A Guide to the Booming World of Performance Enhancing Drugs and Supplements

ALL PERFORMANCE ENHANCERS claim to help you build muscle and stoke strength. But some of them come at a cost. Here’s your guide to them all—and the risks they carry.

Anabolic Steroids

When Arnold ruled the Mr. Olympia stage in the 1970s, steroid use was basic and legal. “You took one or two doses at a time, and the total amount most guys used per week was significantly less than it is today,” says Mike Israetel, Ph.D., a competitive bodybuilder and cofounder of RP Strength. “Today, bodybuilders often stack several different steroids, layering and overlapping them in cycles that focus on competitions and stretch as long as a year.” Anabolic steroids function similarly to testosterone: They bind to your androgen receptors to help regulate libido, sperm production, bone building, and muscle growth. The federal government designates anabolic steroids as Schedule III substances and has approved only a small number for human use. (Doctors may prescribe some steroids to treat low T.) Anabolic steroids come in two main forms, injectable and oral.

INJECTABLE

EXAMPLES: Testosterone, nandrolone (Deca-Durabolin or “Deca”), trenbolone (Finajet or “tren”), methenolone (Primobolan or “Primo”), drostanolone (Masteron or “Mast”), trestolone (“MENT”), dihydroboldenone (DHB).

SIDE EFFECTS: Testicular shrinkage; infertility; hair loss; mood swings;
paranoia; gynecomastia; heart, liver, and kidney issues; and prostate cancer risk.

ORAL

EXAMPLES: Oxandrolone (Anavar), methandienone (Dianabol), stanozolol (Winstrol or “Winnie”).

SIDE EFFECTS: Testicular shrinkage; infertility; hair loss; mood swings; paranoia; gynecomastia; heart, liver, and kidney issues; and risk of prostate cancer—plus a more elevated risk of liver damage than with injectable steroids.

Clenbuterol

Made famous by pro cyclist Alberto Contador, who attributed his failed drug test to tainted meat, clenbuterol is classified as a bronchodilator in countries where it’s prescribed legally. (The U. S. isn’t one of them.) Despite its main use in facilitating breathing, clenbuterol also has steroid-like effects, including an ability to elevate metabolism and support muscle building.

SIDE EFFECTS: Heart palpitations, tremors, anxiety, agitation, and insomnia.

KNOW THIS: “This is a gnarly drug,” says Israetel, adding that it feels like a super stimulant when you take it. So don’t.

Growth Hormone (GH or HGH)

Secreted by the pituitary gland, growth hormone is vital for regulating metabolism and stimulating growth in just about every bone and tissue in your body, including your muscles. Popular with bodybuilders (and allegedly Barry Bonds), GH, in addition to increasing muscle growth, minimizes fat gain and improves sleep quality.

SIDE EFFECTS: Mild ones include increased blood-sugar levels
(a reason it’s often stacked with insulin); fluid retention, which causes swelling in the extremities; and breast enlargement. Severe side effects include an increased risk of diabetes and certain cancers.

KNOW THIS: It’s illegal unless you have a prescription. Two of the most potent ways to dial up GH production naturally are high–quality sleep and regular exercise that includes strength training.

Testosterone Replacement Theory (TRT)

If you have low T (below 300ng/dl), you might experience a reduced sex drive, erectile dysfunction, fatigue, sleep issues, and difficulty building muscle and strength. That’s where TRT comes in. Typically administered in a medical setting with a prescription from a doc, “TRT can be life-changing,” says Israetel. “Getting your T back up into the normal range can make you feel like you’re 22 again—you’ll have a greater zest for life and pack on muscle more easily.”

SIDE EFFECTS: Acne, disturbed breathing during sleep, breast swelling or tenderness, and growth of the prostate.

KNOW THIS: If you have a normal T level, TRT is unlikely to make any difference at all.

Insulin

This naturally occurring hormone regulates blood-glucose levels. Diabetics need to take insulin because their bodies don’t produce enough (or any) of it, but it’s also used by bodybuilders to facilitate protein synthesis (i.e., muscle growth) by enhancing nutrient storage and inhibiting protein breakdown.

SIDE EFFECTS: Low blood sugar (hypoglycemia), which can result in fatigue, hunger, irritability, confusion, headache, irregular heartbeat, and (in severe cases) loss of consciousness, seizures, coma, and even death.

KNOW THIS: Because insulin tends to lower blood-sugar levels, it’s important to pair it with the appropriate amount of carbs to prevent hypoglycemia.

