Are Performance Enhancing Drugs worth it?



The first official ban on “stimulating substances” or performance enhancing drugs by a sporting organisation was introduced by the International Amateur Athletic Federation in 1928. However, the use of performance enhancing drugs can be dated all the way back to the third Olympic games, when Thomas Hicks won the marathon after receiving an injection of strychnine (used as a rat poison today and works by interfering with the inhibitory neurotransmitter system, putting a brake on the stimulatory nerves). Performance enhancing drugs (PEDs) are definitely not new, but they are becoming significantly more effective and harder to detect.


Most media attention is almost solely focused on the use of PEDs by elite athletes to gain a competitive advantage in sports and is rarely focused on its use for appearance purposes by non-athletes, particularly weightlifters. There is also a widespread misperception that PEDs are safe for use and that adverse effects are manageable. However, this is very far from the truth.


What are Performance enhancing drugs?

PEDs are pharmacologic agents that athletes and non-athlete weightlifters use to enhance performance. “Doping” refers to the use of PEDs in competitive sports.


Types of PEDs…

Androgenic-anabolic steroid

Commonly known as steroids, athletes use this to increase their muscle mass and strength. Steroids are usually synthetic modifications of Testosterone - a natural hormone produced by the body, which has two main effects.


Androgenic effects- Androgen is the sex hormone that promotes the development and maintenance of male sex characteristics. It has a masculinising effect, promoting the development of male secondary sex characteristics.


Anabolic effects- result in an increase in skeletal muscle mass and strength, which is the preferential result of steroids. It works by increasing the number of muscle progenitor cells which contribute to muscle fiber hypertrophy, increasing maximal voluntary strength and power. It also promotes mitochondrial biogenesis and increases net oxygen delivery to tissue by increased red cell mass and tissue capillarity, facilitating the unloading of oxygen to cells. Furthermore, it possibly improves neuromuscular transmission, leading to speculation that it may reduce reaction time, aiding in sprint events or sports that require hand eye coordination.


As such Pharmaceutical companies have attempted to develop androgens that have preferential anabolic activity, though it should be noted that most steroids still have both components.


Anabolic steroids are popular because of their low price and easy access. It is also challenging for detectors to distinguish between exogenous and endogenous sources of testosterone.

Designer steroids are a particularly dangerous class of anabolic steroid, made specifically for athletes to be undetectable by drug tests. Because they have no approved medical use, they haven’t been tested or approved by the FDA, representing a health threat.


Androstenidone- a hormone produced by the adrenal gland, ovaries and testes. It is normally converted to testosterone and a form of estrogen in both men and women. Manufacturers and bodybuilding magazines tout its ability to allow athletes to train harder and recover more quickly, but scientific studies have refuted these claims.


Human growth hormone - has an anabolic effect. Athletes use it to improve muscle mass and performance, but it hasn’t been shown to conclusively improve strength or endurance.


Eryhtropoietin- used as a hormone to treat anaemia in people with severe kidney disease. It increases the production of red blood cells and haemoglobin, improving the movement of oxygen to the muscles. Its hence used to increase endurance in events such as long distance running, skiing and cycling


Diuretics- Drugs such as furosemide and thiazides, can change your body’s natural balance of fluids and salts which can lead to dehydration, decreasing an athletes weight. This can improve muscle definition onstage and enable boxers to fight in a lower weight class. It may also help athletes pass drug tests by diluting their urine, reducing the concentration of other drugs below the limit of detection.


Creatine- A naturally occurring compound produced by your body that helps your muscles release energy. Scientific research indicates that creatine may have athletic benefit by producing small gains in short-term burst of power. It appears to enable muscles to make more Adenosine Triphosphate (ATP) which stores and transports energy in cells and can be used for short bursts of activity like weightlifting or sprinting.


How are these drugs used?

The type of drug and its means of consumption usually depend on what an athlete or non-athlete’s aims are. Drugs are usually taken orally daily, transdermally or by injection weekly or bi-weekly.


Androgenic-anabolic steroids are used in the highest proportion amongst athletes and non-athletes, due to their ease of access and efficacy. Some also take a combination of drugs. For instance, combining steroids and erythropoietins for athletes to train harder and recover faster. Most steroid users engage in high-intensity exercise to maximize anabolic gains. The combined use of steroids and opiates enables the user to continue training despite muscle and joint pain. Inevitably, some individuals develop opioid dependence. Additionally, more substances (masking drugs) are often taken to reduce the ability to detect a banned substance. For instance, epitestosterone can mask the detection of testosterone use.


How are PEDs regulated?

