Performance-enhancing drugs: Know the risks
Hoping to gain a competitive edge by taking performance-enhancing drugs? Learn how these drugs work and how they can affect your health.
Most serious athletes will tell you that the drive to win is fierce. Besides the satisfaction of personal accomplishment, athletes often pursue dreams of winning a medal for their country or securing a spot on a professional team. In such an environment, the use of performance-enhancing drugs has become increasingly common.
But using performance-enhancing drugs (doping) has risks. Take the time to learn about the potential benefits, the health risks and the many unknowns regarding so-called performance-enhancing drugs such as anabolic steroids, androstenedione, human growth hormone, erythropoietin, diuretics, creatine and stimulants. You may decide that the benefits aren’t worth the risks.
What are they?
Some athletes take a form of steroids — known as anabolic-androgenic steroids or just anabolic steroids — to increase their muscle mass and strength. The main anabolic steroid hormone produced by your body is testosterone.
Testosterone has two main effects on your body:
- Anabolic effects promote muscle building.
- Androgenic effects are responsible for male traits, such as facial hair and a deeper voice.
Some athletes take straight testosterone to boost their performance. The anabolic steroids used by athletes are often synthetic modifications of testosterone.
These hormones have approved medical uses. But improving athletic performance isn’t one of them.
Why are these drugs so appealing to athletes? Besides making muscles bigger, anabolic steroids may reduce the muscle damage that occurs during a hard workout, helping athletes recover from the session more quickly and enabling them to work out harder and more frequently. Some athletes, as well as nonathletes, may like the muscular appearance they get when they take the drugs.
A particularly dangerous class of anabolic steroids are the so-called designer drugs — synthetic steroids that have been illicitly created to be undetectable by current drug tests. They are made specifically for athletes and have no approved medical use. Because of this, they haven’t been tested or approved by the Food and Drug Administration (FDA) and represent a particular health threat to athletes.
Many athletes take anabolic steroids at doses that are much higher than those prescribed for medical reasons. Anabolic steroids have serious physical side effects.
Men may develop:
- Prominent breasts
- Shrunken testicles
- Prostate gland enlargement
Women may develop:
- A deeper voice, which may be irreversible
- An enlarged clitoris, which may be irreversible
- Increased body hair
- Baldness, which may be irreversible
- Infrequent or absent periods
Both men and women might experience:
- Severe acne
- Increased risk of tendinitis and tendon rupture
- Liver abnormalities and tumors
- Increased low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol)
- Decreased high-density lipoprotein (HDL) cholesterol (the “good” cholesterol
- High blood pressure (hypertension)
- Heart and blood circulation problems
- Aggressive behaviors, rage or violence
- Psychiatric disorders, such as depression
- Drug dependence
- Infections or diseases such as HIV or hepatitis if you’re injecting the drugs
- Inhibited growth and development, and risk of future health problems in teenagers
Taking anabolic-androgenic steroids to enhance athletic performance is prohibited by most sports organizations — and it’s illegal. In the past 20 years, more-effective law enforcement in the United States has pushed much of the illegal steroid industry into the black market.
This poses additional health risks because the drugs are either made in other countries and smuggled in or made in clandestine labs in the United States. Either way, they aren’t subject to government safety standards and could be impure or mislabeled.
What is it?
Androstenedione (andro) is a hormone produced by the adrenal glands, ovaries and testes. It’s a hormone that’s normally converted to testosterone and a form of estrogen (estradiol) in both men and women.
Andro is available legally only by prescription and is a controlled substance. Its use as a performance-enhancing drug is illegal in the United States.
Manufacturers and bodybuilding magazines tout andro’s ability to allow athletes to train harder and recover more quickly. Scientific studies that refute these claims show that supplemental androstenedione doesn’t increase testosterone and that your muscles don’t get stronger with andro use.
Side effects of andro in men include:
- Diminished sperm production
- Shrinking of the testicles
- Enlargement of the breasts
In women, side effects include:
- Masculinization, such as deepening of the voice and male-pattern baldness
In both men and women, andro can damage the heart and blood vessels, increasing the risk of heart attack and stroke.
Human growth hormone
What is it?
Human growth hormone is a hormone that has an anabolic effect. Athletes take it to improve muscle mass and performance. However, it hasn’t been shown conclusively to improve either strength or endurance.
Human growth hormone is available only by prescription and is administered by injection.
Adverse effects related to human growth hormone range in severity and may include:
- Joint pain
- Muscle weakness
- Fluid retention
- Vision problems
- Carpal tunnel syndrome
- Impaired glucose regulation
- Enlarged heart (cardiomegaly)
- High blood pressure (hypertension)
What is it?
Erythropoietin is a type of hormone used to treat anemia in people with severe kidney disease. It increases production of red blood cells and hemoglobin — the protein that carries oxygen to your body’s organs.
