Performance-enhancing substances (PESs), also known as performance-enhancing drugs (PEDs), are substances that are used to improve any form of activity performance in humans. Many substances, such as anabolic steroids, can be used to improve athletic performance and build muscle, which in most cases is considered cheating by organized athletic organizations. This usage is often referred to as doping. Athletic performance-enhancing substances are sometimes referred to as ergogenic aids. Cognitive performance-enhancing drugs, commonly called nootropics, are sometimes used by students to improve academic performance. Performance-enhancing substances are also used by military personnel to enhance combat performance.
Definition The classifications of substances as performance-enhancing substances are not entirely clear-cut and objective. As in other types of categorization, certain prototype performance enhancers are universally classified as such (like anabolic steroids), whereas other substances (like vitamins and protein supplements) are virtually never classified as performance enhancers despite their effects on performance. As is usual with categorization, there are borderline cases; caffeine, for example, is considered a performance enhancer by some but not others.
Types The phrase has been used to refer to several distinct classes of drugs:
Anabolic steroids
Anabolic steroids are synthetically derived from testosterone and modified to have greater anabolic effects. They work by increasing the concentration of nitrogen in the muscle which inhibits catabolic glucocorticoid binding to muscle. This ultimately prohibits the breakdown of muscle and preserves muscle mass. Examples of anabolic steroids include: oxandrolone, stanozolol and nandrolone. Anabolic steroids can be taken through a transdermal method, orally, or through injection. Injectable forms of the steroid are the most potent and long-lasting. In general, potential side effects include: muscle hypertrophy, acne, hypertension, elevated cholesterol, thrombosis, decreased high-density lipoproteins, altered libido, hepatic carcinoma, cholestasis, peliosis hepatitis, septic arthritis, Wilm's tumor, psychosis, aggression, addiction, and depression. Potential side effects specifically in males include: male pattern baldness, oligospermia, prostate hypertrophy, testicular atrophy, and prostate cancer. Potential side effects specifically in females include: hirsutism, uterine atrophy, amenorrhea, breast atrophy, and thickening of vocal cords (voice deepening). Urine samples are tested to determine the ratio of testosterone glucuronide to epitestosterone glucuronide, which should be 3:1. Any ratio of 4:1 or greater is considered a positive test. The Anti-Drug Abuse Act of 1988 and the Anabolic Steroid Act of 1990 both deemed anabolic steroids as an illegal substance when not used for disease treatment.
Stimulants
Stimulants improve focus and alertness. Low (therapeutic) doses of dopaminergic stimulants (e.g., reuptake inhibitors and releasing agents) also promote mental and athletic performance, as cognitive enhancers and ergogenic aids respectively, by improving muscle strength and endurance while decreasing reaction time and fatigue. Stimulants are commonly used in lengthy exercises that require short bursts (e.g., tennis, team sports, etc.). Stimulants work by increasing catecholamine levels and agonistic activity at the adrenergic receptors. Examples of stimulants include caffeine, ephedrine, methylphenidate and amphetamine. Potential side effects include hypertension, insomnia, headaches, weight loss, arrhythmia, tremors, anxiety, addiction, and strokes. Some stimulants are allowed in competitive sports and are widely accessible, though may also be monitored by the World Anti-Doping Agency (WADA), such as caffeine. Others are banned as per the WADA (e.g., cocaine, amphetamines, ephedrine, etc.).
Ergogenic aids Ergogenic aids, or athletic performance-enhancing substances, include a number of drugs with various effects on physical performance. Drugs such as amphetamine and methylphenidate increase power output at constant levels of perceived exertion and delay the onset of fatigue, among other athletic-performance-enhancing effects; bupropion also increases power output at constant levels of perceived exertion, but only during short-term use.
Examples
Creatine: one of the most popular nutritional supplements, it contributes to 400 million dollars in sales globally every year. It is a nonessential amino acid that helps to improve an athlete's performance during short-term, high intensity exercises such as weightlifting. Supplementation of creatine increases skeletal muscle creatine levels, boosting performance by increasing the rate at which adenosine triphosphate can be replenished from adenosine diphosphate, thereby increasing maximal power output. Potential side effects include gastrointestinal cramps, weight gain, fatigue, and diarrhea. Creatine is currently not recognized as a prohibited substance and can be purchased as a legal dietary supplement. β-hydroxy β-methylbutyrate, a metabolite of leucine also used as a supplement, has positive effects on lean muscle mass, possibly through a decrease in muscle catabolism. Human Growth Hormone (hGH): endogenous hormone that can help decrease fat mass while increasing lean body mass. hGH is one of the most commonly used substances among professional athletes because it has a small window for detection. It works by promoting the release of IGF-1, insulin-like growth factor, the release of which has anabolic effects on the body. Potential side effects include: cardiomyopathy, diabetes, renal failure, and hepatitis. If not prescribed by a professional, it is a banned substance in competition per WADA. Despite its small window for detection, two primary methods of testing have been developed for hGH, one being an isoform test which detects changes in growth hormone structure in the blood, and the markers test, which detects changes in serum protein ratios.
Adaptogens
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