The Controversy Over Performance-Enhancing Drugs (PEDs)
House Call Doctor explains the most widely-used performance-enhancing drugs (PEDs) and their side effects on athletes. Here’s looking at you, A-Rod!
Sanaz Majd, MD
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The Controversy Over Performance-Enhancing Drugs (PEDs)
Many of us are anxiously awaiting Major League Baseball’s opening day this Sunday, April 5. Few things gets Americans more excited than baseball, football, and basketball seasons (American Idol, Dancing with the Stars, and reality TV families can’t even compete). These athletes are truly our celebrities, so it’s not surprising that their every move is under intense scrutiny.
With the pressure to out-perform themselves and one another (to maintain not only the adoration of their fans but also keep those large paychecks coming), athletes are often desperate to enhance their performance and gain an edge.
And therein lies the problem.
Take A-Rod for example. Alex Rodriguez returns this season after a 162-game suspension for doping – that’s a full year and a half out of the sport and a loss of $25 million for the three-time MVP.
But what’s the harm in dabbling with a little Ritalin or gene doping, you may be wondering? Well, besides creating a totally unfair playing field and falsifying athleticism, performance-enhancing drugs (PEDs) can be quite risky – even life-threatening.
Let’s learn about some of the more common substances used by professional athletes today, their frightening side-effects, and why we may never know how widespread the problem is..
Who Sets the Game Rules?
Athletes use performance-enhancing drugs for various purposes. Some may use them for improved physical performance or alertness, while others like bodybuilders (think Ah-nold) and celebrities (Sylvester Stallone) may use them to increase muscle mass and for appearance purposes. (You didn’t think Sly gets this buff at age 69 simply from working out, did you?)
You may be wondering who sets guidelines for these drugs? The World Anti-Doping Agency (or WADA) maintains a list of drugs that are banned for competitive athletes. The list has reached to over 100 substances in just the last few years as athletes have found more advanced techniques to beat the system.
Most Commonly Used Performance-Enhancing Drugs
Let’s review some of the most commonly used substances that you may have heard about:
Steroids. Often referred to as “androgens,” steroids are the most frequently abused substance on the WADA list. They include testosterone and its various derivatives and have been reportedly abused by players like Mark McGuire and Jose Conseco. This category of substances includes exogenous testosterone, androstenedione, DHEA, selective androgen receptor modulators (SARMs), anti-estrogens like tamoxifen and raloxifene, estrogen blockers, and human chorionic gonadotropin (HCG, the same hormone used to detect pregnancy in urine and blood).
All steroids work to increase testosterone and reduce estrogen levels. They enhance performance specifically by increasing muscle mass and strength. But there is no silver bullet. Androgens come with some major side effects:
- Reports of sudden death due to heart enlargement in young athletes.
- Increase in LDL (bad) cholesterol and decrease in HDL (good) cholesterol and associated risks in the development of heart disease.
- Development of mood changes, depression, or aggressive behavior.
- Diminished fertility and sperm production in males.
- Gynecomastia, a medical term referring to increased breast tissue in men.
- Increased risk of prostate enlargement and cancer.
- Increased risk of tendon rupture
Growth Hormone. Human Growth Hormone (HGH) is released by the pituitary gland and is responsible for growth in children. Children deficient in this hormone will have short stature. For years HGH has been called the “fountain of youth” and used off-label by many Hollywood stars. They claim it to be the ultimate anti-aging elixir that decreases fat, increases muscle mass, improves libido, and produces many other supposed enhancements. However, there is currently not enough scientific evidence to back up these claims.
Please be sure to read my previous episode on The Pros and Cons of Caffeine where I describe features of “good” scientific studies. Possible adverse effects of HGH use include:
- Development of pre-diabetes and diabetes.
- High blood pressure
- Swelling in the hands
- Carpal Tunnel Syndrome
Erythropoetin (EPO). Erythropoetin is a substance that is often prescribed for those with anemia due to chronic kidney disease. It helps to increase the oxygen carrying capacity of red blood cells. Self-injections with EPO, along with training in high altitude and blood transfusions (think Lance Armstrong), are several newer, more advanced tactics athletes have used to enhance performance.
Risks of EPO use are quite serious and include stroke, heart attacks, and blood clots. This isn’t surprising since anything that works to increase the viscosity (or thickness) of your blood can cause these potentially deadly side effects.
Stimulants. As you can intuitively surmise, stimulants help to, well…stimulate performance. Substances in this category include drugs used to treat ADHD (like methylphenidate), the now-regulated nasal decongestant pseudoephedrine, cocaine, and even caffeine.
This group of substances is the drug of choice for many college students who use them for improved cognitive and concentration abilities, increased alertness, and increased endurance. Risks of stimulant use include agitation, panic attacks, weight loss, insomnia, high blood pressure, increased heart rate, and in rare cases even strokes and heart attacks by overburdening the heart and blood vessels.
Narcotics. Prescription narcotics (like Vicodin or codeine), besides being one of the most widely abused drugs in the world, are also used to mask pain in athletes. Risks include addiction, constipation, nausea, vomiting, and sedation.
Diuretics. Diuretics are prescription medications used in the treatment of high blood pressure and congestive heart failure. They are easily accessible and often used by athletes who require rapid weight loss, such as wrestlers and boxers. Risks include dehydration, electrolyte abnormalities, heart arrhythmias, dizziness, and breast enlargement.
Gene doping. This is one of the newer and more clever methods athletes use to improve their performance. This technique allows athletes to actually alter their genetic makeup in order to produce greater EPO levels and intrinsic HGH levels.
These are the most popular PEDs used by today’s athletes. But this list is by no means comprehensive.
The unfortunate side effect of extreme competition and financial potential of professional sports is the increased doping by athletes. There seems to be an understanding among elite athletes that they all engage in these tactics to some degree. The only question is who will get caught and when.
The scale of PED use is impossible to know. In the end, it’s like the famous saying goes, “It’s about playing catch and throwing strikes.”
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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
