Higher levels of red blood cells in the blood result in more oxygen being transported to the muscles, resulting in increased stamina and performance. There are three main types of blood doping:. Erythropoietin—more commonly known as EPO—has long been the drug of choice for endurance athletes.
Although used in a wide variety of sports, it is most commonly associated with cycling—particularly with the disgraced former champion of the Tour de France—Lance Armstrong. Produced naturally by the kidneys, EPO is also available as a pharmaceutical.
EPO stimulates the production of red blood cells in bone marrow and regulates the concentration of red blood cells and haemoglobin in the blood. This is useful for athletes, since red blood cells shuttle oxygen to the cells, including muscle cells, enabling them to operate more effectively. Longer chains of amino acids are called proteins.
By injecting EPO, athletes aim to increase their concentration of red blood cells and, consequently, their aerobic capacity. If EPO levels are too high the body will produce too many red blood cells which can thicken the blood, leading to clotting, heart attack and stroke. In fact, EPO has been implicated in the deaths of numerous athletes, predominantly cyclists.
Repeated doses of EPO can also stimulate the development of antibodies directed against EPO, which can result in anaemia. The long-term health risks of sustained EPO use are still unclear. The Tour de France hit controversy when the entire Festina team was disqualified after several hundred doses of EPO and other doping products were found in the team car.
Methods such as isoelectric focusing, which is the separation of proteins based on their electrical charge, and sodium dodecyl sulfate polyacrylamide gel electrophoresis, which is the separation of proteins based on their size, are used to detect EPO. Since , EPO tests in the United States were undertaken using only urine, however, in recent years the joint testing methods, such as direct EPO testing in urine and use of indirect blood tests as part of the Athlete Biological Passport see below , have been used to help identify the use of newly-developed erythropoiesis stimulating agents.
A new testing technique for EPO is also in the pipeline. In essence the new test will look for genetic expressions which prove that EPO has been used. If the new test proves accurate and viable, it will be almost impossible to use EPO without detection.
Synthetic oxygen carriers SOCs are purified proteins or chemicals that have that ability to carry oxygen. They are still under development and have not been approved for use outside of South Africa and Russia. SOCs were developed for use in crisis situations where blood transfusions are not possible or blood products are not available. There are several different types of SOCs available.
Like red blood cells, they work to deliver this oxygen to the muscles, increasing aerobic capacity and endurance. However, they also have some additional benefits. HBOCs are not only great at tissue oxygenation, they can deliver increases in blood serum iron, ferritin and naturally occurring EPO. SOCs are still under development and testing, and have not yet been proven safe for human use.
However, this has not stopped rumours of athletes using them to get an advantage. The health risks associated with using SOCs are similar to those of EPO—increased risk of heart attack, stroke and pulmonary embolism. A complex four-step test was made available for SOCs in The first step involves the elimination of abundance proteins in blood samples via immunodepletion. Prior to the introduction of synthetic blood doping drugs like EPO, blood transfusions were common practice among endurance athletes.
Even with these drugs available the practice still persists. Blood transfusion is an effective and relatively simple method of allowing athletes to boost the number of red blood cells in their blood, improving their aerobic capacity and endurance. Athletes who choose to use this method generally begin undergoing blood withdrawals several weeks before a competition, building up a supply of blood between millilitres and millilitres. The plasma is returned to the body during the withdrawal while the corpuscular elements—basically the red blood cells RBCs —are stored.
These can then be re-infused in the patient directly before or during a high-endurance event. Blood transfusions were common practice before being banned in The first known case was Kaarlo Maaninka, who transfused two pints of blood prior to winning medals in the Olympics. By the Olympics, one-third of the US cycle team received transfusions, resulting in nine medals. In Alexander Vinokourov, a rider in the Tour de France, tested positive after winning the 13 th stage of the race.
His blood was found to contain two different blood cell populations, which confirmed the use of allogenic transfusions. Cheating via blood transfusions was initially difficult to catch, especially if athletes re-infused their own blood.
The arrival in of a test to detect allogenic blood transfusions meant athletes could no longer use the blood of a donor, however, they could still cheat by re-infusing their own. The development of Athlete Biological Passports see below , has made even this method more detectable, as the passports allow testers to see the indirect markers of blood doping. The risks of using blood transfusions to increase red blood cells is similar to the risks associated with EPO and SOC use: thickened blood leading to clotting, heart attack and stroke.
Another risk relates to the process itself. Because transfusions involve several stages—the withdrawal of blood, its storage and re-use—there are many opportunities for something to go wrong. Contamination of the blood or equipment, infection and improper administration of blood products, all of which could easily lead to drastic health problems, even death.
Beta Blockers work to block the effects of adrenaline. They work to slow the heart rate, thereby reducing blood pressure, anxiety and muscle tremors, and improving the ability to focus. This makes them particularly useful to athletes performing in sports that require a steady hand such as shooting, archery, darts, snooker, even golf.
