Best Practice Case Studies-Case 142 Asset 2 Performance-Enhancing Drugs in Healthy Athletes

Pdf Summary

This umbrella review assessed evidence from systematic reviews and meta-analyses on seven common performance-enhancing drugs/substances used by healthy athletes: anabolic-androgenic steroids (AAS), growth hormone (GH), selective androgen receptor modulators (SARMs), creatine, ACE-inhibitors, recombinant human erythropoietin (rHuEPO), and cannabis. After screening 3,033 records, 27 reviews met inclusion criteria, covering five substances; no eligible studies were found for SARMs or ACE-inhibitors.<br /><br />Main findings:<br />- AAS increased lean body mass and strength, especially in trained athletes, but were linked to adverse effects such as unfavorable lipid changes, mood disturbances, liver enzyme elevations, acne, alopecia, higher hematocrit, and testicular atrophy.<br />- GH increased body weight and lean mass and reduced fat mass, but did not improve strength or sports performance. Side effects included edema, fatigue, joint pain, and carpal tunnel syndrome.<br />- Creatine showed the clearest benefit: when used properly, it safely increased total and lean body mass, strength, and short-duration, high-intensity performance. Short-term side effects were usually mild, such as gastrointestinal upset, rash, or headache.<br />- rHuEPO increased hemoglobin-related measures, VO2max, and maximal power output, but evidence that this translated into better race performance was limited. Serious risks included thrombosis, stroke, myocardial infarction, and pulmonary embolism.<br />- Cannabis did not improve performance and may impair strength, endurance, balance, and work capacity.<br /><br />Overall conclusion: creatine is the only reviewed substance with consistent evidence of a safe ergogenic benefit in healthy athletes when appropriately dosed. AAS, GH, and rHuEPO may alter body composition or physiology but carry substantial health risks and lack convincing performance benefit. Cannabis appears ergolytic rather than ergogenic.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 142

Topic Metabolic

Keywords

4th Edition

4th Edition, Case 142

Metabolic

creatine

anabolic-androgenic steroids

growth hormone

erythropoietin

cannabis

ergogenic aid

athletic performance

systematic review

meta-analysis

health risks