The Creation and Evolution of
Performance Enhancing Drugs
By Dr George Touliatos
Since the ancient Olympic Games, held in the city Amphetamines were used widely by soldiers from
of Olympia in 776 B.C, athletes have been many countries during the Second World War.
competing against one other. The motto ”ciltius, These drugs minimize the uncomfortable
altius, fortius”, Latin for “Faster, Higher, sensations of fatigue during exercise, and help
Stronger”, revealed the competitive spirit early on. provide energy and focus. These cognitive and
Beginning with the initial competition, there have ergogenic benefits are also experienced by
been reports of speculated cheating and athletes, and have ensured this class of drug a
performance enhancing drug usage. Athletes place in the drug regimens of many athletes from
competing in pankration, a primitive form of the early 1950’s to the present day.
wrestling mixed with boxing, consumed bull
testicles in order to gain strength. This was Later, during the 60’s, several other testosterone
thought, at the time, to increase testosterone derivatives came to the forefront. Stanozolol
levels. The athlete would eat the testosterone (winstrol), methenolone (primobolan),
producing organs of this larger, stronger animal, mesterolone (proviron), oxymetholone (anadrol)
seeking to obtain its vitality and virility. Later, and drostanolone (masterone) were also
during the third modern Olympic Games in 1904 synthesized for purely medical purposes. In
and held in Athens, there was speculation a cyclist professional sports, steroid use was also on the
had used the narcotic strychnine in order to avoid rise, especially in football where size and strength
the feeling of pain, and prolong his stamina. The are essential to a player’s effectiveness. During the
origin of the word ‘doping’ is attributed to the cold war, Eastern bloc countries (DDR, USSR,
Dutch word ‘doop’, which is a viscous opium juice Bulgaria and China-N.Korea later) specialized in
and was the drug of choice in ancient Greece. PED doping methods as a means of establishing
their superiority. There was a program organized
The breakthrough point in modern chemical from the communist government in which
enhancement took place in Germany, in the politicians, physicians, trainers and athletes
1930’s. A team of scientists was able to create a focused on how to win medals in order to promote
synthetic form of testosterone to help treat men communism. Although it was suspected during
who were unable to produce enough of the this period that AAS were being used
hormone for normal growth, development and systematically by athletes, testing methods were
sexual function. The basic male androgen, insufficiently developed to warrant the inclusion
testosterone, was manufactured and a Nobel Prize of steroids in the list of banned substances in
was awarded to the German scientists for their urine/blood analysis.
crowning achievement. In 1954 the American Dr.
John Zeigler manufactured the first Androgenic
Anabolic Steroid in the form of tablet,
methandrostenolone(better known as Dianabol).
In 1975, the International Olympic Committee (IOC) finally banned the use
of steroids in Olympic competition; while in 1976 steroid testing was
conducted for the first time at the Montreal Olympics.
In the 1990’s, during the reunification of Germany, numerous documents
from this program were revealed. These documents showed evidence of a
vast steroid program used by Olympic athletes. Type of drugs, dosage
administered, regularity of administration, and proper timing of pre-
competition withdrawal in order to pass the anti-doping control were
revealed for roughly 400 athletes.
The Ministry for State Security was in charge of overseeing this operation
and also providing the drugs. Professors, doctors, scientists performed
doping research and administered prescription drugs as well as unapproved
experimental drug preparations to thousand athletes, including women and
A study showed that over 68 percent of the
athletes at the 1972 Olympics were using or had
used steroids. And in 1976, East Germany’s
women’s track and swim teams, the Wonder Girls
(as they came to be known), were discovered using
steroids. Sadly, parents of the young athletes had
no idea what the trainers had given to their
children. They had assumed it was just basic
supplementation with vitamins. Athletes pressed
charges against their trainers, as several Olympic
champions and world champion athletes have
faced serious medical issues as a result of their
Soon after the fall of the Berlin wall (early 1990’s),
many PED gurus left their countries and
immigrated west. Many came to the US in
particular, asking for political asylum. Afterwards,
the anabolic knowledge of Eastern Europe was
united with America’s advanced technology, and
evolutionary methods of chemical enhancement
were developed. Peptides, as well as synthetic
form of somatotropin (Human Growth
Hormone) [rhGH]) and other hormones
(Somatomedin C-IGF1, Human Chorionic
Gonadotropin [HCG]) were manufactured
through molecular biology techniques, including
recombinant DNA technology. It’s been
speculated by some that the Olympic Games of
1988 belonged to AAS, while the Olympic Games
of 1996 to creatine monohydrate. In the 2000
Olympic Games EPO was on stage and in 2004
HGH was the new undetected weapon of athletes.
