Faster, Stronger, Better — Is it Worth It?

Performance enhancing drugs can contribute to range of negative health effects

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Lance Armstrong. Barry Bonds. Floyd Landis. Jose Canseco. Marion Jones. Roger Clemens. And so on. They betrayed our trust, but what might performance-enhancing drugs have done to their health?

A recent statement reviewed the negative health effects that can be caused by performance-enhancing drugs.

Performance-enhancing drugs include any drug used to try to improve one's strength, speed, or other asset in sports or similar athletic pursuits.

Although celebrity athletes get a lot of attention with this issue, the authors argue that the problem is much greater for a wide range of non-elite athletes and ordinary Americans.

"Don't use performance-enhancing drugs."

The statement, authored by a group led by Harrison G. Pope, MD, MPH, of McLean Hospital at Harvard Medical School, discussed the health risks associated with performance-enhancing drugs.

The most commonly used type of performance-enhancing drug includes anabolic steroids, which this paper especially focused on.

Examples include testosterone, bodenone, and trenbolone that are frequently detected among users in the US.

"There is a widespread misperception that performance-enhancing drug use is safe or that adverse effects are manageable," the authors wrote.

They noted that one reason the health risks of performance-enhancing drug use may be neglected is that public attention has often focused on elite athletes' use of the drugs.

"In reality, the vast majority of performance-enhancing drug users are not athletes but rather non-athlete weightlifters, and the adverse health effects of performance-enhancing drug use are greatly under-appreciated," they wrote.

Another obstacle to learning about and conveying the health risks of these drugs is that only observational studies can be used to learn about them.

It would be unethical to conduct randomized, controlled studies in which researchers compare one group that is purposely given performance-enhancing drugs with another that is not.

An additional obstacle is the relatively recent arrival of these drugs since most past or current users are still under age 50, before many chronic health problems might appear.

Additionally, those using performance-enhancing drugs usually do so secretively and often do not trust doctors, so they can be more difficult to study than other drugs.

Yet the range of health problems that can be caused by individual performance-enhancing drugs, or ones used together, include cardiovascular, psychiatric, metabolic, endocrine, neurologic and musculoskeletal disorders.

They can also include infectious diseases and health problems with the liver and kidneys.

Use of performance-enhancing drugs has also been linked to other drug use, including opiates and alcohol use.

Although some teenagers may use performance-enhancing drugs, the authors report that the vast majority of users begin after adolescence, particularly around the early 20s.

Yet many of the conditions that can be caused by these drugs may not show up until much later.

In particular, steroid use has been linked to cardiovascular problems that include atherosclerotic disease, heart irregularities, a weakened heart, high blood pressure, clotting disorders, and disorders related to blood volume and flow.

In men, negative effects of steroids can include prostate cancer and sterility.

Users of performance-enhancing drugs can also experience psychiatric and neurological problems, including aggressiveness, mood disorders, depression, and dependence on other drugs such as alcohol or opiates.

A more visible negative effect from steroids can be acne, but the authors also discuss a range of kidney, muscular and liver disorders that can result from use of steroids and other performance-enhancing drugs.

Another commonly used performance-enhancing drug, human growth hormone, has less research available on negative effects.

However, it has been linked to edema (fluid-filled swelling within tissues), excessive sweating, carpal tunnel syndrome, diabetes, muscle pain, and joint pain.

Based on studies of individuals who naturally produce excess human growth hormone, there is reason to suspect other serious conditions can result from its use, including cardiovascular problems, high blood pressure, and higher risk of overall death.

The authors emphasized that more research is necessary to understand all the different negative effects that can result from use of different performance-enhancing drugs.

In the meantime, however, enough is known about negative health effects that greater public attention should be paid to reducing their use, the authors suggested.

The statement was published December 17 in the journal Endocrine Reviews. The statement's preparation was funded by the Endocrine Society.

One author has received research funds from AbbVie, Regeneron and Eli Lilly and Company not related to this research. Two other authors have testified in legal cases related to steroid use.

Several authors have received funding from the National Institutes of Health and one from the Swedish Research Council. One is an employee of the US Anti-Doping Agency.

Review Date: 
December 20, 2013
Last Updated:
December 20, 2013