Performance Enhancing Drugs: Complete Guide to Risks and Side Effects

The competitive world of athletics often drives individuals to seek any advantage possible. For some, this pursuit leads to the use of performance-enhancing drugs (PEDs), substances designed to boost physical capabilities, strength, endurance, or recovery. While these substances may promise improved athletic performance, they carry significant health risks that can have lasting, sometimes irreversible consequences.

Understanding what these drugs are, how they work, and their potential dangers is crucial for athletes, parents, coaches, and anyone involved in competitive sports. This comprehensive guide explores the most common performance-enhancing drugs, their effects on the body, and why the risks far outweigh any perceived benefits.

What Are Performance-Enhancing Drugs?

Performance-enhancing drugs, commonly referred to as PEDs, are substances used to improve athletic performance beyond what training and nutrition alone can achieve. These drugs work through various mechanisms—some build muscle mass, others increase endurance, while some improve focus or reduce fatigue.

The use of PEDs, known as doping, is prohibited in virtually all professional and amateur sports organizations worldwide. Beyond the ethical concerns and potential for unfair competition, these substances pose serious medical risks that can affect multiple organ systems and overall health.

Athletes may feel pressure to use these drugs from various sources: the desire to win, financial incentives, peer pressure, or simply the belief that “everyone else is doing it.” However, the short-term gains come at a potentially devastating long-term cost.

Anabolic Steroids: The Most Commonly Abused PEDs

How Anabolic Steroids Work

Anabolic-androgenic steroids are synthetic versions of testosterone, the primary male hormone. These substances have two main effects on the body: anabolic effects (building muscle tissue) and androgenic effects (developing male characteristics like facial hair and deeper voice).

Athletes use anabolic steroids because they can potentially reduce muscle damage during intense training, allowing for faster recovery and more frequent, intense workouts. Some users also appreciate the aesthetic changes that occur with muscle development.

While these drugs have legitimate medical applications when prescribed by healthcare providers for specific conditions, their use for athletic enhancement is illegal and dangerous. The doses athletes take for performance enhancement typically far exceed therapeutic doses, multiplying the health risks.

Serious Health Risks of Anabolic Steroids

The side effects of anabolic steroid abuse are extensive and can affect nearly every system in the body. These risks vary somewhat between men and women due to hormonal differences.

In men, anabolic steroids can cause:

• Breast tissue development (gynecomastia)
• Testicular shrinkage and reduced sperm production
• Infertility issues
• Prostate gland enlargement
• Increased risk of prostate cancer

In women, these drugs can lead to:

• Voice deepening that may be permanent
• Clitoral enlargement
• Excessive body hair growth
• Male-pattern baldness that may be irreversible
• Menstrual irregularities or complete cessation of periods

Both men and women who abuse anabolic steroids face risks including:

• Severe acne and skin problems
• Increased risk of tendon rupture and muscle tears
• Liver damage, including tumors and cysts
• Cardiovascular problems, including heart attacks and strokes
• Elevated LDL (bad) cholesterol and decreased HDL (good) cholesterol
• High blood pressure and increased risk of blood clots
• Mood swings, aggression, and violent behavior
• Depression and other mental health disorders
• Physical dependence and addiction
• Risk of HIV, hepatitis, and other infections from needle sharing

Adolescents who use anabolic steroids face additional dangers. These substances can cause premature closure of growth plates in bones, resulting in permanently stunted height. The hormonal disruption during critical developmental years can also lead to long-term health complications.

Androstenedione (Andro): The Precursor Hormone

Androstenedione is a hormone naturally produced by the body that serves as a precursor to testosterone and estrogen. Laboratory-made versions have been marketed to athletes with claims of increased testosterone levels and muscle growth.

However, scientific research has not supported these marketing claims. Studies indicate that andro supplementation does not significantly increase testosterone levels or improve muscle strength in the way manufacturers suggest.

