scientifically rigorous fashion, that the true rate of real
    anabolic steroid use among teenage girls is still only a few
    tenths of 1 percent. And it's important for us to concentrate
    on this science because we've got to know where to apportion
    our resources in what is really a genuine problem.
        Chairman Tom Davis. Thank you very much.
        [The prepared statement of Dr. Pope follows:]

        Chairman Tom Davis. Dr. Yesalis.

                      STATEMENT OF CHARLES YESALIS

        Mr. Yesalis. Well, I'm going to depart from my prepared
    remarks to strongly disagree with my long-term colleague, Dr.
    Pope. First I want to start by looking at the motives. During
    the hearing so far----
        Chairman Tom Davis. This is the kind of hearing we like. Go
    ahead.
        Dr. Yesalis. Well, we talked about the benefits, perceived
    benefits of using anabolic steroids: adulation, financial
    rewards, scholarships, improved appearance, the competitive
    pressure on our young people to use these drugs. I don't know
    of any evidence why all those trends would impact young men
    greater than young women. So I think motivation applies equally
    across the aboard.
        Availability. A couple weeks ago I was in New York
    testifying at a criminal trial regarding anabolic steroids. I
    had in my hand a 10-week supply of human growth hormone, real
    stuff coming from Communist China. It cost $1,400. If any of us
    would have received this legitimately through a physician,
    going to a pharmacy, it would cost $2,500. I had 20,000
    Stanozolol pills in my hand, real stuff from Communist China,
    that cost $400; 20,000.
        Clearly the Internet is out of control, but the point I'm
    trying to make is it's available, and it's available equally to
    young boys and young girls.
        Three, effectiveness. These drugs are dramatically more
    effective on females than they are males. There is no debate
    about that. If you look at the data, not only the CDC's data
    but the Monitoring the Future data conducted by contract
    through the University of Michigan, showed, under the
    Monitoring the Future in 1989, it went--this is lifetime use--
    from 0.9 percent to 1.7 percent, approximately doubled. The one
    out of DSS went from 1989--it just didn't pop up to 5.3; it
    started at 1.2 percent in 1989, it went to 5.3. So this 5.3
    just didn't come out of nowhere; it's been increasing steadily.
        Also when we've done these surveys of children, there have
    been reliability studies that kids pretty much tell the truth.
    Now, you're not going to get that same level of candidness from
    an NFL player, an MLB player, but kids tend to tell the truth
    on these surveys. Surveys do have an advantage--applied
    surveys, questionnaires, do have an advantage over face to
    face. Sometimes when you see somebody face to face, it
    intimidates you. So the National Household Survey on Drug
    Abuse, as it was called back then, is a very good survey but
    there is not a consensus that it's gold standard.
        In regard to bias, if I had to--if you asked me where the
    bias is, it's underreporting. Dr. Goldberg, who had testified
    at previous hearings, agrees with me on that, along with Dr.
    Wadler.
        And with regard to confusion on this, I would submit if a
    kid is confused in that with one of these surveys, I would
    submit that the average kid, when it comes to this, has more
    street smarts than the majority of the people in this room as
    to what is really meant by these drugs.
        Well, what should we do? First of all, my background is
    public health, I'm an epidemiologist, and I would err on the
    side of caution. I'm assuming--I'm going to assume that we have
    200,000 to 500,000 young women in this country who have used
    these drugs at least once. And what do I mean by used at least
    once? Nobody uses one injection or one pill; it would have no
    impact. And these drugs are used in cycles which are 6 to 12
    weeks or more duration.
        I've been an educator for going on 30 years. Education
    isn't working on this. You need to add to educational efforts,
    some level of testing at the high school level, and test--
    random testing and testing with suspicion. I think that's
    imperative.
        And, finally, we have to give our kids a real clear message
    that steroid use, growth hormone use, and other performance-
    enhancing drug use will not be tolerated by their role models,
    these elite athletes.
        And I know that a very good bill has come out of this
    committee which would mandate that the WADA--World Anti-Doping
    Agency--lists the drugs be used, to take amphetamine use out of
    the NFL and pro baseball. It would also turn over testing to a
    disinterested third party so we don't have the fox guarding the
    hen house. And I think that's imperative; that if you keep
    letting professional and collegiate organizations do their own
    testing, you're going to give a horrible message to our
    children, and that has to be stopped. And a disinterested third
    party like USADA needs to take over the testing.
        Thank you very much.
        Chairman Tom Davis. And thank you very much.
        [The prepared statement of Mr. Yesalis follows:]

        Chairman Thomas. Dr. Faigenbaum.

                     STATEMENT OF AVERY FAIGENBAUM

        Mr. Faigenbaum. Mr. Chairman and committee members, thank
    you for inviting me to participate in this important hearing
    examining steroid use among young females.
        Although anabolic steroids, or, more appropriately,
    anabolic androgenic steroids, have traditionally been used by
    adult strength and power-athletes, in the United States the use
    of anabolic steroids has in fact extended to younger
    populations.
        While the use of anabolic steroids is generally higher in
    males than females, the CDC reports that adolescents have used
    or are currently using anabolic steroids. Researchers have
    recently suggested that anabolic steroid use may begin before
    students enter high school.
        It has been reported that up to 2.8 percent of middle
    school females report using anabolic steroids. The latest
    report from the CDC, as we have heard today, suggests that
    about 7 percent of middle school females have tried anabolic
    steroids at least once.
        While it appears that a growing number of young females in
    the United States are using anabolic steroids for nonmedical
    reasons, I do believe that the possibility of underrecording
    false negatives and overreporting false positives needs to be
    considered. As we have heard today, it is possible that some
    children and adolescents may have confused anabolic steroids
    with similar medications such as corticosteroids. On the other
    hand, it is possible that students may have underreported
    anabolic steroid use for fear of punishment or
    disqualification?
