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Extended Essay

The effects of performance enhancing drugs on powerlifters

Do performance enhancing drugs provide a significant increase on muscle growth and muscular

strength of powerlifters in comparison to the health risks of performance enhancing drugs in

powerlifters in the United States ages 18-30?

Word count: 3510

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Table of Contents

1. Introduction…………………………………………………………………………….03

2. Theoretical Background………………………………………………………………..05

3. Performance Enhancing Drugs……………………………………………………...…08

Anabolic Steroids………………………………………………………………….…..09

Creatine………………………………………………………………………………..11

Testosterone……………...……………………………………………………………12

4. Health Risks of Performance Enhancing Drugs……………………………………….13

Anabolic Steroids……………………………..………………………………………15

Creatine……………………………………………………………………………….17

Testosterone…………………………………………………………………………..18

5. Conclusion……………………………………………………………………………20

6. Works Cited…………..………………………………………………………………22
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Introduction

Powerlifting in the United States has started to gain popularity again as a new generation of

lifters have sought to replicate physiques and one rep maxes as professional powerlifters of the

past. For example, the two main powerlifting organizations in the U.S have over 22,000 new

members since 2019 (Family Media 2022). As new records for lifts are being set annually at

state and national competitions, not all success might be coming from hard work. A study

conducted by The Substance Abuse and Mental Health Organization found that an “estimated

one million Americans have used anabolic steroids.”

This information gained by the study from The Substance Abuse and Mental Health

Organization can be backed up by data collected from winning totals from tested and untested

powerlifters. Seen through all three lifts, untested lifters have completed significantly heavier

lifts than those that were tested.

Figure 1:
Photo shows a graph of three main

powerlifting lifts: deadlift, squat, and clean.

The graph differentiates the max weight

lifted for tested and un-tested lifters from

different weight classes.

(Easter 2014)
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Powerlifting has been a hobby of mine for 4 years now. Even though I have not compteted at a

competive level, I wanted to help the professional powerlifting community through my EE by

researching the impacts on muscular strength and growth from steroids.

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Theoretical Background

Testosterone was first tested in Germany in 1935 and at the time, its only use was to cure

depression. Professional athletes began misusing anabolic steroids during the 1954 Olympics,

when Russian weightlifters were given testosterone (4). In the 1980s, “anabolic steroid use began

to extend into the general population, and young men began using these substances, sometimes

to enhance athletic performance but in most cases to improve personal appearance (4).” At the

time most PED users were non-athlete males to improve their body physique. To combat the use

of PED’s in the United States, “Congress passed the Anabolic Steroid Act of 1990 to respond to

the increasing levels of illicit traffic in steroids.”(4). This Act identified anabolic steroids as a

separate drug class and categorized over two dozen drugs as controlled substances. The Act also

gave a four-part definition of this drug class, which allowed for flexibility in controlling new

anabolic steroids as they were synthesized. Powerlifting is one type of weightlifting in which the

competition is based around three types of lifts, which are the bench press, the squat, and the

deadlift. The International Powerlifting Committee, better known as IPF was formed in 1972.

“Each athlete does three attempts at doing the maximal weight the can for each lift, and the

overall competition winner is the one that has the most overall weight lifted by combining their

weights lifted successful to their overall total weight lifted” (Rookieroad 2017). When lifting,

each lift requires a different skillset from different muscle groups. For example, the deadlift

focuses on glutes, hamstrings, lower back, and the traps while the squat focuses on glutes,

quadriceps, and abductors. During the lift, the lifter must follow a series of commands from the

front judge regarding the lift. For a successful lift to be completed two of three judges must

approve of your lift. The two most popular powerlifting federations are USAPL and USPA, each

with their respective differences. “USAPL is affiliated with the IPF and USPA is affiliated with
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the IPL. USAPL is a fully drug tested organization and uses one type of barbell in competition

whereas USPA do not drug test most competitions and use different barbells in each event.

USPA offers more variety of disciplines than USAPL.” (PowerliftingTechnique). With the

different drug testing stipulations of both organizations’ powerlifters are able to make a choice

whether or not to use performance enhancing drugs. Figure 2: The image

gives data for all-time
records for
powerlifters tested for
PED’s.

Figure 3: The image

gives data for all-time
records for
powerlifters not
tested for PED’s.

I chose to compare the lifting numbers of the two types of lifters directly as a result of

performance enhancing drugs as it gives the clearest information on whether or not they are

providing benefit to these lifters. When looking at national records for the tested non-tested

division in the USPA, there is a significant increase in numbers in the non-tested division. For

example, the deadlift total for the non-tested division is about 108 pounds higher. Also, a

physical difference in muscle mass and size is noticeable between each division.

