Muscles use creatine to release energy, which enhances lean muscle mass and increases muscle energy. Those who take creatine often do so as a means to build muscle mass.

Taking creatine is also not without its side effects. For example, creatine can cause weight gain, muscle cramping, and stomach cramping. Additionally, the liver and kidneys must filter creatine. Taking an excessive amount can put a strain on these important organs, which could potentially damage them.

Individual results may vary for all of these supplements. Talk with your doctor or athletic trainer about the safety and effectiveness of individual supplements. The NCAA and the Olympics commission have banned some substances because they offer an unfair advantage or can cause harm to the athlete.

Anabolic and other steroids are illegal in sporting events and according to the law. The side effects are numerous and potentially fatal.

Examples include androstenedione, stanozolol, axiron, and fortesta. DHEA is possibly the most abundant steroid in humans. Using synthetic versions to increase steroid production is potentially dangerous.

Diuretics are medications that cause a person to urinate more frequently. Diuretics can cause a variety of harmful side effects, such as cramping, dizziness, blood pressure drops, and electrolyte imbalances.

Blood doping is the process of boosting red blood cells to help carry more oxygen to the muscles and lungs. It can be done through a blood transfusion or through use of drugs like erythropoietin. Athletes use the medication to make more red blood cells in their bodies. Endurance athletes may especially try to use erythropoietin, believing they they can perform longer with more oxygen.

Ephedrine is a central nervous stimulant. Ephedrine produces similar effects to adrenaline, but it too can be dangerous. It can cause serious cardiovascular effects, including stroke, and a whole host of other problems.

Both athletic organizations and the FDA have banned it. HGH is a drug developed to help treat growth disorders in children. It stimulates cell reproduction and regeneration.

Athletes looking to gain an edge may misuse this drug to achieve it. Potential complications include enlarged organs and chronic disease. They can cause more damage than stripping an athlete of a title. Training, dedication, hydrating fluids, and proper diet are safer options and better than any ergogenic aids for boosting performance.

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Learn what anabolic steroids are, what they're used for both legally and illegally , and how to find safe alternatives that'll give you the same….

There are several dietary supplements that can help increase muscle mass and strength. Here are the 6 best supplements to gain more muscle. People use it for livestock and horses. Maintaining optimal levels of nitric oxide in your body is essential for your overall health. This article reviews the top 5 ways to increase your….

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Constantly dream of romance? Fixate on thoughts of your partner? Feel a need to always be in love? Learn why — and why this isn't an "addiction. Toxic femininity, or behavior that aligns with patriarchal beliefs about what women should and shouldn't do, can affect your well-being.

Here's how. A new study, released this week has found that death rates are increased for people with obesity who are also socially isolated and lonely. A new study finds a type of psychedelic called ibogaine may help people with traumatic brain injury.

In the study 30 male Special Operations Forces…. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Mental Well-Being. In October , after years of speculation and repeated denials on his part, renowned cyclist Lance Armstrong admitted to doping.

He took erythropoietin, testosterone, hGH , blood transfusions — any performance-enhancing drug that would give him more strength, more endurance and a faster recovery so he could win. And win he did. Armstrong won seven consecutive Tour de France titles and an Olympic bronze in his decorated cycling career.

He was stripped of them all. It was hardly an isolated incident. Almost every professional sport — from weightlifting to baseball to archery — has been scandalized by claims of doping. And many sports heroes have been dethroned as a result. Athletes and others use performance-enhancing drugs PEDs to increase strength, endurance, recovery and other physical abilities beyond what is considered natural for the individual.

The intention behind using these drugs is to gain a competitive edge or enhance one's physical appearance. Anabolic steroids are among the most popular PEDs of choice. Chemicals in this special class of steroids, which include testosterone, androstenediol, androstenedione, nandrolone and stanozolol, are credited with increasing muscle mass and strength, but drug tests can easily detect anabolic steroid abuse.

In the s and '90s, however, other doping alternatives started appearing on the scene. Now there are numerous PEDs that aren't classified as steroids. Their effects are quite varied, and some only benefit certain athletes playing certain sports.

That makes it extremely tricky for regulatory agencies like the International Cycling Union and the World Anti-Doping Agency WADA to keep up — and to keep drugs out of competing athletes. Today, WADA prohibits more than PEDs to some degree.

New ones are constantly being developed, as are the methods used to detect them. Red blood cells carry oxygen throughout the body, so it makes sense that if an athlete can increase their red blood cell count, they'll deliver more oxygen to their muscles and perform at a higher level.