        In my opinion, some young females are in fact using
    anabolic steroids. The perceived benefits of anabolic steroids
    are not without serious consequences, which may include
    clotting disorders, liver dysfunction, reproductive
    abnormalities, and psychological effects, including
    uncontrolled aggression.
        The use of anabolic steroids by children and adolescents
    poses additional concerns because the use of these drugs during
    this developmental period may result in premature closure of
    growth plates that may result in stunted growth.
        In my judgment, it is reasonable to conclude that increased
    pressure in young females to excel in sports, as well as
    concerns that some females have about their physical
    appearance, may result in a perceived need for chemical
    interventions to enhance performance or alter body size
    favorably.
        At a time when the number of overweight children and
    adolescents in the United States continues to increase, it
    seems that some middle school and high school athletes and
    nonathletes may be tempted to use anabolic steroids for weight
    control and body fat reduction. Young females, like adults,
    want quick results. The CDC reports that 59 percent of adults
    and females are currently trying to lose weight.
        While anabolic steroids can in fact favorably alter body
    composition and enhance strength and power performance, users
    must participate regularly in a vigorous strength and
    conditioning program in order to achieve the desired results.
    Without the stimulus of strength exercise, anabolic steroids
    will not be ergogenic or performance enhancing.
        Findings suggest that children and adolescents are
    knowledgeable about the potential physiological effects of
    anabolic steroids as well as the potential influence of these
    drugs on physical appearance. However, their knowledge of the
    potential harmful effects of anabolic steroids, in my view,
    seems incomplete. These findings suggest that proactive
    interventions are needed, and that positive messages young
    females may receive about the use of anabolic steroids from
    peers, parents, coaches, and professional athletes are
    effective.
        In my opinion, the use of anabolic steroids by professional
    athletes contributes to the belief among some young females
    that anabolic steroids are not harmful. In my view,
    comprehensive anabolic steroid prevention education
    interventions, supported enthusiastically by health and
    physical education teachers, should begin before high school.
        In addition, our young females need to be provided with
    healthier alternatives to anabolic steroids. A well-balanced
    nutrition plan, combined with a fitness program that includes
    strength exercise, is a healthy alternative to harmful
    behaviors.
        In our youth physical activity programs over the past 20
    years for young athletes and nonathletes, our motto is, ``It's
    not what you take, it's what you do that counts.'' There is no
    replacement for a healthy diet, proper physical training,
    adequate sleep, and qualified coaching. The best ergogenic aid
    is, in fact, a well-designed training program.
        It appears that the use of anabolic steroids has, in fact,
    trickled down to young females. Health care providers, as well
    as teachers, youth coaches, and school administrators, in my
    view, need to be part of comprehensive steroid education
    interventions that are science-based and promote public media
    awareness. Additional research is needed.
        I also believe that reducing anabolic steroid use by
    professional athletes will have a positive impact on boys and
    girls. Thank you.
        [The prepared statement of Mr. Faigenbaum follows:]

        Chairman Tom Davis. Well, thank you all very much. Let me
    start the questioning.
        And Dr. Elliot, you mentioned in your testimony that the
    ATLAS and ATHENA programs have been effective and successful in
    promoting healthy life-styles and preventing steroid use for
    middle and high school age females. Do you have any idea how
    many high schools are currently implementing ATLAS and ATHENA?
        Dr. Elliot. I know it's in 30 States right now; I don't
    know how many kids have gone through.
        Chairman Tom Davis. Any idea why more schools aren't using
    the program.
        Dr. Elliot. Well, it's a new paradigm. It's health
    promotion not in a health class. It's in a role that coaches
    aren't used to; so it takes some additional effort, like
    funding the--appropriating funds to help tip that, to get it to
    take off, because it is a new way that coaches aren't used to
    doing these peer-led curriculums, even though the sport team,
    when you think about it, is certainly an ideal setting to do
    that: to teach healthy behaviors, to strengthen the things that
    protect girls from drug use, how to prevent depression, insight
    into the media, to increase their self-esteem, to reduce the
    belief that others are doing these things.
        Chairman Tom Davis. We have heard in some of our previous
    panels about how you could identify potential steroid use among
    young athletes, because they would bulk up, gain weight
    quickly.
        What are the warning signs that parents and teachers and
    coaches would look for in the case of females?
        Dr. Elliot. I think it is important to remember that
    steroids among young women is part of a constellation of
    health-harming behaviors, disordered eating behaviors, use of
    diuretics, laxatives. I think that it is important that you, as
    you have heard here, that parents state clear messages to their
    kids about not doing these things, they do things to help
    increase their self-esteem, that they reinforce, it is not
    about winning, that sports is about learning to be physically
    active, something you are going to do for life, the enjoyment
    of being with your teammates.
        I had to train myself not to have the first question out of
    my mouth is, did you win? It is not supposed to be about
    winning. And if they do suspect something, if they see that
    there is mood changes, kind of a funk last more than 2 weeks,
    that they ask the child about their suspect behaviors, saying,
    I have a concern about your behavior.
        And because I love you and care more about you and not
    about how you look and whether you win, ask them about it
    directly.
        Just in response to what Skip said, in our questionnaire,
    the words anabolic steroids are used to gain strength. They are
    not corticosteroids used for treatments of asthma or rashes. On
    how many occasions have you used anabolic steroids in pill or
    injectable form? Don't count pills you buy in health food
    stores. That gives us 1 or 2 percent girls answering positive
    to that question.
        Chairman Tom Davis. Thank you. Thank you. Dr. Schlifstein,
    as a doctor, do you ever ask patients where they obtain the
    drugs, and their knowledge on how to use steroids?
        Dr. Schlifstein. I always want to know who is giving it
    them or how they are getting it. Very rarely are they getting
    it from a physician. Very rarely. Lots of times they are buying
    it at the gym, or they are buying it on line, ordering it from
    other countries.
