Everyone understands the phrase "sports pharmacology" in their own way: for some it is protein and creatine, for others it is hormones and stimulants. The editors figured out which substances really belong to this field, how they are classified, where the medical, sports and legal boundaries are and what risks should be known before making any decisions.
What we call sports pharmacology
Under sports pharmacology, the editors understand the totality of knowledge about substances that people use to support training, recovery, body composition or results. Products of very different status fall here: from ordinary protein and creatine to prescription hormones, which in medicine are prescribed only according to strict indications.
The term historically originated in the sports medicine environment, where team doctors dealt with the correction of deficiencies, treatment of injuries and prevention of overtraining. Later, in everyday use, it expanded and often came to mean specifically doping drugs. Such a change of concepts is dangerous: it mixes dietary supplements and substances with a serious risk profile into one heap.
That is why we find it useful to clearly separate several levels. The first is food and supplements with evidence for defined uses and amounts. The second is medicines that the athlete receives from a doctor for medical reasons. The third is substances used without indications for the sake of the result, and it is at this level that most health problems are concentrated.
The boundary between levels is not always obvious. For example, caffeine is a common component of coffee, but in large doses it can cause arrhythmia. Iron is needed in confirmed deficiency, but an excess damages the liver. Therefore, not only the substance itself is important, but also the context: dose, indication, health status and control.
Classification of substances
There are several ways to classify the tools used by athletes. Pharmacologists group them by mechanism of action, doctors by indications, and anti-doping organizations by status on the WADA Prohibited List. It is most convenient for the reader to combine these approaches in one table.
| Group | Examples | Status |
|---|---|---|
| Food supplements with an evidence base | Creatine monohydrate, caffeine, beta-alanine, protein, vitamin D in case of deficiency | Allowed, sold freely |
| Medicinal products according to indications | Iron preparations, NSAIDs, inhalers for asthma | Part allowed, part only with therapeutic exception |
| Anabolic agents | Anabolic steroids, SARMs | Prohibited at all times (class S1 WADA) |
| Peptide hormones and growth factors | Growth hormone, erythropoietin, insulin | GH and EPO: S2; insulin: S4.4.2 |
| Modulators of hormones and metabolism | Aromatase inhibitors, anti-estrogens | Prohibited (class S4) |
| Stimulants | Amphetamines, ephedrine above threshold | Prohibited during competition (class S6) |
Androgenic anabolic agents are among the best-known groups. They increase protein synthesis through androgen receptors and at the same time affect the heart, liver, blood and reproductive system. Peptide hormones act through other mechanisms, but also intervene in the fine regulation of metabolism.
The so-called substances promoted as potent “fat burners” stand separately: clenbuterol, thyroid hormones, dinitrophenol. These substances accelerate energy expenditure by overloading the heart or disrupting cellular respiration. Dinitrophenol is not a drug at all and has documented fatalities even at relatively small doses.
Finally, an important group consists of means used to "correct" the effects of other drugs. Their independent use without diagnosis often creates a new problem instead of solving an old one — for example, excessive suppression of estrogens damages lipids and bone tissue.
Where borders cross: medicine, sports and law
The first limit is medical. The medicinal product has indications, contraindications, a researched range of doses and a control system. When testosterone is prescribed to a man with confirmed hypogonadism, the goal is to return the hormone to physiological values, not exceed them. The Endocrine Society's clinical guidelines clearly describe for whom such therapy is indicated and how it should be monitored.
The second limit is sports. Anti-doping rules prohibit substances that meet two of three criteria: potentially performance-enhancing, pose a health risk, or are contrary to the spirit of the sport. WADA's list is updated every year, and a competing athlete is responsible for any substance in his or her body — even a contaminated supplement.
The third limit is legal. In many countries, the circulation of anabolic steroids and other powerful drugs is regulated separately from conventional drugs. The rules differ significantly between countries, so the editors do not give legal advice and recommend checking the current legislation of your country.
