Athletes continue to use a wide range of substances and methods to improve their performance. Banned substances and methods are included in the World Anti-Doping Agency WADA prohibited list. This list is updated every January and is freely available on the WADA website.
Prohibited non-hormonal performance enhancing drugs and some other prohibited methods for performance enhancement are reviewed here. Hormonal performance-enhancing drugs and other illicit methods of performance enhancement are reviewed separately. (See “Use of androgens and other hormones by athletes”.)
WORLD ANTI-DOPING AGENCY AND PROHIBITED SUBSTANCES USED FOR PERFORMANCE ENHANCEMENTNon-hormonal drugs used illicitly to improve sports performance are included in a comprehensive list maintained by the World Anti-Doping Agency (WADA). This list is updated every January and is freely available on the WADA website. Thus, it is important when reading this topic or any source of information about these substances to ensure that it correlates with the latest version of the WADA prohibited substance list.
In the past decade, the WADA list of banned performance-enhancing substances has grown to over 192 drugs and methods. In addition to androgens and other hormones, the WADA prohibited list includes stimulants, recreational drugs such as narcotics and cannabinoids, beta agonists, diuretics, and other prescription medications. In 2011, section S0 was added to the WADA list to include substances that have yet to be approved for human use, are still in clinical development, or have been discontinued (S0). In 2021, WADA introduced a new category to the prohibited list, “Substances of Abuse.” Athletes found using substances in this category may be required to seek appropriate treatment, as well as serve a period of sanction. Helpful resources for information about supplements include: Informed Sport website, Australian Institute of Sport website, and the US Anti-Doping Agency website.
When prescribing medications or advising about supplements, clinicians should check that none of the contents are banned by WADA or any relevant national anti-doping organizations. In the United States, United Kingdom, Japan, Canada, Switzerland, and Australia, medications can be checked on Globaldro.com. This website also provides the email contact details for many national anti-doping organizations. (See “Vitamin supplementation in disease prevention” and “Overview of herbal medicine and dietary supplements”.)
- BANNED NON-HORMONAL PERFORMANCE-ENHANCING DRUGS
- AGENTS USED TO PREVENT DETECTION OF BANNED SUBSTANCES
- TESTING FOR BANNED NON-HORMONAL PERFORMANCE-ENHANCING DRUGS
- THERAPEUTIC USE EXEMPTIONS
- BANNED METHODS OF NON-PHARMACOLOGIC PERFORMANCE ENHANCEMENT
The World Anti-Doping Agency’s 2021 Prohibited List shares all of the illegal performance-enhancing drugs and identifies whether they are prohibited at all times, prohibited only in competition, or prohibited in a particular sport.
Synthetic Anabolic Steroids
Anabolic steroids are popular agents in activities where bulk and strength count for performance. Although natural testosterone can be described as an anabolic agent, various synthetic versions of steroids have been made popular by bodybuilders.
The National Institute on Drug Abuse (NIDA) notes that steroid use is more common among male non-athlete weightlifters in their 20s or 30s. Additionally, those with poor self-esteem, increased depression, and poor knowledge of health are more likely to engage in steroid use.
Examples: anadrol, dianabol, stanozolol
Testosterone and Related Hormones
Testosterone is a natural hormone found in males and females, although men have markedly higher average testosterone than women. Increasing body testosteroneprovides an anabolic effect. Precursor hormones that lead to increased testosterone are also used.
Drug testers like to rely on ‘normal ranges’ because testosterone itself is naturally occurring. Laboratory reference ranges categorize normal testosterone levels in males to be 280 ng/dL to 1,100 ng/dL whereas the normal range for females is 15 ng/dL to 70 ng/dL.
Examples: testosterone, DHEA
Exemption: Non Binary Athlete Policy
Amphetamines and Other Stimulants
Various forms of stimulants, like different types of amphetamines, have been used in a variety of sports from football to cycling and weightlifting to sprinting. These chemical and drug agents work by stimulating the nervous system, improving an athlete’s reaction time.
Some prescribed medications are also stimulants, such as those for attention-deficit hyperactivity disorder (ADHD). An athlete who is taking this type of stimulant must apply for a Therapeutic Use Exemption (TUE) in order to compete.
Examples: dexedrine, fenfluramine, phentermine
Erythropoietin, or EPO, is a hormone that increases red blood cell (RBC) production, which, in turn, improves oxygen availability to tissues. Increased oxygen improves performance, mainly in endurance events like marathons, triathlons, and endurance cycle racing.
EPO doping is sometimes referred to as gene doping. Because gene therapy has rapid advances, detecting this type of doping has been problematic. But some researchers are working to develop genetic detection tests to better determine if gene doping has occurred.
Examples: EPO, CERA
Blood doping is the practice of drawing and saving your own blood, allowing the body to replenish its blood supply. The blood is then added back into the bloodstream to provide increased oxygen-carrying capacity, much like with EPO doping.
Diuretics and Other Masking Agents
Steroids and other drugs inevitably leave a trail that testers can find. One way to attempt to avoid this is to use another agent that increases urine output in the hopes of excreting traces of the banned drug. This is where diuretics and masking agents come into play.
However, testers are wise to this approach and look for masking agents as well as banned substances. So, there is no way to escape detection unless the masking agent or diuretic is excreted or metabolized as well.