Taking erythropoietin improves the movement of oxygen to the muscles. Epoetin, a synthetic form of erythropoietin, is commonly used by endurance athletes.
Erythropoietin use among competitive cyclists was common in the 1990s and allegedly contributed to at least 18 deaths. Inappropriate use of erythropoietin may increase the risk of stroke, heart attack and blockage in an artery in the lung (pulmonary embolism).
What are they?
Diuretics are drugs that change your body’s natural balance of fluids and salts (electrolytes), which can lead to dehydration. This loss of water can decrease an athlete’s weight, which many athletes prefer. Diuretics may also help athletes pass drug tests by diluting their urine and are sometimes referred to as a “masking” agent.
Diuretics taken at any dose, even medically recommended doses, predispose athletes to adverse effects such as:
- Muscle cramps
- Potassium deficiency
- Drop in blood pressure
- Loss of coordination and balance
What is it?
Many athletes take nutritional supplements instead of or in addition to performance-enhancing drugs. Supplements are available over-the-counter as powders or pills. Creatine monohydrate is a supplement that’s popular among athletes.
Creatine is a naturally occurring compound produced by your body that helps your muscles release energy. Scientific research indicates that creatine may have some athletic benefit by producing small gains in short-term bursts of power.
Creatine appears to help muscles make more adenosine triphosphate (ATP), which stores and transports energy in cells, and is used for quick bursts of activity, such as weightlifting or sprinting. But there’s no evidence that creatine enhances performance in aerobic or endurance sports.
Possible side effects of creatine that can decrease athletic performance include:
- Stomach cramps
- Muscle cramps
- Weight gain
Weight gain is sought by athletes who want to increase their size. But with prolonged creatine use, weight gain is more likely the result of water retention than an increase in muscle mass. Water is drawn into your muscle tissue, away from other parts of your body, putting you at risk of dehydration.
It appears safe for adults to use creatine at the doses recommended by manufacturers. But there are no studies investigating the long-term benefits and risks of creatine supplementation.
What are they?
Some athletes use stimulants to stimulate the central nervous system and increase heart rate and blood pressure.
- Improve endurance
- Reduce fatigue
- Suppress appetite
- Increase alertness and aggressiveness
Common stimulants include caffeine and amphetamines. Cold remedies often contain the stimulants ephedrine or pseudoephedrine hydrochloride.
Energy drinks, which are popular among many athletes, often contain high doses of caffeine and other stimulants. The street drugs cocaine and methamphetamine also are stimulants.
Although stimulants can boost physical performance and promote aggressiveness on the field, they have side effects that can impair athletic performance, including:
- Nervousness and irritability, which make it hard to concentrate on the game
- Insomnia, which can prevent an athlete from getting needed sleep
- Addiction or tolerance, meaning that athletes need greater amounts to achieve the desired effect, so they’ll take doses that are much higher than the intended medical dose
Other side effects include:
- Heart palpitations
- Heart rhythm abnormalities
- Weight loss
- Mild high blood pressure (hypertension)
- Heart attack and other circulatory problems
The bottom line
Do performance-enhancing drugs boost performance? Some athletes may appear to achieve physical gains from such drugs, but at what cost?
The long-term effects of performance-enhancing drugs haven’t been rigorously studied. And short-term benefits are tempered by many risks. Not to mention that doping is prohibited by most sports organizations.
No matter how you look at it, using performance-enhancing drugs is risky business.
Dec. 04, 2020
- Madden CC, et al. Drugs and doping in athletes. In: Netter’s Sports Medicine. 2nd ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 11, 2018.
- Snyder PJ. Use of androgens and other hormones by athletes. https://www.uptodate.com/contents/search. Accessed Oct. 11, 2018.
- Effects of performance-enhancing drugs. U.S. Anti-Doping Agency. https://www.usada.org/substances/effects-of-performance-enhancing-drugs/. Accessed Oct. 11, 2018.
- Santos GH, et al. The risk environment of anabolic-androgenic steroid users in the UK: Examining motivations, practices and accounts of use. International Journal of Drug Policy. 2017;40:35.
- Fleisher LA, et al., eds. Androstenedione. In: Essence of Anesthesia Practice. 4th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 19, 2018.
- La Gerche A, et al. Drugs in sport — A change is needed, but what? Heart, Lung, and Circulation. 2018;27:1099.
- Boardley ID, et al. Nutritional, medicinal, and performance enhancing supplementation in dance. Performance Enhancement & Health. 2016;4:3.
- Baron D, et al. Prohibited non-hormonal performance-enhancing drugs in sport. https://www.uptodate.com/contents/search. Accessed Oct. 11, 2018.
- Robinson D. Permitted non-hormonal performance-enhancing substances. https://www.uptodate.com/contents/search. Accessed Oct. 11, 2018.
- Madden CC, et al. Sports supplements. In: Netter’s Sports Medicine. 2nd ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 11, 2018.