Tox Cards: Athletic Enhancement Drugs

Author: Catherine Yu (4th Year Medical Student, Rutgers NJMS), Cynthia Santos, MD (Assistant Professor, Emergency Medicine, Medical Toxicology, Rutgers NJMS) // Edited by:  Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital), and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX)


A 22-year-old man with no significant past medical history is brought to the emergency department by ambulance. He was involved in a physical altercation at a bar 30 minutes prior. He reports drinking 2 beers and denies illicit drug use. Initial vital signs are BP 145/84, HR 94, RR 18, T 98.6F, SpO2 100% on RA. On examination, the patient is muscular in appearance, agitated, and verbally aggressive to staff. The patient’s chart shows multiple previous emergency department visits after physical altercations within the past year. The patient is accompanied by his girlfriend who suspects that he is abusing athletic enhancement drugs.


What kinds of substances are abused for athletic enhancement?

What are the mechanisms of action behind the various types?

What are the potential adverse effects from abuse of AEDs?



There are many terms that athletic enhancement abusers employ to describe their abuse pattern.

  • Bridging = stopping long-lasting (e.g. alkylated) oral testosterone formulations in time to allow clearance from urine and switching to short-lived (e.g. ester) injectable products
  • Cycling = different types of substances used in an alternating pattern or using multiple substances simultaneously for a period of time and then abstaining for a period of time
  • Doping = prohibited use of substance(s) to enhance athletic performance; usually a term used in professional sports
  • Plateauing = point of a steroid cycle where the effectiveness of the steroid stops. To avoid, users either increase dosage, stop taking the steroid or stagger the cycle with different steroids
  • Pyramiding = starting at low dose followed by increasing the dose several fold then tapering the dose
  • Stacking = multiple types of athletic enhancement drugs taken simultaneously, often involves taking both PO and IM formulations

Main point:

A wide range of substances including hormones, vitamins, and blood products are commonly abused as athletic enhancement drugs. It is important to recognize their associated toxic effects.



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