Performance enhancement drugs: glossary, explanation and practical checklist

Disclaimer: This article is for educational purposes only and does not promote the use of performance enhancement drugs. Many of these substances are illegal without prescription, banned in competitive sports, and may cause serious health risks. Always consult a qualified healthcare professional before taking any medication or supplement.

Key terms (glossary)

Anabolic-androgenic steroids (AAS): Synthetic derivatives of testosterone used to increase muscle mass and strength.
Erythropoietin (EPO): A hormone that stimulates red blood cell production, sometimes misused to improve endurance.
Human growth hormone (HGH): A hormone that promotes growth and cell regeneration; occasionally abused for body composition changes.
Stimulants: Substances (e.g., amphetamines) that increase alertness, energy, and focus.
Selective androgen receptor modulators (SARMs): Compounds designed to selectively stimulate androgen receptors, marketed as steroid alternatives.
Doping: The use of prohibited substances or methods to enhance athletic performance.
Testosterone replacement therapy (TRT): Medical treatment for clinically low testosterone, distinct from non-medical steroid use.
Peptide hormones: Short chains of amino acids (e.g., insulin-like growth factor) sometimes misused for performance gains.
Blood doping: Increasing red blood cell mass through transfusions or drugs to improve oxygen delivery.
Androgenic effects: Masculinizing effects such as facial hair growth and voice deepening.
Hepatotoxicity: Liver damage that may occur with certain oral steroids or supplements.
Cardiovascular risk: Increased likelihood of heart attack, stroke, or hypertension associated with some substances.
Dependency: Psychological or physical reliance on a substance.
Anti-doping testing: Laboratory analysis of blood or urine to detect banned substances.

Clear explanation

1. Why people use performance enhancement drugs

Performance enhancement drugs (PEDs) are used in sports, bodybuilding, academic settings, and even the workplace. Common motivations include increasing muscle size, improving endurance, speeding up recovery, enhancing concentration, or achieving a competitive edge. Social pressure, body image concerns, and unrealistic expectations can also contribute.

Some substances, such as testosterone or growth hormone, have legitimate medical uses. Problems arise when these drugs are used without medical indication or in supraphysiological (above normal) doses.

2. Common types and how they affect the body

Anabolic steroids increase protein synthesis in muscles, leading to faster muscle growth and strength gains. However, they also disrupt natural hormone production.

EPO and blood doping increase red blood cell concentration, improving oxygen delivery to muscles. This may enhance endurance but can thicken the blood and increase clot risk.

Stimulants act on the central nervous system to reduce fatigue and improve alertness. They may raise heart rate and blood pressure.

HGH and peptides are believed to support tissue repair and fat metabolism, though evidence for performance benefit in healthy adults is limited.

For a comparison of medical versus non-medical use of metabolic drugs, see our guide on Nesina: uses, dosage & side effects.

3. Possible manifestations and side effects

Side effects vary depending on the substance, dose, and duration. With anabolic steroids, potential manifestations include:

Acne and oily skin
Mood changes (irritability, aggression)
Testicular shrinkage and infertility in men
Menstrual irregularities and voice deepening in women
Liver toxicity (especially oral steroids)
Increased LDL (“bad”) cholesterol and decreased HDL (“good”) cholesterol

Stimulant misuse may cause insomnia, anxiety, arrhythmias, or dependence. EPO misuse increases the risk of thrombosis, stroke, and heart attack due to thicker blood.

Cardiovascular complications are among the most serious long-term risks of performance enhancement drugs.

4. Diagnosis and detection

Medical professionals may suspect PED use based on symptoms, abnormal lab results (e.g., elevated hematocrit, abnormal liver enzymes), or sudden hormonal changes.

Anti-doping agencies use urine and blood tests to detect banned substances. Advanced testing can identify synthetic hormones, metabolites, and abnormal biological markers.

If you are concerned about substance-related complications, read our overview of how sports organizations regulate performance substances for broader context.

5. Medical and supportive approaches

Treatment depends on the substance involved and associated complications. Approaches may include:

Gradual discontinuation under medical supervision
Hormonal evaluation and recovery protocols
Cardiovascular risk assessment
Psychological support for dependency or body image concerns

In some cases, medically supervised hormone therapy (e.g., TRT) may be appropriate—but only after proper diagnosis.

Reader checklist

What you can do

Seek professional medical advice before taking hormones or stimulants.
Have regular blood tests if using any prescribed hormonal therapy.
Focus on evidence-based performance strategies: sleep, nutrition, structured training.
Educate yourself on legal and sporting consequences of doping.
Discuss body image concerns with a healthcare or mental health professional.

What to avoid

Buying injectable or oral steroids from unverified online sources.
Combining multiple performance enhancement drugs (“stacking”) without medical supervision.
Ignoring symptoms such as chest pain or severe mood changes.
Assuming “natural” or “herbal” supplements are risk-free.

When to see a doctor urgently (red flags)

Chest pain, shortness of breath, or sudden weakness
Severe headache or signs of stroke
Yellowing of the skin or eyes (possible liver damage)
Severe depression, aggression, or suicidal thoughts
Rapid swelling, pain, or redness in a limb (possible clot)

Key concepts in simple terms

Term	In simple words	Why it matters
Anabolic steroids	Artificial testosterone	Can increase muscle, but harm hormones and heart
EPO	Boosts red blood cells	May improve endurance but raises clot risk
HGH	Growth hormone	Limited proven benefit, possible metabolic risks
Stimulants	Energy and focus boosters	Increase heart strain and addiction risk
Doping	Using banned enhancers	Leads to disqualification and health harm

Specialist comment (generalized): In clinical practice, the long-term cardiovascular and hormonal consequences of non-medical performance enhancement drug use are often underestimated. Even young, otherwise healthy individuals may develop lasting complications. A balanced training plan and medical supervision are safer and more sustainable strategies.

For broader discussions on sports culture and regulation, see our related section on international football governance and anti-doping standards.

Sources

World Anti-Doping Agency (WADA). Prohibited List and Anti-Doping Guidelines.
National Institute on Drug Abuse (NIDA). Anabolic Steroids and Other Appearance and Performance Enhancing Drugs (APEDs).
Endocrine Society Clinical Practice Guidelines on Testosterone Therapy.
American Heart Association. Cardiovascular effects of anabolic steroid use.

If specific statistics or prevalence rates are required, consult the latest reports from WADA, NIDA, and peer-reviewed journals, as data are updated regularly.