Medications and Athletes: How Common Drugs Impact Performance and Health

What Athletes Are Really Taking-And What It Does to Their Bodies

Most people think performance-enhancing drugs are only for elite Olympians or pro athletes. But the truth? The biggest users today aren’t competing on TV-they’re lifting weights at the local gym, posting before-and-after photos on Instagram, and calling it "bio-hacking." Anabolic steroids, stimulants, and so-called "research chemicals" are now part of everyday fitness culture. And the health costs? They’re not theoretical. They’re showing up in emergency rooms, cardiologist offices, and mental health clinics across the country.

Take anabolic steroids. These aren’t magic pills. They’re synthetic versions of testosterone that force your body to build muscle faster than nature allows. A typical user might gain 4.5 to 11 pounds of muscle in just 10 weeks. Sounds great, right? But here’s what doesn’t get posted online: their heart grows 27% to 45% larger than normal. Their liver enzymes spike. Their natural testosterone production shuts down. And when they stop, they don’t just lose muscle-they lose motivation, energy, and sometimes, their sense of self.

The Hidden Costs of Quick Gains

It’s not just about muscle. The real damage is quieter, slower, and harder to spot until it’s too late.

Cardiovascular damage is the most dangerous side effect. Studies show steroid users have thicker heart walls, weaker pumping ability, and higher risks of heart attacks-even in people under 30. One study found that chronic users showed signs of heart aging equivalent to someone 10 to 15 years older. That’s not a metaphor. That’s measurable scarring in heart tissue.

Then there’s the liver. Oral steroids like Dianabol or Anadrol are especially toxic. Nearly 70% of users show elevated liver enzymes, a clear sign of stress or damage. Some end up with liver tumors or even liver failure. And it’s not just the liver. Kidneys struggle too. Creatinine clearance-a key measure of kidney function-drops by 15% to 25% in long-term users.

For women, the changes can be permanent. One in three female users experience voice deepening that never reverses. Clitoral enlargement happens. Facial hair grows. Menstrual cycles vanish. These aren’t side effects you can "cycle out" of. Once the damage is done, it’s often irreversible.

Stimulants: The Energy Trap

Then there are stimulants-caffeine, amphetamines, ephedrine. These aren’t always banned, but when used for performance, they cross a line. A 3 to 6 mg/kg dose of caffeine can improve reaction time by 8% to 12%. That’s the difference between winning and losing in a split-second sport.

But push beyond that, and you’re playing Russian roulette with your nervous system. Energy drinks spiked with stimulants send over 2,000 people to U.S. emergency rooms every year. Heart palpitations. Seizures. Stroke. One athlete in his early 20s collapsed during a marathon after mixing pre-workout supplements with caffeine pills. He survived. But his heart never fully recovered.

And the mental toll? Just as bad. Users report severe mood swings-rage one day, crushing depression the next. When the drug wears off, dopamine levels crash. A 2022 study found 83% of recreational steroid users had mood swings severe enough to need therapy. Nearly 70% fell into clinical depression during their "off cycles." That’s not laziness. That’s neurochemistry breaking down.

Blood Doping and SARMs: The New Wild West

Blood doping-injecting your own blood or synthetic oxygen carriers to boost endurance-isn’t just for Tour de France riders anymore. Gym-goers are trying it to push through longer cardio sessions. The result? Thicker blood. Higher risk of clots. Stroke risk jumps sevenfold when hematocrit hits 50%. And it’s not detectable in standard drug tests.

Then there’s SARMs-Selective Androgen Receptor Modulators. Marketed as "safer steroids," they’re sold online as "not for human consumption." The FDA tested over 100 products labeled as SARMs. 89% contained completely different, unapproved chemicals. Some had traces of anabolic steroids. Others had thyroid disruptors or even antidepressants. You don’t know what you’re taking. And no one’s checking.

The Myth of "Therapeutic Use Exemptions"

Some athletes think they can legally use banned substances if they have a prescription. Not true. WADA allows Therapeutic Use Exemptions (TUEs) only for documented medical conditions-like asthma or hormone deficiencies-with strict proof. You can’t get a TUE for "low energy," "low libido," or "wanting to look better." Yet, wellness clinics across the U.S. and Australia are offering "bio-identical hormone therapy" that includes banned steroids. Patients walk out thinking they’re getting treatment. They’re actually doping.

And here’s the scary part: most doctors don’t know. A 2021 study found that 7 out of 10 family physicians missed signs of steroid use in their patients. Why? Because users don’t tell them. And the symptoms-acne, mood swings, fatigue-are dismissed as stress, aging, or depression.

What Happens When You Quit?

Stopping doesn’t mean you go back to normal. For men, testosterone levels can stay suppressed for 6 to 12 months-or longer. Some never recover. A 2023 study found that 38% of long-term users developed permanent hypogonadism and needed lifelong testosterone replacement.

Women who stop may never get their periods back. Fertility can be permanently damaged. Testicular shrinkage is common-some men report testicle size dropping from the normal 15-25 mL down to 2-4 mL. Sperm counts fall below 1 million per mL. Normal is over 15 million.

And the mental withdrawal? It’s brutal. One Reddit user wrote: "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. I thought I was broken. I was.”

Who’s Really Using These Drugs?

Elite athletes? They make up only 15% to 20% of users today. The rest? Recreational gym-goers. People who don’t compete, but want to look like they do. A 2023 University of Colorado study found that 60% to 80% of steroid users are non-competitive. That’s your neighbor, your coworker, maybe even someone you know.

And it’s getting younger. Pediatric cases of steroid-induced heart damage have doubled since 2018. Kids as young as 14 are showing up in hospitals with cardiomyopathy. They saw a TikTok video. Bought a bottle online. Thought it was safe.

The Bottom Line: It’s Not Worth It

There’s no safe way to use performance-enhancing drugs for non-medical reasons. The gains are real-but so are the risks. And they’re not just physical. They’re emotional, social, and lifelong.

You don’t need steroids to build strength. You don’t need stimulants to push harder. You don’t need blood doping to run farther. Natural training takes longer. It’s messier. It’s harder to show off on Instagram. But it’s the only way that doesn’t cost you your health.

The body adapts. Slowly. But it adapts sustainably. And when you stop, you don’t lose everything. You just keep what you earned.

What to Do If You’re Already Using

If you’re using these substances, you’re not alone. But you’re not safe either.

• Stop abruptly? Don’t. Withdrawal can be dangerous. Talk to a doctor who understands sports medicine-not just any GP.
• Get blood work. Check testosterone, liver enzymes, kidney function, and cholesterol. You need data, not guesses.
• Don’t hide it. Most doctors won’t judge. They’ve seen this before. But they can’t help if they don’t know.
• Seek mental health support. Mood crashes are real. Therapy isn’t weakness-it’s recovery.
• Find real community. Join a training group that values progress over pills. You don’t need to look like a bodybuilder to be strong.

There’s no shame in wanting to improve. But there’s a huge cost in cutting corners. Your body doesn’t care about your Instagram likes. It only cares if you’re still alive in 10 years.