        I have patients that go to Mexico regularly just to pick up
    anabolic steroids. Other people are making it. They order
    cattle hormones, and then you can make it yourself, it is very
    easy to do. They will tell you how to do it online. You can
    make mass quantities. It is perfectly legal to buy the
    hormones.
        Chairman Tom Davis. You stated that an ergogenic benefit of
    steroids is incompletely studied in females. You also state
    there are no long-term studies on the side effects.
        Do you think that findings from recent surveys will
    generate a greater amount of research into female steroid use?
        Dr. Schlifstein. Hopefully it will generate more research.
    Certainly on the long-term side effects, no one has really
    looked at over a long period of time. We do not know what these
    people who have been using steroids for 5, 10, 15 years what is
    going to happen to these people 10 years down the road.
        A lot of the side effects that are well documented are well
    documented in short term. That just can be the tip of the
    iceberg. We do not know what kind of problems they are going to
    have 15 years from now. Studies in rats, most of the rats that
    were on steroids had at least a 20 percent reduction in life
    span.
        Chairman Tom Davis. Thank you. Dr. Pope, I am fascinated by
    your study on this, and have done some work on statistics. Let
    me ask you this, do you think that the potential shame and the
    stigma associated with steroid use could lead to an
    underreporting of the problem?
        Dr. Pope. Well, that is an issue that was just raised by
    Chuck. Maybe if I can ask your indulgence to have one more
    slide here, if I could see slide No. 5 from the supplemental
    ones there.
        Chuck raised the reasonable question, if you are in a face-
    to-face interview, maybe people are underreporting their
    steroid use. But we find that in the national household survey,
    which is the face-to-face interview, that the rates for other
    drugs like marijuana, cocaine and other drugs are pretty close
    to those obtained in anonymous questionnaires. So that would
    argue that underreporting is not a major--it may be some
    factor, but it is not a major statistical factor in these
    numbers.
        Chairman Tom Davis. All right. Thank you very much. My time
    is up. Ms. Watson.
        Ms. Watson. I have several questions. I am going to have to
    leave for another meeting. But let me just throw them out real
    fast.
        Dr. Pope, in listening to your testimony and seeing the
    slides, you talk about the face-to-face or the paper interview
    and response. What about the testing that is done? Has that
    been factored into your results?
        Dr. Pope. There is very little actual testing, urine
    testing for women or, even for that matter, men. On that point,
    I would side very strongly with what Chuck Yesalis said. We
    need targeted testing.
        So my answer to your question is, I am all for that, and I
    wish there were more of it, but alas, for our purposes in terms
    of making estimates we have very little.
        Ms. Watson. So you are saying that your look at the use,
    based on paper and pencil, or face-to-face interviews,
    indicates that it is not a widespread problem?
        Dr. Pope. Specifically among teen-aged women. Now, remember
    I am not questioning that it is a problem among elite women
    athletes, as we heard from your previous panelists. And I
    certainly don't question the problem among men.
        I do not question the fact that body image is a major
    problem for young women today. I'm specifically questioning a
    specific scientific point here, which is, the use of anabolic
    steroids by teen-age women, I believe has been exaggerated by
    these studies.
        Ms. Watson. So what you are saying is that we need other
    ways of testing this theory, or whatever you want to call it
    out, rather than giving an estimate, because I did see
    information that was prepared for us, that over 500,000 young
    people in athletics have used steroids.
        And I did not exactly know what the age levels were. So you
    are saying, young women below a certain age, not adult women,
    are probably not using to the extent that you think.
        Dr. Pope. Correct. Now, there are some adult women who have
    used steroids. And to my knowledge, the only actual peer-
    reviewed scientific study in which investigators actually went
    out and interviewed real women who had used steroids, to be
    published in the last 5 years was published by me in 2000. It
    was a NIDA grant, where we spent 2 years aggressively
    recruiting women steroid users.
        And in the eastern Massachusetts area, despite going to the
    most hard-core gyms and other places that we could find, we
    only located 17 women who had used steroids. And of these 17
    women, the number who had started using their steroids as
    teenagers was zero.
        By contrast, when we have done studies of male steroid
    users on various NIDA-funded grants, we have gotten abundant
    numbers of study subjects without any difficulty.
        Ms. Watson. Based on what you know, and what you have found
    from your studies, what are your recommendations?
        Dr. Pope. I think the first thing we need to do is what was
    on my last two slides, which is, to test this in a method
    designed to eliminate these so-called false positives, in other
    words, if you answer yes to the steroid question, fill in on
    the line below the name of the steroid that you took.
        Or use the national household survey, or as it is now
    called, the national survey on drug use and health, to get
    followup data with personal interviews, so that we can try to
    get some scientifically reliable data, up to the minute, on the
    true levels of steroid use among young women, so that we can
    decide how best to apportion our resources here.
        Ms. Watson. The professor who has my same first name,
    Elliot, Dr. Elliot, thank you for being here.
        I am kind of troubled by the testimony I heard from Dr.
    Pope as to our overestimating. But we do know that our young
    people are taking all kinds of drugs. If we delay some other
    form of testing so we can come to--we will have the empirical
    evidence based on scientific methods, what harmful affect can
    the taking of all of these different drugs, be they anabolic
    steroids or whatever they might be, what effect would it have
    in the long run by the time they get to be 21, 22, what effect?
        Dr. Elliot. Well, as I mentioned, it looks like for girls
    there is a progression of, in general, girls in adolescence,
    their self-esteem goes down. They are putting on weight and
    they are seeing images of lean, toned women, and that is not
    the normal change of adolescence for girls.
