ANABOLIC-STEROID use without a prescription is illegal, yet as many as 3 million Americans use these dangerous drugs to improve athletic performance or body shape. And as many as one in four of steroid users started as teenagers. According to a recent survey, an estimated 300,000 high-school students have used these destructive drugs in tablet, injection, gel or patch form.

These numbers are staggering. What is even more eye-opening is that one-third of steroid abusers in high school are not athletes. They are in fact kids who may spend hours in the gym perfecting their physiques to feel bigger and more aesthetically appealing. Some simply use “muscle juice” and don’t exercise.

Anabolic steroids, related to testosterone, are often taken in doses as high as 60 times the normal level. Chronic steroid use affects almost every organ system. Some health-related consequences include shrinking of the testicles, male-breast enlargement, liver damage, severe acne, increased body hair and abnormal menstrual cycle in females, and wild mood swings. A striking effect for young men and women is complications that may affect future fertility.

About 40 percent of 12th-graders declare that steroids are “fairly easy” to obtain. The selling and purchasing of steroids is a multimillion-dollar industry. Internet dealers are a growing source, an unregulated market where steroids can be bought without prescriptions. Simply Google “anabolic steroids” and hundreds of sites selling these drugs will appear. Even local gyms are often frequented by private dealers who target impressionable adolescents.

The media are important players in the social marketing of the perfect male physique. Male celebrities and high-profile athletes are more muscular and athletic than they were 20 years ago. This trend has altered society’s image of the male body, and fuels a growing addiction to bodybuilding and performance-enhancing drugs.

Teenage boys, just like girls, constantly battle with problems of self-esteem, body image and sports performance. They internalize the media’s portrayal of actors and athletes, and often aspire to be like them. Men’s health magazines and clothing ads portray the male as a lean, muscular Adonis.

It is no surprise that there is a growing obsession with body image among men. One-third of men surveyed by Psychology Today experienced great body dissatisfaction after viewing muscular male magazines. In young men, there is a growing incidence of “muscle dysmorphia,” a psychiatric disorder in which a person is obsessed with the idea that he or she is not muscular enough. It has been labeled as the “reverse anorexia nervosa.” There is a higher incidence of steroid use among these individuals.

Steroid use is underreported or hidden by adolescents. Steroids have been stigmatized in society; therefore, abusers may deny taking them to parents, friends and physicians. Moreover, screening for steroids is not routine in medical settings. Physicians may not suspect steroid use in children as young as 12.

In recent years, access to health care for young men has become less available because of closings of school health clinics and reduced access to medical insurance. Ostensibly healthy males ages 18-25 are most likely to fall through the cracks in our health system. Once young men transition from pediatric to adult medicine at 18, they are less likely to seek health care. This problem perpetuates steroid use, because young men are not getting proper screening and preventive services from health-care providers.

What can be done? Prevention efforts for steroid abuse should directly target factors that influence this problem. Current interventions have limited access to those at highest risk, specifically high-school athletes. A big problem is that these drugs work, thus messages of “Just say no” tend to be ineffective. School-based educational programs have been suggested as an effective means to tackle steroid abuse.

A successful anti-steroid after-school program in Oregon called Athletes Training and Learning to Avoid Steroids (ATLAS) targets high-school football players. Participants in this program are more knowledgeable of steroid risks, have better drug-refusing skills and increased skepticism toward potentially unhealthy popular media messages. Similar programs should be implemented in Rhode Island, but must include non-athletes because they make up one-third of abusers.

Intervention at the primary-care level can also be valuable. Increasing screening practices in sports physicals or primary-care settings are beneficial, combining questions regarding usage and the physical exam, looking for signs suggestive of steroid use. Parents, coaches, teachers, and school nurses must be vigilant and supportive. Providing healthy alternatives for strength training is also valuable. The health risks of steroid use should be openly publicized in schools, gyms and physician offices.

The drive to win and the obsession to achieve a muscular physique lure impressionable young men and some women to abuse steroids. Community-wide recognition of this hazard is vital. Educational programs, partnering with media to transmit healthy strategies and increased medical screening practices, can be effective interventions.

As long as our society equates success with winning, steroids will always be around. It is imperative that we intervene to help young adults make smart choices by avoiding dangerous behavior.

Rajeev Chaudhry is a fourth-year medical student at the Brown Medical School. Edward Feller, M.D., is a clinical professor of medicine and co-director of the Community Health clerkship at Brown.