Erythropoietin (EPO)

This hormone, made infamous by Lance Armstrong, is produced naturally by the kidneys to stimulate red-blood-cell production. But injecting the synthetic version can inflate that count, enhancing your body’s ability to transport oxygen to working muscles and skyrocketing your aerobic capacity and endurance. If you suffer from anemia caused by kidney disease, such injections prescribed by a doctor can be lifesaving. If you’re an athlete? Well, EPO is banned by every major sport governing body.

SIDE EFFECTS: Elevated risk of pulmonary and cerebral embolism and heart disease.

KNOW THIS: “EPO is really only used by endurance athletes, especially cyclists,” says Israetel, noting that any benefit is unlikely to outweigh the health risks.

SARMs

That’s “selective androgen receptor modulators,” and in the 1990s they were viewed as a safer alternative to steroids. Most commonly taken orally, SARMs remain popular (boxer Ryan Garcia failed a drug test for them recently) and are similar to steroids in that they target androgen receptors.

EXAMPLES: Andarine, Ostarine

SIDE EFFECTS: Testicular shrinkage, liver injury and failure, infertility, sexual dysfunction, sleep disturbances, and increased risk of heart attack and stroke.

KNOW THIS: They’re considered a Schedule III controlled substance and not approved by the FDA for any current medical use. They’re banned by the NCAA, the World Anti-Doping Agency, and the U. S. Department of Defense.

Peptides

Composed of short chains of amino acids, peptides are signaling molecules that regulate various processes from metabolism to tissue growth. Synthetic versions claim to crank up fat burning, enhance sleep quality, or accelerate recovery.

EXAMPLES: BPC-157 (healing and recovery), MK-677 (muscle growth).

SIDE EFFECTS: TBD. The research on the short- and long-term risks of taking peptides is still evolving but points to hormone imbalance and even impaired pituitary function.

KNOW THIS: They’re not all FDA approved; some are prescription only, to be administered by a physician. Some are illegal and banned for sport.

Creatine

Creatine is a compound made by your body and is in red meat, fish, and milk. It enhances your ability to generate quick bursts of energy and increase strength. By supplementing with 5mg of creatine a day, you can raise the amount stored, boosting its effect.

SIDE EFFECTS: Water retention in your muscle cells, which can add five to ten pounds of weight.

KNOW THIS: “Creatine monohydrate is one of the best-studied supplements,” says Israetel. It’s safe and effective when taken as directed.

Beta-alanine

A common ingredient in pre-workout supplements, beta-alanine combines with another amino acid to buffer muscle acidification during extended or intense exercise. Translation: It may help fight muscle fatigue.

SIDE EFFECTS: Paresthesia—a mild, skin-tingling pins-and-needles sensation—soon after ingesting it. It’s harmless and passes quickly, but if it bothers you, reduce your dose.

KNOW THIS: Like creatine, beta-alanine takes up to a month to build to sufficient levels in your cells and make a difference in your workout. If you decide to include it, take it consistently.

Protein Powder

Your muscles need protein in order to recover from and adapt to any form of exercise. Most people don’t eat close to the one gram of protein per pound of your desired bodyweight per day that MH recommends, which makes supplementing critical.

SIDE EFFECTS: Dehydration and digestive issues.

KNOW THIS: Whey reigns supreme thanks to its “complete” amino-acid profile, but many plant proteins, especially soy and pea, work well, too.

BCAAs

Short for branched-chain amino acids, they’re a common ingredient in many pre-workout products designed for fitness performance.

SIDE EFFECTS: Low blood sugar and gastrointestinal upset. If you take them as instructed, you have little to worry about. Use with caution if you have existing heart, liver, or kidney issues.

KNOW THIS: If a protein shake is a regular part of your routine, you can skip the additional BCAAs. “They’re probably already in that shake,” says Israetel. “So save your money.”

Herbal Testosterone Boosters

Some plant-based supplements claim to naturally crank T production.

EXAMPLES: Tongkat ali, Fadogia agrestis, Tribulus terrestris.

KNOW THIS: A lack of human studies and FDA regulation means that nobody has a solid grasp on the hazards of taking these supplements in the short or long term. “They stimulate so little muscle growth that it’s almost undetectable,” says Israetel.

This story appears in the September-October 2024 issue of Men’s Health.

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Additional Credits: Arnold Schwarzenegger: Michael Ochs Archive/ Getty Images, Jose Canseco: Ron Vesely/ MLB Photos/ Getty Images, Lance Armstrong: Tim de Waele/ Corbis/ Getty Images, Ben Johnson: Mike Powel/ Allsport/ Getty Images, Liver King: Mega/ GC Images/ Getty Images, Joe Rogan: Carmen Mandato/ Getty Images, Chris Burnstead: Chris Bernacchi/ Diamond Images/ Getty Images