Tetrahydrogestrinone (THG) was developed at
this time, when EPO, HGH and traditional
anabolic steroids were high on the radar of testing
organizations. The drug has been considered a
designer steroid, and was referred to as an
unapproved new drug by the Food and Drug
Administration (FDA) in 2003, before the
subsequent scheduling of it in 2005. THG, the
second reported designer AAS, was used to
improve athletic performance and was not
approved for medical purposes.
Other kinds of PED’s include diuretics,
β2-agonists & inhibitors, narcotic analgesics,
cannabinoids, a variety of CNS stimulants,
corticosteroids, selective androgen receptor
modulators (SARM’s), selective estrogen receptor
modulators (SERM’s), myostatin inhibitors
(MYOi) and aromatase inhibitors (AI’s).
About the Author: George Touliatos As shown, PED’s are present in numerous sports
and often tarnish the spirit of competition by
Dr. George Touliatos is a physician who creating what is viewed by many as an unfair
specializes in sports medicine and biopathology. playing field. Sports medicine physicians should
be aware of the variety of PED’s available, in order
He has authored several books on bodybuilding, to best advise athletes on the risks and benefits of
and serves as scientific advisor for MuscleMag and these drugs. At the time of this article, doping and
Muscular Development Greek editions. George is performance enhancing drug use is on the rise,
a competitive bodybuilder himself, and also has a and new drugs are being created.
long history working in partnership with Greek
competitive organizations. References:
1. Amit Momaya, Marc Fawal, Reed Este.
Performance-Enhancing Substances in Sports: A
Review of the Literature. Sports Medicine 2015;
45, (4): 517-531
2. Kenneth P. Barnes, Catherine R. Rainbow.
Update on Banned Substances 2013. Sports
Health. 2013; 5, (5): 442–447
3. Werner W. Franke, Brigitte Berendonk.
Hormonal doping and androgenization of
athletes: a secret program of the German
Democratic Republic government.Clinical
Chemistry 1997; 43, (7): 1262–1279
4. Doping in sport. From Wikipedia, the free
For the newest book by Dr George
Touliatos go to Amazon at:
HUMAN GROWTH HORMONE (HGH)
– THE FACTS by Josh Hodnik
The perception of human growth hormone will There are misconceptions regarding HGH. My
vary a great deal depending on who you talk to. goal here is to sort through the common beliefs
Publications such as Men’s Health, Vanity Fair, surrounding HGH and separate fact from fiction.
and several others have recently began to praise
human growth hormone for its reported health Human growth hormone is a peptide hormone
improving and anti-aging qualities. The hormone that stimulates growth, cell production, and cell
has been described as having the ability to regeneration. HGH is a 191-amino acid, single-
increase a person’s quality of life, and quite chain polypeptide that is synthesized, stored, and
possibly the ability to extend a person’s lifespan. It secreted within the pituitary gland.
has also been touted as a wonder drug for its fat-
burning and muscle-building characteristics. Not long after World War One. Researchers first
diagnosed HGH deficiency as a condition. Medical
This same hormone was once blamed, along with researchers attempted to treat this condition by
anabolic steroids, for the brain tumor and death of using growth hormone from different animal. The
football great Lyle Alzado. What truly caused the considerable difference in molecular structure of
death of Alazado is questionable, and his own human growth hormone and animal growth
doctor has denied that the death was related to hormone caused this form of treatment to be
HGH or steroid use. unsuccessful.