        They become depressed. They begin having disordered eating
    behaviors, and using body shaping drugs, one of which is
    anabolic steroids. But as I mentioned, it doesn't have an
    immediate effect like a diuretic or a laxative, and so you take
    it for a few days, nothing is happening, I get a pimple and I
    think it is a side effect and I stop it.
        I am still using a drug, I still have disordered eating
    behavior. You could have prevented that if there had been a
    program to help me prevent getting depressed, to increase my
    self-esteem. Girls are more quickly addicted to drugs, and then
    have problems as an adult, so that disordered eating may
    progress to use of alcohol and other drugs.
        So it is too late if they had a heart attack. I really need
    to treat high blood pressure and get people's cholesterol down.
    Because if I wait until they have real problems, then it
    becomes a big societal problem, there is increased drop-out
    from school, pregnancy, continued problems with other drugs,
    moving on to other types of addictions.
        Today, a girl today, compared to when I was a girl, is 15
    times more likely to become addicted to drugs. It is a problem
    that can be prevented. Testing for anabolic steroids is very
    expensive. Most drug testing programs in high schools do not
    test for anabolic steroids.
        Ms. Watson. I see. I am a former school board member. And I
    also sat on the Senate Education Committee for 20 years. I am
    very concerned about where we go from here. I think whether we
    under or overestimate, we have a problem in this country with
    drug use. And you cannot turn on your television, you cannot
    turn on your radio, you cannot read a newspaper or magazine
    that we are not pushing drugs.
        So from the other doctors on the panel, how can we address
    the use of drugs of any kind, and, you know, maybe they are not
    anabolic steroids, but somewhere along the way, as Dr. Eliot
    just said, it grows by degrees.
        You know, I have a headache. Well, it is a constant
    headache, so I need to use something stronger than an aspirin.
    And how do we, you as medical professionals, and us as
    educators and legislators, how can we--what methods, what
    options do we have to address, regardless of the numbers, Dr.
    Pope, how can we address this excessive drug use?
        Dr. Yesalis. The old fashioned hearing, I advise people to
    go back to basics. You know, in our increasingly secular
    society, I don't think moms and dads are giving constant
    messages to their children about appropriate behavior, drug
    abuse being one of them.
        And I emphasize the word ``constant.'' They need to get
    that word when it comes to performance drugs constantly from
    the coaches, with the same amount of energy as a coach gives a
    half-time talk.
        And, look, if our kids do not have well-established moral
    boundaries that they know not to cross over, all of the
    education in the world just isn't going to cut it. And I think
    that is where, in my lifetime, I am 58, that is what I have
    seen, that we are, more and more of our children are getting
    these messages. Well, it is not cheating if everybody does it,
    or it is only cheating if you get caught.
        Moral relativism. Situational ethics. That is, in my
    judgment, that is root of all of this. And people like us, all
    we do is try and repair, the best we can, and I don't think we
    are doing a very good job of it, of the consequences of that.
        Chairman Tom Davis. Thank you. The gentlewoman's time has
    expired.
        Ms. Watson. Thank you Mr. Chairman.
        Chairman Tom Davis. Mr. Davis.
        Mr. Davis of Illinois. Thank you very much, Mr. Chairman.
    Let me thank you for continuing with this series of hearings
    relative to steroid use in our society.
        I think it is important that we try and get at the true
    nature of it. And I think one of the most important questions
    that we have at this hearing, regards the true extent of
    steroid use by women.
        Now, CDC surveys show that more than 5 percent of women are
    using steroids. The NIDA surveys show a lower number, about 1
    percent. Dr. Pope's testimony stated that the phenomena of
    steroid use by teen-age girls was an illusion. It noted a
    number of reasons why there could be false positives of the CDC
    tests.
        I am trying to get a handle on how big or how small the
    problem really is that we are facing. Dr. Yesalis, do you agree
    with Dr. Pope's analysis of the data?
        Dr. Yesalis. Well, I said I significantly disagreed with
    it. Dr. Pope has contributed a lot of high-quality research to
    this area, and I respect him very much. We just, on this
    particular issue, disagree.
        One of the things I look for, is there consistency from one
    study to another? Now, Monitoring the Future study, the latest
    data I have is 1.7 for 2004, have used, 1.7 girls have used
    data--anabolic steroids in the last year. That is yearly
    prevalence, 1.7 for 12th grade girls.
        Now, lifetime use, common sense tells me it would have to
    be higher than that. So if you go with 1.7 you might have a
    couple hundred thousand, 150,000, 200,000 young girls. If you
    go with the 5.3 or the 7 percent figure, you can have up to a
    half million. As I said before, I want to err on the side of
    caution here.
        And I have earned my living as a scientist, but there is a
    time, you know, you have to say, wait a second, we have to look
    at the health of our kids, the betterment of society. So, you
    know, if you want to do extra studies, fine, I am not going to
    have that stop me. I am going to pursue education and drug
    testing right now.
        Mr. Davis of Illinois. Thank you very much. Dr.
    Schlifstein, it is my understanding that you have treated high
    school girls who have taken steroids, and that have you
    firsthand experience with many high school athletes. Do you
    agree with Dr. Pope's testimony?
        Dr. Schlifstein. I understand where he is coming from. I
    don't necessarily agree with it. I think, well, first of all,
    that study he was commenting on, he was talking about whether
    there were missing inhalers or, it specifically says pills or
    injections. And like Dr. Yesalis said, you are looking at very
    different studies of a similar incidence report. When I spoke
    to people from other countries as well, they found a similar
    rate also.
        I think if you surveyed girls in their 20's and looked at
    it, you would find a higher number. I think as people become
    more Internet savvy, and our younger people become older
    faster, they are very well educated and knowledgeable about
    these things, and they know which ones to take and how often to
    take it and what the side effects are.
        There is a lot of information available out there. Very
    easily accessible, and it is so easy to get. And it is going to
    be helpful, then they may certainly try it. And it doesn't mean
    all of those people are staying on it. No. It means that they
    will be trying it as a weight loss or weight control measure.
