Understanding Doping and Its Impact on the Human Body

The list of banned substances and techniques is extensive.

For many, the term "doping" is linked to high-profile sports scandals involving elite athletes caught using forbidden substances, resulting in disqualifications and loss of medals and titles.

However, few truly understand which drugs athletes use, how these substances enhance human performance, and the ultimate effects on health.

What Is Doping?

Doping refers to prohibited substances and methods that can give competitors an edge in sports events. According to the World Anti-Doping Agency (WADA), doping encompasses any violation of anti-doping rules, including distribution of banned substances, failure to submit to testing, or attempts to tamper with doping controls.

Competitors at national or international levels may be selected at any time for doping tests. Refusal or a positive test can lead to disqualification.

Despite the vast array of substances and techniques, many athletes use some form of doping. Confirming this is challenging, as athletes rarely admit use unless caught.

A 2021 meta-analysis found that under 5% of athletes admit to doping, but a study employing indirect questioning revealed 30–45% acknowledgment among athletes.

Additionally, some athletes use doping during training phases to gain advantages before competition, often appearing "clean" by the time they compete internationally.

Which Substances and Methods Are Considered Doping?

From January 1, 2024, WADA's updated prohibited list includes numerous substances and methods. Below are key categories athletes must avoid.

Anabolic Androgenic Steroids

These synthetic analogs of male sex hormones include testosterone, androsterone, dehydroepiandrosterone, among over 60 banned compounds.

They promote muscle growth by increasing muscle size and stimulating new muscle fiber formation.

Strength gains from these steroids range from 5% to 52%, with effects lasting several years.

Young strength athletes, such as powerlifters, weightlifters, and bodybuilders seeking rapid physique enhancement, are common users.

However, anabolic steroid use carries serious health risks, including:

• Severe acne;
• Gynecomastia (breast tissue development in males);
• Hirsutism (excessive hair growth in females);
• Testicular shrinkage;
• High blood pressure;
• Stunted growth in adolescents;
• Mood swings and manic behavior;
• Male-pattern baldness in both sexes;
• Irregular menstruation;
• Infertility;
• Increased risk of blood clots;
• Yellowing of eyes and skin;
• Liver tumors or cancer;
• Kidney damage and failure.

Peptide Hormones, Growth Factors, and Mimetics

Peptide hormones significantly influence human physiology and behavior. WADA's list includes several types.

Erythropoietins (EPO), hormones produced by the kidneys that stimulate red blood cell production in bone marrow, are medically used to treat anemia from kidney disease or chemotherapy.

In sports, EPO increases hemoglobin levels, enhancing oxygen delivery to tissues and improving endurance.

Endurance athletes like cross-country skiers, runners, cyclists, biathletes, and triathletes commonly misuse EPO.

Side effects of EPO include increased blood viscosity, higher thrombosis risk, potential tumor growth in breast, lung, head and neck, lymphoid tissues, and cervix, as well as digestive issues, fatigue, pain, insomnia, skin rashes, and numbness or tingling sensations.

Other banned peptide hormones and releasing factors include testosterone-stimulating hormones, corticotropins, and growth hormone, mainly used to build muscle and increase strength, often combined with EPO for enhanced effects.

Despite popularity, controlled studies show growth hormone does not significantly increase strength or protein synthesis beyond placebo effects.

Side effects of growth hormone use include swelling in hands and feet, coarsened facial features, dental problems, fluid retention, excessive sweating, and long-term risks like diabetes, hypertension, heart disease, osteoporosis, menstrual irregularities, and impotence.

Beta-2 Agonists

These asthma medications dilate bronchial tubes to improve breathing. While allowed for asthmatic athletes, healthy individuals are prohibited from using them.

Some studies with amateur athletes showed inhaling beta-2 agonists 10–30 minutes before exertion improved peak power and endurance, especially in weaker subjects.

However, professional athletes generally gain minimal benefit, as their respiratory systems are already optimized.

Possible side effects include rapid heartbeat, headaches, dizziness, nausea, tremors, nervousness, insomnia, digestive upset, allergic reactions, chest and ear pain, irregular heartbeat, skin redness, and breathing difficulties.

