Abstract
Background: Consumer use of performance enhancing substances (PES) is a multi-billion dollar industry, fueling public health concerns regarding use in adolescents hoping to enhance athletic performance, body appearance, or fight obesity. PES may also be used for military, sexual, and intellectual performance enhancement. PES consumption can be viewed as a healthy fitness endeavor. Healthcare providers tend to be less familiar with PES than other forms of substance abuse. PES adverse effects can include violent behavior, suicide attempts, and premature deaths.
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