Performance-enhancing substance

The classifications of substances as performance-enhancing substances are not entirely clear-cut and objective. As in other types of categorization, certain prototype performance enhancers are universally classified as such (like anabolic steroids), whereas other substances (like vitamins and protein supplements) are virtually never classified as performance enhancers despite their effects on performance. As is usual with categorization, there are borderline cases; caffeine, for example, is considered a performance enhancer by some but not others. == Types ==

The phrase has been used to refer to several distinct classes of drugs: Anabolic steroids Anabolic steroids are synthetically derived from testosterone and modified to have greater anabolic effects. They work by increasing the concentration of nitrogen in the muscle which inhibits catabolic glucocorticoid binding to muscle. This ultimately prohibits the breakdown of muscle and preserves muscle mass. Examples of anabolic steroids include: oxandrolone, stanozolol and nandrolone. In general, potential side effects include: muscle hypertrophy, acne, hypertension, elevated cholesterol, thrombosis, decreased high-density lipoproteins, altered libido, hepatic carcinoma, cholestasis, peliosis hepatitis, septic arthritis, Wilm's tumor, psychosis, aggression, addiction, and depression. Potential side effects specifically in males include: male pattern baldness, oligospermia, prostate hypertrophy, testicular atrophy, and prostate cancer. Potential side specifically in females include: hirsutism, uterine atrophy, amenorrhea, breast atrophy, and thickening of vocal cords (voice deepening). The Anti-Drug Abuse Act of 1988 and the Anabolic Steroid Act of 1990 both deemed anabolic steroids as an illegal substance when not used for disease treatment. Stimulants are commonly used in lengthy exercises that require short bursts (e.g., tennis, team sports, etc.). Stimulants work by increasing catecholamine levels and agonistic activity at the adrenergic receptors. Examples of stimulants include caffeine, Potential side effects include hypertension, insomnia, headaches, weight loss, arrhythmia, tremors, anxiety, addiction, and strokes. Some stimulants are allowed in competitive sports and are widely accessible, though may also be monitored by the World Anti-Doping Agency (WADA), such as caffeine. Ergogenic aids Ergogenic aids, or athletic performance-enhancing substances, include a number of drugs with various effects on physical performance. Drugs such as amphetamine and methylphenidate increase power output at constant levels of perceived exertion and delay the onset of fatigue, among other athletic-performance-enhancing effects; It is a nonessential amino acid that helps to improve an athlete's performance during short-term, high intensity exercises such as weightlifting. Supplementation of creatine increases skeletal muscle creatine levels, boosting performance by increasing the rate at which adenosine triphosphate can be replenished from adenosine diphosphate, thereby increasing maximal power output. Creatine is currently not recognized as a prohibited substance and can be purchased as a legal dietary supplement. • β-hydroxy β-methylbutyrate, a metabolite of leucine also used as a supplement, has positive effects on lean muscle mass, possibly through a decrease in muscle catabolism. • Human Growth Hormone (hGH): endogenous hormone that can help decrease fat mass while increasing lean body mass. hGH is one of the most commonly used substances among professional athletes because it has a small window for detection. Potential side effects include: cardiomyopathy, diabetes, renal failure, and hepatitis. If not prescribed by a professional, it is a banned substance in competition per WADA. and the markers test, which detects changes in serum protein ratios. As of 2008, the position of the European Medicines Agency was that "The principle of an adaptogenic action needs further clarification and studies in the pre-clinical and clinical area. As such, the term is not accepted in pharmacological and clinical terminology that is commonly used in the EU." Actoprotectors Actoprotectors or synthetic adaptogens are compounds that enhance an organism's resilience to physical stress without increasing heat output. Actoprotectors are distinct from other doping compounds in that they increase physical and psychological resilience via non-exhaustive action. Actoprotectors such as bemethyl and bromantane have been used to prepare athletes and enhance performance in Olympic competition. However, only bromantane has been placed on the World Anti-Doping Agency's banned list. CNS agents Central nervous system agents are medicines that affect the central nervous system (CNS). Painkillers Allows performance beyond the usual pain threshold. Some painkillers raise blood pressure, increasing oxygen supply to muscle cells. Painkillers used by athletes range from common over-the-counter medicines which include NSAIDs (ibuprofen) to powerful prescription narcotics. Sedatives and anxiolytics Sedatives and anxiolytics are used in sports like archery which require steady hands and accurate aim, and also to overcome excessive nervousness or discomfort for more dangerous sports. Diazepam, nicotine, and propranolol are common examples. Ethanol, the most commonly used substance by athletes, can be used for cardiovascular improvements though has significant detrimental effects. Ethanol was formerly banned by WADA during performance for athletes performing in aeronautics, archery, automobile, karate, motorcycling and powerboating, but was taken off the ban list in 2017. It is detected by breath or blood testing. Cannabis is banned at all times for an athlete by WADA, though performance-enhancing effects have yet to be studied. Cannabis and nicotine are detected through urine analysis. Blood boosters Blood doping agents increase the oxygen-carrying capacity of blood beyond the individual's natural capacity. It is commonly used among endurance athletes such as cyclists. Potential side effects include: dehydration and an increase in blood viscosity which could result in a pulmonary embolism or stroke. Per the WADA, it is a banned substance. Gene doping Gene doping agents are a relatively recently described class of athletic performance-enhancing substances. Prohormones Also known as anabolic steroid precursors, they promote lean body mass. Once in the body, these precursors are converted to testosterone and increase endogenous testosterone. The desired effects of steroid precursors however, are often not seen as they do not bind well to androgen receptors. Androstenedione in 2005 became classified as a controlled substance by WADA, however DHEA can still be obtained legally as an over-the-counter nutritional supplement. == History ==

While the use of PEDs has expanded in recent times, the practice of using substances to improve performance has been around since the Ancient Olympic Games. In the Olympic Games of 668 BC, Charmis had consumed a diet consisting of dried figs which was thought, at the time, to be a significant factor in winning the 200-yard stade race. Ancient Greek athletes at the time also incorporated substances such as wine and brandy into their training routines. Stimulants derived from plants (e.g., Cola nitida, Bufotein, etc.) were used by the Roman gladiators to overcome injuries and fatigue. Supplements were now exclusively being used to enhance muscular work capacity. In the 20th century, testosterone was isolated and characterized by scientists. In 1941, the first record of synthesized testosterone use occurred when a horse was given testosterone which successfully improved its race performance. Sports trainers soon after began advocating for testosterone use. The United States Congress established the Anti-Drug Abuse Act of 1988 to criminalize the distribution and possession of non-medical anabolic steroids. In 1999, WADA was formed to address the escalating use of substances in sports, particularly after the 1998 doping scandal in cycling. == Risk factors ==

Adolescents are the most vulnerable group when it comes to taking performance-enhancing substances. This is in part due to the significance placed on physical appearance by this age group as well as feelings of invincibility combined with a lack of knowledge surrounding long-term consequences. Having a negative body image or a history of depression can also be a significant risk factor. Studies show that adolescent males who engage with fitness magazines are twice as likely to use performance-enhancing substances. Adolescents who partake in competitive sports are at a particularly high risk, with those involved in gridiron football, basketball, wrestling, baseball, and gymnastics at the top. == Usage in sport ==

In sports, the term performance-enhancing drugs is popularly used in reference to anabolic steroids or their precursors (hence the colloquial term steroids); anti-doping organizations apply the term broadly. Agencies such as the WADA and United States Anti-Doping Agency try to prevent athletes from using these drugs by performing drug tests. When medical exemptions are granted they are called therapeutic use exemptions. == See also ==