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MENTAL, BEHAVIOPRAL AND PHYSICAL EFFECTS OF POWER ENHANCING 

DRUGS IN CHRONIC USERS 
 

Faizan Mirza, 1 & Sadaf Ahmed 1&2 

1. Neurovascular Physiology & Biophysics Unit, Department of Physiology, University of Karachi 

2. Psychophysiology Research Division, Advance Educational Institute & Research Centre 

Corresponding author: fm.faizan.mirza@gmail.com 

 

ABSTRACT Exercising in gym is largely aimed at getting a desirably muscled physique that is subject to peer approval as well as associated with 

a higher self-esteem. Many people opt for workouts that define the lean body mass, whereas others aim at getting a beefed up body. The latter being 

a long and tiring process, pushes many people to opt for power enhancing drugs, for boosting their athletic endurance. Among others; steroids, 

erythropoietin, creatine, protein supplements are available over the counter all over Pakistani Pharmacies. Together with increasing the muscle 

bulk, they exert highly undesirable effects on hematological as well as lipid parameters. The present study evaluated and compared the side effects 

reported by the users of such PED on their mind, personality and body. A proforma was filled by each subject. The results showed that depending 

on the type of PED used, it has altered the personality of the individual significantly. Attributes that their personality and body did not have initially 

were observed by them upon chronic usage of these ergogenic aids. This lead us to conclude that “amount in PRs” is not the only price these PED 

users pay for attaining their desired beefed up physique, with which emerged another question, is that cost actually worth it?!! 

KEYWORDS Exercise, Power enhancing Drug, Gym, workout, Personality   

 

INTRODUCTION 

Positive influence of exercise on psychological and physiological 

attributes has been agreed upon by several scientists (SIME, 1987). 

Strenuous exercise affects mood of the individual right away (Veale, 

1987). Physical activity is linked with raised level of endorphins in 

brain (Colt , 1981). Here has been evidence that endogenous opioids 

in frontolimbic region of brain increases upon regular physical 

activity which can be linked with the euphoric state that the 

individuals feels as runners high (Henning, 2008). The present study 

focuses on individuals who workout in gym and use Power 

enhancing drugs (PED) such as steroids, creatine, protein, 

erythropoietin that are easily available over the counter in our 

country. These aid athletes to help in their performance on field and 

among non-athletes they result in better shaped body (Koch, 2002). 

Such PED are the favorite choice of youth in here to boost up their 

performance in gym, that quite soon gets translated into a well-

muscled physique. PED usage is reported to be causing an increased 

rage of anger as well as frustration (Mirza, 2013). 

 

OBJECTIVES OF THE STUDY  

To evaluate and compare various side effects observed by 

individuals exercising and using different PEDs. 

 

MATERIALS & METHODS 

The study was conducted on 75 healthy male subjects, in the age 

group of 19-31, bearing weight in the range of 61kg to 138kg and 

height in the range of 5ft 6inches to 6ft 3inches, who have been 

doing regular exercise in a gym for last four to nine consecutive 

years and have been using PEDs for at least three years. They were 

asked to fill a proforma that aimed at analyzing the side effects that 

they started experiencing since they started abusing PED.  

They were divided in following groups  

S; 10 steroid users 

SE; 6 steroids+EPO users 

SC 8 steroids+creatine users 

C; 7 creatine users 

CZ;13 creatine+zinc users 

P; 19 protein users 

PZ 12  protein+zinc users 

 

 

RESULTS & DISCUSSION 

Animal models have shown that exercise leads to an increased 

calcium level in brain, which might be associated with altered brain  

functions such as mood etc. (Denetsu, 1996). Figure. 1 shows 

noticeable changes in moods of male users. Majority of PEDs’ users 

have observed changes in their mood ever since they started taking 

PEDs. The reported changes included sudden mood swings, mood 

fluctuations mainly. All of the users believe that they did not have 

those mood-related issues before. Of steroids users’ majority of 

users of steroids together with erythropoietin reported noticing such 

changes. All the individuals using creatine alone also shared similar 

experience. And so did individuals using protein supplements with 

zinc. Among all these, the creatine users were found to be most 

significantly affected. 

