A Guide to Doping’s Grey Area

Eight weird (and legal) performance-enhancing substances that Olympic athletes have used to gain an advantage

Aug 11, 2016
Outside Magazine
A Guide to Doping’s Grey Area

From pickle juice to thyroid medication, here are a handful of benign, bizarre, and sinister remedies that you might find in the Athlete’s Village.    Photo: Beatrix Boros/Stocksy

Before the 2016 Olympics had even begun last Friday, they were beset by doping controversies: virtually every Russian athlete appeared to be on some sort of performance enhancing drug and the World Anti-Doping Agency was revealed to be nearly as corrupt as FIFA. Not even a week into the Games, two athletes have already been 86’d over failed drug tests. Some Olympics athletes, it seems, will take just about anything that will afford them a small advantage. While they aren't banned, here's a handful of benign, bizarre, and sinister performance enhancing remedies that have been used by everyone from Olympic tennis players to sprinters to skeleton racers. 


2004 study made waves when it appeared to show that mountaineers who took sildenafil citrate, the active ingredient in Viagra, improved arterial oxygen saturation and boosted maximum workload by an average of 22 percent. In other words, it increases your maximum power output. Then, a 2006 study on cyclists found that the supplement improved performance by an average of 15—and up to 45—percent when riding at a simulated altitude of 12,700 feet. And yet, it’s still not banned. That’s because the effect is not universal and appears to be isolated to high altitudes. So,“Viagra doping,” to the extent that it’s happened, has been mostly in sports like mountaineering (not governed by WADA). But research is ongoing, including an effort last year to determine if Viagra had similar potential at more moderate altitudes. If so, WADA may take action.

Nefariousness index (Scale 1-10): Five. No, it’s not banned, and its effectiveness appears to vary greatly by individual, but that little blue pill might be off the menu for athletes in the near future.

Thyroid medication 

The cynical view is that athletes are an awful sickly lot, at least judged by the rates of hypothyroidism diagnoses. Hypothyroidism, from which Galen Rupp has claimed to suffer, can cause fatigue, and is treated by drugs like Cytomel and Synthroid, brand names for T3 and T4 thyroid hormones. The problem: T3 and T4 have a long association with doping. They were part of Victor Conte’s regimen for BALCO athletes, and Floyd Landis used thyroid medication as well. The mechanism of action is unclear, but because they boost metabolic rate, they’re thought to add a kind of explosive quickness that’s valuable to, say, track sprinters. Last year, both USADA and UK Anti-Doping requested that thyroid hormones be banned; WADA declined to add them to the list

Nefariousness index: Eight. Not banned, but clearly associated with doping regimens and sketchy coaches and trainers, often under the excuse of treating hypothyroidism in young and seemingly healthy elite athletes.

Pickle juice

We know: this almost seems like a “One Weird Trick” clickbait ad. But sporadic reports of pickle juice’s anti-cramping effects date back more than a decade. In 2010, a Brigham Young University researcher named Kevin Miller created a stir with a study showing that ingesting pickle juice, even in small doses, could stop cramps within seconds. Subsequent studies have confirmed the phenomenon, adding the caveats that it doesn’t work universally and it may not have a protective effect; rather, it’s an effective response to acute cramps in the moment. Two researchers believe they know the cause: the acidic vinegar, pickle juice’s principal ingredient, stimulates the nervous system in a way that short-circuits the receptor cells responsible for cramps.

Nefariousness Index: One. Although many a race has been lost due to cramps, it’s pretty hard to imagine a WADA ban. I mean, pickles.


These strange parasitic mushrooms, which grow in the larvae of certain Chinese moths, are claimed to do everything from increasing ATP—the cellular fuel for explosive anaerobic efforts like sprinting—to boosting natural testosterone and even oxygen uptake. With all that, you’d think that they’d be banned or taken by every athlete in Rio. But they’re not banned, possibly because the claims aren’t backed by much hard evidence. Take O2 availability, for example: some effects have been seen in elderly subjects, but a 2004 study on trained cyclists found no statistical effect.

Nefariousness Index: Two. Not likely to be banned, but at least claimed to be more broadly “performance enhancing” than a cramp-stopper.

Nitric oxide 

Nitric oxide, a naturally occurring byproduct of exercise, is a well-known vasodilator. What’s that mean? Theoretically, it promotes oxygen transport, which equals more endurance. One way to increase nitric oxide is to exercise—or drink a ton of beet juice, which is rich in nitrates that convert to nitric oxide. Another is to take nitric oxide precursor supplements like L-Arginine. A few years ago, a company called MuscleMeds produced another (since discontinued) supplement that claimed to deliver “real” nitric oxide to the cardiovascular system. But two studies showed no real effect, and studies on L-Arginine draw similar conclusions.

Nefariousness index: Three. The supplements seems to be inconsistent at best and ineffective at worst. 

Platelet-rich plasma 

Platelet-rich plasma therapy is a technique where an athlete’s blood is withdrawn and then spun in a centrifuge to separate platelets—which are partly made up of various hormonal growth factors—from whole blood. The platelets are then re-injected at the site of an injury to speed healing; it’s a technique often used to treat chronic tendon injuries, for example. (Rafael Nadal famously used PRP to recover from a knee injury in 2013.) Researchers aren’t totally clear on how, why, or if it is effective. Because it involves withdrawing and reinjecting components of one’s own blood, you might initially think PRP is a clear violation of WADA’s ban on manipulation of the blood. And in a sport like pro cycling, which has a strict “no needle” policy, it is against the rules. But it is not prohibited for Olympic athletes—it was removed from WADA's banned list in 2011.

Nefariousness index: Six. Although rich in the naturally occurring forms of banned hormones like IGF-1, platelets themselves appear to have mostly therapeutic potential, rather than being directly performance enhancing. But it does seem counter to WADA’s ban on blood manipulation, and there’s a slippery-slope argument as well.


What could possibly be dubious about a full head of hair? Finasteride is the generic name for the active ingredient in Propecia, a drug used to treat male pattern hair loss. But for several years in the mid-2000s, it was banned because, as a 5-alpha-reductase inhibitor, it’s a possible masking agent for certain steroids. American skeleton racer Zach Lund was one of the first cases; a Propecia user since 1999, he tested positive in 2006 and was banned for a year, despite clear mitigating circumstances (he had a doctor’s prescription and told the USA Bobsled and Skeleton Federation well ahead of time that he was taking it). The normally strict U.S. Anti-Doping Agency pressed for a warning rather than a ban, but Lund was forced to miss the Turin Olympics, where he was a likely medal contender. To make matters worse, WADA removed finasteride from the banned list starting in 2009, saying that testing had gotten good enough to beat the masking agent. 

Nefariousness index: Four. While it’s currently still a legal substance, athletes might want to consider racing bald—there’s an ongoing WADA-funded study investigating whether finasteride might, after all, be an effective masking agent.


Telmisartan, an oral anti-hypertension medication, keeps blood vessels from constricting, which could lead to better oxygen uptake in endurance sports. It may also have metabolic modulator properties, like the ability to create more mitochondrial density (the powerhouses of cellular energy production) or change skeletal muscle fiber type (say, from slow- to fast-twitch). It seems that Telmisartan could become the 2017 version of Meldonium, the now-banned drug that brought down scores of Russian athletes this year when it was shifted from the monitoring program to the prohibited list. This is year two on the watch list for Telmisartan—it could be banned in the very near future.

Nefariousness index: Nine. The mechanism of action and actual effect are unclear, but there’s a lot of buzz about similar effects to banned drugs like AICAR and GW1516. Don’t be surprised if it makes the shift from shady to outright outlawed next year.

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