The moment she first plunged the needle of a steroid-laden syringe into her body, Cindy Olavarri knew she had thrust everything into peril: her health, her reputation, her quest for Olympic glory.
"I knew it was cheating," Olavarri said in an interview, 21 years after she tested positive for anabolic steroids and was dumped from the US cycling team just before the 1984 Olympic Games in Los Angeles. "I looked at them in my hand, and once I decided to take them, I knew I had lost my integrity."
A generation later, Olavarri wonders why anabolic steroid users -- from elite athletes to image-conscious middle-school girls -- have not learned from her transgression and many others like it. Or why they simply don't care.
While Congress tries to rid professional and collegiate sports of performance-enhancing drugs, and state governments consider ways to police high school athletics for the illegal substances, surveys show anabolic steroids have infiltrated American culture so deeply that users include non-athletes as young as seventh-grade girls.
Doctors, therapists, and researchers said many of the young women and girls who have joined the ranks of steroid users have done so for no other reason than to enhance their physiques.
"It makes me really angry," said Olavarri, 50, an assistant manager of a fitness club in Oakland, Calif., who never reclaimed her place among the world's elite cyclists. "When are they going to learn? They need to reach inside themselves and test their own natural limits before they reach for [steroids]."
A national survey of high school students released last year by the Centers for Disease Control showed that 5.3 percent of girls in grades 9 through 12 had used steroids without a doctor's prescription, compared with 6.8 percent of boys. In Massachusetts, 3 percent of girls in the same grades reported using steroids, compared with 6 percent of boys. The numbers were slightly lower in the Boston public schools: 2 percent of girls and 3.9 percent of boys.
Yet some specialists believe the problem is even greater than the statistics indicate. They said young users are buying anabolic steroids, which are illegal without a prescription, over the Internet, in Mexico, or from local dealers.
"As shocking as these numbers are, they may just be the tip of the iceberg," said Dr. Todd Schilfstein, a sports medicine physician at NYU Medical Center who treats young women who have used anabolic steroids. "It's a very hidden type of abuse."
In the most startling finding in the national survey, the highest rate of steroid use among high school students nationally was reported by ninth-grade girls, 7.3 percent of whom said they had used steroids without a prescription at least once. Some researchers questioned the figure -- "I think that number is ridiculously high," said Dr. Harrison Pope, a psychiatrist at McLean Hospital in Belmont who in 2000 conducted one of the first studies on the effects of anabolic steroids on women -- while others viewed the finding as a warning sign.
"The problem is getting worse, and the time to act is now," said Avery Faigenbaum, who headed a survey of middle schoolers in Massachusetts in 1998 that showed 2.8 percent of girls and 2.6 percent of boys between the ages of 9 and 13 had used steroids.
"You have 12-year-old girls who are not athletes taking this stuff," said Faigenbaum, a professor of exercise science at the College of New Jersey, who recommended stepping up prevention programs for younger students. "How bad has it gotten that these girls are dabbling with anabolic steroids?"
So bad, several specialists said, that young female users are exposing themselves to serious health consequences. Anabolic steroids, synthetic forms of the male hormone testosterone, can cause serious heart, liver, and kidney damage, as well as aggression, commonly known as "roid rage." The drug also can contribute to the masculinization of women, with the growth of facial hair, male pattern baldness, an irreversibly deepened voice, and the cessation of the menstrual cycle. Adolescents also risk stunting their height.
"The young women who are using them better think about not having kids," warned Teresa Moore, a prize-winning bodybuilder who teaches at the School of Public Health at the University of South Carolina and counsels female athletes against using steroids. "They may be able to see the masculinization one day when they look in the mirror, but they won't be able to see what it's doing to their internal organs, including completely shutting down their reproductive systems."
Non-athletes who use anabolic steroids generally exhibit symptoms similar to those of eating disorders, according to Dr. Diane Elliot, a professor at Oregon Health and Science University and principal investigator of the Athena prevention program for girls in grades 7 through 12.
