Peformance Enhancing Drugs Other Than Anabolic Steroids Used in Sports

Posted on 24 Apr 2012 15:43

By Ground Up Strength

Although most people, when they think of "performance enhancing drugs," only think of anabolic steroids, there is actually a large array of drugs that are used to enhance various aspects of performance. Some basic categories of drugs that are used in this way, including steroids, are stimulants, beta blockers, beta-2 agonists, diuretics, narcotic analgesics, and the oxygen increasing drug epoetin.

Since all such drugs are meant to be prescribed and used for specific medical conditions, using them as ergogenic aids can be very dangerous and such use should be considered abuse. This is especially true since athletes often take drugs in doses that far exceed normal therapeutic doses, and side effects, in some drugs, can occur even at normal levels. The side effects of a drug may also depend on the person's metabolism and whether other drugs are used at the same time. The following is a list of categories of performance enhancing drugs, their intended effect on performance, and their potential side-effects, starting with a brief review of anabolic steroids.

++Anabolic Steroids

Anabolic steroids are derivatives of the male hormone testosterone, which is produced in males by the testes and adrenal cortex, and in females by the ovaries in small amounts. The synthetic analogues are products like methyltestosterone, oxandrolone, stanozolol, olymetholone, methandrostenolone, trenbolone, nandrolone, and boldenone. Some steroids are taken orally and some are injected.

They are used by many athletes in many sports, although they are most famously used by bodybuilding and strength athletes. They can increase strength and endurance and raise the rate of protein synthesis in the body. Athletes can train with higher volume and recover faster. For some, they can help improve mental attitude, if used judiciously. Although proponents of their use deny that there are any side-effect if the drugs are used correctly, the potential side-effects are liver and kidney disease including carcinomas of the liver and kidneys; premature heart disease, hypertension, loss of coordination, testicular atrophy and infertility in males, gynaecomastia, and acne. Increased aggression and anger, mania, or depression can occur.

In females, deepening of the voice, reduction in breast size, and the development of masculine features, including an enlarged clitoris (cliteromegaly), may occur. Although menstrual problems may also be associated, the development of menstrual problems alone in female athletes should absolutely not be considered evidence of anabolic steroid use, as regular intense endurance training has been known to induce amenorrhea. Steroids are the most common performance enhancing drugs used by athletes. See differences in male and female athletes.1,2,3

vials of various anabolic steroids

Various Anabolic Steroids


Stimulants, which can be psychomotor stimulants, sympathomimetic amines or other drugs such as caffeine, are drugs which increase activity in the central nervous system. This is probably the oldest group of drugs used to enhance performance in sport. Today they are the second most common drugs used by athletes, next to anabolic steroids. Drugs such as amphetamines are used for various reasons, including to increase alertness and boost confidence. They may:

  • reduce or mask fatigue
  • increase competitiveness and/or aggression (in competition)
  • cause feelings of euphoria and well-being
  • suppress appetite (useful for athletes desiring to drop weight, but also a potential negative for others)

Side effects of stimulants include restlessness, insomnia, cardiac arrhythmia, increased heart rate, dehydration, increased blood pressure, anxiety, aggression, and other psychological problems, and addiction.

Common Stimulant Drugs

  • Caffeine (found in coffee, tea, soft drinks, energy drinks, or tablet form)
  • Ephedrine (used to be a popular component of many dietary supplements)*
  • Doxapram
  • nicotine (from tobacco products)
  • amphetamines (speed, ecstasy, benzedrine, dexedrine)
  • cocaine
  • crack (freebase form of cocaine)1,2,3

* Ephedrine, or "ephedra," containing supplements were banned from sale in the U.S. on February 11, 2004, with the ban going into final effect on April 12 of that year.

Beta Blockers

Beta blockers are antagonists on β2-adrenoreceptors. They therefore block the effects of adrenaline on the body's beta-receptors. They are used to treat high blood pressure, angina pectoris, arrhythmia, anxiety, and migraine headaches. They can decrease heart rate and block stimulatory responses.

They are used in competitive target sports such as archery and shooting to steady the nerves and control increases in heart rate and breathing, in order to steady the aim. These drugs are only banned by certain international sports bodies, such as diving and synchronized sports and by archery and shooting.

Beta-2 Agonists

Beta-2 adrenergic agonists are bronchodilators which are legitimately used by athletes with asthma. However, their use is sensitive and the rules concerning their use by athletes in sport can be complicated and subject to constant change. Of particular note in athletics, including bodybuilding and strength sports, is Clenbuterol a beta-2 andrenergic agonist that is prescribed as a bronchodilator in Europe but not in the United States. When used in doses far greater than required for bronchodilation, clenbuterol may increase lean mass and help prevent fat gain, at least in chickens and cattle. The hypertrophy effects may be due to the stimulating of protein metabolism by increased calcium transport, increased cyclic AMP levels, and the activation of protein kinase. The retardation of adipose deposition is related to enhanced lipolysis. These actions cause it to be known as a "nutrient partitioning agent," which is a fancy term for something that simultaneously increases lean muscles and decreases fat deposition. Clenbuterol is banned by the World Anti-Doping agency.

