From Gains to Grave Risk: The Toxic Truth About Performance Enhancers

Background: Performance-enhancing agents (PEAs) use is on the rise, particularly among young adolescents and adults, which can have major negative repercussions, like sudden cardiac death. Objectives: The objectives of this review were to define PEAs, determine different classes of PEAs, describe legal regulations of doping substances, demonstrate the prevalence of PEAs, especially in Egypt, discuss the mechanism of action and toxicity of different types of PEAs, describe gene doping, outline PEAs testing, and the treatment approach of their toxicity. Conclusion: Anabolic agents, especially androgenic steroids, nutritional supplements, and energy drinks, take the upper hand among these agents. Sportsmen and gymgoers usually take more than one type of PEAs, leading to the magnification of their adverse effects. Various toxic effects on different systems, especially the heart, liver, kidney, and brain, have been reported. Anabolic agents, especially anabolic androgenic steroids (AASs), are considered the most harmful PEAs that have dangerous effects on different organs, especially the heart. Cardiomyopathy, arrhythmias, myocardial infarction, atherosclerosis, thrombosis, dependence, tumors, renal failure, and decrease in fertility can occur with long-term use of AASs. The difficulty in testing lies in the diversity of PEAs. Screening and confirmation by mass spectrometry are components of traditional testing. Treatment of PEAs toxicity depends mainly on symptomatic and supportive treatment. Raising awareness among the public and medical staff about the dangers of PEAs and promoting healthy practices, governmental control over the shipping of such agents, and early consultation with a medical toxicologist when any adverse toxic effects appear are recommended.