Muscle drugs, which often are associated with performance and image enhancing drugs (PIEDs) and ‘doping’, are used to enhance the structure and function of skeletal muscle. These substances are consumed for both cosmetics reasons (e.g. increase muscle definition) as to enhance physical performance (e.g. increase strength).
The use of performance and image enhancing drugs for the purposes of physical enhancement is nothing new. Human have long sought to improve their physique or performance: from the use of special herbs and mushroom concoctions to the more recent use of anabolic androgenic steroids (or simply steroids) and other muscle enhancing drugs.
The most commonly used muscle drugs are steroids. In a literature review, Sagoe et al. (2014) found that 3.3% of the world’s population (6.4% men/1.6% woman) have used steroids at least once. In particular, subgroups that engage in physical activities for lifestyle purposes or aesthetic reasons often show high consumption levels. For example, people involved in weight training (e.g. fitness, powerlifting and bodybuilding) are commonly use performance and image enhancing drugs to increase muscle size, mass or power. Nonetheless, there are many other subgroups not related to sport or other physical activities that are also no stranger to performance and image enhancing drug consumption or other types as lifestyle drugs. These subgroups will often identify themselves more with other practices (e.g. their occupation) rather than with sport or other forms of physical activity (e.g. someone can still train at a fitness centre or at home).
Aside from steroids, there is a growing interest in human growth hormone (HGH), in particular for anti-ageing purposes, erythropoietin (EPO), and untested substances such as the non-steroidal selective androgen receptor modulators (SARMs). These drugs are often also used in combination with steroids. For instance, illicit HGH use in the weight-training community is often associated with poly-pharmacy involving steroids and other muscle enhancing drugs. In addition to combining muscle drugs with other muscle enhancers (e.g. steroids with HGH), diuretics (e.g. furosemide), weight-loss drugs (e.g. Clenbuterol), anti-oestrogens (e.g. Tamoxifen), and cosmetic or image enhancing drugs (e.g. Melanotan) are often supplanted as well.
The scientific evidence for the adverse health effects of muscle drugs, in particular long-term effects, is scarce, and relatively few deaths are directly linked to their use. However, several harms that are more commonly reported with steroid use include acne, gymnaecomastia, liver damage, cardiovascular issue and effects on behaviour and mood (e.g. depression and aggression). One particular concern of muscle drugs is the quality of the active substance (e.g. strength and purity) and the presence of contamination. Another problem is the indirect harms related to injecting practises (e.g. steroids and HGH are often injected) including damage to the injection site, local and systematic infections. However, there is not enough evidence available to be certain of both the benefits and harms of muscle drugs and more research in this area is needed.
- http://www.anabolic.org/: this website is the authoritative Internet library of anabolic (muscle-building) substances, developed by William Llewellyn.
- http://www.ipedinfo.co.uk: this website is developed by Public Health Wales, in conjunction with partners at the Centre for Public Health, Liverpool John Moores University, and aims to provide reliable and evidence based information and advice to reduce the harms associated with the use of performance and image enhancing drugs (PIEDs).
- www.kfx.org.uk: KFx provides drugs education resources (including performance and image enhancing drugs), training and other tools to help people who use drugs, people who work with drug users and their families and friends.
- www.ergogenics.org [Dutch], www.ergo-log.com [English] and www.ergogenics.org/anabolenboek [English and Dutch]: the Ergogenics and Ergo-Log website are developed by Willem Koert and aims to provide reliable and evidence based information regarding doping, steroids, other performance and image enhancing drugs, nutrition and training. The third link, the ‘anabolenboek’ (steroid book), specifically goes into everything what has to do with steroids.
- Chandler, M., & McVeigh, J. (2013). Steroids and image enhancing drugs 2013 survey results. Liverpool: Public Health Centre.
- Christiansen, A.V. (2015). Drug use in gyms. In V. Møller, I. Waddington and J. Hoberman (eds.), Routledge handbook of drugs and sport (p.421-438). London and New York: Routledge.
