Performance Enhancing Drugs Education
  • Performance Enhancing Drugs Education
    The National Strength and Conditioning Association is committed to supporting and disseminating researched-based knowledge and its practical application as pertains to sport science. Unfortunately, illicit performance enhancing drugs are part of the competitive world at multiple levels. Thus the NSCA is committed to provide the most recent and applied information to strength and conditioning professionals, athletes, parents and coaches. Drug use in sport is a multi-factorial problem and having long-term, sustainable solutions is the essence of the answer.
  • Three Primary Tenets

    1. Performance Enhancing Drug Education: An overview of what performance enhancing drugs are, how they work, what are the effects of usage and other fundamental information is presented. The depth of this information will vary depending on who the target population is.

    2. Strength and Conditioning: In order for athletes and individuals to reach their physical best they need a sound training program. This tenant addresses the fundamental training principals and their application.

    3. Nutrition: A fundamental nutrition program is a building block of peak performance. The six essential nutrients, their correct amounts and meal timing should be addressed. Additionally safe, legal and effective sport supplements could be an option.


    These files can be downloaded and handed out to parents, coaches, and athletes to further combat the use of performance enhancing drugs.

    Additional Web Resources


    Anabolic Steroids in Sport and Exercise, 2nd Edition, Yesalis, C., 2000, Human Kinetics
    This text features the latest research and references on steroid use among professional, high school, collegiate and Olympic level athletes. All aspects of steroid use are covered including use, abuse, dependency, physical and psychological side effects, intervention, withdrawal, treatment and legal issues.

    Essentials of Strength and Conditioning , Baechle, T., Earle, R, 4rd edition, 2016, Human Kinetics
    Students, coaches, strength and conditioning specialists, personal trainers, athletic trainers, and other sport science professionals will find state-of-the-art, comprehensive information on structure and function of body systems, training adaptations, testing and evaluation,exercise techniques, program design (aerobic and anaerobic) and training facility organization and administration.  

    Overview to Performance Enhancing Drugs

    There are four types of performance enhancing drugs:

    1. Anabolic steroids
    2. Masking Agents
    3. Stimulants
    4. Erythropoietin

    Anabolic Steroids - Overview
    Anabolic steroids are manmade derivatives of the male hormone "testosterone". Testosterone is produced by the testes in males and relatively smaller quantities in the adrenal glands and ovaries of females. Exogenous testosterone itself is not as effective in building muscle as chemically altered derivatives of testosterone. These derivatives of testosterone are what most people understand anabolic steroids to be. "Juice" is a synonymous term for steroids in the non-medical community.

    Function and Use
    Testosterone has many different functions in the body. One of the main functions is to synthesize protein resulting in additional muscle size and strength which is obviously compelling to athletes, competitive and otherwise. In order for steroids to be effective they must be taken in dosages that exceed the bodies' natural production. The level needed will depend on age, gender and each person's unique physiology. There is a dose-response relationship that exists with the use of steroids. This means if more of the drug is consumed there will be a greater response, both negative and positive. Recent research has also indicated that there has been an upward trend in the total amount of steroids ingested by users compared to users ten years prior.

    "Stacking" of steroids is a practice used that incorporates the administration of two or more steroids or illicit muscle building agents simultaneously. Stacking will often gradually increase the amount used over the course of weeks and then taper the use toward the end of the cycle (duration of time used).

    Side Effects
    Some of the side effects that are associated with steroid use are increased body hair, male-pattern baldness, aggressive behavior and stimulation of the sebaceous glands contributing to acne. It also should be noted that the degree and severity of these side effects are often transient and reverse with the cessation of steroid use. Additionally, individuals will respond differently depending on each person's unique body physiology.

    Steroid use is known to increase the risk for certain medical conditions. Although many of the physiological and psychological changes associated with anabolic steroid use may be transient (e.g. lipid profile changes, elevated blood pressure, acne), individuals with underlying disease may be at risk for serious adverse events. In women, some of the masculinizing effects from steroid may be permanent, and steroid use by adolescent males may prematurely arrest longitudinal bone growth, resulting in prematurely reaching their maximum height.

    Take Home Message
    Both the risks and the benefits of steroid have been exaggerated by the lay press and general public. Athletes and coaches alike are confused about what fact and what is myth concerning steroids. The NSCA encourages honest and full disclosure of known risks and benefits of steroids in drug education programs in an attempt to stem the abuse of steroids.

