Performance-Enhancing Drugs: A Cheat Sheet
See what athletes are trying, and the side effects they risk.
Aug. 5, 2013— -- intro: Since steroids hit the U.S. sports scene more than 50 years ago, athletes have found new ways to get faster and stronger -- and to avoid getting caught.
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From growth hormones to blood transfusions, here's a list of the substances and procedures athletes are trying, how they work and the health risks they carry.
Sources: The World Anti-Doping Agency, the U.S. Anti-Doping Agency and the National Institutes of Health.
quicklist: 1category: Performance-Enhancing Drugs Cheat Sheettitle: Anabolic Steroidsurl: text: How They Work
Anabolic steroids are synthetic versions of the male hormone testosterone. The drugs promote muscle growth, not to mention signs of male puberty, from body hair to voice changes.
The Health Risks
Steroids disrupt the normal production of hormones, prompting shrinking of the testes and breast development in men. More serious side effects include heart attacks and cancer.
How Often They're Used
Anabolic steroids are the most commonly reported banned substance, accounting for 50.6 percent of incidents reported to the World Anti-Doping Agency in 2012.
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quicklist: 2category: Performance-Enhancing Drugs Cheat Sheettitle: Hormones and Growth Factorsurl: text: How They Work
Testosterone isn't the only naturally-occurring substance exploited for its performance-enhancing effects.
The hormone erythropoietin, dubbed EPO, boosts the production of red blood cells, which deliver oxygen to muscles. And insulin-like growth factor (IGF) and human growth hormone (HGH) are thought to increase muscle strength and speed the recovery from injury.
The Health Risks
EPO's blood-thickening effects raise the risk of heart disease and stroke. And growth factors can raise the risk of diabetes, cardiovascular diseases and pain in the muscles and joints.
How Often They're Used
Peptide hormones and growth factors accounted for 4 percent of all WADA incident reports in 2012.
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quicklist: 3category: Performance-Enhancing Drugs Cheat Sheettitle: Beta-2 Agonistsurl: text: How They Work
Asthma drugs such as Clenbuterol that open up the airways are sometimes used by nonasthmatic athletes to boost lung function. But the jury's out on whether the drugs, dubbed beta-2 agonists, actually enhance performance, with some studies suggesting a slight advantage while others failed to find a benefit.
The Health Risks
Side effects of the drugs range from headache and insomnia to tremors and muscle cramps. They're also considered habit-forming and can cause increases in heart rate and blood pressure.
How Often They're Used
Beta-2 agonists accounted for 2.9 percent of all WADA incident reports in 2012.
quicklist: 4category: Performance-Enhancing Drugs Cheat Sheettitle: Metabolic Modulatorsurl: text: How They Work
Drugs that alter the amounts of circulating hormones like estrogen aren't themselves performance-enhancing. Rather, they're used to fight the unwanted side effects of steroids, such as male breasts and testicular atrophy.
The Health Risks
One of the so-called metabolic modulators, the breast cancer drug tamoxifen, has been linked to blood clots and certain cancers.
How Often They're Used
Metabolic modulators accounted for 1.6 percent of all WADA incident reports in 2012.
quicklist: 5category: Performance-Enhancing Drugs Cheat Sheettitle: Diureticsurl: text: How They Work
Drugs designed to make you pee are sometime used by athletes to mask the use of performance-enhancing drugs that can be easily detected in urine.
The Health Risks
Diuretics can trigger electrolyte imbalances and lead to dehydration, which can cause low blood pressure and blood clots.
How Often They're Used
Diuretics accounted for 7.2 percent of all WADA incident reports in 2012.
quicklist: 6category: Performance-Enhancing Drugs Cheat Sheettitle: Blood Manipulationurl: text: How It Works
Just as EPO can be used to boost the number of oxygen-carrying red blood cells, blood transfusions can directly inject an extra dose of oxygen-rich red blood cells into the blood stream.
Synthetic versions of the iron-based molecule that tethers oxygen to the blood cells, hemoglobin, are also used as a performance-enhancing drug.
The Health Risks
Blood transfusions carry the risk of infection, and abnormally high red blood cell counts can lead to heart disease and stroke.
Synthetic oxygen carriers can also raise the risk of cardiovascular disease.
How Often It's Used
Blood manipulation accounted for 0.2 percent of all WADA incident reports in 2012 – a single case.
quicklist: 7category: Performance-Enhancing Drugs Cheat Sheettitle: Stimulantsurl: text: How They Work
Substances such as caffeine and the ADHD drug methylphenidate can increase energy and alertness, as well as blood flow to muscles. They also decrease fatigue.
The Health Risks
Stimulant drugs can cause abnormal heart rhythms and palpitations, tremors and insomnia. Certain drugs, like cocaine, are also addictive and can be deadly in high doses.
How Often They're Used
Stimulants are the second most reported banned substance behind steroids, accounting for 15.5 percent of all WADA incident reports in 2012.
quicklist: 8category: Performance-Enhancing Drugs Cheat Sheettitle: Narcoticsurl: text: How They Work
Narcotic drugs that block pain like morphine and oxycodone can help athletes compete through injuries.
The Health Risks
The powerful painkillers can slow the heart rate as well as breathing. They can also lead to addiction.
How Often They're Used
Narcotics accounted for 0.6 percent of all WADA incident reports in 2012.
quicklist: 9category: Performance-Enhancing Drugs Cheat Sheettitle: Cannabinoidsurl: text: How They Work
Marijuana can actually inhibit athletic performance by reducing cardiac output and reaction time. But it also works to reduce anxiety, which might be why cannabinoids are the third most commonly reported class of drugs in competitive sport.
The Health Risks
Cannabinoids can cause restlessness and panic attacks in high doses.
How Often They're Used
Narcotics accounted for 9 percent of all WADA incident reports in 2012.
quicklist: 10category: Performance-Enhancing Drugs Cheat Sheettitle: Glucocorticosteroidsurl: text: How They Work
Glucocorticosteroid injections can help suppress inflammation, helping athletes get back on their feet after joint and tendon injuries.
The Health Risks
The drugs can cause pain and infection at the injection site.
How Often They're Used
Narcotics accounted for 8 percent of all WADA incident reports in 2012.
quicklist: 11category: Performance-Enhancing Drugs Cheat Sheettitle: Beta-Blockersurl: text: How They Work
Blood pressure-reducing beta-blockers are banned from sports like darts and golf because of their anti-anxiety effects.
The Health Risks
The drugs can cause headaches and dizziness but are generally considered quite safe.
How Often They're Used
Beta-Blockers accounted for 0.3 percent of all WADA incident reports in 2012.