The phrase has been used to refer to several distinct classes of drugs: Anabolic steroids Anabolic steroids are synthetically derived from testosterone and modified to have greater anabolic effects. They work by increasing the concentration of nitrogen in the muscle which inhibits catabolic glucocorticoid binding to muscle. This ultimately prohibits the breakdown of muscle and preserves muscle mass. Examples of anabolic steroids include: oxandrolone, stanozolol and nandrolone. Anabolic steroids can be taken through a transdermal method, orally, or through injection. Injectable forms of the steroid are the most potent and long-lasting. In general, potential side effects include: muscle hypertrophy, acne, increased blood pressure, elevated cholesterol, thrombosis, decreased high-density lipoproteins, altered libido, hepatic carcinoma, cholestasis, peliosis hepatitis, septic arthritis, Wilm's tumor, psychosis, aggression, addiction, and depression. Potential side effects specifically in males include: male pattern baldness, oligospermia, prostate hypertrophy, testicular atrophy, and prostate cancer. Potential side specifically in females include: hirsutism, uterine atrophy, amenorrhea, breast atrophy, and thickening of vocal cords (voice deepening). Urine samples are tested to determine the ratio of testosterone glucuronide to epitestosterone glucuronide, which should be 3:1. Any ratio of 4:1 or greater is considered a positive test. The 1988 Anti-Drug Abuse Act and 1990 Anabolic Steroid Act both deemed Anabolic Steroids as an illegal substance when not used for disease treatment. Stimulants Stimulants improve focus and alertness. Low (therapeutic) doses of dopaminergic stimulants (e.g., reuptake inhibitors and releasing agents) also promote mental and athletic<unk> , as cognitive enhancers and ergogenic aids respectively, by improving muscle strength and endurance while decreasing reaction time and fatigue;. Stimulants are commonly used in lengthy exercises that require short bursts (e.g., tennis, team sports, etc.). Stimulants work by increasing catecholamine levels and agonistic activity at the adrenergic receptors. Examples of stimulants include: caffeine, ephedrine, methylphenidate and amphetamine. Potential side effects include: hypertension, insomnia, headaches, weight loss, arrhythmia, tremors, anxiety, addiction, and strokes. Some stimulants are allowed in competitive sports and are widely accessible (e.g., caffeine). Others are banned as per the World Anti-Doping Agency (WADA) (e.g., cocaine, amphetamines, ephedrine, etc.). Ergogenic aids Ergogenic aids, or athletic<unk> s, include a number of drugs with various effects on physical<unk> . Drugs such as amphetamine and methylphenidate increase power output at constant levels of perceived exertion and delay the onset of fatigue, among other athletic-performance-enhancing effects; bupropion also increases power output at constant levels of perceived exertion, but only during short term use. Examples * Human biomolecules – creatine and β-hydroxy β-methylbutyrate are naturally occurring compounds in humans that have well-established ergogenic effects and effects on body composition when supplemented. * Creatine: one of the most popular nutritional supplements, it contributes to 400 million dollars in sales globally every year. It is a nonessential amino acid that helps to improve an athlete’s<unk>  during short-term, high intensity exercises such as weightlifting. Supplementation of creatine increases skeletal muscle creatine levels, this boosts<unk>  by increasing the rate at which adenosine triphosphate can be replenished from adenosine diphosphate, thereby increasing maximal power output. Potential side effects include gastrointestinal cramps, weight gain, fatigue, and diarrhea. Creatine is currently not recognized as a prohibited substance and can be purchased as a legal dietary supplement. * Human Growth Hormone (hGH): endogenous hormone that can help decrease fat mass while increasing lean body mass. hGH is one of the most commonly used substances among professional athletes because it has a small window for detection. It works by promoting the release of IGF-1, insulin-like growth factor, the release of which has anabolic effects on the body. Potential side effects include: cardiomyopathy, diabetes, renal failure, and hepatitis. If not prescribed by a professional, it is a banned substance in competition per WADA. Despite its small window for detection, two primary methods of testing have been developed for hGH, one being an isoform test which detects changes in growth hormone structure in the blood, and the markers test, which detects changes in serum protein ratios. Adaptogens Adaptogens plants that support health through nonspecific effects, neutralize various environmental and physical stressors while being relatively safe and free of side effects. As of 2008, the position of the European Medicines Agency was that "The principle of an adaptogenic action needs further clarification and studies in the pre-clinical and clinical area. As such, the term is not accepted in pharmacological and clinical terminology that is commonly used in the EU." Nootropics Nootropics, or "cognition enhancers", benefit overall cognition by improving memory (e.g., increasing working memory capacity or updating) or other aspects of cognitive control (e.g., inhibitory control, attentional control, attention span, etc.). CNS agents Painkillers Allows<unk>  beyond the usual pain threshold. Some painkillers raise blood pressure, increasing oxygen supply to muscle cells. Painkillers used by athletes range from common over-the-counter medicines such as NSAIDs (such as ibuprofen) to powerful prescription narcotics. Sedatives and anxiolytics Used in sports like archery which require steady hands and accurate aim, and also to overcome excessive nervousness or discomfort. Diazepam and propranolol are common examples; ethanol and cannabis are also used occasionally. Blood boosters Blood doping agents increase the oxygen-carrying capacity of blood beyond the individual's natural capacity. They are used in endurance sports like long-distance running, cycling, and Nordic skiing. Recombinant human erythropoietin (rhEPO) is one of the most widely known drugs in this class. Erythropoietin Erythropoietin, or EPO, is a hormone that helps increase the production of red blood cells which increases the delivery of oxygen to muscles. It is commonly used among endurance athletes such as cyclists. It functions by protecting red blood cells against destruction whilst simultaneously stimulating bone marrow cells to produce more red blood cells. Potential side effects include: dehydration and an increase in blood viscosity which could result in a pulmonary embolism or stroke. Per the World Anti-Doping Agency, it is a banned substance. Urine samples can be tested via electrophoresis, and blood samples via indirect markers. Gene doping Gene doping agents are a relatively recently described class of athletic<unk> s. These drug therapies, which involve viral vector-mediated gene transfer, are not known to currently be in use . Prohormones Also known as anabolic steroid precursors, they promote lean body mass. Once in the body, these precursors are converted to testosterone and because they increase endogenous testosterone. The desired effects of steroid precursors however, are often not seen as they do not bind well to androgen receptors. Examples of prohormones include norandrostendione, androstenediol, and dehydroepiandrosterone (DHEA). These steroids have little desired effect compared to anabolic steroids, but have the same side effects. Androstenedione in 2005 became classified as a controlled substance by WADA, however DHEA can still be obtained legally as an over-the-counter nutritional supplement.
Performance-enhancing substance
Appetite stimulant
Heroic medicine
Stimulant
Psychoactive drug
Endocannabinoid enhancer
Natural neuroactive substance
Synthetic cannabinoids