Blood doping — removing and preserving a supply of blood so it can be returned, via transfusion, to the body right before competition — is one way to do this. But it's messy and time-consuming.

Taking erythropoietin , or EPO, increases red blood cell production without the need for transfusions. The kidneys make the hormone naturally, although people with severe kidney disease don't produce enough.

That's what the biotechnology firm Amgen was looking to address when it introduced synthetic EPO in By the s, though, cyclists and other endurance athletes discovered that they could train longer and harder if they took the drug regularly.

Not surprisingly, taking EPO comes with significant risk. Studies have shown that it increases the risk of events such as stroke, heart attack and pulmonary edema.

One theory suggests that the drug thickens the blood to the point where it produces fatal clots. Such complications may have contributed to the deaths of at least 20 cyclists by , increasing the urgency to develop a reliable test to detect EPO [source: Zorpette ].

In , anti-doping agencies introduced the concept of a " biological passport ," a record of the substances found normally in an athlete's blood and urine, created by repeated sampling over time. By comparing the results of a blood test administered right before a competition to the passport, officials can determine if an athlete has been using EPO or other performance-enhancing drugs.

Like EPO, human growth hormone hGH occurs naturally in the body. In fact, the pituitary gland , the pea-sized organ located at the base of the brain, produces hGH to stimulate growth in children and adolescents and to increase muscle mass in adults.

As soon as synthetic hGH became available as a prescription medication in , when the U. Food and Drug Administration approved its use for a number of diseases that retard growth or cause muscle deterioration, athletes began eyeing it as a doping agent. They figured it could mimic the muscle-building effects of anabolic steroids.

At first, the high cost of the medication discouraged widespread use as a PED, but, as the saying goes, where there's a will to win, there's a way.

The Summer Olympic Games have been called the "hGH Games" because of the rampant use of the drug among competitors. And it continues to be a problem among athletes. In summer , Nigerian sprinter Blessing Okagbare was kicked out of the Tokyo Olympics after testing positive for hGH.

Today, athletes get hGH from a variety of sources: doctors willing to write prescriptions for off-label use, online pharmacies, illicit websites for performance-enhancing drugs and clinics that use the hormone to reverse the effects of aging. A few athletes even turn to black-market dealers that collect hGH from human cadavers.

It's a risky gamble, especially considering the lack of scientific evidence to suggest that hGH actually increases athletic performance. Oh, and don't forget the side effects.

Using hGH has been linked to a variety of medical conditions, including joint pain, muscle weakness, fluid retention, carpal tunnel syndrome, cardiomyopathy and hyperlipidemia [source: Mayo Clinic ].

Another performance-enhancing drug that made the Summer Olympic Games memorable for the wrong reason was bromantane, a sort of stimulant and masking agent combined. Several Russians tested positive for the drug, which at the time was not included on the International Olympic Committee's IOC's list of banned substances.

That didn't stop the IOC from disqualifying several Russian athletes, stripping medals from two and ultimately blacklisting bromantane based on its performance-enhancing effects. The effects of bromantane are quite unlike any other PED. Russian army doctors developed bromantane as a stimulant, something they could give to soldiers and cosmonauts to help them feel more alert and fight fatigue.

Soon after, Russian athletes got hold of the drug, reporting that it helped them perform at peak levels without feeling exhausted. Some anti-doping officials believe bromantane can hide the abuse of more serious drugs, such as steroids.

Known as masking, this is just one more way athletes can find a way to cheat. For example, the masking agent probenecid stops the excretion of steroids for a few hours, decreasing the concentration of steroids in the urine. The exact masking mechanism of bromantane, however, remains unclear.

Bromantane gained popularity because it appealed on multiple fronts. But stimulants by themselves function reasonably well as performance-enhancing substances. Athletes take stimulants to improve athletic performance, reduce fatigue and increase aggressiveness.

And someone trying to qualify for a lower weight class may rely on stimulants for their ability to suppress appetite. You may think first of amphetamines — prescription-only "speed" pills — when you hear of this class of drugs, but not all stimulants require a physician's signature.

Ephedrine, for example, is available behind the counter in drug products, mostly as decongestants. Dietary supplements containing ephedrine are illegal in the U.

Athletes, of course, aren't interested in these. They want ephedrine for an extra boost of energy despite the warnings that the drug can cause high blood pressure, dizziness, shortness of breath and cardiac arrhythmia. Along with bromantane, diuretics have long served to mask steroid use.

