Table 2.

Potential side effects of different substances and methods of doping

Substance/method	Potential side effects
Androgens (eg, testosterone, danazol, nandrolone, stanozolol)	• Reproductive: diminished spermatogenesis and gynecomastia in men, decreased fertility, decreased testicular size, possible benign prostatic hypertrophy or prostate cancer • Cardiovascular: decreased high-density lipoprotein cholesterol, increased low-density lipoprotein cholesterol • Hepatic: hepatotoxicity • Neuropsychiatric: depression, mania, psychosis, aggression • Other: hastened epiphyseal closure in adolescents, acne, hirsutism, temporal hair recession, clitoromegaly, voice deepening, and oligomenorrhea/amenorrhea in women, infections (abscesses at injection sites, septic arthritis, and hepatitis/human immunodeficiency virus from sharing needles), tendon rupture
Growth hormone and growth factors (eg, insulin-like growth factor, insulin)	• I nsulin resistance, hyperglycemia, diabetes mellitus, cardiomegaly, hastened epiphyseal closure in adolescents, myopathy, hypertension, edema, carpal tunnel syndrome
Stimulants (eg, amphetamine, D-methamphetamine, methylphenidate, ephedrine, pseudoephedrine, caffeine, cocaine)	• Hypertension, tachycardia, myocardial infarction, stroke, heat stroke, weight loss, rhabdomyolysis, headache, nausea, tremor, insomnia, anxiety/panic attacks, agitation, aggression, psychosis
Methods to increase oxygen transport (eg, blood transfusions, recombinant human erythropoietin, darbepoetin alfa)	• Myocardial infarction, stroke, deep vein thrombosis/pulmonary embolism, hypertension, antibody-mediated anemia
Nutritional supplements (eg, vitamins, minerals, herbs, extracts, metabolites)	• Depends on the components • Creatine: acute interstitial nephritis, more rapid progression of chronic kidney disease57,58
Other recreational drugs	• Alcohol: sedation, decreased concentration and coordination • Cannabinoids: reduced alertness, impaired short-term memory, psychomotor retardation, dysphoria, anxiety, psychosis59 • Narcotics: physical dependence, nausea/vomiting, constipation, decreased concentration and coordination, fatigue • Nicotine: chronic use associated with cardiovascular disease, chronic obstructive lung disease, and many types of cancer
Beta agonists (eg, albuterol, formoterol, salmeterol))	• Tachycardia, arrhythmias, hypokalemia, hyperglycemia, tremor
Beta blockers (eg, propranolol)	• Bradycardia, increased airway resistance, decreased endurance
Other prescription drugs	• Diuretics and other masking agents: dizziness, muscle cramps, rash, gout, renal insufficiency, electrolyte imbalances, gynecomastia (spironolactone) • Glucocorticoids: hyperglycemia, fluid retention, depression, mania, psychosis, chronic use may result in reduced muscle mass/weakness, osteoporosis, diabetes mellitus, hypertension, weight gain, central obesity, and cataracts
Gene doping	• Unknown

Note: Copyright © 2013. John Wiley & Sons. Adapted with permission from Baron DA, Reardon CL, Baron SH. Doping in sport. In: Baron DA, Reardon CL, Baron SH, editors. Clinical Sports Psychiatry: An International Perspective. Oxford, UK: Wiley; 2013.16