Performance-enhancing drugs: Know the risks

Hoping to get an edge by taking performance-enhancing drugs? Learn how these drugs work and how they can have effects on your health.

By Mayo Clinic Staff

Most serious athletes feel a strong drive to win. They often dream big too. Some athletes want to play for professional sports teams. Others want to win medals for their countries. The pressure to win leads some athletes to use drugs that might give them an edge. These are called performance-enhancing drugs. Use of these drugs is known as doping.

But doping comes with risks. Learn more about the effects that performance-enhancing drugs can have on health.

Anabolic steroids

What are they?

Anabolic steroids are drugs that athletes take to boost their strength and add muscle. These drugs also are called anabolic-androgenic steroids. They are made to work like a hormone that the body makes called testosterone.

Testosterone has two main effects on the body:

  • Helps build muscle.
  • Causes features such as facial hair and a deeper voice.

The anabolic steroids used by athletes are often forms of testosterone made in a lab.

Some people use anabolic steroids for medical reasons. But doping for sports isn't one of the uses the drugs are approved for.

What makes some athletes want to use anabolic steroids? These drugs might lower the damage that happens to muscles during a hard workout. That could help athletes bounce back faster from a workout. They might be able to exercise harder and more often. Some people also may like how their muscles look when they take these drugs.

More-dangerous types of anabolic steroids are called designer steroids. Some drug tests may not be able to spot them in a person's body. Anabolic steroids have no medical use that's approved by the government.


Many athletes take anabolic steroids at doses that are too high. These doses are much higher than those that health care providers use for medical reasons. Anabolic steroids have serious side effects too.

Men may:

  • See their breasts grow.
  • Notice their testicles shrink.
  • Not be able to get their partner pregnant.
  • Learn from a health care provider that their prostate gland has gotten bigger.

Women may:

  • Get a deeper voice. Treatment may not be able to change it back.
  • Notice that a part of their genitals called the clitoris has gotten bigger.
  • Grow more body hair.
  • Lose the hair on the head. Treatment might not be able to bring the hair back.
  • Stop getting periods or get them much less often than they used to.

All people who use anabolic steroids might start to get:

  • Severe acne.
  • A higher risk of swollen or torn cords in the body called tendons, which attach muscle to bone.
  • Liver tumors, or other changes to the liver.
  • Higher levels of the "bad" cholesterol, called low-density lipoprotein (LDL) cholesterol.
  • Lower levels of the "good" cholesterol, called high-density lipoprotein (HDL) cholesterol.
  • High blood pressure.
  • Problems with the heart and blood flow.
  • Issues with anger or violence.
  • Mental health conditions, such as depression.
  • A need for anabolic steroids that can't be controlled.
  • Diseases, such as HIV or hepatitis, if using needles to give shots of the drugs.

Teens who take anabolic steroids might grow less than usual too. They also might raise their risk of health problems later in life.

Doping with anabolic steroids is banned by most sports leagues and groups. And it is not legal. It's never safe to buy anabolic steroids from a drug dealer. The drugs could be tainted or labeled the wrong way.


What is it?

Androstenedione, also called andro, is a hormone everyone's body makes. The body turns andro into the hormone testosterone and a form of the hormone estrogen.

Andro can be made in a lab. Some drugmakers and workout magazines claim that andro products help athletes train harder and recover faster. But some studies show that andro doesn't boost testosterone. They also show that muscles don't get stronger.

Andro is legal to use only if a health care provider prescribes it. It's not legal to use as a doping drug in the United States.


Side effects of andro in men include:

  • Acne.
  • Testicles that shrink or make less sperm.
  • Breast growth.

Side effects in women include:

  • Acne.
  • Deeper voice.
  • Loss of hair on the head.

Andro can damage the heart and blood vessels in anyone who takes it. This raises the risk of a serious problem that can happen when the heart doesn't get enough blood, called a heart attack. It also raises the risk of a condition that keeps the brain from getting enough oxygen, called a stroke. Heart attack and stroke can be deadly.

Human growth hormone

What is it?

Athletes take human growth hormone, also called somatotropin, to build more muscle and do better at their sports. But studies don't clearly prove that human growth hormone boosts strength or helps people exercise longer.

A health care provider can prescribe human growth hormone for some health reasons. It is given as a shot.