In 1985 a serious drawback to using HGH from Its believed by many that the addition of HGH has
cadavers became apparent. People who received led to bodybuilders of today dwarfing those who
the HGH from cadavers in their youth later stepped on stage in the 70’s and 80’s. NFL players
developed Creutzfeldt Jakob disease due to the have continued to become bigger, leaner, and
human growth hormone being contaminated with faster. Steroids have been used in the NFL for
disease causing prions. Doctors around the world decades. Again, the belief is that the continued
stopped prescribing HGH no matter how extreme physical progress is a result of the addition of
the case. Just a few years later, a synthetic version HGH.
of HGH was developed by Genentech. This made
treating human growth hormone deficiency much Human growth hormone has been shown to
safer and easier. improve strength by stimulating collagen
synthesis in the skeletal muscle and tendons.
HGH DEFICIENCY HGH is a very complex hormone, and many of its
functions are still unknown. However, it is known
The effects of growth hormone deficiency vary to increase protein synthesis and it leads to an
depending on the age at which they occur. With increase in IGF-1. Both of which lead to an
children, short stature and growth failure are the increase in strength and muscle mass. How much
major problems from deficiency. In adults, there muscle tissue that can be gained as a result of
is often an increase in fat, and decrease in muscle HGH is the question?
mass. HGH deficiency can also result in a
decrease in energy, quality of life, and sex drive in While HGH does increase protein synthesis, the
adults. Adults with HGH deficiency have higher increase in strength and muscle mass directly
rates of depression than those without. from HGH is minimal.
“Muscle Growth, Fatloss, Anti-Aging”
Several studies have shown that HGH plays a When HGH is taken alone and not alongside an
vital role in both mental and emotional well- anabolic steroid such as testosterone, a noticeable
being. increase in strength or muscle shouldn’t be
expected unless the person was starting from a
Common Symptoms os HGH Deficiency in large HGH deficit. HGH is just not the mass and
Adults: strength builder that many have pumped it up to
be. There are probably a dozen other drugs that
? Depression have more mass building potential than HGH.
? Hair Loss Insulin, IGF-1, and a handful of anabolic steroids
? Memory Loss are responsible for the increase in size and
? Lack of Concentration strength among athletes and bodybuilders from a
? Fatigue drug standpoint, and not HGH. It appears that an
? Increased Abdominal Fat increase in strength of mass from HGH is an
? Insulin Resistance actual result of increased collagen synthesis. Any
belief that HGH can substantially increase muscle
INCREASING MUSCLE MASS WITH HGH mass and strength is false.
Human growth hormone is often taken with hopes HGH AND FAT LOSS
of dramatically increasing muscle mass and
strength. There is no denying that athletes in Human growth hormone has grown in popularity
every sport imaginable have become bigger and as a fat loss agent. Its use was once limited to top
stronger over the past few decades. This is visibly level bodybuilders and select professional
apparent in the sport of bodybuilding. athletes. A large decrease in price and increase in
Bodybuilders today are much bigger and leaner availability have given more people access to this
than they were during Arnold’s era. Anabolic drug. HGH has been shown to greatly accelerate
steroids were commonly used by Arnold and his lipolysis, the process where fats are broken down
peers. to be used as fuel.
For this reason, its recommended to use HGH for
no less than 3-6 months when the goal is fat loss.
From personal experience, I’d recommend 6
months as the minimum. HGH can have an effect
on thyroid function. It increases the conversion of
storage T4 to the active T3, and this causes the
body to burn fat at an accelerated rate. The body
has a limited amount of T$ thyroid hormone.
With the accelerated conversion to T3, thyroid
hormone will become low as time passes, and this
can slow or even halt growth hormone’s fat
burning effect. This problem can be avoided by
adding a low dose (50-75mcg) of T4. By supplying
the body with extra T4, the HGH has more to
work with and continues to pump out extra fat
burning T3. HGH is a very effective fat burning
hormone. When used correctly, it definitely lives
up to all the hype that surrounds it for fat loss.
