Performance-enhancing substances in sports: a review of the literature.

Performance-enhancing substances (PESs) have unfortunately become ubiquitous in numerous sports, often tarnishing the spirit of competition. Reported rates of PES use among athletes are variable and range from 5 to 31%. More importantly, some of these substances pose a serious threat to the health and well-being of athletes. Common PESs include anabolic-androgenic steroids, human growth hormone, creatine, erythropoietin and blood doping, amphetamines and stimulants, and beta-hydroxy-beta-methylbutyrate. With recent advances in technology, gene doping is also becoming more conceivable. Sports medicine physicians are often unfamiliar with these substances and thus do not routinely broach the topic of PESs with their patients. However, to effect positive change in the sports community, physicians must educate themselves about the physiology, performance benefits, adverse effects, and testing methods. In turn, physicians can then educate athletes at all levels and prevent the use of potentially dangerous PESs.