Figure 4: Lifter Cailer Woolam is seen in this photo

with a much larger physique with larger muscle mass

and size. Compared to the drug tested lifter below, he

is much larger in size.

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Figure 5: Drug-tested lifter Roman Denisyuk is

seen in the photo. Comparing his muscle size and

muscle mass to the untested lifter, Cailer

Woolam, a significant decrease is size is shown

in Denisyuk.

Looking at just the overall physiques of both Woolam and Denisyuk, you are able to tell the

significant difference in the muscle size due to PED’s between both athletes, aiding to the idea

that PED’s do cause larger appearance of muscles.

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Performance Enhancing Drugs

Performance enhancing drugs (commonly known as PED’s) are “defined as any substance taken

in non-pharmacologic doses specifically for purposes of improving sports performance. The

more common ones that you hear of are anabolic steroids, testosterone, human growth hormone,

creatine, and ephedrine.” (1). PED’s are mostly used for gaining a competitive edge for

powerlifters and bodybuilders. PED’s are used in all powerlifting and bodybuilding leagues they

are allowed in. These commonly used PED’s are majority used for the same affect; to build

muscle and lose body fat. PED’s like erythropoietin and stimulants are used to “increase the

number of red blood cells in the body, thereby increasing oxygen in the bloodstream” (3) and

“can function as PEDs when they are used to enhance mental performance and physical

functioning.” Performance enhancing drugs have also been tested in clinical trials. In a trial

conducted in 2001, participants aged 18-35 with prior weightlifting experience were assigned to

one of five groups. “All received monthly injections of a long-acting GnRH agonist to suppress

endogenous testosterone production. In addition, group 1 received 25 mg of testosterone

enanthate intramuscularly weekly; group 2, 50 mg testosterone enanthate; group 3, 125 mg

testosterone enanthate; group 4, 300 mg testosterone enanthate; and group 5, 600 mg testosterone

enanthate.” Data from the trial found significant increase in volume and strength from muscles

when using testosterone.

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Anabolic Steroids

Anabolic steroids are among the most popular performance enhancing drugs. It is estimated

Approximately 3 to 4 million people in the United States use anabolic steroids for nonmedical

purposes (Cleveland clinic). Anabolic steroids are medications that are manufactured forms of

testosterone. The technical term for these compounds is anabolic-androgenic steroids. Anabolic

steroids also come in many different forms including pills, injections, and skin patches. Anabolic

steroids work by “activating androgen receptors in your body and mimicking the effects of

natural androgens.” (Cleveland clinic). In a clinical study completed in 1999, it was found

“Intake of anabolic steroids and strength-training induce an increase in muscle size by both

hypertrophy and the formation of new muscle fibers.”(LWW journals)

Figure 6: This data depicts the mean cross-sectional

area of Type I and Type IIA fibers in the trapezius

muscle from the reported steroid-using and the

nonsteroid-using groups.

From the data in the graph, there is a significant increase from the muscle fibers in the steroid-

using group and non-steroid-using group. This data shows the impact of anabolic steroids on

muscle size in steroid users. Also, taking anabolic steroids for a period dopes the muscles with

more nuclei, which can be used to synthesize more proteins upon future strength training.
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Furthermore, with the addition of the number of nuclei, size and strength will continue to grow

as more cycles of the steroids are taken.

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Creatine

Creatine is a supplement well-known for its ability to enhance physical performance and muscle

growth, is a popular option among athletes, bodybuilders, and powerlifters. It naturally occurs

within muscles which makes it an important energy source during high-intensity workouts.

Taking this compound through supplements can result in higher levels stored in muscles

resulting ultimately leading to more strength gains and increased power output from the athlete's

lifts or repetitions per set- perfect for anyone who wants better natural fitness outcomes." By

incorporating creatine supplements into your routine, you can reap the rewards of improved

muscularity. The supplementation initiates an internal process that ultimately results in new

tissue creation within the muscles- bringing about a more robust and defined musculature

overall. Additionally, this supplement has been found to increase cellular volume resulting in

even greater muscle definition throughout various parts of the body. Enhanced staying power:

Creatine has the potential to boost your endurance levels by augmenting the energy reserves

accessible for muscle activity. In particular, creatine is capable of renovating ATP (adenosine

triphosphate), which functions as a predominant source of energy in muscular tissues. With

elevated accessibility to ATP, creatine can hinder exhaustion from setting in too soon and thus

permit you to undertake prolonged physical activities. Following exercise, using creatine can aid

muscle recovery and minimize inflammation. Creatine is capable of elevating specific molecules

that lessen swelling in the body and boost the healing process; therefore, leading to fast relief

from aches associated with an intense workout.