The World Anti-Doping Agency (WADA) is an international agency that oversees the implementation of the anti doping policies in all sports worldwide, maintaining a list of substances (drugs, supplements, etc,) that are banned from use in all sports and during competition.


The world Anti-Doping agency code declares a drug illegal if it is performance enhancing, a health risk or violates the “spirit of sport”.


When athletes willfully or accidentally ingest PEDs, markers of those drugs can be detected in biological samples such as the urine, saliva and blood (should they be collected). Evidence of drug use can be apparent for many weeks after the last exposure of the drug. Some indicators that suggest PED use include increased hemoglobin and hematocrit, suppressed LH, FSH and testosterone levels; low high-density lipoprotein cholesterol and low sperm density.


Although testing procedures do deter PED use, new designer drugs that can escape testing constantly become available. To detect early use of designer steroids and provide more accurate baseline standards for each athlete, testing laboratories store data from each drug testing sample. These samples are then used as reference points for future testing, thereby eliminating the possibility that a person tests positive simply because he or she has naturally elevated levels of testosterone when compared to the general population. An indicator of long-term use of designer steroids suppresses levels endogenous steroids in urine samples.


According to WADA’s codes, athletes are responsible for any prohibited substance found in their samples, regardless of whether ingestion was intentional or unintentional. However, sanctions may be reduced or avoided if the athlete can demonstrate that the substance was ingested through no significant fault or negligence on his/her part, or in some circumstances where the athlete did not intend to enhance performance


Why is the desire to dope is strong?

The desire of many athletes to win is fierce. Athletes dream of winning medals for their country or securing a spot on a professional team. With the benefits PEDs could bring to their performance, the temptation is strong.


Kjetil Haugen hypothesised that athletes face a kind of prisoner’s dilemma regarding drugs. He theorised that unless the likelihood of athletes caught were raised to unrealistically high levels, or the payoffs for winning were reduced to unrealistically low levels, many athletes would choose to take the risk and cheat.


Should doping be allowed?

In reality, sport is really just a test of one’s biological potential and training aims to bring out that potential. As such, drugs that improve natural potential should theoretically be against this model of sport.


People do well at sport as a result of the genetic lottery. A stark example of this was the Finnish skier Eero Maentyranta. In 1964, he won three Olympic golds. Subsequently, it was revealed that he had a genetic mutation that meant he “naturally” had 40-50% more red blood cells than the average person. As such, some argue that by allowing everyone to take performance enhancing drugs, the playing field is levelled as the effects of genetic inequality are removed. However, this argument does not at all take into account the consequences and health effects of PEDs on health and the lives of athletes.


Consequences of using PEDs

The real issue of the use of PEDs is often neglected as public attention is almost always focused on how PEDs are used to gain a competitive advantage, distracting attention from the health risks associated with it. In fact, most PED users are non-athlete weightlifters, who use PEDs to grow muscle for aesthetic purposes. Testing is also virtually non-existent with non-athletes and rare with athletes due to the high costs associated with it. In addition to this, healthcare systems do not yet feel the effect of PED use as the great majority of users are still under 50, having not yet reached the age of risk for disease that typically arises later in life.


Common Effects of PEDs…

Cardiovascular- loss of tissue elasticity and increased fibrotic content in the heart. This increases the coronary artery calcium score, contributing to cases of myocardial infarction.


Psychiatric -major mood disorders, manic symptoms, irritability, exaggerated self confidence and depressive symptoms during withdrawal. However, not all who use PEDs experience these symptoms


PED users also experience more hematologic, neuropsychologic, hormonal and metabolic effects and can develop a dependence to it.


Other adverse effects can also include infertility, gynecomastia, sexual dysfunction, hair loss, acne and testicular atrophy.



Further studies needed

Clinical trials cannot ethically duplicate large doses of PEDs and researchers cannot ethically conduct studies on the long-term effects of PEDs in normal volunteers. As such, the majority of knowledge on PEDs comes from users in the field. More observational studies are still required on the prevalence of PED use and how it affects health. Given the mounting evidence of the health effects of PED use, there is a strong justification for the need to improve methods for detecting use of PEDs and eliminating abuse. Athletes may appear to achieve physical gains from drugs. But at what cost?


References

1)https://academic.oup.com/edrv/article/35/3/341/2354633

2)https://bjsm.bmj.com/content/38/6/666

3) https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/performance-enhancing-drugs/art-20046134

4)https://pubmed.ncbi.nlm.nih.gov/25675030/#:~:text=Whenever%20athletes%20willfully%20or%20accidentally,for%20many%20weeks%20following%20the



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