Diuretics are any drugs that affect kidney function, resulting in increased urine output. The "water pill" chlorthalidone , for example, prevents kidney tubules from reabsorbing fluids and salts and returning them to the blood. As a result, more water leaves the body. In patients with certain conditions, such as heart disease, diuretics can also help control high blood pressure.

But athletes who take anabolic steroids pop diuretics to dilute their urine, which decreases steroid concentration and makes it much more difficult to detect during drug testing. Of course, there is testing for diuretics, too.

Weightlifters and boxers may also down water pills to expel large amounts of fluid, which qualifies them to compete in a lower weight category. Then, right before the match, they stop taking the pills to return to their heavier fighting weight, giving them an advantage against their opponent.

However, an athlete taking diuretics may also get dizzy, become dehydrated or experience a severe drop in blood pressure — symptoms that make it hard to compete. Sometimes, a drug's effect on athletic performance depends on how it's administered.

For example, the well-known asthma drug albuterol works by relaxing the muscles lining the bronchial tubes, allowing more air to flow into the lungs. Athletes with asthma believe it or not, elite athletes tend to have higher rates of asthma than people in the general population commonly use inhaled albuterol to treat their symptoms, allowing them to compete without shortness of breath [source: Kindermann ].

But what about athletes who don't have asthma? Could they suck in a few shots of albuterol and increase their lung capacity? According to research published in the journal Sports Medicine, this performance-enhancing effect simply doesn't exist.

The authors found that, in 17 of 19 clinical trials involving non-asthmatic competitive athletes, the performance-enhancing effects of inhaled beta2-agonists could not be proved.

All bets are off, however, when an athlete takes albuterol orally or by injection. When administered in this fashion, albuterol has anabolic properties, which means it can help build muscle like steroids and, according to a study published in the British Journal of Sports Medicine, it can also boost sprint and strength performance.

Another orally ingested beta2-agonist known as clenbuterol aka clen packs an even bigger punch than albuterol. Athletes in several sports — cycling, swimming, baseball and soccer — have tested positive for clenbuterol use, although many have claimed that the drug could be traced to contaminated food.

While clenbuterol has historically been given to animals to produce leaner meat, the U. banned its use in meat in and the European Union followed suit in If the acronym sounds familiar, it probably is.

GHB is known as a "date rape" drug because it can quickly render a user so relaxed and euphoric — especially when combined with alcohol — that they are easily taken advantage of. Even scarier, it can cause amnesia, improving the chances that predators who slip the tasteless chemical into an unsuspecting imbiber's cocktail will get away with their misdeeds.

Because of the risks it posed, the Drug Enforcement Administration DEA banned GHB in but then brought it back to the market two years later after it was found to be useful in treating narcolepsy. Its use has since expanded to include another rare sleeping disorder, but GHB is only prescribed under strict safety controls.

Even before it gained infamy as a date rape drug, GHB was thought to improve exercise performance and muscle mass. There's even some scientific evidence that GHB increases growth hormone concentration.

The drug apparently became popular among bodybuilders looking for alternatives to steroids in the s when the hormones were first being controlled.

Rising levels of testosterone and other sex hormones normally trigger the growth spurt that occurs during puberty and adolescence. These rising levels of testosterone also provide the signals to stop growth.

Evidence suggests that weightlifters who misuse anabolic steroids have stiffer tendons, which could lead to an increased risk for tendon injury. Steroid misuse can cause acne, 70—72 hair loss on the head, cysts, and oily hair and skin. Anabolic steroids can also produce jaundice, or yellowing of the skin or eyes, as a result of damage to the liver.

Case reports and small studies indicate that anabolic steroids increase irritability and aggression, 75 although findings may be confounded by personality traits that are overrepresented in steroid users i.

Scientists have attempted to test the association between anabolic steroids and aggression by administering high steroid doses or placebo for days or weeks to human volunteers and then assessing behavioral symptoms. In one such study, researchers found that testosterone over a six week period was associated with increased aggression, as assessed by a questionnaire and computer-based model of aggressive behavior.

Anabolic steroid users are more likely than nonusers to report anxiety. Anabolic steroid users are more likely to use drugs such as marijuana, prescription opioids, cocaine, 88 or heroin.

Some described first learning about opioids from friends at the gym, and that they first purchased opioids from the same person who had sold them the anabolic steroids. They also described widespread use of nalbuphine in their gyms.

Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of anabolic steroids. For example, a study of men admitted in to a private treatment center for addiction to heroin or other opioids found that 9.

Of these, most reported using opioids to counteract insomnia, irritability, depression, and withdrawal from anabolic steroids. Unlike most illicit drug use, misuse of anabolic steroids most commonly begins in young adulthood rather than adolescence.

But steroid use in teens is of concern, especially since the hormonal systems they interact with play a critical role in brain development during these years.

Four weeks after withdrawal, these increases in neuronal spine densities returned to normal in the amygdala, but not in the hippocampus.

This suggests that pubertal steroid exposure could produce long-lasting structural changes in certain brain regions. Teens who use anabolic steroids may also be at increased risk for some cognitive side effects compared with adults. For example, males who begin using anabolic steroids during the teen years show increased impulsivity and decreased attention, compared to men who began using steroids in their adult years.

These aggressive effects are paralleled by changes in levels of serotonin , and androgen receptors in the rodent brain. Anabolic steroids act at androgen receptors to influence cellular functioning and gene expression.

In addition to regulating pathways involved in the development of male characteristics, activation of androgen receptors also produces rapid increases in calcium levels within skeletal muscle, heart, and brain cells. Research with human cells demonstrates that anabolic steroids also interact with certain types of GABA A receptors, which could mediate the increased anxiety reported by steroid users.

Specifically, rats given twice daily nandrolone injections for four weeks showed loss of sweet preference a sign of reward dysfunction that was accompanied by reductions of dopamine, serotonin, and noradrenaline in the nucleus accumbens, a reward-related brain region.

An undetermined percentage of steroid users may develop a steroid use disorder. Substance use disorders are defined by continued use despite adverse consequences; for steroid users, these may include physical or psychological problems such as breast growth in men , sexual dysfunction, high blood pressure, excessive fats in the blood, heart disease, mood swings, severe irritability, or aggressiveness.

Anabolic steroid users also may give up other important activities for fear that they will miss workouts, violate their dietary restrictions, or be prevented from using steroids.

Steroid users also typically spend large amounts of time and money obtaining the drugs, and they may try to reduce or stop anabolic steroid use without success—possibly due to depression, anxiety about losing muscle mass, or and other unpleasant effects of withdrawal.

Withdrawal from steroids occurs when an individual develops dependence. A review of the research suggests that about 32 percent of people who misuse anabolic steroids become dependent. Another indicator of dependence is withdrawal once anabolic steroid use stops.

Although non-athlete weightlifters account for the bulk of anabolic steroid misuse, occasional steroid use by professional and Olympic athletes to improve performance or cheat in competition "doping" has done the most to raise awareness of steroid misuse.

The World Anti-Doping Agency WADA was founded in to consistently apply anti-doping policies across sports organizations and governments around the world.

Non-compliant organizations can face sanctions such as event cancellation, loss of WADA funding, or ineligibility to host events. Refinements in drug testing have improved the ability to detect anti-doping violations, resulting in increased numbers of reported violations over recent years.

For example, the discovery of long-term steroid metabolites has lengthened the drug detection window, making it more difficult for athletes to pass drug tests by simply discontinuing steroid use just prior to an event.

In addition, more sensitive technologies have allowed detection of lower metabolite thresholds. Although testing procedures are now in place to deter steroid use among professional and Olympic athletes, new designer drugs constantly become available that can escape detection and put athletes willing to cheat one step ahead of testing efforts.

These samples are then used as reference points for future testing, thereby eliminating the possibility that a person tests positive simply because he or she has naturally elevated levels of testosterone when compared to the general population. Athletes taking over-the-counter nutritional supplements may believe that such products are safe.

However, nutritional supplements are not subjected to the same pre-approval requirements and quality tests as FDA-approved medications. Nutritional supplements sometimes contain banned substances that are not indicated in their labels. Research suggests that high school athletes are less likely to use steroids if their peers and parents disapprove, indicating that peers and parents can be strong partners in prevention efforts.

However, research shows that simply teaching students about steroids' adverse effects does not convince adolescents that they will be adversely affected, nor does such instruction discourage young people from taking steroids in the future.

Presenting both the risks and benefits of anabolic steroid use is more effective in convincing adolescents about steroids' negative effects, apparently because the students find a balanced approach more credible. Research also indicates that some adolescents misuse steroids as part of a pattern of high-risk behaviors such as drinking and driving, carrying a gun, driving a motorcycle without a helmet, and using other illicit drugs.

