Fair Play or Foul? The Impact of Doping on Athletic Integrity

Explore the ethical, health, and performance implications of doping in sports, shedding light on the controversies and choices facing athletes today

In the competitive world of sports, the line between success and integrity can sometimes blur, leading athletes down the path of doping. As a former marathon runner, I’ve seen how the pressure to excel can tempt even the most dedicated athletes to consider performance-enhancing substances. This article aims to shed light on doping’s realities, examining its impact on health, performance, and the ethical landscape of sports. Join me as we dive into an honest discussion about the challenges and choices athletes face in the pursuit of greatness.

The word “doping” is often associated with high-profile scandals in competitive sports. Athletes are caught using banned substances, disqualified, and stripped of their medals and titles.

However, few are aware of the specifics of the substances athletes use, how these substances enhance human capabilities, and ultimately, their impact on health.

What is Doping

Doping refers to the prohibited substances and methods that can give an individual an advantage in sports competitions. According to the World Anti-Doping Agency’s definition, doping is any violation of anti-doping rules. This includes distribution of a banned substance, failure to show up for a drug test, or attempting to tamper with any stage of doping control.

Athletes competing at national or international levels can be selected at any time for doping control — asked to provide a sample for testing. If an athlete refuses or fails the test for banned substances, they can be disqualified.

Despite the variety of drugs and methods, a significant number of athletes use doping in some form. However, it’s challenging to confirm this as no one voluntarily admits to doping until caught.

A meta-analysis in 2021 revealed that in most cases, less than 5% of athletes use doping. In another study, where scientists used cleverly designed questions, 30–45% of athletes admitted to using banned methods.

Many athletes start doping even before they begin competing, which can provide advantages during training. By the time they enter the international arena, they are already “clean.”

Substances and Methods Considered Doping

As of January 1, 2024, an updated list of prohibited substances and methods by WADA has come into effect. Below, we list what athletes are not allowed to take.

Anabolic Androgenic Steroids

These are synthetic analogs of male sex hormones, including testosterone, androstenedione, dehydroepiandrosterone, among others, with more than 60 substances banned in this category.

These drugs help increase muscle mass, both by enlarging existing muscle fibers and forming new ones.

Furthermore, androgenic steroids can provide a strength increase of 5 to 52%, with effects lasting for several years.

Young athletes in power sports, such as powerlifting or weightlifting, often use anabolics. Bodybuilders also use them to achieve their “dream physique” faster.

However, the use of anabolic steroids poses serious health risks, including:

• Severe acne;
• Gynecomastia — development of breast tissue in men;
• Hirsutism — excessive hair growth on the face and body in women;
• Testicular shrinkage;
• High blood pressure;
• Stunted growth in young people;
• Severe mood swings;
• Manic behavior;
• Male-pattern baldness in both sexes;
• Irregular menstruation;
• Infertility;
• Increased risk of thrombosis;
• Jaundice;
• Liver tumors or cancer;
• Kidney problems and failure.

Peptide Hormones, Growth Factors, and Mimetics

Peptide hormones play a crucial role in human physiology and behavior. The WADA list includes several types of such prohibited substances.

First on the list are erythropoietins. These hormones, synthesized in the kidneys, stimulate the production of red blood cells in the bone marrow. They are used medically to treat anemia due to kidney disease and chemotherapy.

For athletes, these drugs help increase hemoglobin levels. Since this protein delivers oxygen to the body’s tissues, increasing its quantity can enhance endurance.

Therefore, this type of doping is most commonly used by skiers, track and field athletes, cyclists, biathletes, and triathletes — athletes who need to use oxygen as efficiently as possible.

However, erythropoietins have side effects. These drugs increase blood viscosity and the risk of thrombosis, can trigger the growth of tumors in the breast, lungs, head and neck, lymphoid system, and cervix. Other side effects include digestive disorders, fatigue, various pains, insomnia, rashes, and paresthesia — a feeling of numbness or tingling in the limbs.

