Medicine has a history of bad therapies that failed because they tried to subvert the natural human growth or healing processes. We are appalled by the practices of societies that produce physical deformity for a perceived social good. We would not allow the castrating of young boys who sing well so that they can continue to sing soprano. We would not allow parents to bind the feet of infant girls to produce a lotus foot. Yet it is not clear how far this society will go to prevent the use of medical and hormonal techniques to alter normal development to produce a better athlete.

Physicians who practice sports medicine on children should be very careful about interfering with natural development. Modern training techniques and machines have made it possible to alter the balance of muscle function in a way that natural exercise cannot. Drugs and hormones can be used to change the very processes of growth. These changes can have unexpected and undesirable side effects. What seems reasonable during training or performance may appear unreasonable in later years if it results in permanent deformity or disability. The engineering of people to improve athletic performance may appear to the adult athlete or the jury as abhorrent as castrating boy sopranos. Physicians should be cautious about recommending any nontherapeutic interventions in athletes who are not fully grown.