This suggests that a prevention program should focus on comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.

A more sophisticated approach has shown promise for preventing steroid misuse among players on high school sports teams. The Adolescents Training and Learning to Avoid Steroids ATLAS program is showing high school football players that they do not need steroids to build powerful muscles and improve athletic performance.

By educating student athletes about the harmful effects of anabolic steroids and providing nutrition and weight-training alternatives to steroid use, the ATLAS program has increased football players' healthy behaviors and reduced their intentions to misuse steroids.

In the program, coaches and team leaders teach the harmful effects of anabolic steroids and other illicit drugs on immediate sports performance and discuss how to refuse offers of drugs. The Athletes Targeting Healthy Exercise and Nutrition Alternatives ATHENA program was patterned after the ATLAS program, but designed for adolescent girls on sports teams.

Early testing of girls enrolled in the ATHENA program showed significant decreases compared to controls in risky behaviors such as riding with an intoxicated driver or engaging in sexual activity with new partners. ATHENA participants were also less likely to use diet pills, amphetamines, anabolic steroids, and muscle-building supplements during the sports season.

Although the program had no immediate effect on tobacco, alcohol, or marijuana use, ATHENA-trained athletes reported less lifetime use of these substances when surveyed one to three years following high school graduation.

Diet pill and steroid use declined by this one to three year follow-up for both ATHENA-trained and control-group athletes, so that these groups no longer differed in their use of these substances.

People who use steroids often do not seek treatment for their use, with one study reporting that 56 percent of users had never told their physician about their use. Current views recommend that treatment for steroid use address the underlying causes of the steroid use.

This can include:. National Institutes of Health. Research Topics. More Research Topics. Quick Links. NIDAMED: Clinical Resources. About NIDA. Anabolic Steroids and Other Appearance and Performance Enhancing Drugs APEDs.

En español. Highlights Anabolic-androgenic steroids are the best-studied class of appearance and performance enhancing drugs APEDs. APEDs are used to improve appearance by building muscle mass or to enhance athletic performance.

However, people who use these substances may develop a substance use disorder, defined as continued use despite adverse consequences. Anabolic steroids can cause severe, long-lasting, and in some cases, irreversible damage. They can lead to early heart attacks, strokes, liver tumors, kidney failure, and psychiatric problems.

In addition, stopping steroid use can cause depression, often leading to resumption of use. Expand All What are anabolic steroids and other appearance and performance enhancing drugs APEDs? Examples are caffeine, the asthma drug theophylline, and theobromine—a substance found in chocolate, coffee, and tea.

An example is ephedrine, which is derived from the ephedra plant. What is the scope of anabolic steroid use in the United States? All data refer to the United States population. How many young students use steroids? Why are anabolic steroids misused? How are anabolic steroids used?

Commonly Misused Steroids Oral Steroids Anadrol oxymetholone Anavar oxandrolone Dianabol methandienone Winstrol stanozolol Restandol testosterone undecanoate Injectable Steroids Deca-Durabolin nandrolone decanoate Durabolin nandrolone phenpropionate Depo-Testosterone testosterone cypionate Agovirin testosterone propionate Retandrol testosterone phenylpropionate Equipoise boldenone undecylenate 29, What are the side effects of anabolic steroid misuse?

Liver Steroid misuse has been associated with liver damage, 50,51 tumors, 46,52,53 and a rare condition called peliosis hepatis, in which blood-filled cysts form in the liver. How does anabolic steroid misuse affect behavior?

Aggression Case reports and small studies indicate that anabolic steroids increase irritability and aggression, 75 although findings may be confounded by personality traits that are overrepresented in steroid users i.

Psychiatric Disorders Anabolic steroid users are more likely than nonusers to report anxiety. What are the risks of anabolic steroid use in teens? How do anabolic steroids work in the brain?

Are anabolic steroids addictive? How are anabolic steroids tested in athletes? Drug Testing and Nutritional Supplements Athletes taking over-the-counter nutritional supplements may believe that such products are safe.

What can be done to prevent steroid misuse? What treatments are effective for anabolic steroid misuse? This can include: psychological therapies and possibly medications for muscle dysmorphia endocrine therapies to restore function in those suffering from hypogonadism and to alleviate symptoms of depression antidepressants for those whose depression does not respond to endocrine therapies pharmacological and psychosocial treatments for patients who are also dependent on opioids, which appear to also be effective in alleviating signs of anabolic steroid dependence Find More Resources on Anabolic Steroids and Other Appearance and Performance Enhancing Drugs Learn more about steroids and their legal status from the U.