Next on the WADA list are peptide hormones and releasing factors. This class includes testosterone-stimulating hormones, corticotropins, and growth hormone. Such drugs are primarily used to build muscle and increase power. They are often used in conjunction with erythropoietins for comprehensive improvements.

Although growth hormone is used by athletes and amateurs and seems to help gain muscle mass, controlled studies do not show a significant effect.

For example, it does not increase strength, and its effect on protein synthesis is no greater than a placebo.

Side effects include swelling of the hands and feet, coarser facial features, dental problems, fluid retention, and excessive sweating. Long-term use also increases the risk of diabetes and hypertension, cardiomyopathy, osteoporosis, irregular menstruation, and impotence.

Beta-2 Agonists

These asthma medications help dilate the bronchioles and improve breathing. Athletes with bronchial asthma can use them, but healthy individuals cannot.

Some studies have shown that inhaling these drugs by people not suffering from the condition, 10–30 minutes before exercise, helped improve peak power, work time, and performance. However, these experiments involved amateurs, and the most significant effect was observed in the weakest subjects.

At the same time, beta-2 agonists are unlikely to significantly help professional athletes since their respiratory efficiency is already optimal, and other factors limit performance.

Side effects from these drugs include increased heart rate, headache and dizziness, nausea, tremor, nervousness, insomnia, and stomach upset. Allergies, chest and ear pain, irregular heartbeat, skin redness, and breathing difficulties may also occur.

Hormones and Metabolic Modulators

As synthetic androgens are easily detectable, even months after intake, athletes needed to find something less noticeable. Thus, they began using other drugs that affect estrogen suppression and thereby exert an androgenic effect.

For instance, aromatase inhibitors block the synthesis of the female sex hormone estradiol and are used to treat breast cancer in women, while in men, they can increase testosterone levels by half.

Side effects include ulcers and blisters, allergic reactions, liver inflammation, and reduced bone density due to a lack of estrogen. Joint pain (arthralgia) is also common.

Other drugs with anabolic effects include selective estrogen receptor modulators used to treat and prevent breast tumors. These medications can also increase the amount of free testosterone and mitigate side effects from taking anabolic steroids.

However, taking these drugs can lead to thrombosis in the legs, pulmonary embolism, and even death.

Metabolic modulators include substances that can affect a person’s physical and mental state, such as the controversial meldonium and trimetazidine. Both drugs help protect heart cells and, in theory, can increase endurance, reduce oxidative stress, and aid recovery after exertion.

Despite being on the WADA prohibited list, there is no solid evidence that meldonium or trimetazidine can improve athletes’ performance significantly.

As for side effects, meldonium may cause allergies, stomach upset, tachycardia, and blood pressure changes, while trimetazidine can cause nausea and vomiting, headache.

In rare cases, trimetazidine may reduce the number of platelets and white blood cells, lead to liver dysfunction, and worsen Parkinson’s disease conditions.

Diuretics and Masking Agents

These drugs increase urine volume and sodium excretion. Athletes might use diuretics to quickly shed extra pounds and fit into a specific weight category, gaining an advantage over other competitors.

Moreover, such drugs can help rapidly eliminate other previously taken prohibited substances.

However, using diuretics can be dangerous for several reasons.

Dehydration adversely affects the cardiovascular system and disrupts thermoregulation, potentially leading to fatigue, irregular heart rhythm, and even a heart attack during physical exertion.

Diuretics also deplete potassium from cells — its deficiency can cause painful muscle cramps.

Stimulants and Narcotics

Stimulant drugs act on the nervous system, increasing alertness and concentration, reducing fatigue, and potentially enhancing the desire to win. Therefore, they are prohibited during competition periods.

The most common stimulants, nicotine and caffeine, are not considered doping. However, other substances in this class, such as amphetamines, cocaine, or ephedrine, are understandably banned.

Cannabis is also on the prohibited list, though it’s unlikely to enhance sports performance.

Since stimulants can decrease perceived effort and dull pain sensation, their use during competitions can lead to heatstroke, heart attacks, serious injuries, seizures, and even death.

