REF-1593 · Pope et al., 2014 · Endocrine Reviews · Paper · PubMed · Free full text

An Endocrine Society scientific statement concluded that most users of performance-enhancing drugs are non-athlete weightlifters who often take doses far above physiological levels and combine drugs, and that use has been linked to a higher risk of death and of cardiovascular, psychiatric, metabolic, endocrine, neurological, infectious, liver, kidney and musculoskeletal disorders, and called for observational studies because trials cannot ethically reproduce real-world doses; from the abstract

Main caveat: Written from the abstract (the full text is in PMC, but Europe PMC does not list it as open access); no numbers could be checked.
moderate evidenceMeasured on recreational peopleRead from the abstract only

Pope and colleagues, for the Endocrine Society, argue that media attention to performance-enhancing drugs has centred on cheating by elite athletes while their health risks have been neglected.

They write that most users are not athletes but non-athlete weightlifters, that many people wrongly believe the drugs are safe or their side effects manageable, and that users often take very high doses, combine several drugs and drugs of abuse, and carry other risk factors. Use has been linked to higher risk of death and of disorders across many organ systems.

Because trials cannot ethically give the doses users take, the authors call for observational studies of health risks, studies of prevalence and mechanisms, and trials of treatments for adverse effects such as the anabolic-steroid withdrawal syndrome.

Participants

Not applicable (a scientific statement). Population discussed: users of performance-enhancing drugs, mostly non-athlete weightlifters.

Protocol

Method: synthesis of available information by a society panel; the abstract describes no systematic search or grading.
Scope (MEDLINE indexing): anabolic agents, androgens, erythropoietin, human growth hormone, insulin, performance-enhancing substances.

Key Findings

Supraphysiological doses, combinations with other performance drugs or drugs of abuse, and other risk factors are common among users.
Use has been linked to higher risk of death and of cardiovascular, psychiatric, metabolic, endocrine, neurological, infectious, hepatic, renal and musculoskeletal disorders.
The authors see a widespread misperception that use is safe or that side effects are manageable.
Research gaps named: prevalence, mechanisms of harm, interactions with sports injuries and other high-risk behaviour, and treatment trials for adverse effects, including anabolic-steroid withdrawal.
The abstract gives no rates or effect sizes.

Practical Application

Are performance drugs a health risk? An Endocrine Society statement links performance-drug use — mostly by non-athlete weightlifters on very high doses and combinations — to a higher risk of death and of heart, mental-health, hormonal, liver, kidney and other disorders; 'linked to' marks associations, not effects measured in trials, which the authors say cannot ethically give users' doses, and peptides were not its subject.
The statement names a withdrawal syndrome after anabolic steroids as a condition needing treatment trials. Inference, not tested here: stopping the drugs can bring problems of its own.
Inference, not tested here: if real-world doses cannot be tested ethically in trials, then claims that an unapproved drug or peptide is safe at the doses users take cannot rest on trials either.
Practice, not from this paper: the assistant does not advise on doping drugs or doses; chest pain, palpitations, marked mood change or other symptoms in someone using them go to a doctor.

Limitations

Written from the abstract (the full text is in PMC, but Europe PMC does not list it as open access); no numbers could be checked.
2014; the abstract names anabolic-steroid withdrawal and is indexed under anabolic agents, androgens, EPO, growth hormone and insulin, but does not say how much of the evidence concerns each drug; the users described are mostly weightlifters, not endurance athletes.
A scientific statement, not a systematic review. Users carry other risk factors (authors); inference, not tested here: observational links alone cannot separate drug effects from those factors.
How this entry was checked and changed
Why this level

a consensus or scientific statement not built on a graded systematic review, the rubric's ceiling for this design; read from the abstract only, which gives no numbers, and the authors say trials cannot ethically reproduce users' doses, so harms at those doses cannot be measured in trials (our reading)