HGH AND HEALTH BENEFITS
HGH has gained attention for its reported anti-
aging properties, and its ability to increase overall
health. HGH plays a vital role in cellular repair
and regeneration. This in itself can slow the
overall aging process. HGH increases calcium
retention, and strengthens bones. It has also been
shown to drastically improve fracture healing. It
can reduce cardiovascular disease. In Sweden, 104
patients who were growth-hormone deficient were
studied for cardiovascular disease risk.
These patients had higher body mass and
triglyceride concentrations compared to controls.
This suggests lipoprotein metabolism is altered
by HGH deficiency, increasing the risk of
cardiovascular disease. In the short term, many
report an improvement of their skin, better sleep,
and more energy from HGH treatment.
Excess doses of HGH for prolonged periods will
often result in side effects. It can thicken the
bones of the jaw, fingers, and toes. It can cause
pressure on nerves, which results in carpal tunnel
type symptoms. Muscle weakness, insulin
resistance, and reduced sexual function can all
result from excess HGH.
For anti-aging purposes, HGH should be dosed at
around 2 IU’s per day for men and 1-2 IU’s per
day for women. For fat loss, 3-4 IU’s for men and
2-3 IU’s for women. For bodybuilding purposes
4-6 IU’s daily is sufficient. Its not unheard of for
bodybuilders to dose HGH in the range of 12-18
IU’s per day. Dosing in this range is not something
I recommend. The potential side-effects greatly
outweigh any benefit from dosing HGH above 6
IU’s daily. Whether its taken for anti-aging, fat
loss, or bodybuilding, HGH should be split into
two doses: half taken after waking up, and the
other half 8-12 hours later. Growth hormone can
be injected into the muscle or subcutaneously
(under the skin). Some have reported localized fat
loss from injecting subcutaneously in the
abdominal area, and some prefer injecting into
Finding legitimate HGH is a tedious task in itself. Counterfeit HGH isn’t the only scam you have to
Growth hormone is the most counterfeited watch out for. There are countless pills and sprays
bodybuilding drug used today. Often times that are sold as HGH supplements that can be
generic Chinese HGH is repackaged and passed purchased legally without a prescription. The
off as a more expensive brand name HGH. In this advertising online and in magazines is very
case, the vials may still contain real HGH, but the deceptive. Many will purchase these supplements
purity may be lowered. The most reliable route thinking they are taking a form of real HGH, and
would be an anti-aging or hormone replacement they expect to experience the same benefits
clinic. The cost will be much higher, but there is associated with real HGH, only to be
less of a chance of getting counterfeit HGH when disappointed.
going to one of these clinics. Yes, even when going
to a clinic to get HGH from a doctor, there is still a HGH is an extraordinary hormone. It lives up to
chance that the growth hormone could be its hype in certain areas and falls short in others.
counterfeit. Its rare but it still happens. One thing it isn’t is a magic potion. Anyone that is
thinking of trying HGH should do plenty of
research while having realistic expectations.
Know the risks by Mayo Clinic Staff
“Are you hoping to gain a competitive edge by
taking muscle-building supplements or other
performance-enhancing drugs? Learn how these
drugs work and how they can affect your health.”
Most serious athletes will tell you that the strength. The main anabolic steroid hormone
competitive drive to win can be fierce. Besides the produced by your body is testosterone.
satisfaction of personal accomplishment, athletes
often pursue dreams of winning a medal for their Testosterone has two main effects on your body:
country or securing a spot on a professional team.
In such an environment, the use of performance- Anabolic effects promote muscle building.
enhancing drugs has become increasingly Androgenic effects are responsible for male
common. traits, such as facial hair and a deeper voice.
But using performance-enhancing drugs — aka, Some athletes take straight testosterone to boost
doping — isn't without risks. Take the time to their performance. Frequently, the anabolic
learn about the potential benefits, the health risks steroids that athletes use are synthetic
and the many unknowns regarding so-called modifications of testosterone.
performance-enhancing drugs such as anabolic
steroids, androstenedione, human growth These hormones have approved medical uses,
hormone, erythropoietin, diuretics, creatine and though improving athletic performance is not one
stimulants. You may decide that the benefits of them. They can be taken as pills, injections or
aren't worth the risks. topical treatments.
Anabolic steroids Why are these drugs so appealing to athletes?
