Legal Performance-Enhancing Substances in Children and Adolescents: Why Should We Care?

* Abbreviation: PES — : performance-enhancing substance The use of legal performance-enhancing substances (PESs) is common among adolescents, particularly boys.1 Approximately one-third of all youth use creatine, protein powders, or dietary supplements,2–4 and an even greater proportion of athletes and college students do so.5,6 Although previous studies have correlated legal PES use with future use of illegal PESs,7,8 in a study in this issue of Pediatrics , Ganson et al9 explore a broader role for PESs as a gateway to alcohol and other substance use. There are 2 key points to recognize when addressing this topic: 1. “PES” is a misleading term. Most legal supplements marketed for athletic performance enhancement are ineffective at increasing muscle mass or athletic performance beyond what can be achieved through appropriate nutrition and training.1,10 They are not truly performance enhancing. 2. Many adolescents, both athletes and nonathletes, are using PESs primarily in pursuit of a more muscular appearance, rather than for performance-oriented goals. This recognition has spurred an evolution of terminology, with increasing use of “appearance and PESs” in place of the … Address correspondence to Steven Cuff, MD, FAAP, Division of Sports Medicine, Nationwide Children’s Hospital, 584 County Line Rd West, Westerville, OH 43082. E-mail: steven.cuff{at}nationwidechildrens.org