Age-restricted supplements sold to male teens

What do health food stores suggest when young teenaged boys phone to ask what products would help with strength training? Sales associates at these stores, which primarily sell dietary supplements, often recommend creatine products and, sometimes, testosterone boosters, according to a study involving 244 stores in 49 states. Although selling these 2 types of boosters to minors currently is not illegal in any jurisdiction, their manufacturers, as well as the American Academy of Pediatrics (AAP), generally do not recommend the products for anyone aged younger than 18 years.

In asking for recommendations over the phone, adult researchers posing as 15-year-old males identified themselves as football players going into their sophomore year of high school. If the sales attendant did not initially recommend creatine or testosterone boosters to help with strength training, the researcher then asked him or her specifically-and separately-about these supplements. The researcher also inquired if he could purchase either of these boosters on his own in the store.

More than 38% of salespersons recommended creatine without prompting, as did an additional 28.7% after they were prompted, a total of more than 67.2% of all sales associates, with male sales attendants significantly more likely than their female peers to make the recommendation without prompting. About 30% of all salespersons recommended against creatine, and 2.5% refused to make a recommendation over the phone. A total of 74.2% of sales attendants said that a 15-year-old could purchase creatine on his own, whereas 22.5% stated that it was necessary to be aged at least 18 years.

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As for testosterone, only 2 salespersons recommended a booster without prompting, although 9.0% made a recommendation after prompting. However, 88.5% recommended against a testosterone booster, and 1.2% refused to make a recommendation over the phone. About 41% thought a 15-year-old could make the purchase on his own, whereas 55.7% stated that the purchaser needed to be aged at least 18 years (Herriman M, et al. Pediatrics. 2017;139[2]:e20161257).

Thoughts from Dr Burke

The AAP strongly condemns use of performance-enhancing substances, including creatine, in children and adolescents (Pediatrics. 2005;115[4]:1103-1106). Nonetheless, many high school athletes use creatine and other supplements. By asking adolescents about their use of these products, you can start a conversation that will allow them to avoid relying on a sales clerk for important health advice.

Years ago, a pediatrician colleague suggested that all pediatricians should periodically wander through a toy store “just to see what’s out there.” Perhaps the local dietary supplement shop should be added to that field trip. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.