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Updated on November 28, 2022

Risks of Performance-Enhancing Drugs

What Are Performance-Enhancing Drugs?

Performance-enhancing drugs have become increasingly common among athletes to enhance their physique and improve performance.

However, using performance-enhancing drugs comes with risks. Before considering performance-enhancing drugs, learn about the potential benefits and health risks.1

Types of Performance-Enhancing Drugs

There are various types of performance-enhancing drugs. Here are some of the most common.

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Anabolic Steroids

Anabolic steroids are a type of steroid used to increase muscle mass and strength.1

The primary anabolic steroid hormone produced by your body is testosterone

Testosterone has two significant effects on your body. Anabolic effects trigger muscle building. Androgenic effects contribute to male traits, including developing facial hair and a deeper voice.

Some athletes use straight testosterone to boost their performance. The anabolic steroids used by athletes are usually synthetic modifications of testosterone. 

These hormones are medically approved for some uses. However, enhancing athletic performance isn’t one of them.

As well as enhancing muscles, anabolic steroids can lessen the muscle damage that can occur during a challenging workout. This can help athletes recover from the session more quickly and work out harder and more often.

Some non-athletes may also like their muscular appearance when taking anabolic steroids.

Taking anabolic-androgenic steroids to improve athletic performance is prohibited by most sports organizations, and it’s also illegal.

Designer Steroids

A particularly dangerous type of anabolic steroid is the ‘designer steroid.’ These synthetic steroids have been illicitly produced to be undetectable by drug tests.1

Designer steroids are made specifically for athletes without approved medical use. As such, they haven’t been tested or approved by the FDA and are a health threat to athletes.

Androstenedione 

Androstenedione, otherwise known as andro, is a hormone created by the adrenal glands, ovaries, and testes. Andro is a hormone that’s usually converted to testosterone and a type of estrogen (estradiol) in men and women.1

Andro is only available legally by prescription and is a controlled substance. It’s illegal as a performance-enhancing drug in the United States.

Athletes use the drug to train harder and recover more quickly. 

Human Growth Hormone

Human growth hormone has an anabolic effect. Exogenous growth hormone is often indictated for children with a deficiency (in medication form). However, sometimes athletes use it to enhance muscle mass and performance.1

Research lacks support that the exogenous human growth hormone improves endurance or strength. This drug is available only by prescription and is delivered by injection.

Erythropoietin

Erythropoietin treats anemia in people with severe kidney disease. It boosts the production of red blood cells and hemoglobin. Hemoglobin is the protein that carries oxygen to your body’s organs.1

Taking erythropoietin increases the movement of oxygen to the muscles. Epoetin is a synthetic form of erythropoietin. Endurance athletes commonly use it.

Diuretics

Diuretics alter your body’s natural balance of fluids and salts (electrolytes), leading to dehydration.1 

This water loss can reduce an athlete’s weight. Diuretics can also help people pass drug tests by diluting their urine. They’re sometimes called a ‘masking’ agent. 

Creatine

Many athletes use nutritional supplements instead of or as well as performance-enhancing drugs.1

Supplements are available OTC as pills or powders. Creatine monohydrate is a supplement popular among athletes. 

Creatine is a naturally occurring compound in your body that helps your muscles release energy. Creatine may help produce small gains in short-term bursts of power.

The compound also helps make muscles more adenosine triphosphate (ATP). This allows the body to store and transport energy in cells and is helpful for quick bursts of activity, like weightlifting or sprinting.

Who Uses Performance-Enhancing Drugs?

Most people who misuse performance-enhancing drugs like steroids are male non-athlete weightlifters in their 20s or 30s. Approximately 22 percent of anabolic steroid users begin as teenagers.2 

Anabolic steroid use is less common among women. This is because women typically don’t want to develop an extremely muscular physique or desire the masculinizing effects of steroids. 

Risks, Consequences, and Side Effects of Using Performance-Enhancing Drugs

Performance-enhancing drugs come with various risks, consequences, and side effects depending on the substance.

Anabolic Steroids

Many athletes take anabolic steroids in quantities much higher than doses prescribed for medical reasons. However, anabolic steroids have severe physical side effects.