Health Dangers of Androstenedione

Despite questionable effectiveness, andro carries significant health risks:

Men may experience:

• Acne outbreaks
• Testicular atrophy and reduced sperm production
• Gynecomastia (breast tissue development)

Women may develop:

• Acne
• Voice deepening
• Hair loss

Most concerning, androstenedione can cause cardiovascular damage in anyone who uses it, significantly increasing the risk of heart attack and stroke—both potentially fatal conditions. This cardiovascular risk alone makes andro use extremely dangerous.

Human Growth Hormone (HGH): The Recovery Aid

Human growth hormone, also called somatotropin, is naturally produced by the pituitary gland and plays a crucial role in growth and metabolism. Athletes use synthetic HGH believing it will increase muscle mass, improve recovery, and enhance performance.

Despite its popularity among some athletes, scientific evidence does not clearly demonstrate that HGH improves strength or athletic endurance. The perceived benefits often do not match reality, while the health risks are very real.

Side Effects of HGH Abuse

Misuse of human growth hormone can lead to numerous health complications:

• Joint pain and stiffness
• Muscle weakness (ironically, the opposite of the intended effect)
• Fluid retention and swelling (edema)
• Development or worsening of diabetes
• Vision problems
• Carpal tunnel syndrome (nerve compression in the wrist)
• Difficulty regulating blood sugar levels
• Cardiomegaly (abnormal heart enlargement)
• High blood pressure
• Increased risk of certain cancers

Erythropoietin (EPO): The Endurance Enhancer

Erythropoietin is a hormone that stimulates red blood cell production. When prescribed by healthcare providers, it treats anemia in patients with severe kidney disease. Athletes, particularly endurance athletes like cyclists and long-distance runners, abuse synthetic EPO to increase oxygen-carrying capacity.

By boosting red blood cell counts, EPO can theoretically improve oxygen delivery to muscles during prolonged exercise. However, this manipulation of blood composition carries deadly risks.

Deadly Consequences of EPO Doping

The dangers of EPO abuse became tragically apparent in the 1990s when it was linked to at least 18 deaths among professional cyclists. EPO thickens the blood by increasing red blood cell concentration, which can lead to:

• Blood clots that can travel to the lungs, brain, or heart
• Stroke from blocked blood vessels in the brain
• Heart attacks
• Pulmonary embolism (blocked arteries in the lungs)
• Sudden death, particularly during sleep when heart rate naturally slows

The risk-to-benefit ratio of EPO doping is extremely unfavorable, with potentially fatal consequences far outweighing any performance advantages.

Diuretics: The Masking Agents

Diuretics are medications that increase urine production, helping the body eliminate excess fluid and salt. Athletes abuse diuretics for two primary reasons: rapid weight loss (important in sports with weight classes) and masking other banned substances by diluting urine samples.

Even at medically appropriate doses, diuretics can cause side effects. At the higher doses athletes may take, these risks multiply significantly.

Dangerous Side Effects of Diuretic Abuse

Misuse of diuretics can lead to:

• Severe dehydration that can impair performance and damage organs
• Painful muscle cramps
• Dizziness, lightheadedness, and fainting
• Dangerous electrolyte imbalances, particularly potassium depletion
• Low blood pressure that can cause collapse
• Impaired coordination and balance
• Kidney damage or failure
• Heat stroke, especially when exercising in warm conditions
• Cardiac arrhythmias (irregular heartbeat) that can be fatal

Deaths have occurred from diuretic abuse in sports. The combination of dehydration, electrolyte imbalances, and physical exertion creates a dangerous situation that can quickly become life-threatening.

Creatine: The Popular Supplement

Unlike the other substances discussed, creatine monohydrate occupies a different category. It’s a compound naturally produced by the body and found in foods like meat and fish. Creatine supplements are legal and widely available.

Creatine helps supply energy to muscles during short bursts of high-intensity activity. Research suggests it may provide modest benefits for activities involving quick, explosive movements like sprinting or weightlifting. However, it does not appear to benefit endurance activities.