- Cohen, J., Collins, R., Darkes, J., & Gwartney, D. (2007). A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States. Journal of the International Society of Sports Nutrition, 4, 1-14.
- Dunn, M., Bartle, J., & McKay, F.H. (2016). Exploring judicial opinion on the relationship between anabolic-androgenic steroid use and violent offending. Performance Enhancement & Health, in press.
- Dunn, M., McKay, F.H. & Iversen, J. (2014). Steroid users and the unique challenge they pose to needle and syringe program (NSP) workers. Drug and Alcohol Review, 33 (1), 71-77.
- Goldsworthy, T. (2014, January 10). Muscling up: are steroids an emerging criminal treat? Australia: The Conversation.
- Monaghan, L.F. (2001). Bodybuilding, drugs and risk. Abingdon: Routledge.
- Sagoe, D., Molde, H., Andreassen, C.S., Torsheim, T., & Pallesen, S. (2014). The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Annals of Epidemiology, 24, 383-389.
- Seear, K., Fraser, S., Moore, D. and Murphy, D.A. (2015). Understanding and responding to anabolic steroid injecting and hepatitis C risk in Australia: A research agenda. Drugs: Education, Prevention and Policy, 22(5), 449-455.
- Stubbe J., A. Chorus, L. Frank, O. de Hon, P. van der Heijden (2014). Prevalence of use of performance enhancing drugs by fitness centre members. Drug Testing and Analysis, 6(5), 434-438.
- Van de Ven, K., & Mulrooney, K.J.D. (2016). Social Suppliers: exploring the cultural contours of the performance and image enhancing drug (PIED) market among bodybuilding in the Netherlands and Belgium. International Journal of Drug Policy.
Information for health care providers:
- Flemen, K. (2011). Performance enhancing drugs: resource pack 2011. UK: KFx.
- Bell, C. (2008). Bigger, Stronger, faster*. USA.
Examples of drugs used to enhance the structure and function of skeletal muscle:
|Name||How it works||Duration*||Route of administration|
|Anabolic androgenic steroids (AAS) (e.g. Nandrolone decanoate, Methandienone (Dianabol))||Steroids are used to treat a variety of conditions in which the body’s defense system malfunctions and causes tissues damage and certain inflammatory conditions such as rheumatoid arthritis and lupus. Off-label these drugs are used to increase muscle mass and strength.||The half-life of steroids differs considerably, e.g. the half-life of Nandrolone decanoate is 6 to 8 days while the half-life of Methandienone is 5 to 8 hours||Oral and Injection|
|Anti-oestrogens (e.g. Tamoxifen)
|As a prescription drugs these drugs are, for instance, used to treat breast cancer in both men and women. Off-label this drugs is often used after a steroid cycle. This drugs blocks the action of oestrogen and stimulates testosterone production.||Half-life of 5 to 7 days||Oral|
|Erythropoietin (EPO)||The believed benefits of EPO are to increase oxygen absorption, reduce fatigue and improve endurance by increasing the rate of red cell production. EPO increases the metabolism and the healing process of muscles because the extra red cells carry more oxygen and nutrients.||4 to 13 hours half-life||Oral|
|Human Growth Hormone (HGH; Somatropin)
|In a medical setting HGH is prescribed to adults with growth hormone deficiency or to treat adults with short bowel syndrome, AIDS or HIV-related muscle wasting. Off-label HGH is used to reduce fat and building muscles. While little evidence exists for its ‘anti-ageing purposes’, some suggest that HGH may help adults regain youth and vitality.||30 minutes half-life||Injection|
|Testosterone (e.g. testosterone enanthate and testosterone cipionate)
|Testosterone in a medical setting is used to treat symptoms for sexual dysfunction in men and women and to treat breast cancer. Potential benefits include improved libido, increased bone mass, and increased sense of well-being. Non-medical users consume these drugs to increase muscle mass and strength.||The half-life of testosterone differs considerably, e.g. the half-life of testosterone enanthate is 4 to 7 days while the half-life of testosterone cipionate can be up to 12 days.||Oral, crème, and injectable|
* The duration can vary depending on the type of drugs.