    It is very easy to obtain these steroids from numerous
    different sources. It is not difficult. There is plenty of
    information out there, that may be also very misleading.
        Some of these Web sites will give you information, tell you
    how to do it with getting the least amount of side effects,
    where areas and Web sites just for women, it says women, what
    kind of benefits you will get from it, how to avoid getting the
    male hormone side effects, the androgenic side effects.
        So I think there is a problem out there. Even if the number
    is 0.1, if it is not zero, there is a problem.
        Mr. Davis of Illinois. Thank you. Dr. Faigenbaum, you have
    conducted your own studies of steroid use among young girls.
    They found that over 2 percent of middle school girls in
    Massachusetts had taken steroids. Do you agree with Dr. Pope's
    testimony?
        Dr. Faigenbaum. I disagree. I think it is important that we
    look at the scientific data. And I think there is a need for
    better scientific data to get out there. I have also worked
    with physical education teachers, health education teachers,
    and coaches for the past 15 to 20 years.
        I think you would be hard pressed to find a health
    education teacher at the middle school or high school level who
    will say it is not a problem at all for athletes and
    nonathletes. So we have the science, but then we have reality.
        And my experience has been, at conferences, seminars, in my
    professional work with coaches, physical education teachers and
    health education teachers, that it is a real problem among
    young female athletes, and nonathletes. I think if a 14-year-
    old girl is willing to take laxatives, diuretics and
    amphetamines to get skinny, I think anabolic steroids might be
    on her list.
        Mr. Davis of Illinois. Dr. Elliot, would you have anything
    to add?
        Dr. Elliot. It is not about steroids by themselves; these
    kids are using alcohol, marijuana, other drugs. They are risk-
    takers, they drink and drive. So I know that you heard this
    tragedy of Taylor Hooten, but in general, the kids who use
    steroids are using lots of other drugs.
        You have heard that half of them are not in sports to make
    them look better, they are not even in sports. So it is a
    marker for deviant behavior.
        Mr. Davis of Illinois. You know, in conclusion, I think
    that some of the estimates for girls may be a bit high, but I
    am also thinking that, it seems to me, that female athletics is
    becoming more and more competitive.
        I mean, it seems to me that there was a time when not as
    much emphasis was put on the competitive nature. And as female
    athletics become more competitive, do you think that we may
    have a problem as females compete now more ferociously than
    perhaps we have always seen in the past, and we need to do
    something to head off this trend that might be developing. I
    thank you, Mr. Chairman.
        Dr. Elliot. You are absolutely right. I mean, there were 1
    in 27 girls in sports when I was in high school, and now it is
    1 in 2. There is scholarship parity. There are not the
    lucrative, you know, obscene salaries that some professional
    athletes get for young women, there are no women on the Forbes
    50 top paid athletes list. It is really bringing boys down to
    where girls are, if they are just getting caught up with the
    boys, if that is how they are, it is bringing all of the
    sports, all of the emphasis on winning down for boys and girls,
    so they do not feel this pressure to win, it is about having
    fun, being physically active, something you are going to
    continue for life.
        Mr. Davis of Illinois. Thank you. Mr. Chairman----
        Mr. Shays [presiding]. It is just the two of us. So let's
    have fun. You have the floor.
        Mr. Davis of Illinois. Go right ahead.
        Dr. Yesalis. Well, if you look at some of the NCAA
    violations, it is unfortunate that some of the women's
    collegiate athletic programs have gone down, or are going down
    the same road, as far as violations, as the men's sport have.
        So, you know, I agree with Dr. Faigenbaum. If you use that
    analogy, or Dr. Elliot I think said, if they are using other
    drugs or if they are cheating in other respects, use of
    steroids is unfortunately not that big a deal after a certain
    point.
        So I think your point is a good one. Quite clearly women's
    sports, the level of competition, I was a strength coach, in
    another aspect of my life, and, I remember in the mid 1970's,
    later 1970's watching female collegiate athletes in the weight
    room, and they were going in there with make-up on and jewelry.
        About 3 years, 4 years later, they were in there pushing it
    as hard at the guys were, just in that short period of time
    there has been a significant shift. So the pressure is there.
    And the temptation is there.
        If you do not have that boundary line that you will not
    cross, if that is absent, or it is grey, I do not know of any
    reason why women won't cross that line just as quickly as men.
        Dr. Elliot. You saw the positives were really comparable
    for men and women over the last couple of years. It is not
    confined to men.
        Dr. Pope. I would have no question that these trends are
    alarming, and that the increasing pressure on women to excel in
    sports it is in things that we should definitely be watching
    closely. Certainly this engages many risks, the issues of body
    image and the pressure to win that has been discussed here.
        But I differ a little bit from Chuck Yesalis on this issue
    of what is the scientifically conservative approach. I would
    argue that the conservative scientific approach would first be
    to show, in rigorous scientific fashion, that there is a
    problem; rather, they assuming that there is a problem before
    we have done a rigorous test of the type that I described.
        Mr. Davis of Illinois. Well, thank you very much gentlemen,
    lady. And, Mr. Chairman, I have no further questions. I
    appreciate your indulgence.
        Mr. Shays. I thank the gentleman. Gentlemen and lady, this
    has been a very, very interesting hearing.
        I am struck first by the fact that I am leaving this
    hearing believing that the temptation for women is almost
    greater than for men in the sense that steroid use can have an
    even greater impact. Is that a false impression to leave?
        So for the record, shaking of heads, no answers, I will
    assume that everybody agrees for the record.
        I have something that the staff wants, I have some of my
    own questions, but the one that the staff wants to put on the
    record, Dr. Faigenbaum, could you please elaborate upon your
    reference to multi-dimensional school-based approaches?