Side effects of abuse include tachycardia, cardiac arrhythmia, muscle tremor, nausea, fever, insomnia, headache, and perhaps myocardial infarction.5,1,2


Diuretics are used to help eliminate fluids from the tissues by increasing the secretion of urine. They do this by preventing the re-absorption of water from the kidneys. In sports, they are used to aid in temporary weight loss through the loss of water-weight. They are also used as "masking agents," although these have no performance enhancing benefits. These drugs are discussed more thoroughly in What are Diuretics and Why are They Used in Sports and Bodybuilding?6

Narcotic Analgesics in Sport

Narcotic analgesics are various drugs such as heroin, morphine and codeine that stop pain through action on the brain or the central nervous system, The term narcotic is used to describe opium, opium derivatives, or substances that mimic the effects of morphine and the use of these substances dates as far back as the third century. The chemicals interact with specific receptors in the central nervous system. Associated with the analgesic effect is a decrease in anxiety and a relief of tension. Often, athletes turn to these drugs because they allow them to compete even with a serious injury. Examples are:

  • Codeine
  • Meperidine
  • Methadone
  • Kydropmorphone
  • Oxycodone
  • Oxymorphone
  • Fentanyl
  • Sufentanyl
  • Alfentanyl
  • Remifentanyl
  • Pantazocine
  • Butorphanol
  • Nalbuphine
  • Buprenorphine

Narcotic analgesics are highly addictive and such addiction can occur quickly. They cause tolerance which is accompanied by physical dependence. This dependence arises because abrupt cessation of use causes a number of very unpleasant symptoms known as the abstinence syndrome. These symptoms quickly go away after the drug is re-administered. Over time, larger and larger doses of the drug are needed to produce the same effects because a tolerance to the drug is built up. The physical dependence is only one part of the power of the addiction. Psychogenic dependence also occurs, which results in a irresistible compulsion or craving to take the drug to experience the pleasure it causes or to relieve feelings of psychological and physical discomfort. Once such an addiction has taken hold, withdrawal from the drug, should the user attempt to stop taking it, can be deadly, and intensive clinical supervision is needed. Even once the user had safely "detoxed," and the drug is removed from the system, the psychological addiction remains.

Not all narcotic analgesics are prohibited in sports and some are only prohibited in high doses.5,1,2,3

opium poppy flower

Opium Poppy Flower
Image by Evelyn Simak via wikimedia

Blood Doping and Oxygen Increasing Drugs

Endurance athletes need a great deal of oxygen delivered to their muscles in order to perform. If an athlete can get extra oxygen into their blood, and thus to their muscles, performance capacity should increase. A more "natural" way to do this is to train for months at high altitude where there is less oxygen in the air. This increases the amount of hemoglobin in the blood so that when the athlete returns to normal altitude, more oxygen is delivered to the muscles. A less natural short-cut to this is known as blood doping, which is banned from all sports.

Blood doping is used as an ergogenic aid to increase aerobic performance. The old-fashioned way to "dope" the blood is different than the modern way. In the old way, an athlete had blood drawn two or three months prior to an athletic event. The blood was then frozen for storage, during which time the athlete's body replaced the blood cells to return the blood to the normal level. A few days prior to competition, the stored blood was injected back into the athlete's blood stream, thereby increasing the amount of oxygen carrying hemoglobin in the bloodstream by raising the blood cell count well above normal. This temporarily increased the oxygen carrying capacity of the blood. Some studies suggest that this practice does increase aerobic performance, since increasing the number of circulating red blood cells increases the amount of oxygen available to the muscles. This method of blood doping can be dangerous, risking infections and blood clots (especially if the athlete is dehydrated). Heart failure may occur since the extra blood puts more pressure on the heart and stroke may occur from blood clots.

During the 1980's, an alternative to blood doping was discovered, the taking of the drug epoetin. Epoetin (EPO) is derived from the human hormone erythropoietin, produced naturally by the kidneys, which controls the production of red blood cells. EPO is used legitimately in medicine for patients who do not have enough red blood cells. For athletes, taking EPO can boost the oxygen carrying capacity of the blood up to 10 percent and increase performance by 12 to 15%. It carries the same dangers as blood doping. Use of EPO is banned in all sports and athletes are often given a urine test, or a blood and urine test, depending on the sporting body. Several cyclists are believed to have died due to EPO use.3,4

With the recent revelation concerning Lance Armstrong, drugs in sports is more a hot-button topic than ever. Many books have been written exploring this controversial topic from biochemical, sociological, and many other points of view.

1. Weinberg, Robert S., and Daniel Gould. Foundations of Sport and Exercise Psychology. Champaign, IL: Human Kinetics, 1999. 425.
2. Mottram, D. R. Drugs in Sport. London: Routledge, 2011.
3. Gifford, Clive. Drugs and Sports. Chicago, IL: Raintree, 2004.
4. Whitney, Eleanor Noss., and Sharon Rady. Rolfes. Understanding Nutrition. Minneapolis/St. Paul: West Pub., 1993. 475.
5. Jenkins, Simon P. R. Sports Science Handbook. Brentwood, Essex: Multi-Science Publ., 2005.
6. Troy, Eric. "What Are Diuretics and Why Are They Used in Sports and Bodybuilding?" Ground Up Strength. Ground Up Strength. Web. 24 Apr. 2012. <>

This page is provided by Ground Up Strength for information purposes only and should not take the place of professional medical advice. Although we have done our utmost to provide accurate and safe information, we are not medical professionals and the information on this page should not be taken as professional medical advice, or any other kind of medical advice.

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