Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement

Abstract

Despite the high prevalence of performance-enhancing drug (PED) use, media attention has focused almost entirely on PED use by elite athletes to illicitly gain a competitive advantage in sports, and not on the health risks of PEDs.There is a widespread misperception that PED use is safe or that adverse effects are manageable.In reality, the vast majority of PED users are not athletes but rather nonathlete weightlifters, and the adverse health effects of PED use are greatly underappreciated.This scientific statement synthesizes available information on the medical consequences of PED use, identifies gaps in knowledge, and aims to focus the attention of the medical community and policymakers on PED use as an important public health problem.PED users frequently consume highly supraphysiologic doses of PEDs, combine them with other PEDs and/or other classical drugs of abuse, and display additional associated risk factors.PED use has been linked to an increased risk of death and a wide variety of cardiovascular, psychiatric, metabolic, endocrine, neurologic, infectious, hepatic, renal, and musculoskeletal disorders.Because randomized trials cannot ethically duplicate the large doses of PEDs and the many factors associated with PED use, we need observational studies to collect valid outcome data on the health risks associated with PEDs.In addition, we need studies regarding the prevalence of PED use, the mechanisms by which PEDs exert their adverse health effects, and the interactive effects of PEDs with sports injuries and other high-risk behaviors.We also need randomized trials to assess therapeutic interventions for treating the adverse effects of PEDs, such as the anabolic-androgen steroid withdrawal syndrome.Finally, we need to raise public awareness of the serious health consequences of PEDs.(Endocrine Reviews 35: 341-375, 2014) I. Introduction II.Definitions III.The Process of Data Gathering and Synthesis IV.Factors Contributing to the Limited Appreciation of the Adverse Effects of PEDs V. A History of PED Use VI.Epidemiology of PED Use A. Age of onset B. Prevalence of use C. The types and patterns of PED use D. Association of PED use with other high-risk behaviors VII.Adverse Health Effects of PEDs A. Androgenic-anabolic steroids B. Human GH C. Insulin D. Erythropoiesis-stimulating agents VIII.The Interactive Effects of Performance-enhancing Drugs and Sports Injury IX.Gene Doping X. Gaps in Our Knowledge I. Introduction T he Endocrine Society's Scientific Statement Task Force (SSTF) deemed the medical consequences of performance-enhancing drug (PED) use an important topic for a