        Is this consistent with programs such as Dr. Elliot's
    ATHENA Program for females.
        Dr. Faigenbaum. That is exactly the program I am referring
    to, the work of Dr. Elliot, which is a multi-faceted program,
    which doesn't simply focus on steroid education.
        That kind of multi-faceted program, which is not simply
    telling children that steroids are good or bad, but it is a
    comprehensive program with a healthy alternative. That is what
    I am referring to with a multi-faceted kind of focus.
        Dr. Yesalis. I would like to add, one of the Members asked
    a question of you, Diane, why your program is not in more
    schools. And I, look, Dr. Elliott's and Dr. Goldberg's program
    in my judgment is the best in the Nation by far.
        I think it is not in more schools because of this problem
    of denial. You know, as I was quoted accurately by the AP
    several months ago, if I had $100 for every time a high school
    principal or coach told me, Doc, it is a problem, but not in
    our school, I would have a Ferrari in my driveway instead of a
    Corvette.
        So, you know, every school district is short of money. That
    is what they always argue. So if they deny having a problem,
    then they do not have want to spend the time or effort to
    institute such a program. That is the big problem that I have
    seen around the country.
        When we did our steroid study in Massachusetts, 20 randomly
    selected middle schools were selected to participate by the
    Board of Education in Massachusetts. All 20 school
    administrators, as we just heard, denied there was a problem at
    that school and would not allow us to administer that survey at
    that school. It was a problem in other schools, but not their
    school. Therefore, we needed other methods to administer this
    survey in Massachusetts.
        Mr. Shays. That is a good trigger point for me just to
    comment. I taught at a private--I didn't teach, I worked as an
    administrator in a private school on a part-time basis. And the
    school was a school where the students did not drink or smoke,
    and, you know, it was a religious school, and that sex before
    marriage was just not condoned. And there was this sense that
    there was this real high moral standard.
        And the students struck me as being angry. And I couldn't
    quite figure it out, until I realized there was drinking, there
    was sex, and there was smoking in the school. And the anger was
    that none of us--the students knew it, and we did not. And
    there was such a big disconnect between the students and the
    administrators. And once we uncovered it, it was stunning how
    pervasive it was, and how obvious it was, and frankly how
    hypocritical it was for us to have assumed it, and the students
    were basically living this lie, but really not aware.
        You get my gist. And I am--which leads me, Dr. Pope, I came
    to this hearing thinking, give me a break. Not this many
    people, students are involved. Then you went through your
    analysis, and I thought the exact opposite after you went
    through your analysis, because I thought, if I had filled out a
    questionnaire, and then someone came back and wanted to know
    more detail, I would clam up.
        Like, with when I was in the Peace Corps, they wanted to
    know how many people were, just tell us how many of you have
    used marijuana and everything will be all right. The next thing
    we know, we saw a busload of these volunteers leave the first
    day, who had volunteered that they had used marijuana. That
    was, you know, that was the integrity of that question and that
    process, I mean, and nobody wanted to say anything after that
    point.
        I guess my point is, given that it is so easy, given that
    there is this network, kids talk to each other, and it is a
    network under the radar screen. And I think if a few kids know
    it, everybody knows it. If some kids know how to get it, most
    everyone knows how to get it. That is my sense of it. I am
    saying that, because I like to know how many disagree with what
    I just said, or how many agree? And I am going to go right down
    the line, and tell me where you disagree.
        Dr. Elliot.
        Dr. Elliot. Well, you are right, that there is a halo
    effect around your own kids or coaches for his own team. It is
    a problem at other schools. But coaches do care about kids.
    They really are there for the kids. They feel pressure from
    parents and the school to have a winning season. Too, if a
    child is using steroids, they are getting bigger and stronger,
    they are becoming a better player, unlike other drugs.
        Mr. Shays. Do you believe that kids also are aware, maybe
    not who is taking it, but aware of how they can get these
    drugs?
        Dr. Elliot. The CDC data are that the availability is the
    same. I mean, by seniors, most--that there is a high
    availability and they don't believe it is that harmful if you
    just use it a little bit.
        There is more hits for ``buy steroids'' on the Internet
    then there are for ``buy baseballs''.
        Mr. Shays. OK. Anything else you want to add?
        Dr. Elliot. No, thank you.
        Dr. Schlifstein. Kids are very knowledgeable. They know how
    to get this. And certainly there is a lot of denial from anyone
    about their own local school or their own personal problem. But
    also some of these people suggested maybe get it from personal
    trainers, fitness trainers, maybe those are older people, but
    certainly coaches and other people are involved, and at the
    higher competitive levels, maybe giving access or suggesting
    the use of some of these supplements as well.
        But also, denial is a large part of it, and also there is
    no testing in high schools. Less than 4 percent of the U.S.
    high schools have done testing for anabolic steroids ever.
        Mr. Shays. Do you buy the numbers that have been, the
    number of kids?
        Dr. Schlifstein. Yeah, I believe those numbers. I think the
    questionnaire was fine. I think it has limitations on it, of
    course there are. But, also you have to remember, when you are
    asking a 14, 15-year-old girl, are you taking illegal male
    hormones in order to make yourself look better, I do not know,
    even if she has been doing it her whole life she is probably
    going to say no. It is a very hard to answer even on a survey.
        Mr. Shays. Dr. Pope.
        Dr. Pope. I certainly agree with you on your point that
    these kids are aware. I wouldn't quarrel with that for a
    minute. But, I would stick very strongly to the scientific
    precautions that I have given you about the numbers. And if I
    could just, you know, tolerate one more slide, if you can just
    put up No. 4 there. This is the national household survey,
    which Chuck Yesalis alluded to. Could I have No. 4 back,
    please.
