PED Talk: A Pharmacist’s Primer to Performance Enhancing Drugs

Kimmy Nguyen
Dec 23, 2025
4 min read

Written by Lauren Wilcox, PharmD, BCACP

It’s unlikely that you learned about anabolic steroids or other performance enhancing substances in your pharmacy training because these are not commonly encountered in most fields of pharmacy. However, this is a growing area of pharmacy with pharmacists working in sports medicine specialties alongside athletes. Even in more traditional pharmacy careers, there are opportunities in daily practice to address issues with these substances and provide guidance to non-athlete patients.

Performance enhancing drugs (PEDs) are defined by the U.S. Anti-Doping Agency (USADA) as drugs that “have the ability or potential to drastically alter the human body and biological functions, including the ability to considerably improve athletic performance in certain instances.”(1) One common example of a class of PEDs is anabolic steroids which are synthetically produced derivatives of testosterone. This differs from glucocorticoids (confusingly also referred to as “steroids”) which are cortisol derivatives. Anabolic steroids bind to androgen receptors and are used to increase muscle mass, strength, and bone density. Doses that are abused are generally 10-100 times higher than any therapeutic approved dose. (2) While there might be athletic benefits gleaned, there are many consequences of abuse of these drugs including acne, mood disorders (“roid rage”), increased cholesterol (ultimately leading to cardiac events), infertility, breast changes, male baldness, and others.(2,3) These common symptoms can be used to help practitioners spot steroid abuse in patients simply based on physical exam.

For those working with college or Olympic-level athletes, close attention must be given to the types of prescriptions these athletes receive, as even some prescription medications can be considered performance-enhancing. Some examples of common medications that could be performance-enhancing include insulin, stimulants, beta-blockers, and beta2-agonists.(4,5) A prescription medication can be classified as performance-enhancing based on its potential to enhance sport performance (i.e., pain reduction, increased glycogen storage, weight loss, increased alertness, etc.) or based on its potential health risk to an athlete.(6) Before prescribing, medications should be checked through the Global DRO (drug reference online) website (4) for Olympic athletes and through the Drug Free Sport Axis website (7) for NCAA athletes (subscription likely obtained through the university). For athletes with a medical indication for a prohibited medication, exceptions can be made with submission of necessary paperwork.

Not all performance enhancing drugs are illegal or banned. For example, creatine has been deemed safe and effective both for performance enhancement and also for some medical indications.(8) Other over the counter (OTC) products such as branched chain amino acids may also be safe and effective.(9) However, caution must be taken with OTC products as they are not FDA regulated.(10) It is best to check for products that have 3rd party testing and certification.(11,12)

While it is easy to think that abuse of PEDs is mainly an issue within athlete circles, easy access to the internet (including social media, influencers, and black-market products) in addition to societal body image pressure has made this an issue outside of the realm of athletes.(13,14) These online messages can be particularly influential on young/teenage populations who may not fully understand the consequences of using PEDs.(15)

Pharmacists can play a role in this area by providing guidance to athlete patients, helping prepare and submit necessary exemption paperwork, spotting abuse of substances in everyday patients, supporting sports medicine or athletic teams, or having meaningful conversations about potential dangers with patients and parents of under-age patients. For those looking to get more plugged in with this field, a great place to start is by networking through the International Sports Pharmacists Network (16) or the U.S. Sports Pharmacy Group.(17)

1. Effects of performance-enhancing drugs: USADA. U.S. Anti-Doping Agency (USADA). August 27, 2024.

2. Steroids. DEA. https://www.dea.gov/factsheets/steroids.

3. Anabolic Steroid Misuse. April 13, 2022. https://www.nhs.uk/conditions/anabolic-steroid-misuse/.

4. Global Dro. https://www.globaldro.com/US/search.

5. NCAA banned substances. June 24, 2025. https://www.ncaa.org/sports/2015/6/10/ncaa-banned-substances.aspx.

6. The Prohibited List. January 1, 2025. https://www.wada-ama.org/en/prohibited-list.

7. Drug free sport. https://axis.drugfreesport.com/login.

8. Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18. Published 2017 Jun 13. doi:10.1186/s12970-017-0173-z.

9. Petre A. BCAA benefits: A review of branched-chain amino acids. Healthline. July 30, 2021. https://www.healthline.com/nutrition/bcaa#The-bottom-line.

10. FDA 101: Dietary supplements. U.S. Food and Drug Administration. June 2, 2022. https://www.fda.gov/consumers/consumer-updates/fda-101-dietary-supplements.

11. Reduce your supplement risk with NSF Certified for sport: USADA. https://www.usada.org/athletes/substances/supplement-connect/reduce-risk-testing-positive-experiencing-adverse-health-effects/.

12. Why is third-party certification important for dietary supplements? May 29, 2024. https://www.opss.org/article/why-third-party-certification-important-dietary-supplements.

13. Hahamyan HA, Vasireddi N, Voos JE, Calcei JG. Social media's impact on widespread SARMs abuse. Phys Sportsmed. 2023;51(4):291-293. doi:10.1080/00913847.2022.2078679.

14. Cohen R, Newton-John T, Slater A. The relationship between Facebook and Instagram appearance-focused activities and body image concerns in young women. Body Image. 2017;23:183-187. doi:10.1016/j.bodyim.2017.10.002.

15. Franckowiak B. Performance-Enhancing Drugs and the High School Athlete. NASN Sch Nurse. 2015;30(4):214-216. doi:10.1177/1942602X14562962.

16. International Sports Pharmacists Network. https://www.sportspharmacists.org/.

17. Enhancing the U.S. Sports Pharmacy Community. Accessed August 11, 2025. https://www.ussportspharmacy.org/.