This document discusses the history and use of ergogenic aids and performance enhancing drugs in sports. It defines ergogenic aids as anything used to enhance athletic performance through increasing exercise capacity, enhancing physiological processes, or depressing psychological inhibition. It then discusses various performance enhancing drugs that have been used throughout history, from ancient times to more modern Olympic scandals. The document outlines some of the most common performance enhancing drugs like anabolic steroids and human chorionic gonadotropin, and details their intended physiological effects as well as serious health risks and side effects.

1. Ergogenic Aids
Anything used to enhance athletic performance:
•increase exercise capacity
•enhance physiological processes
•depress psychological inhibition
•provide mechanical advantage

2. Performance Enhancing Drugs
Abuses and Consequences
1922 Most Perfectly
Developed Man

4. Florence Joyner
Arnold
John McEnroe
Jesse Ventura
Lyle Alzado

5. 1988 Summer Olympic Games, Ben Johnson tested
positive for anabolic-androgenic steroid stanozolol

6. Ancient Greece
–Early Olympians use mushrooms, herbs, liquor, plant seeds.
Roman Period
–Chariot racers drug horses and gladiators doped for vigorous and bloody spectacle.
Vikings
–Psychedelic mushrooms
19th Century
–Alcohol, caffeine, opium, strychnine, trimethyl
World War II
–Amphetamines, testosterone

7. First Recorded Death Due to
Performance Enhancing Drugs - 1886?
Arthur Linton
Dies of stimulant
trimethyl
overdose
Only two Brits have won Bordeaux-Paris, Arthur Linton won in 1886 and Tom Simpson in
1963. Linton overdosed on trimethyl and Simpson died of amphetamines in 1967.

8. Cycling – Most Doped Sport?
• 1960 Danish cyclist
Knut Jensen on
amphetamine-
powered bicycle dies
• July 13, 1967 British
cyclist Tom Simpson
dies on Mt. Ventoux
– Amphetamines

9. 1998 Tour De France
French team Festina

Amphetamines
EPO
AAS
hGH
Prescription drugs
Narcotics
Richard Virenque

10. DOPING
• Dutch doop
– Viscous opium juice
• World Anti-Doping Agency (WADA)
• U.S. Anti-Doping Agency (USADA)
“The presence of a prohibited substance or its metabolites or markers in an athlete’s
bodily specimen; use or attempted used of a prohibited substance or method;
tampering, or attempting to tamper, with any part of doping control; possession of
prohibited substances and methods, trafficking in any prohibited substance or
prohibited method; administration or attempted administration of a prohibited
substance or prohibited method to any athlete, assisting, encouraging, aiding,
abetting, covering up or any other type of complicity involving an anti-doping rule
violation or any attempted violation”

11. DOPING
• Withdrawing and saving red
blood cells for later re-infusion
Dr. Bjorn Ekblom
invented “blood packing”
in 1972
• Later the term was used to
describe taking Erythropoietin
• Generic term to describe any
illegal performance- enhancing
drug

12. History of Doping in Sport
1860’s – Amsterdam swimmers take
speedballs – mix of heroin and cocaine.
1904 - Marathoner Thomas Hicks dies
at Olympics – “stimulating strychnine
and courage-inspiring brandy”
1935 - Testosterone was first
synthesized, and German soldiers were
reportedly using it to perform better
and to become more aggressive.
1950’s – During the 1952 Olympics the
Russian weightlifting team won the
gold medal due to synthetic steroid

13. Historical Controversy
The controversy surrounding steroids began in the 1950’s during the Olympic
Games when the athletic community discovered that athletes from Russia and
some East European nations, which had dominated the games, had taken large
doses of steroids. It became evident that they had not been "healthy" due to
the fact that many of the male athletes developed such large prostate glands
that they needed a tube inserted in order to urinate. The females of these
nations had developed so many male characteristics that chromosome tests
were needed to prove that they were still female.

15. 1950’s (cont) – A U.S. pharmaceutical firm develops the
first anabolic steroids.
1952 Amphetamine-related illnesses of speed skaters in
Olympics in Oslo, Norway
1968 Olympic drug testing begins in Mexico City
1975 – The International Olympic Committee officially
bans the use of steroids, just prior to 1976 Montreal
Games

16. 1976 Olympics
East German Swimmers won 11 out of 13
Olympic events.
In 1990 it emerges that they had been
on an organized drug program

17. Newer agents
–Erythropoietin (EPO)
–Growth hormone (hGH)
–Tetrahydrogestrinone (THG)

18. Avoiding Detection
Weightlifters Machine

20. 1992
• German sprinters Katrin Krabbe, Silke Muller
and Grit Breuer submit identical urine samples
Later suspended for + clenbuterol test

21. Scientific Milestones becoming
Sports Millstone

22. Future Performance
Enhancing Techniques?
Perfluorocarbon (PFC)
–Synthetic blood
–Enormous O2 carrying capacity
–X-country skiers and skaters in Nagano?

