The American Academy of Pediatrics continues to condemn the use of anabolic steroids for body building or enhancement of sports performance; however, many users, their parents, and their coaches believe that anabolic steroids are useful and even necessary for optimal performance. There is a clear need for input that is objective, rational, unbiased, and readily available to the adolescent. Because clinical trials are not feasible, much of the information on adverse reactions to anabolic steroids is anecdotal or is assumed from known problems associated with the therapeutic use of these agents. Elevations in levels of liver enzymes are common, but the more severe hepatic complications are rare. In men, steroid use depresses levels of luteinizing hormone and follicle-stimulating hormones, which leads to decreased endogenous testosterone production, decreased spermatogenesis, and testicular atrophy. The long-term effects on the development of coronary artery disease have not been determined. Some individuals may experience mental status and behavioral changes with anabolic steroid use. Of particular concern is premature physeal closure in any child/adolescent, which results in a decrease in adult height. Pediatricians have an opportunity to fulfill a positive role in the recognition and management of anabolic steroid abuse in adolescents. Physicians must recognize clinical signs that suggest use. Part of drug-prevention counseling is to provide a healthy alternative to drug use. Most athletes will find a way to meet their sports goals without using anabolic steroids. 3 tables and 33 references