Is That Perfect Body Worth the Risk? The Truth About PEDs

Normally a taboo topic because it is linked to cheating in sports, performance enhancing drugs (PEDs) have become a popular shortcut to getting a great physique. Many young people are quietly using PEDs to attain their ideal physique within a shorter time and with less effort, without fully understanding the risks involved.

WORDS DR HARPREET KAUR HARNAM SINGH

FEATURED EXPERT DR HARPREET KAUR HARNAM SINGH Consultant Internal Medicine Physician Columbia Asia Hospital — Tebrau

AN INTRODUCTION TO PERFORMANCE ENHANCING DRUGS (PEDs)

Performance enhancing drugs are substances that are taken, particularly amongst athletes, to improve stamina, endurance, and overall physical performance.

• The use of PEDs is banned in most international sports under anti-doping regulations. Athletes caught using them risk suspensions, disqualification, and permanent damage to their careers.
• Moreover, there is limited evidence supporting the effectiveness of PEDs without significant health risks.

WIDESPREAD USE AND POPULARITY

Despite the risks, media coverage of performance-enhancing substances has fueled growing interest and demand.

Once limited to athletes, their use has now spread to gyms and health clubs worldwide.

A new generation of users, influenced by reports of celebrities and sports icons seemingly thriving on these substances, is turning to them for physical enhancement and endurance.

Increasingly, they’re also being used for cosmetic reasons, with younger users chasing idealized body images.

MORE THAN JUST STEROIDS: A CLOSER LOOK INTO PEDs

Anabolic Steroids

• The most common and most widely known PEDs available.
• These are not the same as steroid medications that are routinely prescribed for treatment of asthma or eczema.
• Instead, anabolic steroids are derived from the male sex hormone, testosterone, and serve to mimic the body’s natural testosterone.
• In doing so, anabolic steroids increase lean body mass and muscle strength.

Peptide Hormones

• Produced and released from various glands in the body.
• Synthetic forms of several of these peptides have been developed that have a wide range of therapeutic indications.
• However, over the years they have been gaining popularity in its use for performance enhancement.

Human growth hormone (HGH) is an example of a peptide hormone.

• It is naturally produced by the pituitary gland, and as its name denotes, it is important for growth and development, particularly in puberty and the adolescence.
• The synthetic version is to treat individuals with HGH deficiency.
• However, HGH has become very popular among athletes as a PED because it can increase lean muscle mass and strength. It is particularly favoured amongst athletes that have to endure prolonged high intensity training and sports.

Erythropoeitin (EPO) is a natural peptide hormone that is produced in the kidney to stimulate the bone marrow to produce red blood cells.

• The main function of red blood cells is to transport oxygen to all the cells within our vital organs.
• A synthetic form is available for patients with conditions affecting kidney function or bone marrow function.
• When used as a PED, EPO can increase the number of red blood cells thereby increasing the oxygen carrying capacity of the body. So, the oxygen supply to the muscles is increased. This enhances stamina and allows an athlete to be active for a prolonged period of time.

Insulin is a peptide hormone that is familiar to everyone.

• Insulin is produced and released from the pancreas to regulate blood sugar levels.
• Synthetic insulin is indicated as one of the treatments for type 2 diabetes mellitus.
• However, athletes tend to use insulin as a PED because it has some anabolic properties to build muscle mass.
• If taken inappropriately, it can cause severely low blood sugar levels which can lead to seizures and death.

Selective Androgen Receptor Modulators (SARMs)

• SARMS are a class of therapeutic compounds that are similar to anabolic steroids but without the unwanted side effect of masculinity.
• SARMs have a potential medical role in stimulating specific tissue growth such as bone or muscle, while avoiding side effects to the liver or skin.
• Indeed, SARMs are being evaluated as a treatment for several diseases including osteoporosis, cancer and heart failure.
• However, SARMs have the potential for misuse as a PED due to them having similar properties to anabolic steroids as well as their ability to stimulate bone and muscle growth.
• SARMs are currently not licensed for use but are openly marketed on social media platforms as PEDs.

Beta-2 agonists is one example of SARMs.

• They are available by prescription only for medical use in opening up the airways to help with breathing in those with asthma or other respiratory conditions.
• However, they have become increasingly popular among athletes and bodybuilders as a PED, because they have properties similar to amphetamines.
• They stimulate the heart and the central nervous system, similar to amphetamines and causes excitability, increased energy, increased metabolism and rapid fat burning.
• They are particularly popular among bodybuilders who want to build muscle, lose weight, or enhance their athletic performance.
• However, there is actually no substantial evidence to support the notion that they actually helps with either weight loss or muscle gain.
• Furthermore, misusing beta-2 agonists can lead to serious side effects such as cardiac arrhythmias, electrolyte imbalances, and high blood sugar levels.