Potential Issues with Creatine Supplementation

While generally considered safer than the drugs previously discussed, creatine supplementation can still cause problems:

• Weight gain, primarily from water retention in muscles
• Stomach cramping and digestive discomfort
• Muscle cramps in some individuals
• Dehydration risk, as creatine draws water into muscle tissue
• Potential kidney stress with excessive doses or pre-existing kidney problems

Anyone considering creatine supplementation should consult with a healthcare provider first, especially those with kidney conditions or other health concerns. Following manufacturer-recommended doses is essential if use is deemed appropriate.

Stimulants: The Focus and Energy Boosters

Stimulants are substances that increase activity in the central nervous system, making users feel more alert, energetic, and focused. These range from legal substances like caffeine to prescription medications and illegal street drugs.

Athletes may use stimulants to:

• Increase alertness and concentration
• Reduce fatigue sensations
• Suppress appetite for weight management
• Increase aggression and competitiveness
• Extend training duration

Common stimulants include caffeine (in high doses), amphetamines, cocaine, methamphetamine, and certain ingredients in cold medications and energy drinks.

Health Risks of Stimulant Abuse

While moderate caffeine consumption is generally safe for most people, stimulant abuse carries serious risks:

Performance-impairing effects:

• Anxiety and nervousness that reduce focus
• Insomnia and sleep disruption that impairs recovery
• Dehydration
• Heat stroke from impaired temperature regulation
• Addiction and tolerance, requiring higher doses

Serious health consequences:

• Heart palpitations and irregular heartbeat
• Dangerously elevated heart rate
• High blood pressure
• Tremors and involuntary shaking
• Significant weight loss and malnutrition
• Hallucinations and psychosis
• Stroke from burst blood vessels
• Heart attack or cardiac arrest
• Sudden death, particularly in those with undiagnosed heart conditions

The combination of stimulants with intense physical exertion puts extraordinary stress on the cardiovascular system, creating a potentially lethal situation.

Blood Doping: Artificially Boosting Oxygen Capacity

Blood doping refers to techniques that increase the blood’s oxygen-carrying capacity. This can involve blood transfusions (receiving donated blood or one’s own previously stored blood) or using substances like EPO.

Endurance athletes have used blood doping to improve performance in events where oxygen delivery is crucial. However, like EPO, blood doping thickens the blood and creates severe health risks including blood clots, stroke, heart attack, and sudden death.

Beta-2 Agonists: The Breathing Aids

Beta-2 agonists are medications legitimately prescribed for asthma and other respiratory conditions. They work by relaxing airway muscles, making breathing easier. Some athletes abuse these drugs believing they’ll improve oxygen intake and endurance.

At high doses, beta-2 agonists can cause tremors, heart palpitations, headaches, muscle cramps, and potentially dangerous heart rhythm disturbances.

The Psychological Impact of PED Use

Beyond the physical health consequences, performance-enhancing drug use can significantly impact mental health and well-being:

• Mood disorders: Many PEDs, especially anabolic steroids, can cause severe mood swings, depression, anxiety, and aggressive behavior sometimes called “roid rage.”
• Addiction: Some performance-enhancing drugs are physically and psychologically addictive, making it difficult to stop use even when harmful effects become apparent.
• Body dysmorphia: PED use can contribute to distorted body image, where users never feel satisfied with their physique regardless of changes.
• Guilt and anxiety: The secrecy required to hide doping, fear of testing positive, and ethical concerns can create significant psychological stress.
• Identity issues: Athletes who dope may struggle with questions about whether their achievements are truly their own.

Legal and Career Consequences

The ramifications of PED use extend beyond health concerns:

Athletic consequences:

• Suspension or lifetime bans from competition
• Forfeiture of medals, titles, and records
• Loss of sponsorships and endorsements
• Damage to reputation that may never be repaired
• Exclusion from Halls of Fame and other honors

Legal issues:

• Possession of controlled substances without prescription is illegal
• Distribution can lead to serious criminal charges
• Crossing international borders with banned substances can result in arrest

The Myth of “Safe” Doping

Some athletes believe they can use performance-enhancing drugs safely through careful dosing, cycling (periods of use followed by breaks), or monitoring. This is a dangerous misconception.

