Risks of Performance-Enhancing Drugs (2024)

What Are Performance-Enhancing Drugs?

Performance-enhancing drugs have become increasingly common among athletes to enhance their physique and improve performance.

However, using performance-enhancing drugs comes with risks. Before considering performance-enhancing drugs, learn about the potential benefits and health risks.1

Types of Performance-Enhancing Drugs

There are various types of performance-enhancing drugs. Here are some of the most common.


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Risks of Performance-Enhancing Drugs (1)

Anabolic Steroids

Anabolic steroids are a type of steroid used to increase muscle mass and strength.1

The primary anabolic steroid hormone produced by your body is testosterone.

Testosterone has two significant effects on your body. Anabolic effects trigger muscle building. Androgenic effects contribute to male traits, including developing facial hair and a deeper voice.

Some athletes use straight testosterone to boost their performance. The anabolic steroids used by athletes are usually synthetic modifications of testosterone.

These hormones are medically approved for some uses. However, enhancing athletic performance isn’t one of them.

As well as enhancing muscles, anabolic steroids can lessen the muscle damage that can occur during a challenging workout. This can help athletes recover from the session more quickly and work out harder and more often.

Some non-athletes may also like their muscular appearance when taking anabolic steroids.

Taking anabolic-androgenic steroids to improve athletic performance is prohibited by most sports organizations, and it’s also illegal.

Designer Steroids

A particularly dangerous type of anabolic steroid is the ‘designer steroid.’ These synthetic steroids have been illicitly produced to be undetectable by drug tests.1

Designer steroids are made specifically for athletes without approved medical use. As such, they haven’t been tested or approved by the FDA and are a health threat to athletes.


Androstenedione, otherwise known as andro, is a hormone created by the adrenal glands, ovaries, and testes. Andro is a hormone that’s usually converted to testosterone and a type of estrogen (estradiol) in men and women.1

Andro is only available legally by prescription and is a controlled substance. It’s illegal as a performance-enhancing drug in the United States.

Athletes use the drug to train harder and recover more quickly.

Human Growth Hormone

Human growth hormone has an anabolic effect. Exogenous growth hormone is often indictated for children with a deficiency (in medication form). However, sometimes athletes use it to enhance muscle mass and performance.1

Research lacks support that the exogenous human growth hormone improves endurance or strength. This drug is available only by prescription and is delivered by injection.


Erythropoietin treats anemia in people with severe kidney disease. It boosts the production of red blood cells and hemoglobin. Hemoglobin is the protein that carries oxygen to your body’s organs.1

Taking erythropoietin increases the movement of oxygen to the muscles. Epoetin is a synthetic form of erythropoietin. Endurance athletes commonly use it.


Diuretics alter your body’s natural balance of fluids and salts (electrolytes), leading to dehydration.1

This water loss can reduce an athlete’s weight. Diuretics can also help people pass drug tests by diluting their urine. They’re sometimes called a ‘masking’ agent.


Many athletes use nutritional supplements instead of or as well as performance-enhancing drugs.1

Supplements are available OTC as pills or powders. Creatine monohydrate is a supplement popular among athletes.

Creatine is a naturally occurring compound in your body that helps your muscles release energy. Creatine may help produce small gains in short-term bursts of power.

The compound also helps make muscles more adenosine triphosphate (ATP). This allows the body to store and transport energy in cells and is helpful for quick bursts of activity, like weightlifting or sprinting.

Who Uses Performance-Enhancing Drugs?

Most people who misuse performance-enhancing drugs like steroids are male non-athlete weightlifters in their 20s or 30s. Approximately 22 percent of anabolic steroid users begin as teenagers.2

Anabolic steroid use is less common among women. This is because women typically don’t want to develop an extremely muscular physique or desire the masculinizing effects of steroids.

Risks, Consequences, and Side Effects of Using Performance-Enhancing Drugs

Performance-enhancing drugs come with various risks, consequences, and side effects depending on the substance.

Anabolic Steroids

Many athletes take anabolic steroids in quantities much higher than doses prescribed for medical reasons. However, anabolic steroids have severe physical side effects.

