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The world of sport has become extremely competitive and strict and most elite athletes agree that the drive to win can be fierce. In such an environment, the use of performance-enhancing drugs (PEDs) has become increasingly common. But using PEDs or doping is not risk-free. In this week’s article, learn about the potential benefits, the health risks and the many unknown facts regarding some of the most common PEDs such as anabolic steroids, human growth hormone, erythropoietin, diuretics and stimulants. In case you are considering such practises, you may decide that the benefits aren’t worth the risks.

Basics & Definition

Performance-enhancing drugs are substances used by athletes to improve their performance. Although the term PEDs is often used in reference to anabolic steroids, world anti-doping organizations apply the term more broadly. Anabolic steroids were first made in the 1930s, and are now used therapeutically in medicine to stimulate bone growth and appetite, induce male puberty, and treat chronic wasting conditions, such as cancer and AIDS. But why are these drugs so appealing to athletes? Besides increasing muscle mass, anabolic steroids may help athletes recover from a hard workout more quickly by reducing the muscle damage that occurs during the session. Therefore, athletes are able to work out harder and more frequently without overtraining.

Types of PEDs
Lean mass builders enhance muscle and lean body mass growth and are sometimes used to reduce body fat. This class of drugs includes anabolic steroids, xenoandrogens, beta-2 agonists, selective androgen receptor modulators (SARMs), and various human hormones such as human growth hormone (HGH).
Stimulants like caffeine, amphetamine, and methamphetamine can enhance performance by enhancing focus, and energy.
Diuretics expel water from the body and are very often used by wrestlers who need to meet weight restrictions.
Sedatives such as diazepam, propranolol or even alcohol are sometimes used by athletes in certain sports which require steady hands and accurate aim, and also in order to overcome stress or nervousness.
Painkillers mask athletes’ pain in order to continue competing beyond their usual pain thresholds. They range from common over-the-counter medicines such as NSAIDs (such as ibuprofen) to prescription narcotics.
Blood boosters such as Erythropoietin (EPO), increase the oxygen-carrying capacity of blood and are often used in endurance sports.
Masking drugs prevent the detection of other drugs and unfortunately, they evolve as quickly as the testing methods.

The most popular PEDs – Anabolic Steroids

The main anabolic steroid hormone produced by the body is testosterone. Testosterone has two main effects on your body; anabolic effects which promote muscle building, and androgenic effects which are responsible for male characteristics, such as a deeper voice and facial hair. The anabolic steroids that athletes use are often synthetic modifications of testosterone, and they can be taken as pills, injections or topical treatments. Some athletes take straight testosterone to boost their performance. Although these hormones have approved medical uses, improving athletic performance is definitely not one of them.


Androstenedione is a hormone produced by the adrenal glands, ovaries and testes, which is normally converted to testosterone and estradiol in both men and women. Although it is available only in prescription form its use as a PED is illegal, manufacturers and bodybuilding magazines promote its ability to allow athletes to train harder and recover more quickly.

Long-term use or excessive doses of anabolic steroids can have serious health risks. These effects include high blood pressure, liver damage, heart problems, harmful changes in cholesterol levels, acne and also hormonal imbalances such as gynecomastia (enlargement of breasts in men) and testicular atrophy. Anabolic steroids come with serious physical side effects as well.

Men may develop:
• Baldness
• Infertility
• Impotence
Women may develop:
• Infrequent or absent periods
• A deeper voice
• Enlarged Genitals
• Increased body hair
• Baldness

Both men and women might experience:
• Increased low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol)
• Decreased high-density lipoprotein (HDL) cholesterol (the “good” cholesterol)
• High blood pressure (hypertension)
• Aggressive behaviours, rage or violence
• Psychiatric disorders, such as depression
• Increased risk of tendinitis and tendon rupture
• Liver abnormalities and tumors
• Infections or diseases such as HIV or hepatitis if you’re injecting the drugs
• Drug dependence
• Inhibited growth and development, and risk of future health problems in teenagers

Human growth hormone

Human growth hormone (HGH) which is available only by prescription, is a hormone that has an anabolic effect. Athletes take it to improve performance and increase muscle mass. Adverse effects related to human growth hormone range in severity and may include:
• Joint pain
• Muscle weakness
• Fluid retention
• Impaired glucose regulation
• High cholesterol (hyperlipidemia)
• High blood pressure (hypertension)


Erythropoietin (EPO) is a type of hormone which increases production of red blood cells and haemoglobin, resulting in improved movement of oxygen to the muscles and it is often used by endurance athletes. EPO misuse may increase the risk of thrombotic events, such as heart attack or stroke.


Diuretics change your body’s natural balance of fluids and salts (electrolytes) and can lead to dehydration. However, their misuse may predispose athletes to adverse effects such as:
• Heart arrhythmias
• Exhaustion
• Dizziness
• Fainting
• Dehydration
• Muscle cramps
• Heatstroke
• Drop in blood pressure
• Loss of coordination and balance
• Death


Although stimulants can boost physical performance and promote aggressiveness on the field, they have side effects that can impair athletic performance.
• Nervousness and irritability, which make it hard to concentrate on the game.
• Insomnia, which can prevent an athlete from getting needed sleep.
• Dehydration
• Heatstroke
• Addiction
Other side effects include:
• Heart palpitations, circulatory problems and even heart attack or stroke
• Mild high blood pressure (hypertension)
• Weight loss
• Tremors
• Hallucinations

PEDs & Sports

Anabolic steroids are banned by all major sports bodies. The World Anti-Doping Agency (WADA) maintains the list of PEDs used by many major sports bodies and includes all anabolic agents. The legal status of anabolic steroids varies from country to country: some have stricter controls on their use or prescription than others though in many countries they are not illegal. In the United Kingdom, anabolic steroids are classified as class C drugs for their illegal abuse potential.


The use and misuse of PEDs is a subject that started many debates and unfortunately is not an uncommon event during major sports events like the Olympics. Do PEDs boost performance? Some athletes may appear to achieve physical gains from such drugs, but at what cost? How can the major sports bodies ensure that all competitions are fair? What about the athletes’ health? The long-term effects of PEDs haven’t been rigorously studied, and their short-term benefits come with many risks. Maybe we should all consider the values that lie in the heart of sports like fair play, participation and determination and discourage the use of illegal and possibly harmful substances.

By Kleio Bathrellou
Associate Nutritionist

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