Performance enhancement drugs — evidence-based review (educational content, not medical advice)
Disclaimer: This article is for educational purposes only. It does not provide medical advice, diagnosis, or treatment recommendations. Performance-enhancing drugs (PEDs) can carry significant health risks. Always consult a qualified healthcare professional before making decisions related to medications or supplements.
Quick summary
- “Performance enhancement drugs” (PEDs) is a broad term covering substances used to improve strength, endurance, appearance, focus, or recovery.
- Some PEDs (e.g., anabolic steroids, erythropoietin) have proven performance effects but also well-documented health risks.
- Many supplements marketed for performance have limited or mixed scientific evidence.
- Risks include heart disease, liver injury, hormonal disruption, mental health effects, and legal consequences.
- Evidence-based strategies like training, sleep, and nutrition remain safer and highly effective for most people.
What is known
1. Anabolic-androgenic steroids (AAS)
Anabolic steroids are synthetic versions of testosterone. They are among the most studied performance enhancement drugs.
- What they do: Increase muscle mass, strength, and recovery speed.
- Evidence: Strong evidence shows they increase muscle size and power in healthy adults.
- Risks: High blood pressure, abnormal cholesterol, heart enlargement, liver damage (especially oral forms), infertility, mood changes, aggression, and dependence.
Major medical organizations such as the National Institute on Drug Abuse (NIDA) and the U.S. Centers for Disease Control and Prevention (CDC) warn about long-term cardiovascular and hormonal complications.
2. Erythropoietin (EPO) and blood doping
EPO stimulates red blood cell production, improving oxygen delivery to muscles.
- What they do: Increase endurance capacity.
- Evidence: Strong evidence supports improved aerobic performance.
- Risks: Thickened blood, increased risk of clots, stroke, and heart attack.
These methods are banned in competitive sports and can be life-threatening when misused.
3. Stimulants (e.g., amphetamines, certain ADHD medications)
Stimulants may increase alertness, reaction time, and perceived energy.
- What they do: Improve focus and reduce fatigue in the short term.
- Evidence: Moderate evidence for cognitive and short-term performance benefits.
- Risks: Increased heart rate, blood pressure, anxiety, insomnia, dependence.
4. Creatine
Creatine is a naturally occurring compound found in muscle cells and one of the most researched sports supplements.
- What it does: Supports short bursts of high-intensity activity.
- Evidence: Strong evidence for improved strength and power performance.
- Risks: Generally safe in healthy individuals when used appropriately; mild gastrointestinal discomfort in some people.
Unlike anabolic steroids, creatine is legal and widely supported by sports nutrition guidelines.
5. Testosterone therapy (medical use vs misuse)
Testosterone replacement therapy (TRT) is medically prescribed for diagnosed low testosterone. Outside medical supervision, it is often used as a PED.
- Evidence: Effective for treating confirmed deficiency; increases muscle mass.
- Risks: Similar to anabolic steroids when misused; may suppress natural hormone production.
Official prescribing information can be found through government drug databases such as the U.S. FDA (e.g., FDA drug labels).
What is unclear / where evidence is limited
- Long-term safety of many supplements: Herbal “test boosters,” SARMs (selective androgen receptor modulators), and new compounds often lack high-quality, long-term human studies.
- Combined use (“stacking”): Many users combine multiple substances. There is limited controlled research on safety or interaction effects.
- Individual risk differences: Genetics, age, sex, and underlying health conditions significantly affect risk, but data are incomplete.
- Psychological effects: Some users report mood swings, depression, or aggression, but exact rates vary between studies.
Products sold online may also contain undeclared substances, increasing unpredictability.
Overview of approaches
Performance enhancement strategies generally fall into three categories:
1. Pharmacological (drug-based)
- Anabolic steroids
- Hormones (testosterone, growth hormone)
- EPO and blood manipulation
- Prescription stimulants
These often have measurable performance effects but carry medical, legal, and ethical risks.
2. Nutritional supplements
- Creatine
- Caffeine
- Beta-alanine
- Protein supplements
Some are supported by sports science research, especially creatine and caffeine, while others show mixed or small effects.
3. Non-drug performance optimization
- Structured training programs
- Sleep optimization
- Periodized recovery
- Balanced nutrition
These approaches have strong evidence and lower health risk. For more general health foundations, see our overview on sports nutrition basics and sleep and recovery science.
Legal and ethical considerations
Many PEDs are banned by the World Anti-Doping Agency (WADA). In some countries, possession or distribution of anabolic steroids without prescription is illegal. Competitive athletes should consult official anti-doping rules.
Evidence table
| Statement | Confidence level | Why |
|---|---|---|
| Anabolic steroids increase muscle mass and strength. | High | Multiple randomized and observational studies show consistent effects. |
| Anabolic steroids increase cardiovascular risk. | High | Strong epidemiological data and biological mechanisms support this. |
| EPO improves endurance performance. | High | Well-documented physiological mechanism and clinical evidence. |
| Most “natural test boosters” significantly raise testosterone. | Low | Limited high-quality human trials; inconsistent findings. |
| Creatine improves high-intensity exercise performance. | High | Supported by numerous meta-analyses in sports science. |
Practical recommendations
Safer general measures
- Prioritize progressive training and proper technique.
- Ensure adequate protein intake and balanced nutrition.
- Sleep 7–9 hours per night.
- Monitor blood pressure and cholesterol regularly if engaging in intense training.
When to see a doctor
- Chest pain, shortness of breath, or unexplained fatigue.
- Severe mood changes, depression, or aggression.
- Hormonal symptoms (testicular shrinkage, menstrual changes).
- Abnormal liver tests or yellowing of skin/eyes.
Preparing for a consultation
- List all substances and supplements used (including over-the-counter products).
- Note duration and reasons for use.
- Bring recent lab results if available.
You may also find it helpful to review our page on hormonal health and testing before your visit.
Sources
- National Institute on Drug Abuse (NIDA): Anabolic Steroids DrugFacts — https://nida.nih.gov
- U.S. Food and Drug Administration (FDA): Drug Safety Communications — https://www.fda.gov
- World Anti-Doping Agency (WADA): Prohibited List — https://www.wada-ama.org
- American College of Sports Medicine (ACSM) Position Stands on performance-enhancing substances — https://www.acsm.org
- Centers for Disease Control and Prevention (CDC): Steroid and supplement safety — https://www.cdc.gov
Bottom line: Some performance enhancement drugs clearly improve certain physical abilities, but the health risks—especially with hormonal or blood-based doping—are substantial. Evidence-based training, nutrition, and recovery strategies remain the safest and most sustainable path to improved performance.
