Medications and Athletes: How Common Drugs Affect Performance and Health

Many athletes believe taking medications or supplements will give them an edge-faster recovery, more muscle, better endurance. But what they don’t always realize is that these substances don’t just boost performance. They also wreck the body in ways that show up years later, often when it’s too late to fix.

What You’re Really Taking

It’s not just steroids anymore. The landscape of performance-affecting drugs has exploded. Anabolic steroids like nandrolone and stanozolol still dominate, making up about 75% of underground use. But now, you’ve got SARMs (selective androgen receptor modulators), peptide hormones, stimulants like ephedrine, and even blood doping kits sold online as "research chemicals."

These aren’t lab-made miracles. They’re unregulated, often mislabeled, and sometimes contain completely different substances than what’s on the bottle. The FDA tested SARMs products and found 89% had undeclared ingredients-sometimes toxic compounds not meant for human use. People think they’re buying something safe because it’s called "legal" or "natural." It’s not.

How These Drugs Actually Work

Anabolic steroids mimic testosterone. They bind to muscle cell receptors and force the body to build more protein than it normally could. In 6 to 12 weeks, users gain 10 to 20% more muscle mass than they ever could naturally. That sounds amazing-until you learn what else happens.

Stimulants like caffeine (at doses of 3-6 mg per kg of body weight) or amphetamines flood the brain with dopamine and norepinephrine. That gives you sharper focus, faster reaction times, and less perceived fatigue. But it also spikes your heart rate and blood pressure. One study showed that energy drink overdoses send over 2,000 people to U.S. emergency rooms every year.

Blood doping-injecting extra red blood cells or using EPO to boost their production-can increase VO2 max by 5-15%. That means better endurance. But when hematocrit (the percentage of red blood cells in your blood) climbs past 50%, your blood thickens. It starts to clot. Stroke risk jumps sevenfold.

The Hidden Damage

The biggest lie told to athletes is that "it’s just for a while." You cycle on and off, you think you’re being smart. But the damage doesn’t reset.

Cardiovascular strain is the most dangerous side effect. Studies show anabolic steroid users have 27-45% more heart muscle mass than non-users-even after adjusting for size and age. Their hearts don’t pump as efficiently. Ejection fractions drop by 8-12%. This isn’t temporary. Fibrosis builds up in heart tissue. It doesn’t go away.

Men lose testicular size. Normal testicular volume is 15-25 mL. After 18 months of steroid use, it drops to 2-4 mL. Sperm counts plunge below 1 million per mL. Normal is over 15 million. In 90% of cases, natural testosterone production shuts down after 8 weeks of use. Recovery takes 6 to 12 months-if it happens at all. A third of chronic users end up needing lifelong testosterone replacement.

Women face irreversible changes. Voice deepening sticks in 35% of cases. Clitoral enlargement beyond 2.5 cm is documented. Hair loss, acne, and menstrual disruption are common. And these aren’t rare cases. These are clinical observations from hospitals.

Liver damage? Oral steroids like oxymetholone spike liver enzymes in 68% of users. Kidneys struggle too. Creatinine clearance drops 15-25% in long-term users. That’s early kidney disease.

Mental Health Isn’t Safe Either

It’s not just physical. Mood swings are so common they’re almost expected. One survey of recreational users found 83% had severe mood swings requiring intervention. Depression hits hard during off-cycles. Sixty-seven percent reported clinically significant depression when the drugs wore off.

Reddit threads are full of stories like: "I gained 25 pounds of muscle in 10 weeks. Lost it all in 8 weeks off. Then I couldn’t get out of bed for months." That’s not weakness. That’s neurochemistry breaking down.

And the worst part? Many users don’t tell their doctors. AAFP data shows 42% of recreational athletes use performance-affecting drugs-but only 12% ever mention it to their physician. Why? Shame. Fear. They think their doctor won’t understand. Or worse-they think their doctor won’t care.

Therapeutic Use Exemptions? Not What You Think

Some athletes think they can get away with it if they have a prescription. Not true. WADA allows Therapeutic Use Exemptions (TUEs), but only under strict conditions. You need documented medical proof-like testosterone levels below 250 ng/dL on two separate tests-that you have a real hormonal disorder.

Doctors can’t approve TUEs for "anti-aging," "energy boosts," or "better recovery." Those aren’t medical conditions. They’re lifestyle choices. And if you’re caught using a banned substance without a TUE? Suspension. Loss of medals. Reputation destroyed.

Who’s Really Using These Drugs?

You might think it’s elite Olympians. It’s not. Only 15-20% of users are competitive athletes. The rest? Recreational gym-goers. People who post before-and-after photos on Instagram. Teens trying to look like influencers. Men in their 30s chasing a lost physique.

University of Colorado research shows 60-80% of anabolic steroid misuse happens in non-competitive settings. That’s the new reality. Fitness culture has normalized this. People see someone with massive arms and assume they took something. They don’t ask how. They just want the same result.

And now, wellness clinics are getting involved. Sixty-five percent of anti-aging clinics offer "bio-identical hormone therapy"-which often includes banned substances. Patients think they’re getting health care. They’re getting banned drugs.

The Cost of a Quick Fix

Let’s say you gain 10 pounds of muscle in 8 weeks. Sounds great. But here’s what else you’re buying:

• Higher risk of tendon rupture-your muscles grow faster than your tendons can adapt. Athletes have torn Achilles tendons lifting weights they could’ve handled perfectly without drugs.
• Permanent voice changes in women.
• Heart damage that won’t reverse.
• Infertility that may never recover.
• Depression that lasts longer than the cycle.
• Legal trouble if you’re tested.

Dr. Laura Barnes from the University of Colorado says it best: "PEDs create a false sense of security. You push harder because you feel stronger. Then you tear something-and you don’t even realize how much you were cheating your body to get there."

What Should You Do Instead?

There’s no magic pill that replaces years of smart training, proper sleep, and good nutrition. But there are real ways to improve:

• Focus on progressive overload-not weight gain. Lift heavier over time, not faster.
• Recovery is part of training. Sleep 7-9 hours. Take rest days. Your body rebuilds when you rest.
• Protein intake matters. Aim for 1.6-2.2 grams per kg of body weight daily. That’s enough to support muscle growth without drugs.
• Hydration and electrolytes beat stimulants. Dehydration kills performance more than caffeine can fix.
• Work with a coach who understands physiology, not marketing.

Real progress is slow. It’s boring. It doesn’t show up in 10 days. But it lasts. Your heart stays healthy. Your hormones stay balanced. You don’t need a prescription to get stronger.

Final Reality Check

The American Heart Association says anabolic steroid use increases the risk of major cardiac events by 36%. That’s not a guess. That’s data from thousands of patients.

You don’t need to be a pro athlete to risk your life. You just need to believe the lie that "everyone’s doing it" or "it’s just once." It’s not. And it’s not worth it.

There’s no trophy worth a damaged heart. No six-pack worth lifelong hormone therapy. No Instagram likes worth dying for.