“Performance enhancement drugs”: what it is and what your next step should be

Disclaimer: This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. Performance enhancement drugs (PEDs) can have significant health risks. Always consult a licensed healthcare professional before starting or stopping any medication or supplement.

“Performance enhancement drugs” (PEDs) is a broad term covering substances used to improve physical strength, endurance, muscle mass, cognitive performance, or sexual function. These may include anabolic steroids, stimulants, hormone therapies, nootropics, and certain prescription medications used off-label.

If you’re considering PEDs — or already using them — your next step depends on your situation, goals, and symptoms. Below is a practical user journey to help you understand where you are and what to do next.

3 typical scenarios

1. Athlete or gym-goer considering anabolic steroids for muscle gain

What this might mean:
You may feel pressure to improve physique or performance quickly. Anabolic-androgenic steroids (AAS), testosterone boosters, and growth hormone are commonly discussed in bodybuilding communities. While they can increase muscle mass, they also carry risks such as hormonal imbalance, infertility, liver strain, cardiovascular disease, and mood changes.

What a doctor usually does:
A physician will ask about your goals, training routine, supplements, and any substances already used. They may order blood tests (testosterone levels, liver function tests, lipid profile), check blood pressure, and evaluate cardiovascular risk. If hormonal therapy is medically indicated (e.g., hypogonadism), treatment may be discussed under strict supervision. You can also review related medical topics in our Uncategorized health resources section.

2. Student or professional using stimulants or nootropics for focus

What this might mean:
Prescription stimulants (e.g., ADHD medications), modafinil, or over-the-counter “brain boosters” are sometimes used for cognitive enhancement. Misuse can lead to anxiety, insomnia, heart rhythm issues, dependence, and worsening concentration over time.

What a doctor usually does:
A clinician will assess sleep habits, stress levels, mental health history, and screen for ADHD or other conditions. They may evaluate heart rate and blood pressure. If attention difficulties are diagnosed, treatment may include behavioral therapy, lifestyle changes, or prescription medication — as prescribed by a doctor.

3. Individual seeking sexual performance enhancement

What this might mean:
Drugs such as phosphodiesterase-5 inhibitors (e.g., sildenafil-type medications) are used for erectile dysfunction (ED). Some people use them recreationally without medical evaluation. ED can be linked to cardiovascular disease, diabetes, hormonal issues, or psychological stress.

What a doctor usually does:
Evaluation may include questions about cardiovascular health, medications, blood sugar levels, testosterone levels, and mental health. A physical exam and basic lab tests are common. If appropriate, medication may be prescribed under supervision. Learn more about safe medication practices in our medication safety overview.

Decision tree

1. If you are considering a performance-enhancing drug for the first time, then schedule a consultation with a healthcare professional before starting anything.
2. If you are already using anabolic steroids or hormones without supervision, then request blood work (liver function, lipids, hormone panel) and cardiovascular screening.
3. If you use stimulants for focus and experience insomnia, anxiety, or palpitations, then stop self-adjusting doses and seek medical advice.
4. If you experience sexual performance issues, then get evaluated for underlying conditions rather than self-medicating.
5. If you notice side effects (mood swings, chest pain, jaundice, severe acne, testicular shrinkage, menstrual irregularities), then seek prompt medical evaluation.
6. If your goal is improved performance, then consider evidence-based alternatives (nutrition, sleep optimization, structured training, therapy) before pharmacological options.

When to seek help urgently (red flags)

• Chest pain or pressure: Possible heart-related complication, especially with stimulants or anabolic steroids.
• Shortness of breath: May indicate cardiovascular or pulmonary issues.
• Severe mood changes or aggression: Could be linked to steroid use or stimulant misuse.
• Yellowing of skin/eyes (jaundice): Possible liver damage.
• Fainting or severe palpitations: Potential arrhythmia.
• Severe headache with vision changes: Could signal high blood pressure or vascular issues.

In these cases, seek emergency medical care.

Approaches to treatment/management (overview)

Management depends on whether the goal is safe optimization, discontinuation, or treatment of side effects.

• Medical evaluation and monitoring: Blood tests, ECG, hormone panels, and metabolic screening.
• Supervised hormone therapy: Only when medically indicated (e.g., testosterone replacement therapy for diagnosed deficiency), as prescribed by a doctor.
• Gradual discontinuation: Some substances require careful tapering under medical supervision.
• Psychological support: For body image concerns, performance anxiety, or dependency patterns.
• Lifestyle optimization: Sleep hygiene, evidence-based training programs, balanced nutrition, and stress management.

For a broader perspective on medical treatments and safe usage principles, visit our clinical treatment guidance section.

Prevention

Preventing harm from performance enhancement drugs involves informed decision-making and addressing root causes.

• Set realistic performance goals.
• Work with certified trainers and licensed healthcare providers.
• Prioritize sleep (7–9 hours per night).
• Follow a balanced diet with adequate protein and micronutrients.
• Address stress and mental health proactively.
• Avoid purchasing drugs from unverified online sources.

Method	Who it suits	Limitations/Risks
Structured strength training	Beginners to advanced athletes	Requires consistency; slower results than drugs
Sports nutrition planning	Individuals optimizing physique or endurance	May require professional guidance
Prescription hormone therapy (medically indicated)	Patients with diagnosed deficiency	Requires monitoring; potential side effects
ADHD medication (as prescribed)	Patients with confirmed ADHD diagnosis	Risk of misuse, cardiovascular effects
ED medications (as prescribed)	Men with diagnosed erectile dysfunction	Interaction with nitrates; cardiovascular considerations
Cognitive behavioral therapy	Performance anxiety or body image concerns	Requires time and engagement

Questions to ask your doctor

• Do I have a medical condition affecting my performance?
• What tests should I undergo before considering any medication?
• What are the short- and long-term risks of this drug?
• Are there safer alternatives for my goal?
• How will this affect my heart, liver, and hormones?
• What monitoring schedule would I need?
• Could this interact with my current medications?
• What are signs that I should stop immediately?
• How might this impact fertility?
• Are there non-drug strategies that could achieve similar results?

Sources

• World Health Organization (WHO) – Guidelines on substance use and health.
• U.S. Food and Drug Administration (FDA) – Drug safety communications.
• National Institute on Drug Abuse (NIDA) – Anabolic steroid and stimulant misuse resources.
• Endocrine Society – Clinical practice guidelines on testosterone therapy.
• American Heart Association (AHA) – Cardiovascular risks associated with stimulant use.