Side effects linked to human growth hormone may include:

  • Pain in joints, where two or more bones come together.
  • Muscles that feel weak.
  • A buildup of extra fluid in the body.
  • A condition that affects how the body uses sugar for energy. This is called diabetes.
  • Trouble seeing.
  • A problem that can make the hand and the arm get weak, tingle or lose feeling. This is called carpal tunnel syndrome.
  • Trouble controlling blood sugar.
  • A heart that grows bigger than usual, called cardiomegaly.
  • High blood pressure.


What is it?

Erythropoietin is a type of hormone. It treats anemia in people with severe kidney disease. It raises the level of red blood cells. It also raises the levels of the protein in red blood cells that carries oxygen to the body's organs, called hemoglobin.

Taking erythropoietin improves how oxygen moves to the muscles. It's common for athletes who exercise for long amounts of time to use a lab-made type of erythropoietin called epoetin.


In the 1990s, it was common for pro cyclists to use erythropoietin. But the drug may have played a role in at least 18 deaths. Doping with erythropoietin may raise the risk of serious health problems. These include stroke, heart attack and blocked arteries in the lung.


What are they?

Diuretics are drugs that change the body's balance of fluids and salts. They can cause the body to lose water, which can lower an athlete's weight. Diuretics also may help athletes pass drug tests that check for signs of drugs in the urine. They dilute the urine and may hide traces of drugs.


Diuretics can cause side effects when you take them at any dose — even at doses that health care providers suggest. These drugs make athletes more likely to have side effects such as:

  • Losing more fluids than you take in. This is a serious problem called dehydration.
  • Squeezing pain in muscles called cramps.
  • Feeling faint, woozy, weak or not steady.
  • Being low on a mineral called potassium, which the body needs to work well.
  • Having a drop in blood pressure.
  • Feeling clumsy when you move and having trouble keeping your balance.

Diuretics can lead to death if an athlete uses them for doping.


What is it?

Nutrients are vitamins and minerals in foods that are good for you. Some people try to get more nutrients from products called supplements. Supplements are sold in stores and online as powders or pills. One supplement that's popular with athletes is called creatine monohydrate.

The body makes its own creatine too. It helps muscles release energy. Creatine supplements may help athletes gain small, short-term bursts of power.

Creatine seems to help muscles make more of an energy source called adenosine triphosphate (ATP). ATP stores and moves energy in the body's cells. It's used for activity that involves quick bursts of movement, such as weightlifting or sprinting. But there's no proof that creatine helps you do better at sports that make you breathe at a higher rate and raise your heart rate, called aerobic sports.


Side effects of creatine can include gaining weight and cramps in the belly or muscles.

Some athletes try to gain weight so they can get bigger in size. Creatine may help you put on weight over time. But that might be due to the extra water that creatine causes the body to hold on to. Water is drawn into muscle tissue, away from other parts of the body. That puts you at risk of getting dehydrated.

Studies show that it's safe for healthy adults to use creatine for a short or long time. It's important to use the doses that creatine makers suggest on the package.


What are they?

Stimulants boost the levels of some chemicals in the brain. They also make the heart beat faster and raise blood pressure.

Stimulants can help an athlete:

  • Exercise longer.
  • Feel less tired or hungry.
  • Feel more alert and aggressive.

Common stimulants include caffeine and drugs called amphetamines. Cold medicines often have a stimulant in them.

Energy drinks are popular among many athletes. They often have high doses of caffeine and other stimulants. The street drugs cocaine and methamphetamine also are stimulants.


Stimulants have side effects that can make an athlete play worse, such as:

  • Lowered focus due to feeling nervous or angry.
  • Trouble sleeping.
  • Dehydration.
  • Heatstroke, which happens when the body gets too hot and can't cool down.
  • Addiction to stimulants, or needing higher doses to feel the effects.

Other side effects include:

  • A feeling that the heart is beating fast, fluttering or pounding.
  • A heartbeat that is too fast, too slow or out of rhythm.
  • Weight loss.
  • A type of shaking called tremors.
  • High blood pressure.
  • The sensation of seeing things that aren't there, called hallucination.
  • Stroke.
  • Heart attack or other problems with blood flow.

The bottom line

Some athletes may seem to get an edge from performance-enhancing drugs. But doping can have bad effects on health.

In general, the long-term effects of performance-enhancing drugs haven't been studied enough. And any short-term perks come with risks. Doping is banned by most sports leagues and groups too.

That's why it's risky to use performance-enhancing drugs.

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June 27, 2023 See more In-depth