Ty Johnston, PharmD Candidate
This is part 2 of a two-part series about performance-enhancing drugs (PEDs). In part 1, we talked about ways athletes get away with doping, while here we talk about commonly abused PEDs; what they are, their medical uses, how they’re abused, and the risks behind their abuse.
What is a Performance-Enhancing Drug:
PEDs are substances that are used to improve any form of activity performance. The use of PEDs by athletes is commonly referred to as “doping” and is considered unethical by most professional sports organizations and is therefore prohibited. Three of the most commonly abused PEDs include anabolic steroids, blood doping agents, and stimulants.1
Common Performance-Enhancing Drugs:
#1 Anabolic Agents:
- What are they: This class of PED includes testosterone, synthetic derivatives of testosterone, and substances that either result in increased testosterone levels or increased testosterone effects. Testosterone is a natural hormone, meaning it’s normally produced in the human body. On the other hand, synthetic compounds are produced in a laboratory but have similar effects to testosterone in the body.
- How do they work: Anabolic steroids work by increasing the actions or effects of testosterone. In general, testosterone has two classes of effects: Anabolic and androgenic.2 Anabolic effects include increased muscle mass, muscle strength, and increased bone growth and durability. The androgenic effects of testosterone include maturation of male sex organs (penis and scrotum), deepening of the voice, and growth of facial/underarm hair. Although testosterone is stereotypically known as a male sex hormone, it occurs naturally in both males and females, but to different extents. Furthermore, anabolic agents are abused by men and women for their desirable effects on sports performance.
- How are they abused: The advantages of anabolic steroids in sports are rather obvious as they increase muscle mass and enhance performance. However, the use of anabolic steroids is also widespread in recreational sports, and the general population for the intent of improving body appearance.2 Data from the US suggests that 1-3% of individuals use anabolic steroids.2 Currently, it is illegal to obtain testosterone and related-compounds without a prescription under the Canadian Controlled Drugs and Substances Act.3
- What are the medical uses: The medical uses of these agents are mostly limited to testosterone supplementation. Supplementation is used to treat testosterone deficiency, muscle-wasting that can occur as a result of disease or certain medications, including osteoporosis, a condition characterised by low bone mass and deterioration of bone tissue.4
- What are the risks: Side effects from these agents are extensive. These agents can affect the reproductive system causing infertility and decreased sperm count, gynecomastia in men (enlargement of breasts), growth of the prostate and possibly prostate cancer. Regarding the cardiovascular system, they can cause cholesterol problems, and recent evidence has shown a possible increased risk of heart attack, stroke, and blood clots.7 Further side effects include liver damage, acne, and psychiatric effects such as aggression, depression, and psychosis.5
#2 Blood Doping
- What is it: Blood doping is the use of drugs or other techniques to enhance the ability of the body’s blood to carry and transport oxygen. There are three widely known methods for blood doping; namely erythropoietin (EPO), artificial oxygen carriers, and blood transfusions.
- How do they work: EPO and blood transfusions work by increasing the number of red blood cells in the body. Since red blood cells carry oxygen to the muscles, increasing the number of cells enhances the body’s aerobic capacity and endurance. Artificial oxygen carriers work differently, but have a very similar effect as they also improve oxygen delivery to organs and muscle tissue.8
- Medical uses: EPO is a medication commonly used to treat anemia related to kidney disease. The kidneys naturally produce EPO, and when they don’t function properly, EPO is no longer provided in sufficient amounts. Supplemental EPO is used to stimulate the production of red blood cells back to normal, or in the case of athletic doping, up to extremely high levels. Furthermore, blood transfusions are commonly used medically to replace blood loss from surgery or trauma.
- Risks: While these agents have important medical uses, their misuse can pose serious health risks. Unnaturally high levels of red blood cells increase the risk of heart attack, stroke, and blood clotting; all of which can have deadly consequences.6
- What are they: Stimulants are a broad category of drugs that work to increase alertness and attention. The most common stimulants include caffeine, pseudoephedrine, amphetamine, and methylphenidate.
- How do they work and how are they abused: Although these medications have varying mechanisms of action, research has shown that stimulants improve endurance, increase aerobic performance, decrease feelings of fatigue, improve reaction time, increase alertness, and cause weight loss.3
- Medical uses: Pseudoephedrine is a medication commonly used in non-prescription cough and cold products. It works as an oral decongestant to constrict the blood vessels in your nose and decrease nasal congestion. Amphetamine and methylphenidate are controlled drugs by Health Canada that are used to treat attention deficit hyperactivity disorder (ADHD). It is illegal to obtain or possess a controlled substance in Canada without a prescription.5
- Risks: Stimulants generally have many side effects, but they tend not to be as serious as the previous two classes of PEDs. The most common side effects include insomnia (difficulty sleeping), reduced appetite, and weight loss. Stimulants can also increase your risk of heart disease, anxiety, and other psychiatric disorders.
The Bottom Line:
Athletic doping typically exploits the benefits of certain medications used to treat various health conditions. Although the benefits can be tempting, these substances have very concerning risks when misused, which need to be considered both when using them medically or illicitly.
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