        Now, this is a survey also done with anonymous
    questionnaires on high school students, 2004, equal time. But
    instead of 7.3 percent of 9th graders in the CDC study, here we
    have another federally funded anonymous survey study with the
    0.9 percent of 10th graders. Now, with two large federally
    funded studies, using identical methods, are getting results of
    7.3 and 1 and 0.9 in another, you know that something has to be
    wrong.
        Mr. Shays. Was this the use over the last year or lifetime
    use?
        Dr. Pope. This is used into a lifetime.
        Dr. Yesalis. That was last year. That is only the last
    year. If you add them up, it would be a lot different.
        Dr. Pope. Let me just get the actual numbers here.
        I have here table 1, trends in lifetime prevalence of use
    of various drugs. For 8th, 10th and 12th graders.
        Mr. Shays. What is the number?
        Dr. Pope. For both sections combined, it was 1.9 percent of
    8th graders and 2.4 percent of 10th graders, but remember, the
    males outnumber the females.
        Mr. Shays. This one, though, was for 1 year.
        Dr. Pope. No. I am pretty sure those are lifetime rates in
    females.
        Mr. Shays. You are under oath here. Let us back up. Slow
    down.
        Dr. Pope. I am sorry. You are correct. That is an annual
    rate that I am quoting.
        Mr. Shays. And that is not my credit, that is good staff
    work.
        Dr. Yesalis. I feel comfortable that the numbers are
    somewhere between 200,000 young women and 500,000 have used
    these at least once in their life. I think the kids know about
    this. I agree with everything, you know, you stated. And I do
    have a Corvette.
        Dr. Faigenbaum. I too believe that children and teenagers
    are aware of what anabolic steroids are, how to get them and
    the potential effects. I also believe that youth coaches are
    well aware of the effects of anabolic steroids.
        I believe that there are certain performance measures that
    can be expected in boys and girls who play sports, those who
    train with weights or perform in track and field and other
    events. And I think youth coaches are aware of what can be
    expected, following 8, 12 or 16 weeks of training, and what
    might be a bit bizarre.
        There are some numbers in my mind, when training young
    athletes that if I see a 10, 20 or a 30 percent gain in a
    beginner, that seems rather common. But when working with a 14-
    year-old or 15-year-old young athlete, who makes a 30-percent
    gain in performance in a matter of 6 to 8 weeks, in my eyes, I
    view that as nearly physiologically impossible to make that
    kind of gain.
        I think youth coaches are aware of the problem, but as we
    have heard today, I think there is a tendency to look the other
    way.
        Mr. Shays. OK. Let me, I just have two other areas of
    questions. I am leaving this hearing with the belief that you
    could make a strong case for using steroids in a controlled and
    moderate way, and they could be healthy and helpful to you.
        And I do not know if I should leave feeling that way. But,
    I believe that what I am leaving with is the view that the
    overuse of steroids is bad. I am not saying using them in
    sports is right, I am not speaking to the rightness or
    wrongness of using steroids, but from a medical standpoint, one
    of the challenges we have is that you could use steroids in a
    moderate way, gain some benefits that would be desirable for
    some people, and that they would not have any adverse health
    affects.
        And so therefore, a parent arguing to their kid, don't do
    this, that this smart young kid could say, mom, in moderation
    it is OK. That is the way I am leaving. And if I am wrong in
    that, then tell me. But if I am right, let us not deny it.
        Dr. Yesalis. The anabolic steroids have been, just to give
    one example, I think you are correct in my judgment, have been,
    the World Health Organization has explored their use as a male
    contraceptive since the mid 1970's. And it has been shown to be
    a successful male contraceptive, using doses significantly
    exceeding what many track athletes have used.
        And these drugs have been used in medicine since 1935 plus.
    So I hope we haven't been killing people, you know, using them.
    So they have been used as a prescription drug for all of that
    time. So, yeah, I have answered, for years of course they can
    be used safely, as any drug. There is no drug that has an
    absence of side effects.
        Mr. Shays. And used for beneficial purposes.
        Dr. Elliot. Would you use amphetamines? They will perk you
    up for the game, maybe a handful of Sudafed. It is not really
    not going to probably kill you. I think that the idea is they
    do have health effects on young women. It is cheating. It is
    doing something unhealthy.
        Mr. Shays. I am not going down that road right yet. But, it
    seems to me, if you do not arm people with the full
    information, and you try to distort some information then you
    lose credibility.
        Dr. Elliot. Absolutely.
        Mr. Shays. And some people may take steroids for a shoulder
    injury. Correct?
        Dr. Elliot. That is a different kind of steroid. They will
    inject you for bursitis with a corticosteroid, that is not an
    anabolic steroid.
        Mr. Shays. All right. So one of the points you want to make
    to me are, there are steroids and there are steroids.
        Dr. Elliot. And for women, there are effects that are
    irreversible. If you start growing hair on your face that does
    not go away.
        Mr. Shays. Well, my first attention to this whole issue was
    when I saw the East German woman swimming team. And when I saw
    them perform, I thought I was seeing men compete against women.
    I remember the women, American women, were complaining at the
    time that they felt like they were--they were just in a whole
    different competition.
        Dr. Elliot. And it has come to light that they were giving
    these young women cycles of steroids and ratcheting up their
    muscle size and strength with each cycle of use.
        Mr. Shays. Is it also true that some of those women
    ultimately had continued that, in some cases against their
    will, in some cases, but had used it so long that they were not
    comfortable being women?
        Dr. Elliot. There is one case of a person who underwent a
    sex change. But it generally does not make you develop gender
    dysphoria or become a transsexual.
        Mr. Shays. OK. Well, just wanted the real information out
    here. Just the last issue then.
        Dr. Elliot. But let me say, I think your point that you
    have to be straight with kids is true. And the underground, if
    you tell them something, they will see right through it unless
    it is true, is right on.