Men may develop:

  • Prominent breasts
  • Shrunken testicles
  • Infertility
  • Prostate gland enlargement

Women may develop:

  • A deeper voice, which can be irreversible
  • An enlarged clitoris, which can be irreversible
  • Increased body hair
  • Baldness, which can be irreversible
  • Infrequent or no periods

Both men and women might experience:

  • Severe acne
  • Increased risk of tendinitis and tendon rupture
  • Liver abnormalities and tumors
  • Increased low-density lipoprotein (LDL) cholesterol
  • Decreased high-density lipoprotein (HDL) cholesterol
  • High blood pressure
  • Heart and blood circulation issues
  • Aggressive behaviors, rage, or violence
  • Psychiatric disorders, such as depression
  • Drug dependence
  • Infections or diseases like hepatitis or HIV if you're injecting the drugs
  • Affected growth and development, and the risk of future health problems in teenagers

In the past 20 years, law enforcement in the United States has driven much of the illegal steroid industry into the black market.

This leads to extra health risks because the drugs are made in illegal labs in the United States or produced in other countries and smuggled in. In any case, they don’t undergo government safety standards and could be mislabeled or impure.


The side effects of andro in men include:

  • Acne
  • Reduced sperm production
  • Shrinking of the testicles
  • Enlargement of the breasts

The side effects of andro in women include:

  • Acne
  • Masculinization, including deepening of the voice and male-pattern baldness

In men and women, andro can affect the heart and blood vessels, heightening the risk of heart attack and stroke.

Human Growth Hormone

The risks linked to human growth hormone range in severity but may include:

  • Joint pain
  • Muscle weakness
  • Fluid retention
  • Diabetes
  • Vision issues
  • Carpal tunnel syndrome
  • Impaired glucose regulation
  • Enlarged heart
  • High blood pressure


Erythropoietin was popular among competitive cyclists in the 1990s. It reportedly contributed to at least 18 deaths.

The use of erythropoietin may increase the risk of:

  • Stroke
  • Heart attack
  • Blockage in an artery in the lung


Even at medically recommended doses, diuretics can lead to adverse side effects, including:

  • Dehydration
  • Muscle cramps
  • Dizziness
  • Potassium deficiency
  • Drop in blood pressure
  • Loss of coordination and balance
  • Death


The possible side effects of creatine include:

  • Stomach cramps
  • Muscle cramps
  • Weight gain

Weight gain is desired by many athletes who want to increase their size. But with consistent creatine use, weight gain is more likely from water retention than an enhancement in muscle mass.

Water is drawn into your muscle tissue away from other body areas. This puts you at risk of dehydration.

It appears safe for adults to take creatine at the doses recommended by manufacturers. However, the long-term benefits and risks of creatine supplementation aren’t known.


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Risks of Performance-Enhancing Drugs (2)

Can You Become Addicted to Performance-Enhancing Drugs?

Around 32 percent of people who misuse anabolic steroids become dependent on the drugs.3

Symptoms of anabolic steroid dependence include tolerance. This is when someone needs to take more steroids to achieve the same results.

Another indicator of dependence is the development of withdrawal symptoms once the use of anabolic steroids stops.

Treatment Options for Substance Abuse

People who use performance-enhancing drugs like steroids don’t often seek treatment. Approximately 56 percent of users don’t tell their physician about their steroid use.4

This may be because users feel their physician lacks knowledge about performance-enhancing drugs. Many websites focusing on anabolic steroids and other performance-enhancing drugs challenge the professionalism of healthcare providers and provide their advice.

Healthcare providers must be educated on the signs and symptoms of steroid use in patients.

Treatment for steroid use and other performance-enhancing drugs should address the underlying causes of drug use.

This can include:4

  • Psychological therapies and medications for muscle dysmorphia
  • Endocrine therapies to restore function in people suffering from hypogonadism and to treat symptoms of depression
  • Antidepressants for people whose depression doesn’t respond to endocrine therapies
  • Pharmacological and psychosocial treatments appear to be effective in treating the signs of anabolic steroid dependece for people who are also dependent on opioids

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Risks of Performance-Enhancing Drugs (3)


  • Performance-enhancing drugs are often used to enhance physique and improve performance in athletes
  • There are various types of performance-enhancing drugs, with anabolic steroids being among the most popular
  • Most people who misuse steroids are male non-athlete weightlifters in their 20s or 30s
  • Performance-enhancing drugs come with risks, consequences, and side effects, such as the development of various physical attributes
  • Approximately 32 percent of people who misuse anabolic steroids become dependent
  • Treatment for people recovering from steroid misuse includes psychological therapies and psychosocial treatments

What's Next?

  • What Is Rehab Like?
  • Why Call an Addiction Hotline?
  • How to Sober Up
  • Tapering off of alcohol
  • What is Considered an Alcoholic?


