Table 3.

Selected performance-enhancing drugs used in relation to AAS.

Class	Selected formulations	Intended effects	Adverse effects
Aromatase inhibitors [46]	Anastrozole, letrozole, exemestane	Increase pituitary gonadotrophin release and therefore increasing endogenous testosterone release by reducing estrogenic negative feedback	Decreased bone density, sexual dysfunction, central adiposity
SERMs [46]	Clomiphene, tamoxifen	Increase pituitary gonadotrophin release and therefore increasing endogenous testosterone release by reducing estrogenic negative feedback	Vasomotor symptoms, visual disturbances, headaches
Fat-burning compounds	Dinitrophenol, liothyronine (T3), clenbuterol	Achieve lower body fat percentages	Hypertension, arrhythmias
Insulin	Lispro, glargine	Increase lean muscle mass	Hypoglycaemia
Human growth-hormone (hGH)	Varied	Hypertension, elevated malignancy risk	Hypertension
Diuretics	Furosemide, hydrochlorothiazide, torsemide	Reduce water retention to improve perceived muscle aesthetics usually taken before competition	Electrolyte disturbances, especially hypokalaemia
SARMs	Andarine, Ostarine, Ligandrol	Increase lean muscle mass	Unknown (experimental compounds)
Human chorionic gonadotropin (hCG) [47]	Varied	Counteract AAS suppression of testicular function and volume, raise testicular testosterone production	Diabetes, cardiomyopathy, renal failure, hepatotoxicity, edema, carpal tunnel syndrome, joint pain, fatigue
Site enhancement oil	Water-based, oil-based, and silicone-based injection options	Improve perceived aesthetics of muscle by locally expanding volume	Infection
Creatine [48]	Varied	Increase performance in short-duration, high-intensity exercises	Water retention, gastrointestinal symptoms, fatigue diarrhoea, liver and renal complications