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Jump to Key Points The French Ministry of Sports commissioned the National Institute of Health and Medical Research (Inserm) to conduct an international analysis of literature on doping and performance-enhancing sports practices. A key feature of the report was its focus on doping among amateur athletes, a group that has been studied far less extensively than professional athletes.
The Forum for Anti-Doping in Recreational Sport (FAIR+ project) investigated the prevalence of doping and the motivations behind substance use among amateur and recreational athletes. The survey included nearly 7300 amateur athletes across eight EU countries and more than 200 sports, with 0.4% of participants, all men, reporting the use of prohibited substances. However, more than 10% reported using over-the-counter medications to enhance athletic performance, while more than 40% reported using them to influence sports-related physiologic functions, including pain relief, sleep or mood, and the menstrual cycle.
Products and Medical Supervision
The types of substances used by amateur athletes differed according to the sport and the intended performance-related effects.
- Athletes involved in long-distance running, trial running, and marathons tended to use analgesics, including acetaminophen and nonsteroidal anti-inflammatory drugs, such as ibuprofen and ketoprofen. Some patients also used opioids including morphine, tramadol, and oxycodone.
- In gyms and fitness settings, anabolic-androgenic steroids (AAS) are primarily used to increase muscle mass. Across studies, the prevalence of use in these settings ranged from 10% to 35%.
- Athletes participating in strength and endurance sports, including bodybuilding and soccer, reported a high use of dietary supplements, including vitamins, minerals, and proteins, which were used to support performance.
When used without medical supervision and sometimes on the recommendation of teammates or coaches, these products can pose significant health risks.
- Amateur doping prevalence low: 0.4% reported prohibited substances; all men.
- >10% used OTC meds to enhance performance; >40% for physiologic effects.
- Analgesics common in endurance sports; AAS prevalent in gyms/fitness, 10%-35%.
- AAS risks: CV, renal, psychiatric, reproductive, dependence; MI, thrombosis, hypogonadism.
- Amateur sport vulnerability = poor information + underestimated risks; train care network.
AAS can pose several health risks, including cardiovascular, psychiatric, reproductive, and dependence-related effects:
- Cardiovascular and kidney effects. Use of AAS can damage the heart muscle and impair kidney function, promote atherosclerosis, and increase the risk for myocardial infarction. Among gym goers who used these products, “mortality and the prevalence of certain heart diseases were reportedly three times higher than in the general population, and five times higher for thromboembolic disorders.”
- Psychiatric effects. The use of AAS can cause anxiety, irritability, aggression, and hypomanic or manic episodes.
- Reproductive effects. The use of AAS can induce hypogonadism, potentially leading to infertility, menstrual disorders, acne, and alopecia.
- Use of addictive substances. The use of AAS is associated with a higher risk of misusing other addictive substances, including opioids.
- Dependence and withdrawal. The use of AAS can lead to dependence, with fatigue, depression, and loss of energy after discontinuation.
These risks are well documented in international literature. However, Inserm experts found no recent data from France regarding the adverse effects of AAS.
According to Inserm experts, “amateur sports present two vulnerabilities: a severe lack of information, which encourages a trivialization of the issue [exacerbated by social media, ed.], and an underestimation of the risks associated with taking potentially dangerous substances.”
Hence, the importance of training the ecosystem — doctors, pharmacists, sports instructors, and others — that supports amateur athletes to detect and address these doping behaviors.
Research has indicated that it is necessary to combine informational and educational approaches aimed at creating an “anti-doping culture” that engages peers and those close to the athlete, including family, coaches, teammates, and medical staff.
This does not imply simply applying the same informational and educational approaches used for elite athletes. Instead, efforts to inform athletes about doping and its risks should be adapted to the social contexts of amateur athletes, with better coordination among professionals and others involved in their care.
This story was translated from Univadis France, part of the Medscape Professional Network.