Hormones and Metabolic Modulators

Because synthetic androgens are easily detected, athletes turn to substances that suppress estrogen and produce androgenic effects.

Aromatase inhibitors block synthesis of the female hormone estradiol, used medically for breast cancer treatment, and can double testosterone levels in men.

Side effects include ulcers, blisters, allergic reactions, liver inflammation, decreased bone density due to low estrogen, and joint pain.

Selective estrogen receptor modulators (SERMs), used to treat breast cancer, also increase free testosterone and mitigate anabolic steroid side effects but carry risks of blood clots, pulmonary embolism, and death.

Metabolic modulators such as meldonium and trimetazidine protect heart cells and theoretically boost endurance and recovery, but lack strong evidence of performance enhancement and have side effects like allergies, stomach issues, heart rate changes, nausea, and headaches.

Diuretics and Masking Agents

Diuretics increase urine output and sodium excretion, helping athletes rapidly lose weight to qualify for weight classes or eliminate other banned substances.

However, they pose dangers including dehydration, cardiovascular strain, impaired temperature regulation, muscle cramps from potassium loss, irregular heart rhythms, fatigue, and risk of heart attack during exercise.

Stimulants and Narcotics

Stimulants affect the nervous system by enhancing alertness, concentration, reducing fatigue, and increasing competitive drive, thus banned during competitions.

Common stimulants like nicotine and caffeine are not banned, but substances such as amphetamines, cocaine, and ephedrine are prohibited.

Cannabis is also banned, despite unlikely performance benefits.

Stimulant use can mask pain and effort, increasing risk of heatstroke, heart attack, severe injuries, seizures, and death during events. They may also cause addiction, insomnia, headaches, anxiety, and psychosis.

Glucocorticoids

These steroid hormones regulate glucose, protein, and fat metabolism, used medically to treat inflammation, allergies, Crohn's disease, ulcerative colitis, rheumatoid arthritis, and blood disorders.

Athletes use glucocorticoids to reduce pain and inflammation, but they are banned during competition.

Long-term use can cause weight gain, acne, muscle weakness, tendon damage, skin thinning, osteoporosis, stomach irritation, hypertension, depression, and increased infection risk.

Beta-Blockers

Beta-blockers block adrenaline effects, slowing heart rate and reducing cardiac workload, lowering blood pressure.

They are prescribed for heart disease, migraines, social anxiety, hypertension, glaucoma, and tremors.

In sports requiring steady hands and calm nerves, like golf, darts, motorsports, skiing, snowboarding, and mini-golf, beta-blockers are banned during competition; in underwater diving, archery, and shooting, they are prohibited at all times.

Side effects include depression, fatigue, cold extremities, headaches, constipation, sexual dysfunction, worsened asthma symptoms, peripheral artery disease, and hypoglycemia in diabetics.

Blood Manipulation

This method involves transfusions of hemoglobin-rich blood to enhance oxygen delivery and endurance.

However, increased blood viscosity strains the heart, raising risks of blood clots, heart attacks, and strokes.

Gene and Cell Doping

Emerging therapies introduce DNA, RNA, or genetically modified cells to correct defective genes, treating conditions like hemophilia, cystic fibrosis, infections, or ischemic heart disease.

In sports, gene doping aims to boost performance by enhancing genes that regulate oxygen delivery, capillary density, mitochondrial content, pain control, or muscle growth.

Risks include mutations, abnormal cell growth, toxicity from excessive growth factor expression, tumor formation, cancer, muscle and tendon damage, immune suppression, heart attack, stroke, and death.

Is Doping Safe for Amateur Athletes?

Many WADA-prohibited substances are available without prescriptions, leading some amateurs to self-administer them. However, interfering with the body's natural functions carries significant risks.

Negative health consequences often outweigh potential benefits. For instance, using growth hormone or insulin-like growth factors may accelerate muscle growth but increase cancer risk.

Using erythropoietin to improve race times can cause fatal blood clots, and using painkillers to complete marathons may result in severe injuries.

Often, athletes learn about these substances from peers or coaches, but individual reactions vary, and what works for one may harm another.

Some drugs can exacerbate undiagnosed health issues. Therefore, before attempting to enhance muscle growth, endurance, or recovery with such substances, consult a healthcare professional to understand potential health risks.

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