E D I T O R I A L
Widespread Use of Performance-Enhancing Drugs—
An Inconvenient Truth
Frances J. Hayes
Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114
W
hat do Ben Johnson, Barry Bonds, Marion Jones,
and Lance Armstrong have in common? I think
even non-sports fans would recognize these names as the
public face of performance-enhancing drug (PED) use.
Public fascination with this topic is such that over 3 million
people tuned in to watch Oprah Winfrey’s interview with
Lance Armstrong in January 2013 when he admitted to
using PEDs throughout the course of his illustrious career
as a competitive cyclist. However, as highlighted by Pope
et al (1) in a scholarly and comprehensive review of PED
use in a recent issue of Endocrine Reviews, elite athletes
account for only a fraction of the 3 million or so PED users
in the United States, most of whom are weightlifters enticed not only by the performance-enhancing, but also the
appearance-enhancing, properties of these agents. To
date, however, media interest has focused largely on doping and on naming and shaming the latest athlete to be
stripped of a medal or title with scant attention being paid
to the growing public health problem of PED use among
nonathletes.
The Endocrine Society’s Scientific Statement on PEDs
should be of interest to physicians and scientists across a
range of specialties. It reviews the clinical pharmacology
of the most popular classes of PEDs, including hormones
(androgenic-anabolic steroids [AAS], human GH, IGF-1,
and insulin) and blood boosters (erythropoietins). It also
details the significant adverse effects of these agents, the
prevalence of which is likely to be an underestimate, given
the surreptitious nature of PED use. The review is particularly timely, given that in recent years some have called
for PEDs to be legalized in sport in an effort to level the
playing field by eliminating the competitive advantage
that they offer, ultimately allowing spectators to witness
even more extraordinary feats of athletic prowess. Proponents of this approach include a former president of the
International Olympic Committee, Juan-Antonio Samaranch, who suggested that athletes be allowed to use nonharmful PEDs. This common misperception that PEDs are
generally safe has contributed to their widespread use.
However, as highlighted by this review, these drugs have
adverse effects on multiple organ systems including cardiovascular, hepatic, neuroendocrine, psychiatric, renal,
and dermatological. Hence, the concept of a “nonharmful
PED” is really an oxymoron. The authors also highlight
that most PED users are still under the age of 50 and thus
may not have yet manifested adverse events that typically
arise later in life such as cardiovascular disease. It is ironic
that at a time when considerable controversy surrounds
the cardiovascular safety of T therapy in older men (2– 4),
prompting review by the US Food and Drug Administration, scant attention is being paid to the cardiovascular
safety of AAS, which are used at doses that are severalfold
higher than physiological T replacement.
Another important concern raised by this Endocrine
Society Scientific Statement is the potential for AAS to
cause addiction and dependence. It is estimated that about
one in three AAS users becomes dependent, and of these,
50% are addicted to other drugs of abuse, including opiates. Given that use of AAS is becoming increasingly common in college athletes, it is incumbent upon us to look at
the culture that values athletic prowess over health. We
need to bring resources to bear to make the public aware
of the addictive potential of these drugs and to have an
effective policy for their use in the same way we do for
other drugs of addiction such as heroin. Hopefully, this
scientific statement, by highlighting the “inconvenient
truth” about the growing use and safety concerns of PED
use, will focus the attention of both the media and the
medical community on this important public health issue.
ISSN Print 0163-769X ISSN Online 1945-7189
Printed in U.S.A.
Copyright © 2014 by the Endocrine Society
Received May 19, 2014. Accepted August 1, 2014.
Abbreviations: AAS, androgenic-anabolic steroids; PED, performance-enhancing drug.
doi: 10.1210/er.2014-1047
Endocrine Reviews, December 2014, 35(6):E1–E2
edrv.endojournals.org
E1
E2
Hayes
Performance-Enhancing Drugs
Acknowledgments
Address all correspondence and requests for reprints to: Frances J.
Hayes, MB, FRCPI, Reproductive Endocrine Unit, Massachusetts General Hospital, Bartlett Hall Extension 511, 55 Fruit Street, Boston, MA
02114. E-mail: [email protected]
Disclosure Summary: The author has nothing to disclose.
References
1. Pope HG Jr, Wood RI, Rogol A, Nyberg F, Bowers L,
Bhasin S. Adverse health consequences of performance-
Endocrine Reviews
enhancing drugs: an Endocrine Society scientific statement.
Endocr Rev. 2014;35:341–375.
2. Basaria S, Coviello AD, Travison TG, et al. Adverse events
associated with testosterone administration. N Engl J Med.
2010;363(2):109 –122.
3. Vigen R, O’Donnell CI, Barón AE, et al. Association of
testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA.
2013;310:1829 –1836.
4. Finkle WD, Greenland S, Ridgeway GK, et al. Increased
risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014;9:
e85805.