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Testosterone

Testosterone is a hormone that is naturally produced by the body, and it plays an important role

in the development of muscle mass and strength. It is often used as a performance-enhancing

drug by powerlifters and other strength athletes to improve their performance. The augmentation

of muscle mass by testosterone has the capability to endow stimulation towards producing

muscle protein, resulting in expansion and magnification of your muscles. This process can be

highly advantageous for those who engage in powerlifting since larger muscular structures

possess greater capacity for generating force; thus, enabling them to lift heavier weights with

ease. Testosterone also serves to heighten the force and effectiveness of musculature via

enhancement of both fiber size and quantity, along with heightened neuromuscular capacity. This

provides for an increased ability to lift weights in powerlifting competitions, leading directly

towards superior performance from participating athletes. The administration of testosterone can

hasten recovery post-workout, thereby minimizing muscle trauma and irritation. This translates

to a higher frequency of intense training sessions for powerlifters which ultimately facilitates

quicker progress in both muscularity and physical physique.

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Health Risks of Performance Enhancing Drugs

PEDs can cause various complications for the cardiovascular system. One example is anabolic

steroids, which may induce blood pressure elevation and exacerbate heart strain that ultimately

heightens susceptibility to strokes or cardiac arrest. Moreover, certain PEDs could stimulate

atypical enlargements in the size of one's heart muscle, thereby amplifying vulnerability to

cardiovascular issues as well. The liver may be negatively impacted by substances that aid in

performance. For example, anabolic steroids have a connection to the development of growths

and sacs on this organ. Furthermore, certain PEDs can block or slow down bile movement from

the liver leading to cholestasis. Additionally known as stagnation jaundice; it's when there isn't

proper drainage for bile causing high levels buildup within the body which is dangerous if not

treated promptly Ingesting substances that enhance physical performance can cause negative

consequences to the renal system, specifically in relation to damage or failure of the tubules

within. Anabolic steroids and particular growth hormone therapies are commonly linked with

this sort of harm inflicted on kidneys by PEDs. To achieve desired results, PEDs (performance-

enhancing drugs) disturb the hormone balance of the body. This manipulation of natural

hormones may trigger various outcomes; for instance, anabolic steroids could stimulate

excessive testosterone production resulting in adverse side effects such as skin breakouts and

emotional instability while altering sexual capabilities—the growth hormone treatment side

causes surplus insulin-like-growth factor-1 (IGF-1) secretion responsible for acromegaly—

wherein facial features along with hand and foot bones overgrow bizarrely. Psychological

conditions: Various substances used as performance enhancing drugs can result in psychological

impairments. This may include animosity, melancholy, and apprehension. Moreover, PED users

are susceptible to developing an addiction that may lead to numerous psychological and social
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challenges. Using performance enhancing drugs increases the chances of contracting diseases

like HIV and hepatitis B or C. This probability increases due to needle-sharing among steroid

users that can spread illnesses through blood contact.

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Anabolic Steroids

The use of anabolic steroids could have negative impacts on the functioning of one's heart,

making it difficult to operate. This may result in increased blood pressure which can strain

cardiovascular systems and increase chances of people experiencing cardiac issues or

strokes. “Additionally, these materials are linked with rising levels of LDL cholesterol while also

decreasing HDL (which is deemed beneficial).” (NHS choices). Consequently, those who

consume such elements raise their risk factors related to coronary problems as well. The use of

anabolic steroids poses a risk to one's hormonal balance, potentially leading to various

complications. “Indulging in these substances can lead to problems concerning reproductive

organs and potency; as well as infertility issues which may affect both males and females - while

women might also face menstrual cycle disruptions or difficulty conceiving.” (NHS choices).

With continual usage among female users specifically, it is likely for them to exhibit physical

traits that resemble those found in men such as facial hair growth caused by elevated hormone

levels. Long-term abuse of such medication has been linked with adverse effects on the psyche

across genders equally." The harmful effects of anabolic steroids have severe consequences,

particularly for the hepatic system. “Growth of neoplasms or fluid-filled sacs can result from

liver damage caused by these substances. This is a common occurrence when using such

drugs. Consumption in oral form increases risk even further as they are first processed through

the liver before entering circulation which may exacerbate its dysfunctionality over time.” (NHS

choices). When one ingests anabolic steroids, it brings forth a multitude of psychological

consequences that consist of alterations in demeanor and lack of tolerance. Utilizing these

substances on a consistent basis may also induce the state frequently identified as "roid rage,"

