Ergogenic aids, such as nutritional supplements, anabolic steroids and human growth hormone, are increasingly being used to enhance sports performance or body image. While few rigorous scientific studies have derived significant conclusions, the marketing and promotion of most supplements is intense and far exceeds the data supporting their use. Particular concern has arisen regarding safety in the use of these substances among adolescents, who may be at particular risk when using caffeine-ephedra and anabolic steroid combinations. Indeed, long-term effects and fatalities have been reported. As a consequence, the American Academy of Pediatrics has condemned the use of anabolic steroid use for bodybuilding or performance enhancement in adolescents. Health care professionals need to educate themselves about ergogenic use and ask informed questions of their adolescent patients. An honest discussion of the limitations of most supplements, and acknowledgement that some supplements may work some of the time, may allow the physician to be more credible and useful in providing medical care and guidance to the adolescent seeking to improve body image or athletic performance.