Blog: The other side of performance enhancing drugs

31 October 2018

Athletes are blinded by perceived short-term gains and neglect the long-term health impacts, according to Dr David Hughes.

Heart failure. Organ damage. Tumours. The side effects associated with taking performance and image enhancing drugs (PIEDs) that most athletes ignore, or are blind to.

Dr David Hughes, Chief Medical Officer at the AIS, says athletes “will often trivialise the potential side effects” relative to the performance gains.

Performance enhancing drugs can have a “detrimental effect” on athletes’ health, he warns, but these effects vary, depending on the substance.

Stimulants and anabolic steroids are often the illegal drug of choice but “they do have dangerous side effects”.

“Stimulants are known to cause things like heart palpitations, heart arrhythmias, anxiety attacks, panic attacks, cardiovascular collapse,” Dr Hughes says.

“We know that these illegal substances do cause people to present to emergency departments with acute psychiatric conditions or with collapse related to cardiac arrhythmias or cardiac palpitations.”

Anabolic steroids can have far reaching effects in addition to what is simply called “roid rage”, he warns.

“Anabolic steroids can also have negative effects on liver functions, they can cause things like acne, they can have a detrimental effect on fertility and cause shrinking of the testicles.”

Another substance that’s used in endurance sports is erythropoietin (EPO), which stimulates erythropoiesis, the production of red blood cells.

“The problem is you’re overriding the body’s own natural safety feedback mechanisms …There have been cases where individuals abusing EPO have had strokes or other clotting events as a result of overproduction of red blood cells, causing thickening of the blood and stroke or cardiovascular events.”

And he likens athletes who take substances that have not been clinically tested as to their effects on humans as “playing Russian roulette” with their health.

Ostarine is one such drug. It’s not approved for human use in Australia because of the possible side effects such as increased risk of heart attack, stroke and life-threatening liver toxicity.

Likewise DMBA. Ipamorelin. Dehydrochloromethyltestosterone. These drugs all carry the risk of sudden death but have been found in the systems of athletes.

While the effects vary from medication to medication, substance to substance, Dr Hughes says anybody can have a susceptibility to any dose or substance.

“You can have negative side effects from taking any dose but certainly the higher the dose and the more frequently it is taken, the more likely you are to run into the negative side effects,” he says. “Medications are idiosyncratic which means what I might take and the effect it has on me might be completely different to what effect it has on you.”

Such is the potential danger to an individual’s health, it is illegal to manufacture, import, possess, use or supply steroids without a prescription or medical practitioner licence.

"For reasons of athletes’ health, we strongly urge people to not take performance enhancing drugs, which is completely separate to the issues of illegality in sport and damage that can be done to an individual’s sporting reputation.”

However Dr Hughes, who has worked with, among others, the Opals, Wallabies, Brumbies, Raiders, Manchester City and Fulham, believes the vast majority of athletes are clean.

“There will always be rogue athletes who wish to abuse the system and decide to try and take a shortcut but this can be detrimental to their health. If they are caught taking an illegal substance, then it’s going to have enormous ramifications for them, their family and their reputation, which is a great pity because a reputation is made over a lifetime and lost in a moment of poor decision making."