CSCS Chapter 11: Performance-Enhancing Substances and Methods
CSCS Study Guide Chapter 11

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    Chapter Goals:

    • Give some reliable and recent information to athletes regarding risks and benefits of substances that enhance performance, like anabolic steroids.
    • Know the efficacy and adverse effects of dietary supplements over the counter that are used to enhance sport and exercise performance.
    • Learn the performance-enhancing supplements that have the same effects of hormones within the body and the ones that improve performance through other means.
    • Find out what supplements benefit strength and power performance, endurance performance, or both.

    The first priority for athletes is to maintain sound principles of raining, like adequate nutrition, prior to any supplements or ergogenic acid. 

    Types of Performance Enhancing Substances

    Products that are able to be sold as dietary supplements.

    Any product, besides tobacco, that is intended to supplement a part of your diet will have one or more of these ingredients.

    • Vitamins
    • Minerals
    • Herbs or other botanicals
    • Amino acids
    • Dietary substances used to increase total dietary intakes
    • Concentrates, metabolites, constituents, or extracts

    Products need to also be intended for ingestion and can’t be advertised for use as conventional foods or as the single items in a meal or diet.


    Anabolic Steroids

    This manmade derivative of testosterone


    • Typically used in a stacking Regimen, where they are administered with several different drugs at the same time.
    • One anabolic agent’s potency may get enhanced when consumed with another anabolic agent.
    • A lot of people take anabolic steroids on a cycle. This means for some weeks or months and then discontinued for weeks or months.
    • Many athletes take drugs in pyramid patterns where dosages are increased over weeks and then decreased later on.

    Who uses anabolic steroids?

    • Olympic athletes, pro athletes, college athletes, and high schoolers have been seen to use steroids.
    • Many steroid users don’t use them for sports.


    • Muscle mass and strength
    • Increased protein synthesis in muscles is likely with steroid use.
    • Changes happen for recreational and competitive users.
    • Increased athletic performance.

    Psychological Effects

    • Anabolic steroid usage can change aggression, arousal, and irritability.

    Adverse effects

    Associated medical problems may be overstated.

    Many side effects will reverse when you cease using them.

    Side effects differ among people, but may include:


    • Lipid profile changes
    • Increased Blood Pressure
    • Lessened Myocardial Function


    • Gynecomastia
    • Lessened sperm count
    • Testicular atrophy
    • Impotence and Transient Infertility


    • Decreased sperm count and testicular size in males.
    • Menstrual irregularities, Clitoromegaly, and Masculinization in females. 
    • Gynecomastia and libido changes in males and females.


    • Acne and male pattern baldness


    • Increased risk of tumor and damage to the liver.


    • Premature epiphyseal plate closure.
    • Increased risk for tearing tendons.
    • Intramuscular abscess


    • Mania
    • Depression
    • Aggression
    • Mood swings

    Testosterone Precursors

    Performance changes may not happen with prohormone use, but athletes may have greater risk for adverse side effects like those associated with anabolic steroid use.

    Human Chorionic Gonadotropin

    HCG offers no enhance in performance for women, but in men it can increase testosterone production.


    Increases the synthesis of protein, but hypoglycemia side effects can be fatal.

    Human Growth Hormone


    No studies on efficacy in athletes

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    The anabolic potential of GHG and its ability to reduce body fat have given rise to HGH use in athletes.

    Adverse effects

    Growth hormone is used as replacement therapy for people that have deficiencies and can be effective. Osages for athletes give significant risks for acromegaly.


    EPO injections have to do with increases in hematocrit and hemoglobin.

    Some health risks are increased blood clotting, higher systolic blood pressure, hurt thermoregulatory systems, and dehydration while aerobically exercising.

    B-Adrenergic Agonists

    These can increase lean mass and decrease stored fats.


    These can reduce anxiety and tremors while performing.

    Dietary Supplements

    Essential Amino Acids

    EAAs may augment the synthesis of muscle proteins in healthy people.

    Leucine is a main part of regulation in stimulating muscle protein synthesis. It activates Akt/mTOR pathways in skeletal muscle, which is important for skeletal muscle protein synthesis.


    Claims associated with arginine supplementation are the ability to raise nitric oxide levels, raise muscle blood flow, and improved performance when exercising.

    There isn’t much evidence that arginine supplements do this.

    Oral arginine supplementation is not recommended for healthy athletes.


    HMB stimulates the synthesis of proteins and decreases the breakdown of proteins by inhibiting ubiquitin proteasome pathways. It may be an effective supplement to reduce lean muscle loss in a catabolic state.

    HMB is most effective when you have adequate training stimuli. For the untrained, it requires little training stimulus. For the trained, it requires high intensity and high volume resistance programs.

    Nutritional Muscle Buffers


    Sodium Bicarbonate

    Sodium Citrate


    L-Carnitine study’s show unclear efficacy in its role as an ergogenic acid that increases lipid oxidation.

    It may increase exercise recovery times.


    Importance of Creatine to Exercise

    IT has the ability to rapidly rephosphorylate ADP, which depends on the enzyme creatine kinase and creatine phosphates availability in muscles.

    Creatine Supplementation

    These supplements increase the creatine content of muscles by about 20%, with a saturation limit.

    Creatine supplementation has shown to raise max strength, power, and amount of lean body mass in trained and untrained people.

    Creatine is safe and also pretty inexpensive.


    Significant ergogenic benefits have been shown.

    Body Mass Changes

    Prolonged supplementation of creatine has shown increased body weight, mostly with fat free mass. This is mostly due to total body water increasing.

    Adverse Effects

    Creatine does not enhance risks for dehydration and cramping.




    Increased time until exhaustion

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    Unclear sprint and power effects

    Caffeine is ergogenic in doses of 3 – 9 mg/kg of body weight before exercise.

    No benefit after the 9 mg/kg of body weight.

    Decreased feelings of perceived exertion, an improved capacity of work, and mental alertness increases.

    Adverse Effects

    Causes anxiety, GI disturbances, Restlessness, Insomnia, Tremors, Heart Arrhythmias, And increases in the risks for heart illness.

    Physically addicting

    No harmful fluid imbalances when exercising have been found.

    Preworkout Energy Drinks

    Most common ingredients are: caffeine, carbs, B vitamins, Tyrosine, and gingko biloba


    Effective for raising resistance training volume performance, but not as responsive during other anaerobic exercises.

    A minimum of 2 mg of caffeine per kg of body mass has been shown to increase cycling and running performance.



    Effective when used with caffeine

    Improves mostly Aerobic endurance

    Adverse Effects

    Lots of adverse effects, like death

    Banned by most governing institutions.

    Citrus Aurantium


    May contribute to suppression of appetite, increase rate of metabolism and lipolysis.

    Time to fatigue improves when combined with caffeine

    Adverse effects

    Increased blood pressure and vasoconstriction

    It is on the NCAA’s list for banned PEDs

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