    Masking Agents - Overview

    Masking agents are drugs or compounds that are taken with the express purpose of hiding or "masking" the presence of specific illegal drugs that are screened for athletic drug testing (4). Masking agents have the potential to impair or conceal the banned substance in the urine (4). The most common masking agents include diuretics, epitestosterone, probenecid and plasma volume expanders (4, 8). Each of these categories is addressed.

    Function and Use
    Diuretics: Diuretics have been placed on the prohibited list for some time because of two reasons: 1) they facilitate weight loss via their ability to enhance rapid water loss via urine excretion and 2) they have the potential to rapidly dilute the urine by increasing renal flow. When utilized as a "masking" agent diuretics dilute the urine, which results in lower levels of the banned substance being excreted from the body. This can therefore make it more difficult for the laboratories conducting doping controls to detect (8).

    The dosage of diuretic administered varies depending upon the actual drug that is administered. When looking at the diuretic furmosimide the clinical dosage for adults is to give 20-80 mg as a single dosage. However, if needed the same dosage can be give 6-8 hours later. With this dosage scheme a very rapid secretion of urine occurs (1).

    Epitestosterone: When athletes take exogenous testosterone two basic methods can be employed to "mask" the use of these compounds: 1) Utilize transdermal delivery mechanisms or 2) use epitestosterone in conjunction with testosterone use.

    One mechanism for "masking" testosterone use is to use transdermal preparations which have the potential to raise circulating testosterone and are only detectable by doping controls via blood profiles in the period of 4-8 hours after administration (2). If the athlete were to utilize transdermal solutions in a systematic method they may be able to administer a low dosage of testosterone that would be below the testing standards. No pharmaceutical dosages for epitestosterone are available because epitestosterone is only available as a chemical (2).

    Probenecid: Probenecid has been shown to reduce the excretion of anabolic steroids into the urine (3), thus potentially reducing the level of androgens below the levels established. In animal studies it has been reported that the co-administration of probenecid and the anabolic steroid stanozolol results in an increased disappearance of the anabolic steroid from the plasma. Additionally, the co-administration of these drugs results in a decrease in the total amount of stanozolol excreted into the urine (7).

    Alpha-Reductase Inhibitors: Alpha-reductase inhibitors are generally used for the treatment of prostate hypertrophy and androgenic alopecia (1). It appears that alph-reductase inhibitors have the potential to significantly impact steroid profiles which are used in drug testing. Specifically, they appear to complicate or even prevent the detection of some prohibited substances.

    The recommended medical dosage for the common alpha-reductase inhibitor, Dutasteride is 0.5 mg taken once daily. However, studies have shown that between 5-40 mg of Dutasteride can be taken per day with minimal adverse side effects. The recommended clinical dosage of Finasteride, another common alpha-reductase inhibitor, is 1 mg per day. Dosages of 80-400 mg per day have been shown to produce minimal adverse reactions (1).

    Plasma Volume Expanders: Plasma volume expanders (i.e. albumin, dextran or hydroxyethyl startch) can be used by athletes for several reasons: 1) to prevent dehydration (6) or 2) in order to mask recombinant erythropoietin use (5). When plasma volume expanders are taken with recombinant erythropoietin they can elevate the blood volume while maintaining a blood profile level that is within the legal range (6).

    Generally plasma expanders such as albumin are administered with other compounds such as blood, plasma, or saline. Generally, the total dose and rate of infusion relies on the individual's condition and response to treatment. When plasma expanders are administered to adults for medical reasons the general amount used is between 250-500 ml, but dosages should be individualized (1).

    Side effects
    Diuretics: The utilization of diuretics may result in the occurrence of heart arrhythmias, dehydration, muscle cramping, blood volume depletion, significant drops in blood pressure and severe electrolyte imbalances. These arrhythmias can occur as a result of a deficiency of potassium in the blood and dehydration (4).

    Probenecid: Probenecid use generally results in very few minor side effects. These side effects can include the formation of kidney stones, acute gouty arthritis, hair loss, skin rash, headache, nausea, sore gums, fever and in very rare cases severe anemias (1).

    Alpha-Reductase Inhibitors: The most significant side effects associated with the use of some of these masking agents are associated with reproductive dysfunction (1). Reproductive side effects include a decreased libido, increased occurrence of erectile dysfunction, and an increase occurrence in ejaculation disorders (1).