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Risks of Performance-Enhancing Drugs (4)

Risks of Performance-Enhancing Drugs (2024)


What are the dangers of performing enhancing drugs? ›

  • Insomnia.
  • Anxiety.
  • Weight Loss.
  • Dependence and addiction.
  • Dehydration.
  • Tremors.
  • Increased heart rate and blood pressure.
  • Increased risk of stroke, heart attack, and cardiac arrhythmia.

Why do athletes risk using performance enhancing drugs? ›

Simply put, many of the drugs athletes take illegally are designed to increase their athletic performance. For example, steroids and related hormones (such as testosterone) are used to increase muscle mass and strength by promoting testosterone production.

What are the pros and cons of performance enhancing drugs? ›


Athletes use the drugs illicitly to increase alertness, competitiveness, responsiveness, and weight loss. However, side-effects of the drugs include addiction, aggression, anxiety, hypertension, brain hemorrhage, coma, convulsions, dehydration, heart attacks, insomnia, stroke, tremors, and even death.

What are the cons of performance enhancing drugs in sports? ›

Performance-enhancing drugs are thought to gives athletes an edge in competition, but do so with adverse health effects in the long-run. Many of these substances cause cardiovascular conditions, organ damage, tumors, and endocrine effects, all of which do more harm to the athlete than good.

What do steroids do to your body? ›

Steroids reduce redness and swelling (inflammation). This can help with inflammatory conditions such as asthma and eczema. Steroids also reduce the activity of the immune system, which is the body's natural defence against illness and infection.

What are the side effects of steroids? ›

Side effects of steroid tablets
  • increased appetite – which may lead to weight gain if you find it difficult to control what you eat.
  • acne.
  • rapid mood swings and mood changes – becoming aggressive, irritable and short-tempered with people.
  • thin skin that bruises easily.
  • muscle weakness.
  • delayed wound healing.

How do steroids cause liver damage? ›

The two markers of liver stress most commonly elevated in users of anabolic steroids are the enzymes ALT and AST. These enzymes are necessary for amino acid metabolism in the liver and will leak into the bloodstream as the liver becomes inflamed or damaged.

How do steroids cause heart attacks? ›

A temporary rise in blood pressure, prothrombotic effects, impaired lipid metabolism causing increase LDL and decrease HDL result in an increased risk of coronary artery disease. Ultimately AAS abusers can be at increased risk of life-threatening arrhythmias, leading to sudden cardiac death [3].

Can I use steroids safely? ›

There is no 'safe' dose of an anabolic steroid. If you continue to use steroids, despite health warnings and your doctors advice, however, keep the dose to an absolute minimum and take breaks from using the steroids.

What are the arguments for PEDs? ›

Proponents of accepting performance-enhancing drugs (PEDs) in sports argue that their harmful health effects have been overstated, that health risks are an athlete's decision to make, that using drugs is part of the evolution of sports much like improved training techniques and new technologies, and that efforts to ...

What are the pros and cons of steroids for body building? ›

Conclusion. Best Steroids offer potential benefits for athletes and bodybuilders, including increased muscle mass, strength, and improved athletic performance. However, the risks associated with their use, such as cardiovascular problems, liver damage, hormonal imbalances, and mental health issues, cannot be overlooked ...

What are 3 performance enhancing drugs? ›

Examples of anabolic steroids include: oxandrolone, stanozolol and nandrolone. Anabolic steroids can be taken through a transdermal method, orally, or through injection. Injectable forms of the steroid are the most potent and long-lasting.

What are the disadvantages of steroids in sports? ›

When improperly used, anabolic steroids can cause serious health problems such as high blood pressure and heart disease; liver damage and cancers; and, stroke and blood clots.

How common are performance enhancing drugs in sports? ›

Among elite athletes, the prevalence of PED use is estimated to be around 14-39%. This statistic is a stark reminder of the prevalence of Performance Enhancing Drugs (PEDs) in elite sports.

What are 5 common side effects of steroids? ›

2) In spite of its positive effectiveness, long term use of steroid can cause adverse effects, including osteoporosis, renal impairment, infection, gastrointestinal disorder, depression, hypertension and diabetes.

Do steroids affect you mentally? ›

Steroid use can cause anxiety, depression, paranoia and psychosis in those people who have a vulnerability to mental health problems. Drug use can lead to social and emotional problems and affect a person's relationship with family and friends.