23. Myostatin Inhibitors?
Belgian Blue Cow
Myostatin knock-out mouse
Flex Wheeler

24. Insulin-Like Growth Factor –
1 (IGF-I)

25. Detection of Illegal “Nutrition”
•Random drug tests during competition
(forces athletes to become more sophisticated in use)
•Unannounced drug tests year-round
•Lie detectors

26. 1. Steroids – Derivatives of Testosterone
*Banned by the NCAA and IOC
*Illegal to use outside of physician supervision and dosing recommendations
A. Anabolic: “to build”
-accelerated growth of bone, muscle, red cells, and enhanced neural conduction
B. Androgenic: “produce male-like traits”
C. Do they work?
-How they work:
Promote Anabolism:
•Intracellular androgen receptors bind to nuclear chromatin to
activate ribonucleic acid-polymerase system
•Heavy resistance training is required for beneficial effects
Prevent Catabolism:
•cross binding with glucocorticoid receptors interferes with
glucocorticoid receptor-activated catabolism
•faster recovery time *May also decrease fat mass and increase use of
fat for energy

27. How Steroids Work
• Exert actions inside cells
• Binds to androgen receptors
inside the cell
• Influences gene transcription and
translation to enhance protein
production

28. Psychological Effects
• Increased sense of well-being
• Irritability
• Mania
• Depression
• Euphoria
• Aggressiveness
• Enhanced pain tolerance
• Sexual arousal
• Suicidality

29. Side Effects
• There really aren’t any… • Side effects are real and
potentially very severe
– Med Sci Sport Exerc 38(9);
1578, 2006 – J Phys Act Health 2; 460,
2005
– Future predictors of AAS use
• Alcohol use
• Power sports

30. Side Effects
Elevated LDH Prostatic hypertrophy
Elevated blood pressure Prostate cancer
Edema Risk of AIDS/Hep
Accelerated clotting ↓ immune function
↑ cholesterol, TG, and LDL Irregular Heart Beats
Depressed HDL GI distress
Elevated blood glucose Muscle cramps/spasms
Psychosis Increased nervous tension
Altered electrolyte balance Nosebleeds
Decreased spermatogenesis Clitoral enlargement
Lowered testosterone levels Lowered voice
↓LH and FSH production Acne
Increased urine production Sore nipples
Altered Libido Increased aggressiveness
Premature closure of epiphyses Decreased sperm count
AIDS/HIV or TB Cancer

31. Side Effects
• Cardiovascular
– Elevates “bad” LDL cholesterol
– Elevates blood pressure
– Promotes blood clots
– Left ventricular hypertrophy
– Cardiac arrhythmia
*Operative Risk

32. Side Effects
• Hepatic
– Elevated liver enzymes
• Alanine and aspartate aminotransferases
– Formation of blood filled cysts
• Peliosis hepatis
– Liver cancer: hepatocellular carcinoma
– Impaired bile flow: cholestasis
*Orally administered steroids

33. Side Effects
• Dermatologic
– Acne: propionibacteria acnes
– Hair loss: alopecia
– Excessive hair growth: hirsutism
– Stretch marks: striae

34. Side Effects
• Endocrine/Reproductive
– Men
• Libido changes
• Testicular atrophy
• Impotence
• Prostatic hypertrophy
– Women
• Masculinization
• Menstrual irregularities
• Reduced breast size
• Clitoral enlargement

35. Side Effects
• Behavioral
– Depression
– Mania
– Psychosis
– Aggression
– Withdrawal syndrome
• Fatigue
• Depression
• Reduced libido
• Craving next cycle

36. Derrick Whitsett
Died Jan 2004
Sonny Schmidt – Died at 50
9 years after being Master’s
Olympia Champion

37. Detecting Steroid Use

38. Detecting Steroid Use
• Appearance
– Muscular hypertrophy
– Gynecomastia
• Skin
– Acne, stretch marks, needle marks,
baldness
• Behavioral changes
*enlarged nipples

39. 2. Human Chorionic Gonadotropin
Used to boost endogenous testosterone and prevent muscle loss after steroid use.
*anabolic adjunct – mimics leuteinizing hormone to stimulate testosterone
(Pregnancy test)
Some reports that HCG may aid in weight loss…

40. 3. Human Growth Hormone hGH
•increases lean body mass primarily by hyperplasia and facilitated AA transport into cells
-hGH persistently stimulates IGF-1
-reduces fat mass (perhaps by stimulating lipolysis)
•side effects:
-incorrect usage/dosage
-Stimulates the growth of all tissues, not just muscle (including internal organs; resembles
acromegaly)
-Left ventricular hypertrophy w/ ↓ SV
-Swollen feet and ankles, joint pain, carpal tunnel syndrome,
-Development of a diabetic or prediabetic condition

41. 4. “Androgens”
Androstenedione and Dehydroepiandrosterone: weak adrenal androgens
•1600 mg/day 30% decline in fat mass
•300 mg/day increases serum testosterone

