Ergogenic Aids 101

July 9, 2020
Ergogenic Aids 101

Written by Bruce Greene, MD, MHA

In the Olympic film epic “Chariots of Fire” Eric Liddell asks, “Where does the power come from to see the race to its end?” His definitive answer was “from within”. More than eighty years later some may argue that this answer is no longer true for many athletes. Indeed the power may come from without in the form of drugs created to maximize performance.

As a society, we have been bombarded by ads in fitness magazines regarding products that claim to increase speed and endurance, improve strength, increase muscle mass or reduce body fat. Our youth are curious about performance enhancing agents and demand answers. We can no longer merely state that these agents are harmful without giving them a reasonable explanation as to why they are potentially dangerous. In fact, some surveys suggest that 2.5 percent of eight graders (13-14 year olds) have used steroids. And, even more alarming is that 7 percent began using steroids at age 10 or younger. Our best hope is to communicate openly and honestly about steroids and other ergogenic aids and hope that they will then make correct choices.

Nutritional ergogenic aids are dietary supplements that supposedly enhance performance above levels anticipated under normal conditions. In 1994, Congress passed the Dietary Supplement and Health and Education act after the health food industry and its allies urged congress to preserve the consumer’s freedom to choose dietary supplements. This law greatly weakened the ability of the U.S. food and drug administration (FDA) to protect consumers. Under the DSHEA, dietary supplements and ergogenic aids do not have to be proven safe or effective to be sold. There is also no guarantee that the products are what they say they are on the labels. 

Below are a list of commonly used ergogenic aids and their possible side effects:


Creatine is a derivative of amino acids and has gained popularity among athletes participating in power sports like football. It is found in skeletal and cardiac muscle, brain, retinal, testicular, and other tissues. Some studies have shown that oral creatine supplementation can improve sprint and power performance during repeated short duration bouts of high intensity exercise. Other studies have noted weight gain during the first 6 weeks of use. Lean body mass increase has averaged about 2 to 5 kgs. The majority of available data on creatine and endurance exercise suggest that it does not improve performance.   This ergogenic aid became popular after a 1992 study suggested that high doses of creatine resulted in a 20 percent increase in skeletal muscle mass.

Adverse effects: There are not any reported major side effects for short term (eight weeks) supplementation of creatine. However, it can cause weight gain due to increased accumulation of cellular water in muscle. Long-term side effects include muscle cramping, dehydration, gastrointestinal distress, nausea, and seizures. There is speculation that long-term creatinine use may affect kidney function.  The kidneys will usually excrete the un-stored excess. This requires that the athlete increase his/her water intake. Failure to over hydrate can lead to renal failure. 


Androstenedione is a direct precursor of testosterone, a potent androgen, and is sold as a non-prescription nutritional supplement. It is supposed to build muscle mass and promote recovery from injury. This claim cannot be substantiated by objective data. A recent study showed that there was no increase in muscle mass in men given daily doses of 300 mg of androstenedione compared with placebo.

Adverse effects: The same study that showed no increase in muscle mass also found decreased levels of high density lipoproteins (HDL) and elevated levels of estrogens. Low levels of HDL have been implicated in cardiovascular disease risk. An increase in estrogen concentration may increase the risk of cardiovascular disease, breast cancer, and pancreatic cancer. The NCAA, NFL, USOC and IOC have banned Androstenedione.

Anabolic Steroids

These are synthetic derivatives of testosterone. Their original purpose was for the treatment of impotence and to reverse the wasting effects of burns and chronic debilitating illness. Taken in sufficient doses, anabolic steroids can increase muscle size and strength. Use of anabolic steroids has become increasingly popular among strength athletes including weight lifters, football players and body builders. Once the athlete discontinues use of the anabolic steroids the increased size and strength disappear.

Adverse effects: The list is long, including hepatocarcinoma, stroke, tendon rupture, osteonecrosis of the hip, psychosis and suicidal behavior. Anabolic steroids can also cause masculinizing effects in women, such as male-pattern baldness and deepening of the voice that can be irreversible.

Growth Hormones

Growth Hormone has become popular among some athletes because it increases muscle mass but is more difficult to detect than anabolic steroids. Strength and performance have been noted to improve with use of growth hormone although there have been no objective studies to document these results.

Adverse effects: The adverse effects of exogenous administration of growth hormone include gigantism in children and acromegaly in adults. Acromegaly can lead to heart disease, impotence, myopathy, osteoporosis, and death.

Health care providers have been forced to become more knowledgeable about ergogenic aids. Additionally, athletes are encouraged to read as much as possible about these agents and their potential dangers so that they can make an informed and healthy decision.