The reality is:

• No amount of monitoring eliminates the serious health risks
• Long-term effects of many PEDs are still not fully understood
• Individual responses vary—what seems “safe” for one person may be deadly for another
• Black market drugs may be contaminated, mislabeled, or contain dangerous additives
• Combining multiple substances (stacking) multiplies risks in unpredictable ways

Safer Alternatives to Performance-Enhancing Drugs

Athletes seeking to improve performance have many legitimate, healthy options:

Optimized training: Working with qualified coaches to develop periodized training programs that balance intensity with adequate recovery.

Proper nutrition: Consulting with sports nutritionists to ensure adequate calorie, macronutrient, and micronutrient intake for training demands.

Quality sleep: Prioritizing 7-9 hours of quality sleep nightly, when much of recovery and adaptation occurs.

Mental training: Developing psychological skills like visualization, goal-setting, and stress management.

Legal supplements: Under professional guidance, using evidence-based supplements like protein powder, omega-3 fatty acids, and vitamins when dietary intake is inadequate.

Recovery techniques: Incorporating massage, stretching, foam rolling, and other recovery modalities.

Medical support: Working with sports medicine professionals to address injuries and health concerns appropriately.

Warning Signs of PED Use

Coaches, parents, and teammates should be aware of potential signs that someone may be using performance-enhancing drugs:

• Rapid muscle gain or weight changes
• Sudden, dramatic improvements in performance
• Severe acne, particularly on the back and shoulders
• Mood swings, increased aggression, or depression
• Secretive behavior or unusual defensiveness
• Needle marks or syringes
• In males: breast development, testicular shrinkage
• In females: voice deepening, excessive body hair, menstrual changes
• Persistent injuries, particularly tendon problems

If PED use is suspected, approaching the person with concern rather than accusation, and encouraging them to seek help from a healthcare provider, is important.

Getting Help for PED Use

Athletes struggling with performance-enhancing drug use should know that help is available and recovery is possible. Important steps include:

Medical evaluation: Consulting with a healthcare provider who can assess health status, identify complications, and develop a plan for safely discontinuing use. Never attempt to stop certain substances abruptly without medical supervision.

Mental health support: Working with a therapist or counselor who understands sports psychology and substance abuse can address underlying issues and develop healthier coping strategies.

Support systems: Connecting with support groups or other athletes who have successfully stopped using PEDs can provide encouragement and accountability.

Education: Learning about the true risks and limited benefits of PEDs can strengthen commitment to staying clean.

Remember that seeking help is a sign of strength, not weakness. Many athletes have successfully overcome PED use and gone on to achieve success through legitimate means.

The Bottom Line on Performance-Enhancing Drugs

The use of performance-enhancing drugs in sports represents a serious health risk that far outweighs any temporary competitive advantage. While these substances may promise improved strength, endurance, or recovery, they deliver serious and sometimes permanent health consequences.

From cardiovascular damage and liver problems to hormonal disruption and mental health issues, PEDs affect virtually every system in the body. Some effects are irreversible. Some are fatal.

The pressure to win, achieve scholarships, or secure professional contracts can be intense. However, no medal, record, or contract is worth sacrificing your health. True athletic excellence comes from dedication, smart training, proper recovery, and the satisfaction of knowing your achievements are genuinely yours.

If you’re considering performance-enhancing drugs, or are currently using them, speak with a healthcare provider immediately. They can provide confidential guidance, help you understand the specific risks you face, and support you in making healthier choices.

For parents and coaches: creating an environment that values health, realistic goal-setting, and proper training over winning at all costs is essential. Young athletes need to understand that shortcuts have consequences, and that their worth extends far beyond their athletic performance.

The best performance enhancement comes not from a pill, injection, or powder, but from consistent effort, smart training, adequate nutrition, quality sleep, and the knowledge that you’re competing clean and protecting your health for the long term.

Sources:

• Mayo Clinic – Performance-enhancing drugs: Know the risks
• U.S. Anti-Doping Agency – Prohibited Substances
• World Anti-Doping Agency – Prohibited List
• National Institutes of Health – Performance Enhancing Drugs
• National Institute on Drug Abuse – Anabolic Steroids DrugFacts
• CDC – Physical Activity Basics