characterized by erupting fits full of fury which often led to violent behavior arising from
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hopelessness or other causes. There is the possibility for anabolic steroids to generate various

skin-related complications. Some of these entail blemishes appearing on a person's external

layer, their integumentary system becoming greasy or oily and expedited growth rates in both

facial hair as well as physical follicles. It has also been acknowledged that this particular form of

steroid utilization may prompt fluctuations within pigmentation which alters how the individual

appears superficially within their corium while simultaneously initiating extended bruising

across epidermal tissue." It is possible that men would develop mammary glands due to the use

of anabolic steroids, which medical professionals refer to as gynecomastia. This condition can

result in considerable discomfort and have adverse impacts on one's sense of self-esteem. The

use of anabolic steroids heightens the probability for a person to acquire illnesses and infections,

particularly if needles are utilized. The introduction of these substances into the body increases

susceptibility towards developing various types of infection in areas where injection occurs. This

inclination plays a prominent role in exposing people to blood-borne diseases including hepatitis

B & C along with HIV. Developing a predetermined plan for routine and discontinuing the

intake of substances that promote physical muscle development can result in dependency. Those

who elect to end this practice may experience symptoms associated with withdrawal, inducing

feelings such as hopelessness or persistent exhaustion coupled with insomnia leading to

diminished desires for sustenance.

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Creatine

Creatine is a regularly safe performance enhancing drug when taking in correct dosages but still

can still lead to health problems. Inadequate water consumption can lead to dehydration when

the body retains fluids from creatine intake. Water retention caused by Creatine is detrimental if

sufficient hydration measures are not considered. Digestive issues may arise with creatine use in

certain individuals, such as abdominal pain, and loose stool. Consuming high amounts of

creatine over a prolonged period can potentially harm the kidneys. This occurrence, however,

happens infrequently. When it comes to mixing with medication, Creatine is known for its

potential interactions. This supplement has been found to cause concern when combined with

certain drugs classified as diuretics and nonsteroidal anti-inflammatory. Furthermore, another

effect linked with the compound involves how blood sugar levels may be altered in those who

consume it regularly. Information from Cleveland Clinic explains, “But some studies show that

people who take creatine supplements may gain an extra two to four pounds of muscle mass

during four to 12 weeks of regular exercise than people who don’t take creatine.” (Cleveland

Clinic). Cleveland Clinic also suggests some short-term effects of creatine including, “weight

gain because of water retention, dizziness, nausea and vomiting, diarrhea, excessive sweating”.

(Cleveland Clinic). Even though these side effects are not major, they can still cause discomfort

in everyday tasks and interactions. Out of the three PED’s that I have analyzed, creatine is the

safest and most tested but, comes with smaller size and strength compared to anabolic steroids or

testosterone.
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Testosterone

Introducing synthetic testosterone to the human body can lead to an upset in its natural hormonal

balance. “This disturbance has been associated with a variety of negative consequences that

impact reproductive health, including but not limited to impotence and infertility.” (SFGATE). It

is worth noting that some men who take these supplements have reported developing female

breast tissue due to the chemical imbalance caused by artificial substances entering their system.

Harmful consequences may arise from frequent testosterone supplement intake as the liver is

susceptible to damage, such as degeneration of this forefront organ or possible occurrences of

malignancies within it. With the consumption of testosterone supplements, there is an elevated

possibility for acquiring cardiovascular sickness like heart attack and stroke. “The underlying

cause behind this predicament pertains to escalated blood pressure levels in correlation with

intensified cholesterol concentrations which provoke the onset of thrombi formation.”

(SFGATE). The negative impact of testosterone supplements on an individual's psychological

well-being is widely acknowledged. These harmful effects manifest as changes in emotions,

inclinations towards aggression and intense sorrowful feelings. The use of testosterone as a

supplement could result in issues concerning the skin. These problems may include

complications, such as acne and other related ailments. “Administering boosters that increase

hormone levels can cause difficulties like cysts or abscesses leading to oily skin. Without

caution, these side effects could aggravate one's complexion with painful infections or an

increased number of blemishes present on their skin surface area.” (SFGATE) The chances of

hair loss, commonly known as male-pattern baldness or similar illnesses, tend to increase when

using supplements that involve testosterone. Besides causing this adverse effect, the injection of

testosterone amplifies the risk factor for acquiring infections such as hepatitis B/C and
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HIV/AIDS. The intake of testosterone supplements can lead to addiction, and the cessation

thereof may give rise to indications of withdrawal such as exhaustion.