Drug Enforcement Administration Review patient resources on anabolic steroids from MedlinePlus. Explore publications about steroids from the U. Substance Abuse and Mental Health Services Administration. References Kanayama G, Pope HG.

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The new technique, named Paired Ion Electrospray Ionisation PIESI makes traces of steroids or amphetamines more visible to current detection equipment by introducing a chemical agent which effectively binds itself to the traces, right down to the parts per trillion.

To develop reliable tests, researchers have to know what they are looking for. This is difficult because the development of new 'designer' steroids is an on-going process. The World Anti-Doping Agency is aware of the problem. In they were able to develop a test for one of these designer steroids—tetrahydrogestrinone THG —when a syringe full of the drug was given to them.

Human growth hormone HGH; also called somatotrophin or somatotrophic hormone is a naturally-occurring hormone produced in the human body.

It promotes physical development—particularly the growth of bone—during adolescence. It stimulates the synthesis of collagen, which is necessary for strengthening cartilage, bones, tendons and ligaments, and also stimulates the liver to produce growth factors.

In adults, HGH increases the number of red blood cells, boosts heart function and makes more energy available by stimulating the breakdown of fat. Other effects attributed to HGH include increase in muscle mass and strength as well as tissue-repairing recovery. However as HGH is often used in conjunction with other PEDs its direct role in these benefits is unproven.

Still, it is quite easy to see why athletes believe it will enhance their performance. Because HGH is a protein hormone, it is possible to manufacture large amounts of HGH using recombinant DNA technology.

Like anabolic steroids, HGH has a legitimate role in medicine—specifically for people with Growth Hormone Deficiency GHD or muscle weakness due to HIV—but it is also misused by athletes. English Rugby player Terry Newton was suspended in after testing positive for human growth hormone, while Bulgarian sprinter Inna Eftimova was banned from competition in after a returning a positive HGH test.

In the United States, Major League Baseball continues to negotiate its way through the findings of the BALCO scandal, a PED ring involving HGH and other doping drugs which implicated numerous professional pro-baseball players such as Barry Bonds and Jason Giambi.

If you believe all the hype—emanating mainly from drug manufacturers—HGH is a wonder drug that will remove wrinkles, reverse the ageing process, restore vitality and improve sleep.

Nevertheless, there are some health risks. For example, too much HGH before or during puberty can lead to gigantism, which is excessive growth in height and other physical attributes. After puberty, inflated levels of HGH can cause acromegaly, a disease characterised by excessive growth of the head, feet and hands.

The lips, nose, tongue, jaw and forehead increase in size and the fingers and toes widen and become spade-like. The organs and digestive system may also increase in size, which may eventually cause heart failure.

Acromegaly sufferers often die before the age of Excessive use of HGH in adults may also lead to diabetes; muscle, joint and bone pain; osteoarthritis; cardiac limitations; hypertension; and abnormal heightened symptoms of cardiovascular disease.

A full description of the testing method is available on the WADA website. This dual-approach test has been confirmed as robust and scientifically reliable by the Court of Arbitration for Sport. Higher levels of red blood cells in the blood result in more oxygen being transported to the muscles, resulting in increased stamina and performance.

There are three main types of blood doping:. Erythropoietin—more commonly known as EPO—has long been the drug of choice for endurance athletes. Although used in a wide variety of sports, it is most commonly associated with cycling—particularly with the disgraced former champion of the Tour de France—Lance Armstrong.

Produced naturally by the kidneys, EPO is also available as a pharmaceutical. EPO stimulates the production of red blood cells in bone marrow and regulates the concentration of red blood cells and haemoglobin in the blood.

This is useful for athletes, since red blood cells shuttle oxygen to the cells, including muscle cells, enabling them to operate more effectively.

EPO is a peptide GLOSSARY peptide A molecule consisting of a short chain of amino acids. Longer chains of amino acids are called proteins. hormone and can be produced synthetically using recombinant DNA technology. By injecting EPO, athletes aim to increase their concentration of red blood cells and, consequently, their aerobic capacity.

If EPO levels are too high the body will produce too many red blood cells which can thicken the blood, leading to clotting, heart attack and stroke.

In fact, EPO has been implicated in the deaths of numerous athletes, predominantly cyclists. Repeated doses of EPO can also stimulate the development of antibodies directed against EPO, which can result in anaemia.