Beta Blockers are prohibited by several sports darts, racing during competition, but others archery, shooting prohibit their use at all times. There are more than 20 types of beta blockers available. They can be taken orally, via injection or in the treatment of glaucoma as eye drops. Some common beta blockers include:. When used for a legitimate medical reason, for example to treat a heart condition, high blood pressure anxiety, and under the guidance of a trained professional, beta blockers have a good safety record.
When used without a legitimate health reason, side effects can include reduced circulation through the hands and feet, dizziness, fatigue, dry mouth and drowsiness. More serious though rare side-effects can include impotence, asthma attack, memory loss or heart failure.
A high-profile case of Beta Blocker use at the elite level was in , when Olympic shooter Kim Jong-su tested positive for Propranolol and was subsequently stripped of his medals. Diuretics work to promote the production of urine.
While putting your hand up for a toilet break may not be deemed professional in modern sport, athletes use diuretics to assist with weight-loss the loss of water through urination leads to an overall loss of body weight.
This is particularly useful in sports where weight is critical such as boxing, rowing or horse-racing. The increased urine volume also aids in the dilution of doping agents and their metabolites. Diuretics have been banned in sport since When used to treat legitimate medical conditions such as heart failure, high blood pressure, kidney and liver problems and glaucoma, and under the supervision of a trained doctor, diuretic use is quite safe.
However, because diuretics promote frequent urination, when used without medical supervision they can lead to dehydration, dizziness, muscle cramps and constipation. Other side effects include tiredness, fever, skin rash and loss of appetite.
More serious effect include disruptions to the normal rhythms of the heart, and electrolyte abnormalities, which can affect kidney function.
Former Australian cricketer Shane Warne tested positive for a banned diuretic in and subsequently was suspended from all forms of cricket for 12 months, leading to him missing the ICC World Cup. Previously, diuretics were detected in biological samples through the use of high-performance liquid chromatography HPLC coupled with ultraviolet-diode array detection UV-DAD.
However, this method was not deemed rigorous enough in determining the unequivocal identification of banned substances. For this reason, international anti-doping regulations have required the implementation of mass-spectral methodology to test samples. Setting the benchmarks above which an athlete is deemed to be a drug cheat is a difficult issue for sporting bodies.
High levels of hormones do not always indicate cheating, and low levels do not always guarantee innocence. The ABP collates data on the levels of different substances in the body, during and after exercise, and uses this to construct a profile, effectively determining natural levels of various substances in the body for each individual.
From this information, testers can assess if an athlete suddenly has a large jump in certain hormones or proteins in their blood, when compared against their normal levels. Human chorionic gonadotropin HCG. Some men may use this hormone as a PED to increase testosterone if, as a result of anabolic steroid use, their bodies have stopped making high enough concentrations of testosterone naturally.
Erythropoietin EPO. Endurance athletes may use this as a PED to increase the number of red blood cells in the body, thereby increasing oxygen in the bloodstream. Amphetamines — including attention deficit- hyperactivity disorder ADHD medications — can function as PEDs when they are used to enhance mental performance and physical functioning. Commonly used in conjunction with other PEDs, testosterone is particularly easy to abuse because it is applied to skin rather than injected.
Who Uses Performance-Enhancing Drugs? Signs to Watch For Physical changes. PEDs may cause changes that are sudden and pronounced. Look for drastic changes in appearance, such as big gains in muscle in boys or breast enlargement; increased acne in boys and girls; and quick weight loss, excess body hair growth, and a deepening voice in girls. Excessive concern about athletic performance. When taken to extremes, this may be a warning sign.
Has the teen or young adult expressed feelings of extreme pressure to win? Has he or she made sudden gains in athletic performance that training alone can't quite explain? Excessive concern about appearance. Has the teen or young adult expressed feelings of being too weak or overweight, accompanied by sudden physical changes?
Drastic emotional changes. Anabolic steroids can cause emotional changes, including angry outbursts referred to as "'roid rage. Unaccounted-for expenditures. While news reports suggest PEDs can be easy to obtain and relatively cheap, you may still notice that your teen is spending money that isn't fully accounted for.
None of the above. Teens and young adults who are taking PEDs may not obviously exhibit any of the signs mentioned above, making use of the drugs diffi cult to identify. When you discuss drug and alcohol use with a teen or young adult, consider also mentioning the risks involved in using PEDs.
Performance enhancing drug abuse and cardiovascular risk in athletes: implications for the clinician. Br J Sports Med ; ii Androgen abuse and increased cardiac risk. South Med J. Jones G, Jacobson G. The secret edge: steroids in high school. Sign up for free, and stay up-to-date on research advancements, health tips and current health topics, like COVID, plus expert advice on managing your health.
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Products and services. Performance-enhancing drugs and teen athletes Performance-enhancing drugs can tempt teen athletes. By Mayo Clinic Staff. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Please try again. Something went wrong on our side, please try again. Show references Kliegman RM, et al.
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