Sports Pharmacology in Football — What Doping Actually Does

Introduction

Doping in football is less prevalent than in individual endurance sports, but it exists — and understanding what prohibited substances do physiologically is important not just for ethical reasons, but because the science reveals why certain performance deficits exist and why specific supplements are sometimes contaminated with prohibited agents. This article covers the pharmacology of the most relevant prohibited substances in football from a purely scientific perspective: what they do, why they work, and why they are banned.

The Science

Anabolic Androgenic Steroids (AAS): Synthetic derivatives of testosterone. They bind to androgen receptors in muscle cells, increasing gene transcription for contractile proteins (actin, myosin). The result: accelerated muscle protein synthesis, greater hypertrophy from the same training stimulus, faster recovery from damage, and reduced catabolic (breakdown) response to heavy training. In football, the performance benefit would be concentrated in: greater lean mass, higher sprint force production, faster post-match recovery, and compressed pre-season physical development. Side effects: liver toxicity, cardiac hypertrophy (pathological), hormonal disruption, psychological aggression, and endocrine suppression post-cycle.

EPO (Erythropoietin): A glycoprotein hormone naturally produced by the kidneys in response to hypoxia, which stimulates red blood cell production (erythropoiesis). Exogenous recombinant EPO (rHuEPO) raises haematocrit by 5–10%, increasing blood oxygen-carrying capacity by a proportional amount — directly elevating VO2max by approximately 5–7%. For football, this means greater aerobic engine, faster recovery between sprints, and reduced late-game fatigue. Blood doping (transfusion) achieves the same physiological effect by different means. Side effects: significantly increased blood viscosity and thrombosis risk (several cycling deaths linked to EPO abuse in the 1990s).

Human Growth Hormone (HGH): Stimulates IGF-1 production in the liver, promoting protein synthesis, fat mobilisation, and tissue repair. In athletes, HGH supplementation increases lean mass and reduces fat mass, accelerates tendon and connective tissue repair, and increases exercise capacity. Evidence for direct performance improvement is more limited than for AAS or EPO — it primarily accelerates recovery and body composition changes rather than acute performance enhancement.

Beta-2 agonists: Bronchodilators (e.g., salbutamol, formoterol) that are permitted via inhaler for documented asthma but prohibited in systemic doses. At supraphysiological doses, they have anabolic effects — stimulating protein synthesis via β-adrenergic signalling. The WADA threshold (1,000 ng/mL salbutamol in urine) distinguishes therapeutic from performance-enhancing use.

Stimulants (amphetamines, non-therapeutic cocaine): Increase central dopamine and noradrenaline, reducing perceived fatigue, increasing aggression and risk tolerance, and elevating HR and blood pressure. Historically used in football — multiple doping cases from Italian Serie A in the 1980s–90s involved amphetamine-related compounds.

What Research Says

Bhasin et al. (1996) published the definitive controlled study of testosterone effects in New England Journal of Medicine, administering supraphysiological testosterone (600 mg/week) to both trained and untrained men with and without resistance training. Testosterone alone (without training) increased lean mass by 3.2 kg and muscle strength by 38% — more than training alone in the same timeframe. With training, the combined effect was additive. This data established the magnitude of physiological advantage from AAS.

Birkeland et al. (2000) confirmed EPO’s performance effects with a randomised controlled design, demonstrating that weekly rHuEPO injections for 4 weeks increased haematocrit from 43% to 50%, VO2max by 5.6%, and performance on a standardised cycling test by 4.2%.

Handelsman (2015) published a comprehensive review of doping detection in British Journal of Sports Medicine, noting that the fundamental challenge of anti-doping testing is the distinction between endogenous (natural) and exogenous (administered) hormones — particularly for testosterone (where natural variation is wide) and HGH (where pulsatile secretion patterns make single measurements uninformative).

Did You Know? Juventus FC’s team physician between 1994–1998 was the subject of a decade-long Italian criminal investigation into doping practices that produced a first-instance criminal conviction, later overturned on appeal. Testimony from this case provided the most detailed public account of how systematic AAS, EPO, and other substance use was structured in elite club football. While Juventus’s case is the most investigated, anti-doping experts consistently note that football’s testing programme has historically been less rigorous than cycling or athletics — with lower testing frequency, less out-of-competition testing, and no biological passport programme until recently.

Applied to Football

Understanding prohibited substance pharmacology for legitimate purposes:

1. Supplement contamination risk is real. Studies consistently find that 10–25% of commercial sports supplements contain traces of prohibited substances not listed on the label. Every supplement carries contamination risk — and the athlete is responsible regardless. Third-party tested supplements (Informed Sport, NSF Certified) reduce but do not eliminate this risk.
2. Therapeutic Use Exemptions (TUEs) are legitimate. Players with asthma, ADHD, or other documented conditions can apply for TUEs for prohibited medications. The TUE process is not a loophole — it is a medically supervised framework for managing health conditions in athletic populations.
3. The biological passport is football’s most effective detection tool. Longitudinal monitoring of blood parameters (haematological passport) detects EPO use and blood doping by identifying physiologically implausible parameter trajectories, even without direct detection of the substance.
4. Natural performance tools are highly effective. Altitude training (legal EPO stimulus), strength training, plyometrics, creatine, beetroot, and caffeine collectively produce performance improvements that rival short-term doping effects without the health risk or ethical breach.
5. Understanding mechanism protects against ignorance. Players who understand what testosterone, EPO, and HGH do are less susceptible to supplement marketing that implicitly promises the same effects through “legal” means — and better equipped to scrutinise what they are ingesting.

Key Takeaways

• AAS increase muscle protein synthesis and recovery speed; EPO increases VO2max by 5–7%; HGH accelerates recovery and body composition changes
• 10–25% of commercial sports supplements contain contaminating prohibited substances — third-party testing is essential
• The biological passport detects EPO/blood doping via impossible physiological trajectories rather than substance detection
• Natural performance tools (altitude, creatine, caffeine, beetroot, training) produce substantial performance improvements legally
• TUEs allow medically necessary prohibited medications — they are a legitimate health protection mechanism, not a performance exploit

References

• Bhasin, S., Storer, T. W., Berman, N., Callegari, C., Clevenger, B., Phillips, J., … & Casaburi, R. (1996). The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. New England Journal of Medicine, 335(1), 1–7.
• Birkeland, K. I., Stray-Gundersen, J., Hemmersbach, P., Hallen, J., Haug, E., & Bahr, R. (2000). Effect of rhEPO administration on serum levels of soluble transferrin receptors and cycling performance. Medicine & Science in Sports & Exercise, 32(7), 1238–1243.
• Handelsman, D. J. (2015). Performance-enhancing hormone doping in sport. Endocrinology and Metabolism Clinics of North America, 44(3), 655–671.

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Next in Series: Article 61 — Strength and Conditioning Periodisation — Programming the Full Season

Written by Hüseyin Akbulut, MSc Sport Scientist · Founder of Sporeus

Hüseyin Akbulut is the founder of Sporeus and author of THRESHOLD (EŞİK), a 540-page Turkish-language book on endurance science.

• 540pp THRESHOLD Book
• MSc Sport Sciences
• Marmara University

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