"Girls who are using them to change their shape seem be to more depressed and have lower self-esteem," Elliot said.
Several specialists said an increasing number of female steroid users with eating disorders previously might have abused amphetamines, laxatives, or diuretics.
"This whole trend has entered a new phase as steroids take over more and more teenagers looking for a quick fix for fat loss," said Victor Naumov, president of the National Coalition for the Advancement of Drug-Free Athletics. "Unfortunately, a lot of these kids are going to end up with chronic conditions in the prime of their lives."
Surrender to temptation
Olavarri learned about the risks of anabolic steroids while she earned her master's and bachelor's degrees in exercise physiology and physical education at the University of California-Berkeley.
But she was so driven to excel in cycling that she embraced the performance-enhancing benefits of steroids and ignored the medical and ethical consequences.
"I could see people were gaining muscle mass by using them, and as an athlete I became short-sighted," Olavarri said. "I wanted to improve as fast as possible."
Olavarri's surrender to temptation was a dot on the timeline of steroid abuse among elite female athletes that began with the Soviets in the 1950s. US sprinter Kelli White last year became the latest high-profile woman athlete to admit using steroids after she was stripped of her gold medals in the 100- and 200-meter races at the 2003 World Track and Field Championships in Paris.
"The thing about some women in sports is, they don't think about the side effects," Moore said. "Whether they're competing locally, regionally, or nationally, the drive to win overrides all the other risks."
Fueled by steroids, Olavarri emerged as one of the top female road-racing cyclists in the world, winning three national championships, capturing a silver medal in the 1983 World Championships, and clinching a spot on the US team at the '84 Olympic trials. She eluded detection for three years, until she reached the threshold of her childhood dream.
Sixteen days before President Reagan officially opened the Los Angeles Games, the US cycling team announced it was dropping Olavarri because her blood tested positive -- for mononucleosis. It was a lie concocted to spare the team and Olavarri from scandal.
"It certainly seemed like a good idea to me at the time," Olavarri said of the lie. "I wasn't able to compete in the Olympics, which meant everything to me, and then to have to face the public questions seemed too much. It was an easy way out."
Then came the hard part. Olavarri spiraled into a yearlong depression, likely caused in part by her withdrawal from steroids (a number of suicides among steroid users have been linked to such depression).
"A lot of people really don't want to look at the problem, and the consequences can be terrible," Denise Garibaldi, a psychologist in Petaluma, Calif., said in an interview, three years after her son, Rob, fatally shot himself in the head in a state of depression after using steroids. Rob Garibaldi, a baseball star, had been selected by the New York Yankees in the 1999 amateur draft but opted to play for the University of Southern California. He died before he had a chance to pursue a professional career.
Testifying in March before a House committee investigating steroid use in baseball, Denise Garibaldi asked, "How many more youngsters will die questing ego and fame through steroids?"
Olavarri, in addition to her psychological distress, suffered physical effects of steroid abuse, including liver damage and jaundice, aching joints and tendinitis, and a deepened voice.
Schilfstein, who also serves as a clinical assistant professor at NYU School of Medicine, has treated a number of women who used steroids in athletic competition, primarily track and field events. He said the women generally express regret about using the drugs because of the health consequences, some of which they already suffer, others of which may emerge later in their lives.
"They weren't thinking about the short-term or long-term consequences of what they were doing," Schilfstein said. "Now, they are concerned and fearful."
For Olavarri, the worst pain was concealing the truth of why she lost her spot on the Olympic team. By 1986, her conscience prevailed, and when people expressed condolences for her purported bout of mononucleosis, she admitted her steroid use.
"I just couldn't live with the lie anymore," she said. "It was so uncomfortable."
But even now, she bears the burden of her transgression.
"My biggest regret is that I'll never know whether I could have made the Olympic team without steroids," she said. "When you cheat and alter your body that way, you don't know what's real and what's the drug."
And the athlete's legacy is tarnished.
"Unless you become rich in your sport, all you have when you retire are the memories," Olavarri said. "You want to feel proud of what you did, and in my case that's very difficult to do."