Examples: acetazolamide, chlorthalidone, desmopressin
Some athletes use drugs that promote muscle at the expense of fat. These doping drugs can very sophisticated, with compounds like those used in traditional weight-loss treatments acting as a potential performance-enhancing agent.
One example of a fat-burning drug that was also considered a bodybuilding aid is DNP—short for 2,4-dinitrophenol. But it gained the attention of the World Anti-Doping Agency after killing one person and leaving another seriously ill. Now it is on the agency’s Prohibited List.
Examples: clenbuterol, oxilofrine
Human growth hormone or HGH has been used as a supplemental drug for many years by bodybuilders and, more recently, by athletic sprinters. HGH is a naturally occurring substance produced by the body.
Athletes may use peptides, which are essentially small proteins, for a range of performance targets. These targets include stimulating the production of growth hormone (GH) and enhancing muscle growth.
A majority of peptides used as doping drugs have not been approved for human consumption. This puts the athlete at risk since there is no clear understanding of how that particular substance affects the body.
Examples: chorionic gonadotrophin, corticorelin, luteinizing hormone
Beta-blockers are a class of drugs traditionally used in heart disease and blood pressure treatment. They slow the heart rate down substantially. Competitors such as archers, shooters, and billiards players have used them to steady their shots.
In archery and shooting, beta-blockers are prohibited at all times; in other sports—which include billiards, darts, and golf, for instance—they are only banned during competition.
Examples: acebutolol, celiprolol,propranolol
This group includes chemical agents with somewhat idiosyncratic uses, ranging from hormonal manipulation to metabolic effects. For example, men have used the anti-estrogen drug tamoxifen, prescribed for breast cancer treatment, to oppose the estrogenic effects of anabolic steroids.
Additional banned substances during competition include:24
- Narcotics (fentanyl, morphine, oxycodone)
- Cannabinoids (except cannabidiol)
- Glucocorticoids (cortisone, hydrocortisone, methylprednisolone)
Detecting Illegal Doping
Testing for illegal performance enhancing drugs in sports involves taking the athlete’s urine or blood, then shipping it to a laboratory accredited by the World Anti-Doping Agency. This process is designed to protect the integrity of the sample taken.
If an athlete tests positive for a banned substance, the consequences can include disqualification, sanctions, and/or suspension. Anti-doping regulations are strict and hold athletes responsible for everything they put in their bodies, whether prescribed or not.
Even seemingly safe dietary supplements can sometimes present an issue for athletes because some have been found to contain banned substances. If these substances are detected, it can cause a positive result.
Health Risks of Illegal Doping
In addition to risking their sports career, athletes who dope are also risking their own health. Potential health consequences associated with doping drugs include:
- Heart problems
- Mental health effects
- Kidney or liver damage
- Reduced fertility in both men and women
- Brain damage
Frequently Asked Questions
What percentage of athletes use performance-enhancing drugs?
Studies suggest that 14% to 39% of adult elite athletes intentionally use doping. For recreational athletes, the figure is around 18.4%. However, some researchers say that it’s hard to know how many athletes use banned substances because of inconsistent data reporting.
Are there any performance-enhancing drugs allowed in sports?
If a performance-enhancing drug is not on the World Anti-Doping Agency’s Prohibited List, it is allowed in sports; however, that substance must also be approved by a governmental health authority for use by humans as a therapeutic.
Why is it important to test athletes for performance-enhancing drugs?
Performance-enhancing drugs can be harmful to an athlete’s health while also providing an unfair competitive advantage. Testing for these drugs helps to protect the athlete’s health while also protecting the integrity of sport.
What are the side effects of performance-enhancing drugs?
Side effects of performance-enhancing drugs vary based on the substance used but can sometimes include:
- Anabolic steroids: Acne, male pattern baldness, increased aggressiveness, impotence, increased breast size in males, growth of facial and other body hair in females
- EPO: Hypertension, anemia, stroke, blood cancer
- Blood doping: Blood clots, stroke
- Human growth hormone: Thyroid issues, severe headaches, loss of vision, diabetes, tumors, arthritis
- Beta blockers: Reduced blood pressure, sleep issues, airway spasms
- Diuretics: Dehydration, muscle cramps, dizziness, poor coordination, and balance
- Stimulants: Insomnia, anxiety, tremors, increased blood pressure, heart attack, stroke
- Cannabinoids: Heart rate increases, short-term memory issues, reduced reactivity and coordination
- Narcotics: Nausea, vomiting, decreased heart rate
Anti Steroids Practice Policy (ASPP)
USATT has a strict ANTI-Steroids Practice Policy. No USATT athlete is permitted to use any steroids for any purpose, exemptions listed below:
THE ONLY ASPP exemption to the policy and its implementation shall be;
1. If a doctor (licensed and certified) prescribes the substance to the player in attempt to rid a life threatening disease. The said player would have to sit out for 2 MONTHS ( or 60 days) after the 1st Dose. The said player would then be able to compete again on the 61st day. It will be USA Tennis Tour discretion on whether said player could compete on Day 60 vs Day 61. All exemptions must be applied for in writing to LUKEHARDEN2@gmail.com
Check back later for the 2022 USATT BANNED SUBSTANCE LIST.