Furthermore, the use of stimulants can cause dependency, insomnia, headaches, anxiety, and induce psychosis.

Glucocorticoids

These are steroid hormones that affect the metabolism of glucose, protein, and fats in the body. In medicine, such drugs are used to combat inflammation and allergies, and are prescribed for Crohn’s disease, ulcerative colitis, rheumatoid arthritis, and blood disorders.

Athletes take them to reduce pain and inflammation, making glucocorticoids banned during competitions.

Long-term use can cause serious side effects: weight gain, acne, muscle weakness, tendon damage, skin thinning, osteoporosis, stomach irritation, hypertension, depression, and increased susceptibility to infections.

Beta-Blockers

These drugs block the effects of adrenaline, slowing the heart rate and reducing the force of heart muscle contractions. This decreases the workload on the cardiovascular system and lowers blood pressure.

In medicine, beta-blockers are used for heart diseases, migraines, social anxiety disorder, hypertension, glaucoma, and tremors.

Beta-blockers are banned during competition in sports where maximum relaxation is crucial for precise actions to prevent shaky hands: golf, darts, auto racing, skiing and snowboarding, mini-golf. In sports like underwater swimming, archery, and air rifle, these drugs are prohibited even outside of competitions.

Side effects of beta-blockers include depression, fatigue, cold hands, headaches, constipation, and sexual dysfunction. They can also worsen symptoms in people with asthma, peripheral artery diseases, and lower blood sugar in individuals with diabetes.

Blood Manipulation and Its Components

This method involves the transfusion of hemoglobin-rich blood. With additional proteins, an athlete’s body can use oxygen more efficiently, offering significant advantages in endurance sports.

However, this type of doping can lead to complications for the cardiovascular system. After a transfusion, the blood becomes thicker, and the heart must work harder to pump it. This increases the risk of thrombosis, heart attacks, and strokes.

Gene and Cell Doping

This is one of the newest therapeutic methods, where DNA, RNA, or genetically modified cells are introduced into the body to compensate for missing or abnormal genes. This way, it’s possible to treat conditions like hemophilia, cystic fibrosis, infections, or ischemic heart disease.

In sports, such methods can enhance an athlete’s performance by making their body express specific genes. For example, those regulating oxygen delivery, capillary density, mitochondrial content in muscles, pain management, and muscle tissue growth.

The use of gene doping increases the risk of cell mutations, abnormal cell growth regulation, toxicity from chronic overexpression of growth factors and cytokines, and tumor formation. Athletes risk developing cancer, damaging muscles, tendons, and ligaments, reducing immunity, and dying from a heart attack or stroke.

Can Amateur Athletes Use Doping

Many WADA-banned drugs are sold over the counter, so some people buy and use them at their discretion. However, whether it’s wise to interfere with the body’s functioning is a significant question.

The negative effects of doping often outweigh the benefits they might provide. For example, using growth hormone or insulin-like growth factor can speed up muscle mass formation but also lead to cancer.

Using erythropoietin to achieve better competition times can result in death from a thrombus. Injecting painkillers to run a marathon can cause serious injuries.

Moreover, athletes often learn about drugs from gym buddies or coaches. But just because some had positive experiences doesn’t mean others won’t be harmed by the same substances.

Using some medications can exacerbate pre-existing conditions you might not yet be aware of. So, if you’re seriously considering trying drugs to accelerate muscle growth, improve endurance, or recover faster from injuries, at least consult with a physician first and discuss the potential health risks.

In conclusion, the world of sports is at a critical juncture, where the choices we make today will shape the legacy of athletics for generations to come. Doping, with all its allure and dangers, challenges the very principles of fairness and health that sports are meant to promote. As we’ve explored the various facets of performance enhancement, it’s clear that the path to true excellence lies not in the syringes and pills, but in the heart and spirit of the athlete. Let us champion a future where victories are earned through dedication, resilience, and fair play, preserving the integrity of sports for all who love and participate in them.