Performance-enhancing drugs (PEDS), also known as performance-enhancing substances, are substances that are used to improve physical or athletic performance. These drugs can include a variety of substances, such as anabolic steroids, stimulants, and hormones. Prescription medications and supplements may also be on the World Anti-Doping Agency (WADA) prohibited list. The prohibited list outlines substances and methods that are always prohibited, in competition only, or only in particular sports.

To make the WADA prohibited list, the substance or method must meet at least two out of three criteria:

• It has the potential to enhance athletic performance.
• It represents an actual or potential health risk to athletes.
• It violates the spirit of sport.

Using PEDs is considered unethical and is often prohibited by sporting organizations. Using PEDs can also have serious health consequences, including an increased risk of injury and long-term health problems.¹ The majority of PED users are not competitive athletes but rather non-athlete weightlifters.

What Are Performance-Enhancing Drugs?

Performance-enhancing drugs (PEDs) are substances that are used to improve physical performance in sports and other activities. PEDs can be classified as either exogenous or endogenous, depending on their source. Exogenous PEDs are substances that are taken from outside the body, while endogenous PEDs are substances that are naturally produced by the body.

Several PEDs are used to improve physical performance and may be on the prohibited list, including:

• Anabolic steroids: These are synthetic versions of the male hormone testosterone that are used to increase muscle mass and strength. Examples include boldenone, DHEA, pregnenolone, testosterone, stanozolol, zeranol, selective androgen receptor agonists (SERMs), and metabolic modulators.

• Human growth hormone (HGH): HGH is a hormone produced by the pituitary gland that is involved in growth and development. Synthetic forms of HGH are sometimes used to increase muscle mass and strength. Other prohibited growth-promoting substances are insulin-like growth factor 1, clenbuterol, and human chorionic gonadotropin.

• Erythropoietin (EPO): EPO is a hormone produced by the kidneys that stimulates the production of red blood cells. Synthetic forms of EPO are sometimes used to increase the oxygen-carrying capacity of the blood. Other hypoxia-inducible factors (HIF) activating agents include xenon and roxadustat.

• Stimulants: Stimulants are drugs that increase alertness, focus, and energy, and they are sometimes used to improve physical performance. Examples of stimulants include cocaine, epinephrine, octodrine, methylhexanamine, and MDMA.

• Beta-2 agonists: These are medications that stimulate beta-2 receptors and open the airway. Higenamine has mixed adrenergic receptor activity and can act as a general stimulant. Beta-2 agonists are found in many inhalers used to treat asthma and lung diseases.

• Others: Other medications that may be prohibited include diuretics, narcotics, cannabinoids, and glucocorticoids.

What Percentage Of Athletes Use Performance-Enhancing Drugs?

It is difficult to determine the exact percentage of athletes who use performance-enhancing drugs (PEDs), as the use of PEDs is often not reported or detected. Growth hormone (GH) fragments and GH-releasing peptides, GH secretagogues, metabolic modulators, off-market drugs, and a handful of illegal designer stimulants and other small molecules have also emerged as PEDs and are easily accessible on the internet.²

Elite athletes account for only a small percentage of the 2.9 to 4 million users of PEDs in the U.S.³ In a review of studies. Researchers estimated that between 14% and 39% of current adult elite athletes have intentionally used doping.⁴

According to Statistica, the number of anti-doping rule violations worldwide from 2013 to 2019 ranged from 1,595 to 1,953.

Another study published in the journal Drug and Alcohol Dependence estimated that the prevalence of PED use among amateur and professional athletes ranged from 2% to 4%.

When 718 athletes from 92 fitness centers were surveyed about PED use, depending on how questioning was structured, usage ranged from 0.8% to 8.2%. Stimulants to lose weight had the highest prevalence.⁵

What Percent Of High School Athletes Use Performance-Enhancing Drugs?

It is difficult to determine the exact percentage of high school athletes who use performance-enhancing drugs (PEDs), as the use of PEDs is often not reported or detected. However, several studies have estimated the prevalence of PED use among high school athletes in different sports. Common PED choices for teen athletes include creatine, anabolic steroids, steroid precursors, amphetamines and other stimulants, and caffeine.

According to a 2016 study published in the Journal of the American Medical Association, the prevalence of PED use among high school athletes in the United States ranged from 2.7% to 4.0%, depending on the specific sport.⁶ Another study found that 8% of girls and 12% of boys used products to improve appearance, muscle mass, or strength, and 3.3% of high school students admitted to using steroids.⁷

According to The Partnership Attitude Tracking Study, between 5% and 11% of teens said they used either synthetic human growth hormone (hGH) or steroids without a prescription at least once in their lifetime.  

In What Sport Do Athletes Use Performance-Enhancing Drugs The Most?

It is difficult to accurately determine which athletes or sports are most associated with the use of performance-enhancing drugs, as these substances are often difficult to detect and may not be reported or disclosed. However, using performance-enhancing drugs has been a significant issue in several sports, including professional and Olympic-level athletics, bodybuilding, and professional cycling.

According to the WADA 2017 Anti-Doping Rule Violations (ADRVs) Report, the top 10 sports with the highest number of anti-doping violations include:

• Bodybuilding (266)
• Athletics (242)
• Cycling (218)
• Weightlifting (123)
• Powerlifting (101)
• Football (78)
• Wrestling (57)
• Rugby Union (54)
• Boxing (49)
• Aquatics (32)

Whether professional or not, athletes risk their health when taking performance-enhancing drugs that are not prescribed for a documented medical condition. Side Effects vary based on the substance used. This risk is increased when drugs and supplements are purchased from unverified pharmacies.

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DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. USADA. Effects of Performance-Enhancing Drugs. Accessed December 23, 2022. https://www.usada.org/athletes/substances/effects-of-performance-enhancing-drugs/

2. Smith T, Fedoruk M, Eichner A. Performance-Enhancing Drug Use in Recreational Athletes. Am Fam Physician. Feb 15 2021;103(4):203-204.

3. Pope HG, Jr., Kanayama G, Athey A, Ryan E, Hudson JI, Baggish A. The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: current best estimates. Am J Addict. Jul-Aug 2014;23(4):371-7. doi:10.1111/j.1521-0391.2013.12118.x

4. de Hon O, Kuipers H, van Bottenburg M. Prevalence of Doping Use in Elite Sports: A Review of Numbers and Methods. Sports Medicine. 2015/01/01 2015;45(1):57-69. doi:10.1007/s40279-014-0247-x

5. Stubbe JH, Chorus AM, Frank LE, de Hon O, van der Heijden PG. Prevalence of use of performance enhancing drugs by fitness centre members. Drug Test Anal. May 2014;6(5):434-8. doi:10.1002/dta.1525

6. LaBotz M, Griesemer BA, Council On Sports M, et al. Use of Performance-Enhancing Substances. Pediatrics. 2016;138(1):e20161300. doi:10.1542/peds.2016-1300

7. Dandoy C, Gereige RS. Performance-enhancing drugs. Pediatr Rev. Jun 2012;33(6):265-71; quiz 271-2. doi:10.1542/pir.33-6-265

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