        Mr. Shays. So, I mean, in some cases, the message might be,
    the problem with this is there is no need to take it. It is, it
    may be true that you could take a very moderate amount and not
    see harm, but it is the doorway to something that could lead to
    harm.
        Dr. Elliot. And a young man's testosterone level is going
    up every day during adolescence. They make their own
    testosterone. If they eat right and train right, they can get a
    lot bigger and stronger, they do not need to take steroids.
        Dr. Faigenbaum. I think the point that needs to be noted is
    that anabolic steroids need to be combined with a conditioning
    agent----
        Mr. Shays. I am going to have you slow down. I love your
    testimony, but I am--I have a process problem.
        Dr. Faigenbaum. Anabolic steroids need to be combined with
    a conditioning program for them to have this desired effect,
    this ripeness that maybe some females are looking for, or an
    increase in muscle mass. One cannot simply take anabolic
    steroids and expect to see these desired changes.
        I would argue that a 15-year-old girl who follows a
    reasonable exercise program, makes sensible modifications in
    her diet, with adequate sleep and such, will be a better
    athlete, or nonathlete than a 14 or 15-year-old who ingests
    anabolic steroids but does not participate in this well-
    designed kind of program. I do not view them as a magic bullet.
        Mr. Shays. I heard Ms. White's testimony, Kelli White's
    testimony. I want to know what your reactions were when you
    heard her testimony.
        Dr. Yesalis. I agreed with your comment. It was a breath of
    fresh air, given the previous hearings that I have either been
    here or watched on television, as far as her candidness. So I
    thought that was nice.
        I was very glad she brought up the fact that she passed 17
    drug tests, even the so-called Olympic standard has giant
    loopholes in it. So I thought it was a very good thing that was
    brought in front of this committee.
        Dr. Elliot. There is a paradox. She says she is sorry she
    used them. But if I am 14 and I see her, I think she got--she
    was the fastest in the world from taking steroids. They work.
        Mr. Shays. Right. But, she was also good beforehand.
        Dr. Elliot. Absolutely. From age 10 she was a very gifted
    athlete.
        Mr. Shays. She did not take steroids then. So I have my new
    Cinderella movie. My new movie would be to see this young lady
    compete and show that she could compete without taking steroids
    and be very successful.
        Dr. Elliot. You know, in general, programs that have the
    recovered personal with an eating disorder come, make the
    problem worse. The kids get the message that is, you heard her
    say, lots of people were doing it. So they do not always hear
    the bad consequences. They hear, they feel invulnerable, they
    think OK, I am not as talented, and I better take them now.
        Mr. Shays. That gets me to the last point, that is the
    coaches and the trainers. If ever I would want to throw a book
    against anybody, it would be the trainers and the coaches that
    would encourage this, and the doctors maybe that encourage it.
        I would be eager to go after them every way I could. And
    yet they seem to be getting free passes here.
        Dr. Pope. I would strongly support you on that position. A
    coach or a trainer who very likely is aware of what is going on
    is exactly like a bartender serving alcohol to somebody that he
    knows is 17-years-old. That is precisely the same problem. It
    is a point that should be carefully controlled.
        Dr. Yesalis. The notion that elite coaches, whether they be
    in the MLB, or NBA, NFL, NCAA, do not know this is happening on
    specific individuals, these men and women who are supposed to
    be so smart to achieve these positions, can be so ignorant or
    stupid in this way baffles me totally. They darn well know what
    is going on.
        Mr. Shays. You see, I would almost have, you know instead
    of one strike and out, I would have no strike. I would have one
    strike and you are out.
        Dr. Yesalis. For a coach? I agree.
        Mr. Shays. Anybody want to make----
        Dr. Elliot. You know, there is really just a few elite
    coaches. Most kids' contact with coaches is not with a coach
    like Kelli White had, it is with the soccer coach who is also
    the science teacher.
        Mr. Shays. I guess when it comes to track and field, or
    skating where you have a personal coach, and they are
    encouraging it, I just find that relationship quite strong. At
    any rate, any comments you want to put on the record before we
    adjourn?
        Dr. Faigenbaum. In response to your comment on coaches, if
    an elite coach was to give a 22-year-old female an anabolic
    steroid, that is one issue. But if a coach was to give a 12-
    year-old track and field star an anabolic steroid, I think that
    is another issue.
        Knowing the side effects and potential consequences of
    anabolic steroid use, I wonder if that borders on a kind of
    child abuse.
        Mr. Shays. Yeah. It is child abuse.
        It is. OK. Any other comment? This is a fascinating
    hearing. It is a subject that, courtesy of Major League
    Baseball, we have gotten into, because they were so arrogant,
    so obnoxious, so disingenuous, and frankly their testimony
    before us, in my judgment, was--almost bordered on perjury. So
    other than that, I think fondly of them.
        Dr. Elliot. Can I say that, I know that you want to
    harmonize random drug testing. But if there is a problem with
    Baseball, why don't you just have them get a blood test every 2
    weeks, if this is rampant there, and take it out of this random
    testing. Let us just bring them in every 2 weeks, like I would
    somebody in rehab. You do not get random tested there, you are
    given a test every week.
        Mr. Shays. Well, my response would be, once someone had
    broken, crossed that line I would do it, but I am not sure I
    would do it.
        But, you know what, we will think about it, won't we?
        Let me ask unanimous consent that the written testimony
    from the Center for Disease Control and Prevention regarding
    steroid use among females and the youth risk behaviors
    surveillance survey system be included in the official hearing
    record.
        Without objection so ordered.
        With that this hearing is adjourned.
        [Whereupon, at 12:45 p.m., the committee was adjourned.]
        [Note.--The statement of the American College of
    Obstetricians and Gynecologists is on file with the committee.]
        [The prepared statement of Hon. Jon C. Porter and
    additional information submitted for the hearing record
    follows:]