A 36-study meta-analysis of help-seeking and a survey of 2,385 men map the information problem around anabolic steroids: who users trust, who they avoid, and what happens when they tell a doctor.

A 187-study global meta-analysis and a 2024 review of women put numbers on lifetime anabolic steroid use: low in the general population, about one in six among female bodybuilders, and a self-reported floor everywhere.

Alpha blockers lower blood pressure without touching VO2max or capping heart rate, which makes them performance-friendly. The catch is orthostatic dizziness when you stop abruptly - and they are a second-line choice behind ACE inhibitors and ARBs. Here is the evidence.

Beta blockers cut exercising heart rate by about a third, reduce VO2max by 5-15%, and make heart-rate zones useless. They do not touch strength or power. Here is what the pharmacology and the training studies say, and how to train around them.

SSRIs rarely change aerobic performance in temperate conditions, though one dose cut endurance 15% in fit men; bupropion can improve performance in the heat while raising core temperature; and long-term antidepressant use is associated with about 2% extra body weight over six years. Here is the evidence for athletes and coaches.

Histamine is not just an allergy molecule - it is one of the signals that turns a workout into an adaptation. Blocking H1 and H2 receptors during a training block impaired the microvascular and mitochondrial gains from interval training. Here is what that means for athletes on antihistamines.

Blood thinners do not stop you exercising - they change which exercise is safe. The bleeding risk is driven by collision and trauma, not by effort, so non-contact training is broadly fine while contact and collision sport needs real caution. Here is what the athlete-focused evidence says.

Second-generation antipsychotics drive weight gain by increasing appetite, lowering resting metabolism and reducing activity all at once. Exercise cannot fully reverse the weight, but it markedly improves symptoms - and people stick with it as well as with usual care. Here is the evidence.

Unlike beta blockers, ACE inhibitors do not cap heart rate or lower VO2max, which is why they are first-line for active people with high blood pressure. They may even improve insulin sensitivity and muscle metabolism. Here is what the evidence says, and the one side effect to watch.

Angiotensin receptor blockers lower blood pressure without capping heart rate or cutting VO2max, and older adults on them walk further and grip harder than untreated peers. They deliver the ACE-inhibitor benefits with far less cough. Here is what the evidence shows.

Aspirin and clopidogrel do not blunt VO2max or strength - their exercise issue is bleeding. For active people, the real questions are which sports carry trauma risk and how to weigh single versus dual therapy. Here is what the current evidence says.

Rate-control drugs blunt performance, class Ic agents suit athletes with structurally normal hearts, amiodarone and sotalol usually do not - and after a dose of any of them, hard training waits two half-lives. Here is what the evidence says.

Dextromethorphan brings drowsiness and dizziness, a serotonin interaction and a doping-irrelevant profile. The pseudoephedrine packed into many combination cough products raises heart rate, barely helps performance, and is banned in competition above a threshold. Here is how to read the label.

Beta-2 agonists improve lung-function numbers and even nudge heart pumping in healthy athletes - yet time-trial performance does not change at permitted doses. Only supratherapeutic doses show gains, and those breach the rules. Here is the evidence.

Dihydropyridines like amlodipine leave VO2max and heart rate alone; verapamil and diltiazem slow the heart and weaken contraction. The catch with the friendly subclass is an earlier lactate threshold and a glucose bump during long efforts. Here is what the evidence says.

Diuretics shrink plasma volume, drain potassium and magnesium, and worsen thermoregulation - which is why they are risky for endurance athletes and prohibited in tested sport as masking agents and weight-cut tools. Here is the evidence.

Clonidine and its relatives do not blunt training performance, but they bring drowsiness, dry mouth and a lower resting heart rate, and stopping them abruptly can send blood pressure rebounding. Here is why they are rarely first choice for active people.

Digoxin controls the resting rate in atrial fibrillation through the vagus nerve, which sympathetic drive overrides the moment you exercise. Add a narrow safe window and a mortality debate that turned on statistics, and the exercising patient has three things to understand.

Oral or prolonged glucocorticoids raise aerobic performance by a modest margin in trials - and they waste muscle, thin bone, raise glucose and suppress the adrenal axis. Injected, oral and rectal forms are banned in competition; inhalers and creams are not. Here is the evidence.

Oestrogen builds muscle and bone but softens tendons and ligaments - which is part of why women rupture ACLs two to eight times more often and pull muscles half as often as men. Across 51 studies, cycle phase moves performance by a trivial margin. Here is the evidence.