Men may develop:

  • Prominent breasts
  • Shrunken testicles
  • Infertility
  • Prostate gland enlargement

Women may develop: 

  • A deeper voice, which can be irreversible
  • An enlarged clitoris, which can be irreversible
  • Increased body hair
  • Baldness, which can be irreversible
  • Infrequent or no 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 
  • Decreased high-density lipoprotein (HDL) cholesterol
  • High blood pressure
  • Heart and blood circulation issues
  • Aggressive behaviors, rage, or violence
  • Psychiatric disorders, such as depression
  • Drug dependence
  • Infections or diseases like hepatitis or HIV if you're injecting the drugs
  • Affected growth and development, and the risk of future health problems in teenagers

In the past 20 years, law enforcement in the United States has driven much of the illegal steroid industry into the black market. 

This leads to extra health risks because the drugs are made in illegal labs in the United States or produced in other countries and smuggled in. In any case, they don’t undergo government safety standards and could be mislabeled or impure.

Androstenedione

The side effects of andro in men include:

  • Acne
  • Reduced sperm production
  • Shrinking of the testicles
  • Enlargement of the breasts 

The side effects of andro in women include:

  • Acne
  • Masculinization, including deepening of the voice and male-pattern baldness 

In men and women, andro can affect the heart and blood vessels, heightening the risk of heart attack and stroke.

Human Growth Hormone

The risks linked to human growth hormone range in severity but may include:

  • Joint pain
  • Muscle weakness
  • Fluid retention
  • Diabetes
  • Vision issues
  • Carpal tunnel syndrome
  • Impaired glucose regulation
  • Enlarged heart
  • High blood pressure 

Erythropoietin

Erythropoietin was popular among competitive cyclists in the 1990s. It reportedly contributed to at least 18 deaths.

The use of erythropoietin may increase the risk of: 

  • Stroke
  • Heart attack
  • Blockage in an artery in the lung

Diuretics 

Even at medically recommended doses, diuretics can lead to adverse side effects, including:

  • Dehydration
  • Muscle cramps
  • Dizziness
  • Potassium deficiency
  • Drop in blood pressure
  • Loss of coordination and balance
  • Death

Creatine

The possible side effects of creatine include:

  • Stomach cramps
  • Muscle cramps
  • Weight gain

Weight gain is desired by many athletes who want to increase their size. But with consistent creatine use, weight gain is more likely from water retention than an enhancement in muscle mass.

Water is drawn into your muscle tissue away from other body areas. This puts you at risk of dehydration. 

It appears safe for adults to take creatine at the doses recommended by manufacturers. However, the long-term benefits and risks of creatine supplementation aren’t known.

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Can You Become Addicted to Performance-Enhancing Drugs?

Around 32 percent of people who misuse anabolic steroids become dependent on the drugs.3

Symptoms of anabolic steroid dependence include tolerance. This is when someone needs to take more steroids to achieve the same results.

Another indicator of dependence is the development of withdrawal symptoms once the use of anabolic steroids stops.

Treatment Options for Substance Abuse

People who use performance-enhancing drugs like steroids don’t often seek treatment. Approximately 56 percent of users don’t tell their physician about their steroid use.4

This may be because users feel their physician lacks knowledge about performance-enhancing drugs. Many websites focusing on anabolic steroids and other performance-enhancing drugs challenge the professionalism of healthcare providers and provide their advice.

Healthcare providers must be educated on the signs and symptoms of steroid use in patients.

Treatment for steroid use and other performance-enhancing drugs should address the underlying causes of drug use.

This can include:4

  • Psychological therapies and medications for muscle dysmorphia
  • Endocrine therapies to restore function in people suffering from hypogonadism and to treat symptoms of depression
  • Antidepressants for people whose depression doesn’t respond to endocrine therapies
  • Pharmacological and psychosocial treatments appear to be effective in treating the signs of anabolic steroid dependece for people who are also dependent on opioids

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Summary

  • Performance-enhancing drugs are often used to enhance physique and improve performance in athletes
  • There are various types of performance-enhancing drugs, with anabolic steroids being among the most popular
  • Most people who misuse steroids are male non-athlete weightlifters in their 20s or 30s
  • Performance-enhancing drugs come with risks, consequences, and side effects, such as the development of various physical attributes
  • Approximately 32 percent of people who misuse anabolic steroids become dependent
  • Treatment for people recovering from steroid misuse includes psychological therapies and psychosocial treatments
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