This is the first post in a two-part series looking at performance-enhancing drugs. Both posts utilize information from a recently published scientific statement by The Endocrine Society on the medical consequences of PED use.

In this post, I present some facts on the use and dangers of PED’s, such as anabolic-androgenic steroids. In the second post – “Performance-enhancing drugs: What we don’t know (and why)” – I discuss our limited knowledge of the prevalence of PED use and the long-term health risks associated with use. I’ll also examine possible reasons why there seems to be little appreciation of their adverse effects.

Weightlifter - smallWhile much attention centers around professional and elite athletes who use performance-enhancing drugs, concern seems concentrated on catching the athletes and eliminating possible competitive advantages. It is crucial to understand that elite athletes only make up a small fraction of the people who use them.

Here are some important facts about PED use that are known, from The Endocrine Society statement:

Over 3 million people use performance-enhancing drugs in the United States alone. In terms of prevalence, PED use is more common than either HIV or type I diabetes.

Most PED users are nonathlete weightlifters or recreational bodybuilders, not competitive athletes.

When looking at nonathlete weightlifters, the use of anabolic drugs – specifically anabolic-androgenic steroids – is greater than the use of all other PED’s combined. The use of human growth hormone (hGH) and insulin-like growth factor-1 appear to be rising as they have become cheaper and easier to obtain.

WrestlingAmong competitive athletes, many drugs other than steroids are used as well. Boxers, wrestlers, and bodybuilders might use diuretics to decrease body weight or improve muscle definition. Endurance athletes, such as cyclists and long-distance runners, might use blood-boosting agents like erythropoietin. Athletes who compete in events requiring calm nerves might use tranquilizing drugs. Opiates to decrease pain and masking drugs to prevent detection are also common.

Users of anabolic-androgenic steroids (AAS) frequently use other drugs as well. They often combine different steroids – a process called “stacking.” They often use other abused drugs, like opiates. And AAS use has been linked to alcohol abuse.

A review of all possible medical consequences of PED use is far beyond what I can share in this post. Plus, as I talk about in part two of this series, we don’t have long-term, randomized controlled trials studying these drugs. However, there are some adverse effects worth mentioning briefly.

Anabolic-androgenic steroids have been linked to many cardiovascular issues, including heart attacks, strokes, and arrhythmias.

Steroid users can demonstrate psychiatric symptoms. Manic symptoms, such as reckless behavior, irritability, aggressiveness, and hyperactivity, can develop. Users might develop depressive symptoms with steroid withdrawal.

AAS use can adversely affect a number of other body systems. Steroids have been associated with rhabdomyolysis, a condition in which skeletal muscle can break down and can ultimately lead to kidney failure in muscular users. These drugs can damage the liver. They can also have detrimental effects on the musculoskeletal system, especially causing tendon ruptures.Prescription meds

Despite increased awareness of, and possible increased use of, human growth hormone, little scientific research actually shows it to have positive effects on athletic performance. It is possible, though, that competitive athletes use much higher doses than those studied. Plus many athletes claim to use it to recover from injury more quickly, allowing them to train harder.

Erythropoietins increase the risk of blood clots and strokes. Since they increase red blood cell mass and thus increase oxygen delivery to the muscles, their use is reportedly common in endurance events.

There seems to be a common belief that performance-enhancing drugs can be used safely or that their side effects can be mitigated. As I will discuss in my next post on PEDs, we need much more research into the long-term effects of these drugs.

Are you surprised with some of these medical effects? Do you think that we are doing enough to let athletes and other users know about the risks? I’d love to hear your thoughts!

Pope HG Jr, Wood R, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement. Endocr Rev. 2014