Ergogenic aids include performance-enhancing substances, nutritional supplements, and a variety of techniques aimed to improve an athlete’s exercise performance capacity. Dietary supplement consumption in athletes is common and is higher in those with desire to become Olympic or world champions. Supplements with performance benefits include caffeine, creatine, nitrate, and sodium bicarbonate. Anabolic-androgenic steroids; stimulants, such as ephedrine; and body mass builders, such as human growth hormone, are the most used performance-enhancing substances in competition. The World Anti-Doping Agency (WADA) is responsible for generating the list of banned performance-enhancing substances as well as establishing the testing standards for national and international events. Makers of dietary supplements are not required to prove the products are safe or test them for quality. Products with third-party testing certifications can help minimize the risk of ingesting contaminated or banned substances. Therapeutic use exemptions may be granted in Olympic, professional, or NCAA sports for athletes with a medical necessity for banned substances. The role of the physician or other medical professional is to guide informed decision-making.

Case 3. KI is a 15-year-old boy who comes to your office for a preparticipation examination for football and baseball. The medical history and physical examination results are unremarkable. He reports having lost approximately 4 kg (9 lb) over the past 6 months by consuming a lower-carbohydrate diet while trying to become lean. He asks what supplements you recommend for getting stronger and building muscle over the summer. Many of his teammates are using protein supplements. He also knows athletes who are using creatine and “natural” anabolic steroids. He has researched how to build muscle on the Internet, and several supplements seem promising to him. He wants to know which products are worth the expense.