 
Figure 1. Noticeable changes in moods 

Hassmén, (2000) reported how regular exercise could result in less 

anger and depression in the exercising individual. However, the 

findings of present study as shown in Figure. 2 accounts for 

individuals who workout and use PED as well, came up with the 

findings otherwise. Increased testosterone levels in the blood are 

associated with masculine behavior, aggressiveness and increased 

sexual desire, whereas an aggressive attitude is required for boosting 

athletic performance in gym it may result in unnecessary violence 

outside the gym as well (Kuipers, 1998). All the users of steroid with 

erythropoietin and those using creatine alone too reported increase 

in aggression level. Individuals of group S and group PZ showed a 

similar increment in aggression, while majority of group CZ also 

showed this tendency. On the other hand more than half of 

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©Advance Education Institute & Research Centre-2014                                                                                             

individuals of groups SC and P claimed to be more aggressive now 

as compared to when they did not take supplements. This aggressive 

attitude probably has something to do with the way one perceives 

image of his body, since, irrespective of the PED used, individuals 

who were physically stronger reported more aggression than those 

who were not physically that strong. Group C again was found to be 

overtly affected, together with users of steroid and erythropoietin 

combination. 

 

 
Figure 2. An increase in aggression 

 

Figure 4. Reported side effects in steroids users (group S) 

Due to decreased plasma glucose psychological processes that 

demand a conscious mental effort like self-control or decision-

making gets impaired (Fairclough, 2004), which might be attributed 

to the findings presented in the study. Figure. 3 depicts that majority 

of individuals in Groups S, SE and C reported noticing behavioral 

changes. While majority of individuals of groups SC, CZ, P and PZ 

reported not noticing any behavioral changes since they started 

taking their respective PED. The most common behavioral changes 

reported in all the groups were similar. These ranged from anxiety 

to vivid imaginations, difficulty in adjusting in the same age group 

to clumsy attitude, from extremist attitude to negative thoughts.  
In both genders hairloss, acne, sebaceous gland hypetrophy is 

reported upon using steroids (Kuipers, 1998). Hyperresponsivness 

and hyperproliferation of sebocytes as well as follicular 

keratinocytes can be attributed to androgen stimulation, which itself 

is the reason behind acne vulgaris (Thiboutot 1995; Thiboutot 

1998).  Increased acne was also a major finding in this group as 

shown in Figure. 4. The affected parts were not just face, but also 

neck and chest. Majority of the individuals using steroids alone had 

observed the side effects in the form of general hair loss. Androgen 

paradox is the phrase given to male pattern hair loss where androgen 

promotes hair growth on face suppressing it on temples and scalp 

vertex (Inui, 2012). The reported hair loss ranged from severe hair 

loss to hair thinning, from balding to general body hair thinning/loss 

which can be attributed to increased steroids in body. Many 

individuals also reported insomnia and non-restful sleep, especially 

on the day of loading dozes. Arvary (2000) reported how majority 

of cases admitted to a private treatment center for recouping with 

opioids addiction had abused these to counteract the insomnia and 

irritability caused by steroidal usage. Youqi (2004) suggested that 

athletes suffer from increased sleep onset latency due which leads 

to exercise induced insomnia. Muscle cramps was also common in 

group S, this might be due to overtraining or overstraining of 

muscles. Figure 5.  shows that most of the individuals using steroids 

in combination with erythropoietin were also suffering from general 

hair loss and hair thinning. Increased facial acne was also very 

common, together with sparse acne on neck and chest in some 

individuals. This was reported together with an increasingly oily 

skin, which added to the acne problem. Some individuals claimed 

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Figure 3. Noticeable changes in behavior 

 

Figure 5. Reported side effects in steroids+ erythropoietin users (group SE) 

 

Figure 6. Reported side effects in steroids + creatine users (group SC) 



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that they did not have oily skin before using the PEDs. The 

individuals of group SE also reported insomnia and improper 

sleeping habits. Some individuals, who claimed that since the use of 

PED they perspire even at room temperature with minimal physical 

activity, and so increased sweating problem was also reported. Users 

of steroids with creatine reported results that are shown in Figure.6, 

where increased acne followed by general hair loss were major 

findings. The occurrence of acne problem in majority of the users 

can be accounted for by the combinational usage of steroids and 

creatine supplements. Insomnia and non-restful sleeping habits were 

also reported in this group. Increasingly oily skin as well as muscle 

cramps were also reported in group SC. 

