This review shows that only 5 of 23 substance classes on the World Anti-Doping Agency Prohibited List show robust evidence of having the ability to enhance actual sports performance in athletes. |
A total of 11 studies including 266 subjects form all the available level 1 evidence for positive pharmacological effects on strength and sprint performance; there are no studies showing benefit on endurance performance. |
1 Introduction
2 Methodological Considerations
3 Findings
3.1 Prohibited at All Times
3.1.1 S0: Non-approved Substances
3.1.2 S1: Anabolic Agents
3.1.3 S2: Peptide Hormones, Growth Factors, Related Substances and Mimetics
3.1.3.1 Erythropoietins and Agents Affecting Erythropoiesis
3.1.3.2 Peptide Hormones and Hormone Modulators
3.1.3.3 Growth Factors and Growth Factor Modulators
3.1.4 S3: β2-Agonists
3.1.5 S4: Hormone and Metabolic Modulators
3.1.5.1 Aromatase Inhibitors
3.1.5.2 Selective Estrogen Receptor Modulators
3.1.5.3 Other Anti-estrogenic Substances
3.1.5.4 Agents Modifying Myostatin Function(s)
3.1.5.5 Metabolic Modulators
3.1.6 S5: Diuretics and Masking Agents
3.1.7 M1-3: Prohibited Methods
3.2 Prohibited In-Competition
3.2.1 S6: Stimulants
3.2.2 S7: Narcotics
3.2.3 S8: Cannabinoids
3.2.4 S9: Glucocorticoids
3.3 P1: Prohibited in Particular Sports
4 Conclusion
Substance class | Well-designed studies? | Studies with trained athletes? | Relevant performance parameters showing improvement | No. of trained athletes in studies with relevant performance parameters |
---|---|---|---|---|
S0: Non-approved substances | No | NA | NA | NA |
S1: Anabolic agents | Yes | Yes | Muscle strength when combined with strength training + 10–20% bench-press and squatting power [24] + 12% bench press power [25] + 23% and + 12% elbow flexion and knee extension [26] | Total: 91 40 [24] 21 [25] 30 [26] |
S2: Peptide hormones, growth factors, related substances and mimetics | ||||
Erythropoietin-receptor agonists | Yes | Yes | No evidence for effects on relevant endurance parameters, only on VO2max, maximal power output and time to exhaustion | Total: 161 20 [32] 11 [34] 27 [35] 16 [36] 40 [37] 47 [39] |
Hypoxia-inducible factor activating agents | No | NA | NA | NA |
GATA inhibitors | No | NA | NA | NA |
TGFβ inhibitors | No | NA | NA | NA |
Innate repair receptor agonists | No | NA | NA | NA |
Chorionic gonadotrophin and luteinizing hormones and their releasing factors | No | NA | NA | NA |
Corticotrophins and their releasing factors | Yes | Yes | No | Total: 24 16 [54] 8 [55] |
Growth hormone, its fragments and releasing factors | Yes | No | Sprint performance + 3.9% Wingate sprint capacity [62] in untrained subjects | Total: 123 22 [59] 30 [60] 7 [61] 64 untrained [62] |
Growth factors and growth factor modulators | Yes | No | NA | NA |
S3: β2-Agonists | Yes | Yes | Peak sprint power, muscle strength + 6% maximal voluntary isometric contraction, + 11% peak twitch force [70] + 8.4% quadriceps muscle strength, + 2.2% and + 3.3% Wingate peak and mean power, + 3% Wingate total work [71] + 4% (single dose) and + 6% (multiple dose) Wingate peak power [72] | Total: 39 10 [70] 9 [71] 20 [72] |
S4: Hormone and metabolic modulators | ||||
Aromatase inhibitors | No | NA | NA | NA |
Selective estrogen receptor modulators | No | NA | NA | NA |
Other anti-estrogenic substances | No | NA | NA | NA |
Agents modifying myostatin function(s) | No | NA | NA | NA |
Metabolic modulators | No | NA | NA | NA |
S5: Diuretics and masking agents | Yes | Yes | No | Total: 70 62 [89] 8 [90] |
S6: Stimulants | Yes | Yes | Muscle strength, sprint performance, 1500 m run time + 9% knee extension strength, + 3% peak Wingate sprint performance [101] 2% decrease 1500 m run time [104] | Total: 58 9 [97] 22 [101] 9 [102] 11 [103] 7 [104] |
S7: Narcotics | Yes | Yes | No | Total: 8 8 [105] |
S8: Cannabinoids | Yes | No | NA | NA |
S9: Glucocorticoids | Yes | Yes | One-legged hopping force + 11% one-legged hopping maximal force [118] | Total: 10 10 [118] |
P1: β-Blockers (prohibited in particular sports) | Yes | Yes | Shooting performance + 13.4% shooting performance [124] | Total: 33 33 [124] |