Dopaje Atletas

Use of androgens and other hormones to enhance athletic performance
Author
Peter J Snyder, MD
Section Editors
Alvin M Matsumoto, MD
Michael P O'Leary, MD, MPH
Deputy Editor
Kathryn A Martin, MD
Disclosures
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Apr 2012. | This topic last updated: Feb 21, 2012.INTRODUCTION — Hormonal medications have been used for many years to improve athletic performance. The focus of the general news media is on the athletes who are caught using these medications in popular sporting events, such as the Olympics, baseball, and the Tour de France bicycle race [1]. However, recreational athletes also use these medications, and less often others use them to improveoverall strength and appearance [2].
This topic will focus on the epidemiology, physical effects, and adverse effects of hormones used to improve athletic performance and physical appearance. The use of non-hormonal agents is reviewed separately. (See "Non-hormonal performance enhancement".)
EPIDEMIOLOGY — The use of androgens has spread from competitive sports to leisure and fitness sports [2-4].Bodybuilders and non-athletes use androgens as a strategy to increase muscle mass and physical attractiveness. The frequency of this use of drugs by athletes and non-athletes has been addressed in a number of studies:

* In 2009, the United States Anti-Doping Agency (USADA) reported performing over 8000 tests in Olympic, Paralympic, and Pan American sports; 26 potential doping cases wereidentified [5].
* It is estimated that approximately 1 percent of the entire population in the US and Sweden use androgens [3].
* In one US survey, nearly four out of five users of androgens were recreational athletes and body builders [2]. In addition, 1 out of 10 users reported hazardous injection techniques, including sharing needles.
* In 2007, the Centers for Disease Control(CDC) reported that 3.9 percent of high school students had taken androgenic steroids without a doctor's prescription at least once [6].
* Most adolescent steroid users are boys. In 2009, the Monitoring the Future Survey of the National Institute of Drug Abuse reported that 1.0, 1.2, and 2.5 percent of 8th, 10th, and 12th grade boys, respectively, had used steroid drugs during the previousyear. Rates were lower in girls (0.5, 0.4, and 0.4 percent for 8th, 10th, and 12th grade girls, respectively). When both groups are combined, annual prevalence rates have decreased compared to 2004 [7].
* The lifetime prevalence of use in girls is estimated to be 2.2 percent [6].
* Growth hormone, like androgens, has been linked to many prominent athletes in sports such as baseball,swimming, and cycling [8]. In addition, approximately 5 percent of US high school students report using growth hormone [3]. (See 'Growth hormone' below.)
* Use of these medications is more common when there is a family or personal history of drug abuse [9], and in sports where use is more prevalent, such as cycling, baseball, and weightlifting.

Patterns of use — As most athletes who takeandrogens or other agents to improve athletic performance do so surreptitiously, the pattern of use differs substantially from that of other medications/drugs:

* Users often obtain the drugs from sources other than clinicians. Some will use drugs intended for veterinary purposes or obtain substances from laboratories that are not regulated by government agencies for manufacturing quality.* Some users will take more than the prescribed dose or will use medications prescribed for others.
* Athletes often take performance-enhancing drugs in various patterns, including in escalating doses ("pyramiding"), consecutively ("stacking"), simultaneously, intermittently, or cyclically, in an attempt to increase the overall effect on performance and the latter to avoid detection....