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Conclusion

One of the limitations that can be received from the data that is provided is the dosages of

performance enhancing drugs that some of these powerlifters are taking. By not knowing the

dosages they take or how many cycles of a certain PED they have been taking could be skewing

the data in regard to the powerlifting numbers in competition and in the data found in the muscle

fibers of the trapezius muscle of powerlifters who use PED’s (LWW journals).

Furthermore, the body composition of these athletes (height and weight) could play an effect on

how their bodies receive the PED’s. Depending on the athlete’s body composition, they may be

only able to take a certain dosage for their size, causing in a skew in the data for the difference

when testing the lifting maxes for tested and non-tested powerlifters. A way that this data could

be improved is by finding lifters that do and no not take PED’s, all with similar body

compositions, to get a true value on how much a difference in the lifter’s numbers are.

Another limitation that can be caused from the data is a limited sample size. Only a certain

criterion of people can be used to get similar data to see how the tested PED is working. Getting

different types of people can cause for incorrect data being collected due to the possibility of the

PED affecting their bodies differently.

Overall, it can be argued both ways that PED’s are beneficial to powerlifters. As a powerlifter,

there are personal benefits and serous health risks that come with the use of performance

enhancing drugs. Studies have indicated the positive and negatives that have come with the

usage of performance enhancing drugs. Some top powerlifters agree that PED’s have a more
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significant impact on the body than the possible heath risks. From the data that I have provided,

there is an upwards trend in the overall strength and performance that these powerlifters receive

from taking performance enhancing drugs but do receive short- and long-term health risks from

taking PED’s.
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Works Cited

“Underground: The Club Culture of Steroids.” Club Industry, 1 May 2005,

www.clubindustry.com/news/underground-club-culture-steroids.

“Performance-Enhancing Drugs & the Heart: Do You & Your Teens Know the Dangers of
Doping?” The Society for Cardiovascular Angiography and Interventions, 1 Dec. 2016,
www.secondscount.org/pediatric-center/pediatric-detail-2/performanceenhancing-drugs--heart-
do-you-your-teen#.Y83gRC-B3q0.

“What Are the Different Types of Apeds?” National Institutes of Health, U.S. Department of
Health and Human Services, 31 May 2022, nida.nih.gov/publications/research-reports/steroids-
other-appearance-performance-enhancing-drugs-apeds/what-are-different-types-apeds.

“What Is a Ped?” Nationwide Children's Hospital, www.nationwidechildrens.org/family-

resources-education/700childrens/2015/04/what-is-a-ped.

“What Is Powerlifting?” Rookieroad.com, 2017, www.rookieroad.com/powerlifting/what-is/.

Bhasin, Shalender, et al. “Testosterone Dose-Response Relationships in Healthy Young

Men.” American Journal of Physiology-Endocrinology and Metabolism, 1 Dec. 2001,
journals.physiology.org/doi/full/10.1152/ajpendo.2001.281.6.E1172?rfr_dat=cr_pub%2B%2B0p
ubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org.

Biology, Department of Integrative Medical. “Effects of Anabolic Steroids on the Muscle Cells
of... : Medicine & Science in Sports & Exercise.” LWW, journals.lww.com/acsm-
msse/Fulltext/1999/11000/Effects_of_anabolic_steroids_on_the_muscle_cells.6.aspx.

Cheung, Norman. “USAPL VS USPA: What Are the Differences?” PowerliftingTechnique.com,

12 May 2022, powerliftingtechnique.com/usapl-vs-uspa/.

Michael_Easter. “What Powerlifting Tells Us about the Effects of Peds.” FiveThirtyEight,

FiveThirtyEight, 1 Dec. 2014, fivethirtyeight.com/features/what-powerlifting-tells-us-about-the-
effects-of-peds/.

National - Raw Full Power, records.uspa.net/records.php?location=national&status=non-

tested&event=raw-powerlifting.

National - Raw Full Power, records.uspa.net/records.php?location=national&status=drug-

tested&event=raw-powerlifting.

The Incidence of Anabolic Steroid Use among Competitive ... - Sage Journals.
journals.sagepub.com/doi/10.2190/EGT5-4YWD-QX15-FLKK.

NHS Choices, NHS, www.nhs.uk/conditions/anabolic-steroid-misuse/.

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Allday, Erin. “Testosterone Builds Muscle but Has Risks.” SFGATE, San Francisco Chronicle,
16 Aug. 2012, www.sfgate.com/giants/article/Testosterone-builds-muscle-but-has-risks-
3791601.php.

professional, Cleveland Clinic medical. “Creatine.” Cleveland Clinic,

my.clevelandclinic.org/health/treatments/17674-
creatine#:~:text=It%20depends%20on%20your%20exercise,who%20don’t%20take%20cre
atine. Accessed 18 Aug. 2023.