THE PRICE OF USING PEDs

Disruptions to Sexual Function

Our body maintains its natural sex hormone production via the hypothalamic-pituitary-gonadal axis.

PEDs disrupt this axis.

Men

• Consuming PEDs, such as anabolic steroids or testosterone, at high doses for a prolonged period of time will result in the complete suppression of natural testosterone in the body.
• This will lead to erectile dysfunction, testicular atrophy, reduced sperm count, and decreased libido.
• Evidence suggests that even upon discontinuing PEDs, it may take up to several years for the symptoms of sexual dysfunction, in particular erectile dysfunction, to recover.

Women

• The use of synthetic androgens and testosterone will suppress oestrogen and progesterone, while enhancing the effects of the synthetic androgens and testosterone.
• This will result in often undesirable masculine traits such as increased facial and body hair, deepened voice, enlarged clitoris, and flattening of the breasts as well as menstrual abnormalities and infertility.

Hair Loss

• PEDs such as anabolic steroids disrupt the body’s hormonal balance particularly by increasing levels of dihydrotestosterone.
• The body converts excess testosterone to dihydrotestosterone, which is a more potent androgen compared to testosterone and is linked to hair loss.
• Hence, increased levels of dihydrotestosterone will cause our hair follicles to shrink, and we eventually stop producing new hair.

Back Acne or Bacne

• Disruption of the hormonal balance of the body and increased testosterone levels from PED use leads to increased sebum production in the skin.
• The body expels excess testosterone onto the skin.
• This testosterone together with bacteria and dead skin cells can cause a breakout of acne, particularly over one’s back. This is because our back has a higher concentration of sweat glands, making it more prone to develop acne.

Ageing, Dry Skin

• Elevated levels of androgens from the use of PEDs thickens the skin layer.
• Over time, this results in breakdown of collagen that leads to a reduction in skin elasticity and dry wrinkled skin.
• The fluctuating hormone levels further contribute to the signs of ageing by causing the skin to sag and the appearance of fine lines and dark circles around the eyes.
• Some PEDs also have properties similar to diuretic medications, which further reduces the skin’s hydration and worsens the appearance of dry aged skin.

Heart Problems

• The use of PEDs including anabolic steroids and caffeine, have detrimental effects on the cardiovascular health.
• The use of PEDs causes the heart pumps faster and harder, and the blood pressure and heart rate are accelerated beyond normal levels.
• This can lead to massive size increase (hypertrophy) of our heart muscles along with subsequent fatigue and failure.
• A constantly high heart rate can increase the risk of abnormal heart rhythms (cardic arrhythmia).
• Anabolic steroids can also enlarge the heart, raise the risk of heart failure, and clog up the arteries by messing with cholesterol levels and making blood more likely to clot.

THE DANGERS OF OBTAINING PEDs THROUGH INFORMAL OR UNREGULATED CHANNELS

Obtaining PEDs from unregulated sources is dangerous as there is a potential risk of consuming counterfeit or contaminated products.

• Unregulated or counterfeit PEDs may contain toxic substances that are not declared on the label, they may provide incorrect ingredients or no active ingredient at all. This can result in complications ranging from treatment failure to poisoning.
• Such products have also been known to provide incorrect dosing information, which can result in overdose.
• Hence, the potential for an adverse event or severe allergic reaction is higher with unregulated PEDs.

THE PSYCHOLOGICAL PRICE OF USING PEDs

• Social media often glamorizes unrealistic body standards, pushing the idea that perfection equals self-worth.
• In chasing this ideal, some turn to PEDs as a shortcut.
• Athletes with perfectionist traits are especially vulnerable, setting extreme goals that natural training alone may not meet.
• PEDs can seem like a way to close that gap but over time, the body builds tolerance, and users become dependent.
• As results plateau, dissatisfaction can grow, sometimes leading to mental health issues like depression or eating disorders.

MY ADVICE TO THE PUBLIC

Before using PEDs, understand that the consequences can be serious and lasting — far beyond the pursuit of muscle or performance.

In fact, before starting any form of hormone or enhancement therapy, please consult a qualified healthcare professional for a full medical assessment, including blood work to ensure your health and safety.

• Be aware of the risks of the treatments you are planning to explore. Even medically supervised treatments have their risks!
• Ensure that you seek consultation from reputable clinics that are licensed and regulated, to ensure your safety.
• Be cautious of advertisements that promise quick fixes with claims of no side effects.