Anti-doping obligations depend on whether a person is subject to the relevant rules, not simply whether they enter a competition that day. Health risks remain even outside regulated sport, and the absence of testing does not make unsupervised use safe.
- Medical limit: there is a diagnosis, indications and medical supervision.
- Sports Limit: WADA Prohibited List and Federation Rules.
- Legal boundary: national legislation on the circulation of medicinal products.
- Personal Limit: A Conscious Decision Considering Long-Term Consequences.
Main risks
The risks of sports pharmacology depend on the class of substance, dose, duration of use and the state of human health. A scientific review by the Endocrine Society (Pope et al., 2014) systematized the consequences of non-medical use of anabolic agents and showed that they affect almost all body systems.
Cardiovascular consequences are considered the most serious. Supraphysiological doses of androgens reduce the level of "good" cholesterol, increase blood pressure, and can cause myocardial hypertrophy and dysfunction. Stimulants and beta-agonists increase the risk of arrhythmias.
Endocrine consequences are associated with suppression of the own hormonal system. After a long course of anabolic steroids, recovery of testosterone production can take months, and some people develop persistent hypogonadism (Rahnema et al., 2014).
A separate block of risks concerns the psyche: irritability, aggressiveness, depressive states after withdrawal, the formation of addiction. Many researchers attribute the chronic use of anabolic steroids to substance use disorders.
Finally, the illegal market adds a quality risk: wrong dosage, replacement of the active substance, impurities, non-sterile injection forms. Even a high-quality nutritional supplement can be contaminated with prohibited substances, which means disqualification for an athlete.
How to think critically about any substance
The editors propose a simple evaluation algorithm that is suitable for both food supplements and medicinal products. It does not replace a doctor's consultation, but helps to weed out marketing and myths.
- Are there randomized controlled trials in humans, not just cells or animals?
- What is the real effect size and does it matter for your purpose?
- What side effects are described, and how do they depend on the dose?
- Is the substance on the WADA Prohibited List?
- Is it possible to check the quality of the product (certification, third-party analysis)?
For dietary supplements, a good reference is the 2018 International Olympic Committee consensus statement (Maughan et al.). It singles out a small group of products with a strong evidence base—including caffeine, creatine, nitrates, beta-alanine, and sodium bicarbonate—and warns of the risk of contamination.
For prescription drugs, the main question is whether there is a medical indication. Without it, any improvement in outcome comes at the cost of risk, which is difficult to predict for an individual. Genetics, age, co-morbidities and lifestyle change the reaction to the drug.
It is also worth remembering that the basis of progress remains the training program, nutrition, sleep and recovery. These factors give the main part of the result, and their underestimation often pushes people to look for "quick" solutions.
Editorial conclusions
Sports pharmacology is a broad concept that encompasses both supplements with evidence for particular uses and high-risk substances. Mixing these categories makes it difficult to make informed decisions.
Classification by mechanism of action, medical status, and WADA-listed status helps you understand exactly what you're dealing with. Borders are crossed in medical, sports, legal and personal planes.
The risks of prescription hormones, stimulants, and “fat burners” are real and well documented; for some substances, such as dinitrophenol or off-label insulin, there is a risk of death.
To deepen the topic, we advise you to read our materials on the work of androgen receptors, the hypothalamus-pituitary-gonadal axis, and the anabolic and androgenic index.
References
- Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341–375.
- Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439–455.
- World Anti-Doping Agency. The World Anti-Doping Code International Standard: Prohibited List. Montreal: WADA; 2025.
- Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744.
- Rahnema CD, Lipshultz LI, Crosnoe LE, et al. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril. 2014;101(5):1271–1279.
- Kanayama G, Pope HG Jr. History and epidemiology of anabolic androgens in athletes and non-athletes. Mol Cell Endocrinol. 2018;464:4–13.
- Kicman AT. Pharmacology of anabolic steroids. Br J Pharmacol. 2008;154(3):502–521.