    Plasma Expanders: The use of plasma expanders such as albumin can very rarely result in adverse effects. These effects are usually marked by nausea, fever, chills or hives.

    Stimulants - Overview

    Stimulants or amphetamines can be defined as an agent temporarily increasing functional activity by their actions on the sympathetic nervous system. The sympathetic nervous system is responsible for actions on the heart, lungs, and blood vessels to promote the "fight or flight" mechanism. Major stimulants used in athletes are caffeine, widely available in coffee, tea, or soda, and Ma Haung Extract a nutritional supplement similar to ephedra which has been banned in the United States by the Food and Drug Administration.

    Functions and Use
    The exact mechanism for amphetamines are unclear but has been hypothesized that they have an ergogenic effect by increasing oxidation of fats, enhancing thermogenesis, and perhaps a sparing of skeletal muscle glycogen as a result of the greater free-fatty acid utilization.

    The preponderance of evidence would support the reasoning that amphetamines and other stimulants like caffeine can improve performance by delaying time to fatigue and masking pain. Amphetamines or other stimulants can be ingested in a variety of different ways including, inhaled, injected or orally in the form of pills or included in a liquid such as coffee. The amount of caffeine needed to produce an ergogenic effect ranges between 250 to 700 mg which is the equivalent of three cups of coffee or six to eight sodas. Many athletes take caffeine in pill form to more easily reach these levels.

    Side Effects
    Too much caffeine can produce alterations on mood, concentration, and alertness. Additional effects include an increase in heart rate and blood pressure, restlessness, nervousness, insomnia, increased urination, and tremors. More adverse reactions include heart beating abnormalities, hypertension, and hallucinations. Of particular concern to the medical community are individuals who are taking other medications, experiencing allergic reactions and women who are pregnant or breast feeding.

    Erythropoietin - Overview

    As a drug, erythropoietin (EPO) is a man-made version of the hormone in the human body that stimulates the production of red blood cells (RBC). In the body, EPO is a naturally occurring hormone, produced by the kidneys, which stimulates the body to produce more RBCs. When administered to a human it stimulates greater RBC production. It was developed for treating the reduction in red blood cells that comes with kidney disease, HIV, cancer and those undergoing surgery. The use of EPO was classified as banned by the International Olympic Committee in 1990. Blood doping is a method of infusing extra red blood cells either from a donor or from one's own red blood cells that were previously removed.

    Function and Use
    The increase in red blood cells causes an increase in the number of hemoglobin molecules per unit blood. Hemoglobin is the primary molecule that carries oxygen in the blood. More oxygen in the blood allows more oxygen to be delivered to the exercising muscles. Studies have shown that blocking hemoglobin causes a reduction in exercise performance, or adding hemoglobin causes a clear increase in exercise performance.

    Typically, blood doping involves removing 2 to 4 units (900-1800ml) of blood from an individual. The RBCs are spun and separated from plasma, then stored in glycerol. After a 2-3 month time delay, which allows for restoration of RBC in the athlete, and about 3-5 days before competition, the RBC are "washed" and reinfused. Because of the storage in glycerol, the RBC are well preserved. Donor blood can be used, but risk is increased due to the possibility of blood borne pathogens. The benefit of donor blood is that the individual does not have to go through the period of regeneration of their own RBCs.

    EPO is taken by IV or subcutaneous injection. For medical use the typical dosage is: Initial dosage-100IU/kg body weight 3 times/week for 8 weeks. The maintenance dosage is then 25-50IU/kg 3 times/week. The exact dosage is disease/individual dependent. For sport use, the dosage is usually 20-40IU/kg 3 times/week with no "loading" phase.

    Side Effects
    There appears to be minimal side effects associated with blood doping, including no problems in research. Less is known about illicit use. There no changes in BP, which was suspected because of inferred increase in viscosity that was presumed to occur with blood doping. Donor infusion has obvious potential problems, and blood doping could be detrimental if too much is reinfused.

    With EPO use, the most common side effect appears to be an increase in blood pressure. This increase is not explained by increased hematocrit and presumed viscosity, but may be a direct effect of the hormone on blood vessels, causing constriction. This constriction could possibly have very serious side effects, including death. It has been suggested that between 1987 and 1990, 19 Dutch and Belgian cyclists died from suspected misuse of EPO.