Besides making muscles bigger, anabolic steroids
What are they? may help athletes recover from a hard workout
more quickly by reducing the muscle damage that
Some athletes take a form of steroids — known as occurs during the session. This enables athletes to
anabolic-androgen steroids or just anabolic work out harder and more frequently without
steroids — to increase their muscle mass and overtraining.
In addition, some athletes may like
the aggressive feelings they get
when they take the drugs.
A particularly dangerous class of
anabolic steroids are the so-called
designer drugs — synthetic steroids
that have been illicitly created to be
undetectable by current drug tests.
They are made specifically for
athletes and have no approved
medical use. Because of this, they
haven't been tested or approved by
the Food and Drug Administration
(FDA) and represent a particular
health threat to athletes.
Risks Shrunken testicles
Many athletes take anabolic steroids at doses that Impotence
are much higher than those prescribed for medical Prostate gland enlargement
reasons, and most of what is known about the
drugs' effects on athletes comes from observing Women may develop:
A deeper voice
It is impossible for researchers to design studies An enlarged clitoris
that would accurately test the effects of large Increased body hair
doses of steroids on athletes, because giving Baldness
participants such high doses would be unethical. Infrequent or absent periods
This means that the effects of taking anabolic
steroids at very high doses haven't been well- Both men and women might experience:
Anabolic steroids come with serious Increased risk of tendinitis and tendon rupture
physical side effects as well. Liver abnormalities and tumors
Increased low-density lipoprotein (LDL)
Men may develop: cholesterol (the "bad" cholesterol)
Decreased high-density lipoprotein (HDL)
Prominent breasts cholesterol (the "good" cholesterol)
"Are you Sure you want to make that step?"
"HAVE YOU DONE YOUR RESEARCH?"
High blood pressure (hypertension) Androstenedione (andro) is a hormone
Heart and circulatory problems. produced by the adrenal glands, ovaries and
Aggressive behaviors, rage or violence. testes. It's a hormone that's normally converted to
Psychiatric disorders, such as depression testosterone and estradiol in both men and
Drug dependence. women. Andro is available legally only in
Infections or diseases such as HIV or hepatitis if prescription form and is a controlled substance.
you're injecting the drugs.
Inhibited growth and development, and risk of Manufacturers and bodybuilding magazines tout
future health problems in teenagers. its ability to allow athletes to train harder and
recover more quickly. However, its use as a
Taking anabolic-androgenic steroids to enhance performance-enhancing drug is illegal in the
athletic performance, besides being prohibited by United States.
most sports organizations, is illegal. In the past 20
years, more effective law enforcement in the Scientific studies that refute these claims show
United States has pushed much of the illegal that supplemental androstenedione doesn't
steroid industry into the black market. increase testosterone and that your muscles don't
get stronger with andro use.
This poses additional health risks because the
drugs are either made in other countries and Risks
smuggled in or made in clandestine labs in the
United States. Either way, they aren't subject to Side effects of andro in men include:
government safety standards and could be impure
or mislabeled. Acne
Diminished sperm production
Androstenedione Shrinking of the testicles
Enlargement of the breasts
What is it?
In women, side effects include: Risks
Acne Adverse effects related to human growth hormone
Masculinization, such as deepening of the voice range in severity and may include:
and male-pattern baldness.
In both men and women, andro can decrease HDL Muscle weakness
cholesterol (the "good" cholesterol), which puts Fluid retention
you at greater risk of heart attack and stroke. Vision problems
Carpal tunnel syndrome
Human growth hormone Impaired glucose regulation
Enlarged heart (cardiomegaly)
What is it? High cholesterol (hyperlipidemia)
Human growth hormone, also known as High blood pressure (hypertension)
gonadotropin, is a hormone that has an anabolic
effect. Athletes take it to improve muscle mass Erythropoietin
and performance. However, it hasn't been shown
conclusively to improve either strength or What is it?