The long-term health risks of sustained EPO use are still unclear. The Tour de France hit controversy when the entire Festina team was disqualified after several hundred doses of EPO and other doping products were found in the team car.

Other sports associated with EPO use include boxing Shane Mosley, , 50km walk Alex Schwazer, and athletics Rashid Jacobs, An approved test for EPO was first introduced at the Sydney Olympic Games. Methods such as isoelectric focusing, which is the separation of proteins based on their electrical charge, and sodium dodecyl sulfate polyacrylamide gel electrophoresis, which is the separation of proteins based on their size, are used to detect EPO.

Since , EPO tests in the United States were undertaken using only urine, however, in recent years the joint testing methods, such as direct EPO testing in urine and use of indirect blood tests as part of the Athlete Biological Passport see below , have been used to help identify the use of newly-developed erythropoiesis stimulating agents.

A new testing technique for EPO is also in the pipeline. In essence the new test will look for genetic expressions which prove that EPO has been used. If the new test proves accurate and viable, it will be almost impossible to use EPO without detection. Synthetic oxygen carriers SOCs are purified proteins or chemicals that have that ability to carry oxygen.

They are still under development and have not been approved for use outside of South Africa and Russia. SOCs were developed for use in crisis situations where blood transfusions are not possible or blood products are not available.

There are several different types of SOCs available. Two of the most common types include haemoglobin based oxygen carriers HBOCs and perfluorocarbons PFCs. Like red blood cells, they work to deliver this oxygen to the muscles, increasing aerobic capacity and endurance. However, they also have some additional benefits.

HBOCs are not only great at tissue oxygenation, they can deliver increases in blood serum iron, ferritin and naturally occurring EPO.

SOCs are still under development and testing, and have not yet been proven safe for human use. However, this has not stopped rumours of athletes using them to get an advantage. The health risks associated with using SOCs are similar to those of EPO—increased risk of heart attack, stroke and pulmonary embolism.

A complex four-step test was made available for SOCs in The first step involves the elimination of abundance proteins in blood samples via immunodepletion. The last step is Time-of-Flight TOF or Mass Spectrometer MS analysis of the sample. Prior to the introduction of synthetic blood doping drugs like EPO, blood transfusions were common practice among endurance athletes.

Even with these drugs available the practice still persists. Blood transfusion is an effective and relatively simple method of allowing athletes to boost the number of red blood cells in their blood, improving their aerobic capacity and endurance.

Athletes who choose to use this method generally begin undergoing blood withdrawals several weeks before a competition, building up a supply of blood between millilitres and millilitres. The plasma is returned to the body during the withdrawal while the corpuscular elements—basically the red blood cells RBCs —are stored.

These can then be re-infused in the patient directly before or during a high-endurance event. Blood transfusions were common practice before being banned in The first known case was Kaarlo Maaninka, who transfused two pints of blood prior to winning medals in the Olympics.

By the Olympics, one-third of the US cycle team received transfusions, resulting in nine medals. In Alexander Vinokourov, a rider in the Tour de France, tested positive after winning the 13 th stage of the race. His blood was found to contain two different blood cell populations, which confirmed the use of allogenic transfusions.

Cheating via blood transfusions was initially difficult to catch, especially if athletes re-infused their own blood. The arrival in of a test to detect allogenic blood transfusions meant athletes could no longer use the blood of a donor, however, they could still cheat by re-infusing their own.

The development of Athlete Biological Passports see below , has made even this method more detectable, as the passports allow testers to see the indirect markers of blood doping. The risks of using blood transfusions to increase red blood cells is similar to the risks associated with EPO and SOC use: thickened blood leading to clotting, heart attack and stroke.

Another risk relates to the process itself. Because transfusions involve several stages—the withdrawal of blood, its storage and re-use—there are many opportunities for something to go wrong. Contamination of the blood or equipment, infection and improper administration of blood products, all of which could easily lead to drastic health problems, even death.

Beta Blockers work to block the effects of adrenaline. They work to slow the heart rate, thereby reducing blood pressure, anxiety and muscle tremors, and improving the ability to focus.

This makes them particularly useful to athletes performing in sports that require a steady hand such as shooting, archery, darts, snooker, even golf.

Beta Blockers are prohibited by several sports darts, racing during competition, but others archery, shooting prohibit their use at all times. There are more than 20 types of beta blockers available.