42. Eight Research Findings - Androgens
 Little or no elevation of plasma testosterone concentrations
 No favorable effect on muscle mass
 No favorable effect on muscular performance
 No favorable alterations in body composition
 Elevates a variety of estrogen subfractions
 No favorable effects on muscle protein synthesis or tissue anabolism
 Impairs the blood lipid profile in apparently healthy men
 Increases likelihood of testing positive for steroid use

43. 5. Insulin
• Promotes anabolism and stimulates IGFs
*risks hypoglycemic shock

44. 6. Clenbuterol
Beta- adrenoceptor 2 agonist, central stimulant, stimulates protein anabolism, and acts as a thermogen.
•endurance athletes
•serious side effects: MI, cardiomegally, anorexia, and insomnia.

45. 7. HMB
beta-hydroxy-beta-methylbutyrate: amino acid
metabolite
•may boost muscle mass and strength
•may decrease protein loss during stress by inhibiting
protein catabolism
•increases fatty acid oxidation
•The mechanism for HMB’s action on muscle
metabolism, strength improvement, and body
composition remains unknown.

46. 2g/day for up to 28 days
8. Creatine Monohydrate
-Can be derived from protein in foods (but not in same quantity)
-Doesn’t improve endurance, strength, or power, not an anabolic, and doesn’t improve lactate tolerance
-Can improve short-term high-intensity repetitive exercise, best for improving
“burst-type, phasic activity”
-body building
-skating
-sprints
-basketball
-Significant increases in body weight and muscle
cross-sectional area.
*potent placebo effect
•Risks? No long term studies yet
Muscle cramps

47. 9. Amphetamines
psychotropic drugs that mask fatigue
•do not have a pure physiological effect, mainly improve reaction time and stamina in
fatigued states (mostly animal studies).
•Side effects: numerous deaths in sport are ascribed to
amphetamines.
arrhythmias hypertension angina
hypothermia hallucinations aggressiveness
http://www.youtube.com/watch?v=YtAyGvZqiwk
• 1960 Danish cyclist Knut Jensen on
amphetamine- powered bicycle dies
• July 13, 1967 British cyclist Tom
Simpson dies on Mt. Ventoux
– Amphetamines

48. Stimulant that increases lipid mobilization and utilization
10. Caffeine
•prolongs endurance by increasing fat utilization and reducing COH
•may increase speed of muscle contraction
•IOC limits caffeine (4-7 cups of coffee 30 min prior to ex)
600-800 mg
*Effectiveness is reduced as use of caffeine increases

49. Warnings about Caffeine
 Effects become less apparent when
someone:
-Consumes a high-carbohydrate diet
-Uses caffeine habitually
 Can cause restlessness, headaches,
insomnia, nervous irritability, muscle
twitching, tremulousness, psychomotor
agitation, and elevated heart rate and blood
pressure and trigger premature left
ventricular contractions
 Acts as a diuretic

50. 11. Buffers
Prevent metabolic and lactate acidosis
•sodium bicarbonate
•sodium citrate
*diuresis and gas (extreme gi distress in 50% of users)

51. 12. Anti-Cortisol Compounds
reduce protein breakdown by inhibiting cortisol release.
•Phosphatidylserine
•Glutamine
13. COH Loading
•Prolongs endurance performance
•Improves training time
•Prevents use of protein for energy
•“Supercompensation” after COH depletion
-increased water retention
-gi problems
-compromised training during depletion phase

52. 14. B Vitamin Loading
•Folate, B-6 and B-12 for muscle building
•Niacin, Riboflavin and Thiamin for endurance performance
15. Amino Acid Supplements
Protein Shakes
•May help prevent catabolism after a hard workout…
•Conflicting Reports?
16. L-Carnitine
•Carnitine levels correlate well with use of lipids as energy source during exercise.
•May improve endurance performance (~6%)
•Beware of racemic mixtures (D,L-Carnitine) D-Carnitine
causes muscle cramps and weakness.

53. 17. Chromium
•May decrease body fat, increase lean mass and reduce LDL
•Effect is marginal at best
-some studies show placebo works better
-some studies show increased muscle mass without increased strength
•Competes for iron and zinc binding proteins in gi tract
18. Ephedra/Ephedrine/Ma Huang
Sympathomimetic, alpha and beta receptor agonist
-increases metabolic rate
-may enhance mobilization of fats, and suppress appetite
-not an ergogenic aid
-Risks: Sudden death, Tachycardia, PVC, intracerebral hemorrhage, Increased BP
other vascular events

54. 19. Blood Doping: 2 ways
Autologous RBC’s or Exogenous Erythropoietin
•Improves O2 carrying capacity
•Can improve VO2 max
•increases viscosity of the blood (increased work of heart)
•Erythropoietin: hormone that stimulates RBC production
-side effects: hypertension, stroke, heart failure, seizures