How do steroids affect the brain and emotions? ›

Some people who take steroids say the drugs make them feel powerful and energetic. However, steroids are also known to increase irritability, anxiety and aggression and cause mood swings, manic symptoms and paranoia, particularly when taken in high doses.

What are 3 long term effects of steroids? ›

The misuse of anabolic steroids can cause long-term side effects. These can include cardiovascular complications, liver disease, reproductive organ damage and severe mood swings. Support is available for anabolic steroid users who want to change their dependence on these drugs.

How long do steroids affect you? ›

You could expect a dose of prednisone to stay in your system for 16.5 to 22 hours. The elimination half life of prednisone is around 3 to 4 hours. This is the time it takes for your body to reduce the plasma levels by half. It usually takes around 5.5 half lives for a drug to be completely eliminated from your system.

What happens to your body if you take steroids too long? ›

Steroids, particularly at higher doses for long periods of time, can sometimes lead to damage to bones, called aseptic necrosis (also known as osteonecrosis or avascular necrosis). This can happen in a number of joints, but the hip is the most common.

Will my testosterone levels return to normal after steroids? ›

Almost all of the men had testosterone concentrations return to normal three months after the end of the cycle, and 100% by 12 months, providing they had normal gonadal function at the beginning of the study.

Is testosterone toxic to the liver? ›

An industry-supported study of an oral testosterone replacement therapy (TRT), testosterone undecanoate (TU, Jatenzo) finds it is an effective, long-term treatment for men with low testosterone levels, with no evidence of liver toxicity.

How can I protect my liver from steroid cycle? ›

Take supplements to protect liver:

In order to be a responsible steroid user, you should supplement with a liver aid that provides all the building blocks needed to restore and repair your liver during and after oral steroid usage. N2Guard is the most-popular liver support product in the steroid world.

Is heart damage from steroids reversible? ›

Anabolic steroid excess has been associated with development of a reversible dilated cardiomyopathy and potentially severe heart failure and sudden death.

Which anabolic steroid is safest? ›

Testosterone (Sustanon/Testosterone Enanthate), Anavar, and Deca Durabolin are the three safest anabolic steroids to use. Out of the three, testosterone is the safest overall, though, as we have pointed out already, using this synthetic steroid human growth hormone alone for bodybuilding will never be 100% safe.

Can steroids cause sudden death? ›

Anabolic androgenic steroids (AAS) have several adverse effects on the cardiovascular system that may lead to a sudden cardiac death (SCD).

What to avoid when taking steroids? ›

It is important to avoid "simple" carbohydrates and concentrated sweets, such as cakes, pies, cookies, jams, honey, chips, breads, candy and other highly processed foods. This helps keep blood sugar low. Limit saturated fat and cholesterol. Choose lean meats, poultry and fish.

Why you should avoid steroids? ›

Long-term corticosteroid therapy may cause thinning bones, called osteoporosis. Talk with your provider about taking calcium and vitamin D supplements to help protect your bones. Take care when discontinuing therapy.

Why steroids are not recommended? ›

Although growth impairment can be an independent adverse effect of corticosteroid therapy, it can also be a sign of adrenal suppression. Moderate to high dose use of glucocorticoids poses a significant risk of infections, including common mild infections as well as serious life-threatening infections.

What percent of bodybuilders use PEDs? ›

The results of this study indicated that more than half of the male bodybuilders (54%) were using steroids on a regular basis compared to 10 percent of the female competitors.

What are the most popular performance enhancing drugs? ›

Among teens, common performance-enhancing drugs and supplements include:
  • Creatine. Creatine is a naturally occurring compound in the body that's also sold as an over-the-counter supplement. ...
  • Anabolic steroids. ...
  • Steroid precursors. ...
  • Amphetamines and other stimulants. ...
  • Caffeine.
Feb 26, 2022

Do most athletes use PEDs? ›

Elite athletes account for only a small percentage of the 2.9 to 4 million users of PEDs in the U.S.3 In a review of studies. Researchers estimated that between 14% and 39% of current adult elite athletes have intentionally used doping.

Why do most bodybuilders use steroids? ›

Some bodybuilders and athletes use anabolic steroids to build muscles and improve athletic performance. They may take the steroids orally, inject them into muscles, or apply them to the skin as a gel or cream. These doses may be 10 to 100 times higher than doses used to treat medical conditions.