 
Figure 7. Reported side effects in creatine users (group C) 

 

Figure. 7 show results of individuals using creatine supplements 

alone most commonly reported heat intolerance. Most of them 

claimed that they avoided going out in direct sunlight. They also 

reported severe suntans. And they also suggested that in an 

environment where heat was unavoidable, they easily got frustrated, 

irritated and aggressive. They also suggested that heat intolerance 

drove them to train more ferociously during workout. An increased 

level of heat intolerance can be a result of underlying thyroid 

hormone abnormalities (Wilkins, 2007). A large majority also 

reported muscle cramps that maybe because of overstraining of 

muscles. Atheletes using cholesterol lowering drugs suffer from 

muscle cramps (Sinzinger, 2014). This hints that the users of this 

group and others who are suffering from muscle cramps might also 

be suffering from hypercholesterolemia. GIT abnormalities 

including nausea, indigestion, acidity and abdominal cramps were 

also reported. Insomnia was also a finding in this group C. Heat 

intolerance together with muscle cramps continues to be a common 

finding in majority of the users of creatine supplements in all 

combinations. The individuals using creatine with zinc claimed 

having heat intolerance problems also shared similar effects of heat 

intolerance on their mind and body as shown in Figure. 8 which are 

in line with those reported by individuals of group C previously. 

Together with heat intolerance, increased sweating was also a 

common characteristic in this group. Apart from these, GIT 

abnormalities were also found quite commonly in this group, which 

further cements the idea that creatine supplements have a tendency 

of disturbing the normal digestive system physiology. Users of 

protein supplements are asked to include more than usual 

carbohydrates in diet. Increased intake of refined carbohydrates has 

been linked with worsening acne (Mahmood, 2014). Figure. 9 

depicts what individuals using protein supplements. GIT 

abnormalities were most commonly reported. Frequent indigestion, 

oral ulcers, acidity, abdominal cramps and nausea were reported by 

each one of these facing GIT abnormalities. Muscle cramps were 

also a common finding, most probably because of intense weight 

training. Increased acne problem was also reported commonly, 

where acne were limited to face only. This acne problem was also 

further worsened by increasingly oily skin, as reported by some 

individuals. Many individuals in this group also claimed increased 

sweating. Some of them also reported general hair loss, which was 

way less severe than steroids users. Moreover, hair loss did not seem 

to be a common factor in majority of the individuals, those who 

reported it may have a genetic predisposition to balding and hair 

loss. An eyebrow-raising finding was the frequent occurrence of 

nightmares in many individuals. An increased metabolism together 

with increased brain activity due to high energy diet has a potential 

to trigger nightmares (Stephen, 2007). These changes can be 

attributed to constantly high protein rich dietary supplements, which 

normally our body is not used to handling.  

The side effects reported by individuals using protein supplements 

together with zinc are shown in Figure. 10, these were of similar 

pattern as reported by protein users. A large majority shared facing 

same GIT abnormalities as reported by individuals using protein 

supplements only. Frequent nightmares were also a common feature 

in this group too, which further pillars the idea that constantly high 

amount of protein in blood has got the activation of specific 

pathways in brain that lead to the frequent occurrence of nightmares. 

Insomnia was also commonly reported. Nightmares affect sleep 

Figure 9. Reported side effects in group P 

Figure 8. Reported side effects in creatine + zinc users (group CZ) 

 

Figure 10. Reported side effects in group PZ 



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pattern and it has been linked with nocturnal awakenings as well as 

difficulty in falling back asleep (Simor, 2014). The users of protein 

and zinc combination supplements appear to be suffering from the 

same. They also reported an increased incidence of facial acne in 

collaboration with increasing tendency to break into a sweat even a 

room temperature, with minimal of physical activity. Muscle cramps 

were also commonly reported in group protein plus zinc 

combination users owing to over-training of skeletal muscles. 

 

CONCLUSION 

The present study outlines that PED usage exert there effects on 

mind, body and personality of the users. Where mood swings and 

increase in aggression were reported by users of all PED included in 

the study, former was mostly reported by creatine users mainly the 

latter being most common in steroids-eryhtropoietin as well as 

creatine users. A mixed response was given for changes in behavior 

by all PED users, indicating variables other than PED being 

responsible for the reported changes. Apart from these insomnia and 

frequent nightmares suggest influence of PED on mind of users. 

Changes reported on body by users ranged from excess sweating, 

heat intolerance, increasingly oily skin, frequent acne breakouts, 

male pattern alopecia, muscle cramps and GIT abnormalities. 

Findings of this study throw light on the fact that when PED usage 

ensures a muscled physique it also triggers certain influences on the 

users which in turn raise a question, is attaining a beefy physique 

fair enough to trade for one’s original physiologically balanced 

mind, personality and body? This question must be answered by 

gym going individual himself before letting the drug enter the 

circulatory system.  

 

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