They can be taken orally, via injection or in the treatment of glaucoma as eye drops. Some common beta blockers include:. When used for a legitimate medical reason, for example to treat a heart condition, high blood pressure anxiety, and under the guidance of a trained professional, beta blockers have a good safety record.

When used without a legitimate health reason, side effects can include reduced circulation through the hands and feet, dizziness, fatigue, dry mouth and drowsiness.

More serious though rare side-effects can include impotence, asthma attack, memory loss or heart failure. A high-profile case of Beta Blocker use at the elite level was in , when Olympic shooter Kim Jong-su tested positive for Propranolol and was subsequently stripped of his medals.

Beta Blockers can be detected in human urine using Gas Chromatography Mass Spectrometry. Diuretics work to promote the production of urine. While putting your hand up for a toilet break may not be deemed professional in modern sport, athletes use diuretics to assist with weight-loss the loss of water through urination leads to an overall loss of body weight.

This is particularly useful in sports where weight is critical such as boxing, rowing or horse-racing. The increased urine volume also aids in the dilution of doping agents and their metabolites.

Diuretics have been banned in sport since When used to treat legitimate medical conditions such as heart failure, high blood pressure, kidney and liver problems and glaucoma, and under the supervision of a trained doctor, diuretic use is quite safe. However, because diuretics promote frequent urination, when used without medical supervision they can lead to dehydration, dizziness, muscle cramps and constipation.

Other side effects include tiredness, fever, skin rash and loss of appetite. More serious effect include disruptions to the normal rhythms of the heart, and electrolyte abnormalities, which can affect kidney function.

Former Australian cricketer Shane Warne tested positive for a banned diuretic in and subsequently was suspended from all forms of cricket for 12 months, leading to him missing the ICC World Cup. Previously, diuretics were detected in biological samples through the use of high-performance liquid chromatography HPLC coupled with ultraviolet-diode array detection UV-DAD.

However, this method was not deemed rigorous enough in determining the unequivocal identification of banned substances. For this reason, international anti-doping regulations have required the implementation of mass-spectral methodology to test samples. Setting the benchmarks above which an athlete is deemed to be a drug cheat is a difficult issue for sporting bodies.

High levels of hormones do not always indicate cheating, and low levels do not always guarantee innocence. For example, Finnish cross-country skiing champion Eero Mäntyranta, who won two gold medals in the Winter Olympics, had a genetic mutation which enabled him to produce unusually high levels of erythropoietin EPO.

The ABP collates data on the levels of different substances in the body, during and after exercise, and uses this to construct a profile, effectively determining natural levels of various substances in the body for each individual.

From this information, testers can assess if an athlete suddenly has a large jump in certain hormones or proteins in their blood, when compared against their normal levels.

This could indicate that doping has occurred. Since ABPs also include a steroidal module, which monitors selected urinary steroid concentrations over time to monitor for potential steroid doping.

The advantage of this approach is the biological effects of a performance-enhancing agent are commonly present and detectable for a longer period than the agent itself. Most athletes dope for short-term gain, but what are the long-term implications of using these drugs?

From a health perspective, the verdict is unclear. As listed above, all doping drugs have potential immediate or short-term side-effects and drawbacks, but scientists are still researching the longer-term effects they may have on the body.

Some studies have found evidence of early mortality due to cancer or heart attack amongst previous long-term users of PEDs, but these are inconclusive as other factors such as lifestyle, and genetics may also be responsible.

Part of the difficulty is in finding athletes who would agree to participate in such a study. From a performance point of view, scientists from the University of Oslo have released preliminary findings showing that athletes may continue to benefit from having taken banned substances long after the drugs have left their system and their bans have been lifted.

The study , which was undertaken on mice, found that muscles can retain some of the advantages gained through anabolic steroid use for years, possibly even decades after the drugs were taken.

Kristian Gunderson, Professor of Physiology at the University of Oslo said 'If you exercise, or take anabolic steroids, you get more nuclei and you get bigger muscles. If you take away the steroids, you lose the muscle mass, but the nuclei remain inside the muscle fibres.

They are like temporarily closed factories, ready to start producing protein again when you start exercising again. If proven, their study would require a complete reworking of the current anti-doping system, including length of bans and ability to return to competition. On 1 January , WADA introduced tougher punishments for doping, including upping the bans from two to four years.

There are also stronger punishments for coaches, trainers and administrators who are found to have helped athletes dope. More than years of sports history tells us that when one method is detected, another rises to take its place.

See our infographic on performance drugs. Drugs in sport Expert reviewers.