Do steroids permanently make you stronger? ›

"Anabolic steroids produce a permanent increase in users' capacity for muscle development. In keeping with this, studies show that mice given testosterone acquire new myonuclei that persist long after the steroid use ends."

Do most pro bodybuilders use steroids? ›

There are no studies of steroid usage in high-level professional bodybuilders, and the pros aren't drug tested. However, it's likely safe to say that virtually all bodybuilding pros use anabolic steroids.

What is the most common ped? ›

Among the most popular PEDs are anabolic steroids, human growth hormone, erythropoietin (EPO), beta-blockers, stimulants and diuretics to name just a few.

What ped has the least side effects? ›

Primobolan is the steroid with the least side effects that will still give you results. Primo is so mild you can do 20-week cycles without any problems.

What is the best PED for strength? ›

4 Best Oral Steroid For Strength In 2023: Top Steroids For Bodybuilding, Muscle Growth & Raw Power
  • D-Bal – Best Selling.
  • D-Bal Max - Strongest.
  • Testo-Max - Alternative to Testosterone.
  • The Strength Stack – Ultimate and Fast Results.
May 3, 2023

What are the cons of anabolic steroids? ›

In both men and women, anabolic steroid use can cause high cholesterol levels, which may increase the risk of coronary artery disease, strokes, and heart attacks. Anabolic steroid use can also cause acne and fluid retention. Oral preparations of anabolic steroids, in particular, can damage the liver.

Why is it unethical to use steroids in sports? ›

Using steroids to improve athletic performance is considered cheating, and can lead to athletes being penalized or banned from participating in sports. More importantly, using performance-enhancing steroids can have serious, long-term health consequences.

Why do steroids cause hair loss? ›

In particular, increased levels of dihydrotestosterone (DHT) will damage hair follicles. DHT will attach to follicles, causing inflammation. Eventually, these damaged hairs will start to fall out. Many steroids will raise the levels of DHT in your body, leading to significant hair loss.

Are PED and steroids the same? ›

What exactly is a PED? It is defined as any substance taken in non-pharmacologic doses specifically for purposes of improving sports performance. The more common ones that you hear of are anabolic steroids, testosterone, human growth hormone, creatine and ephedrine.

How many pro athletes use PEDs? ›

Epidemiology/Etiology/Prevalence/Incidence. Current data reports 14-39% of athletes are utilizing PEDs with a high prevalence of AAS use.

What percent of high school athletes use PEDs? ›

Between 1% and 12% of high school boys and 0.5% and 3% of high school girls report use of anabolic steroids with the highest rates found in male athletes competing in football, wrestling, and weight lifting.

What are two examples of performance enhancing drugs? ›

Common performance-enhancing drugs
  • Creatine. Creatine is a naturally occurring compound in the body that's also sold as an over-the-counter supplement. ...
  • Anabolic steroids. ...
  • Steroid precursors. ...
  • Amphetamines and other stimulants. ...
  • Caffeine.
Feb 26, 2022

What are the negative effects of sports on the body? ›

Athletes' physical and emotional health might suffer long-term negative effects of sports on the body. Athletes may feel soreness, swelling, and muscular weakness in the near term. They may also risk missing important tournaments or events. Long-term consequences of an injury might eventually lead to chronic illnesses.

What steroids do NFL players use? ›

Anabolic steroids represent another performance-enhancing drug popular among NFL players. These synthetic testosterone and growth hormone products are chosen for their ability to aid in rapid muscle-building and improve performance.

How common are PEDs in sports? ›

The prevalence rate ranges from 1-3% among tested athletes to as high as 43%, with anabolic steroids responsible for 49% of adverse findings in 2018. Olympic athletes reported PED use at a rate of 57.1% during the 2008 Olympics, while 3.3% of U.S. high school students were found to be using PEDs in 2016.

What is the most unhealthy sport? ›

Basketball has the most injuries overall, but the number of injuries varies with each age group. Football is the most dangerous sport for children ages 5 to 14, while basketball has the highest number of injuries among people ages 15 to 24.

What is the hardest sport on your body? ›

According to several studies about “science of muscles and movement” experts label boxing as the most demanding sport for an athlete. Boxing requires strength, power, endurance, and the ability to withstand huge hits over a period of time.

Can sports negatively affect mental health? ›

An athlete whose identity is strongly tied to their sport is also at higher risk for developing mental health concerns, especially when experiencing injury. They can lose their primary sense of self and the dreams, expectations and benefits that go along with their athletic identity.


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