endurance. It is available only by prescription and
is administered by injection. Erythropoietin is a type of hormone used to treat
anemia in people with severe kidney disease. It
increases production of red blood cells and
“Are you really ready to commit”
hemoglobin, resulting in improved movement of Risks
oxygen to the muscles. Epoetin, a synthetic form
of erythropoietin, is commonly used by endurance Diuretics taken at any dose, even medically
athletes. recommended doses, predispose athletes to
adverse effects such as:
Erythropoietin use among competitive cyclists Muscle cramps
was common in the 1990s and allegedly Dizziness
contributed to at least 18 deaths. Inappropriate Potassium deficiency
use of erythropoietin may increase the risk of Rash
thrombotic events, such as stroke, heart attack Gout
and pulmonary embolism. Drop in blood pressure
Loss of coordination and balance
What are they? Creatine
Diuretics are drugs that change your body's What is it?
natural balance of fluids and salts (electrolytes)
and can lead to dehydration. This loss of water can Many athletes take nutritional supplements
decrease an athlete's weight, helping him or her to instead of or in addition to performance-
compete in a lighter weight class, which many enhancing drugs. Supplements are available over-
athletes prefer. Diuretics may also help athletes the-counter as powders or pills. The most popular
pass drug tests by diluting their urine and are supplement among athletes is probably creatine
sometimes referred to as a "masking" agent. monohydrate.
Creatine is a naturally occurring compound sprinting. There's no evidence, however, that
produced by your body that helps your muscles creatine enhances performance in aerobic or
release energy. Scientific research indicates that endurance sports.
creatine may have some athletic benefit by
producing small gains in short-term bursts of Your liver produces about 0.07 ounces (2 grams)
power. of creatine each day. You also get creatine from
the meat in your diet.
Creatine appears to help muscles make more
adenosine triphosphate (ATP), which stores and Creatine is stored in your muscles, and levels are
transports energy in cells, and is used for quick relatively easily maintained. Because your kidneys
bursts of activity, such as weightlifting or remove excess creatine, the value of supplements
to someone who already has adequate muscle
creatine content is questionable.
Supplements are considered food and not drugs
by the FDA. This means supplement
manufacturers are not required to conform to the
same standards as drug manufacturers do. In
some cases, supplements have been found to be
contaminated with other substances, which may
inadvertently lead to a positive test for
Possible side effects of creatine that can decrease
athletic performance include:
Weight gain is sought after by athletes who want
to increase their size. But with prolonged creatine
use, weight gain is more likely the result of water
retention than an increase in muscle mass.
“Think of your health and your future, befor you
Water is drawn into your muscle tissue, away Some athletes use stimulants to stimulate the
from other parts of your body. This puts you at central nervous system and increase heart rate
risk of dehydration. and blood pressure.
High-dose creatine use may potentially damage Stimulants can:
Kidneys Reduce fatigue
Liver Suppress appetite
Increase alertness and aggressiveness
It appears safe for adults to use creatine at the
doses recommended by manufacturers. But there Common stimulants include caffeine and
are no studies investigating the long-term benefits amphetamines. Cold remedies often contain the
and risks of creatine supplementation. stimulants ephedrine or pseudoephedrine
Energy drinks, which are popular among many
What are they? athletes, often contain high doses of caffeine and
The bottom line
Do performance-enhancing drugs
boost performance? Some athletes
may appear to achieve physical gains
from such drugs, but at what cost?
The long-term effects of performance-
enhancing drugs haven't been
rigorously studied. And short-term
benefits are tempered by many risks.
Not to mention that doping is
prohibited by most sports
organizations. No matter how you look
at it, using performance-enhancing
drugs is risky business.
DO YOU REALLY WANT TO
TAKE THAT RISK?
The street drugs cocaine and methamphetamine
also are stimulants.
Although stimulants can boost physical
performance and promote aggressiveness on the
field, they have side effects that can impair
Nervousness and irritability, which make it hard
to concentrate on the game
Insomnia, which can prevent an athlete from
getting needed sleep
Addiction or tolerance, meaning that athletes
need greater amounts to achieve the desired
effect, so they'll take doses that are much higher
than the intended medical dose.
Other side effects include:
Heart rhythm abnormalities
Mild high blood pressure (hypertension)
Stroke Heart attack and other circulatory