The Prohibited List

• Exogenous – substances which are synthetically produced outside of the body to enhance performance.
• Endogenous – substances, which although performance enhancing, are also produced in small quantities by the body itself.

How do they work?
Steroids mimic testosterone by activating certain cells in the body to promote the production of protein, which in-turn elicits muscle growth. These substances may also block the effect of the body’s stress hormone (cortisol), slowing muscle breakdown during intense activity.

Typical Routes of Administration:
Oral, Injection, Transdermal (i.e. skin patches).

Common types:
Androstenedione, Clenbuterol, DHEA, Epitestosterone, Mesterolone, Nandrolone, Testosterone

Possible side effects/risks to health:

Hypertension (high blood pressure), Liver damage, Hypercholesterolaemia (high cholesterol), Increased Risk of Cardiovascular Disease (i.e. heart attack), Diabetes, Mood/Personality Changes.

• Men - Sterility, Gynecomastia (growth of breast tissue in men), Hair loss, Acne,
• Women - Masculinisation (i.e. husky voice, hair growth), Development of Male-Pattern-Baldness, Infertility, Increased Risk of Miscarriage.
  

Hormones & Related Substances

What are they?
Hormones are naturally occurring substances in the human body which act as a ‘switch’ to control various complex processes. Hormones influence virtually all the body’s vital and non-vital functions from growth, to mood and sexual arousal.

Different types of hormones are used by athletes to encourage un-natural growth, increase the blood’s oxygen carrying capacity, and to aid muscle repair.

How do they work?
Hormones are produced by organs in the body called glands (such as the testes and ovaries). In response to an instruction from the brain, these glands will release specific hormones into the blood stream where they will attach themselves to the receptors in our body’s cells. This then causes a signal to be sent into the cell, instructing it to carry out a certain task, such as growth, or increasing arousal.

Typical Routes of Administration:
Oral, Injection.

Common types:
Erythropoietin (EPO), Human Growth Hormone (hGH), Insulin-Like Growth Factor (IGF), Gonadotrophins, Insulin.

Possible side effects/risks to health:
Different hormones have specific risks/side effects. Some of these are outlined below:

• hGH – Pancreatitis, Reduced Insulin Sensitivity, Acromelagy (abnormal and distorted growth of various body parts), Diabetes.
• EPO – Stroke, Heart attack, Anaemia.
• Insulin – Increased Risk of Diabetes, Coma, Death.

Beta-2 Agonists

What are they?
Beta-2 Agonists are a class of drug often used to treat asthma and other pulmonary disorders. Many athletes may therefore use these substances legitimately with a therapeutic use exemption. However, without one, their use is still banned due to the powerful anabolic effect they can elicit when used systemically (injected into the blood stream).

How do they work?
They act on the Beta-2 Adrenergic Receptor which promotes smooth muscle relaxation. This helps to dilate not only the passages in the throat (thus helping to treat asthma), but also the blood vessels surrounding muscles. They also promote the release of insulin (itself a banned hormone).

Typical Routes of Administration:
Oral (inhaler).

Common types:
Salbutamol, Terbutaline, Salmeterol, Fenoterol, Hydrobromide, Formoterol.

Possible side effects/risks to health:
Tremor, Palpitations, Muscle Cramps, Nausea, Anxiety, Headaches.

Agents with Anti-Oestrogenic Activity

What are they?
This category of drug encompasses all those agents or substances which suppress, prevent, or oppose the action of estrogens (the group of steroid compounds, naturally found in the body which act as the primary female sex hormone).

Agents with anti-estrogenic activity are routinely used to treat conditions such as breast-cancer.

How do they work?
Anti-Estrogenic substances work via various different mechanisms, depending on the specific agent used. For example, some anti-estrogens, such as Tamoxifen, have a direct affect on the oestrogen receptors in the body. Others, such as Anastrozole, work by blocking certain enzymes, which play regulatory roles in the production of estrogens.

Typical Routes of Administration:
Oral

Common types:
Tamoxifen, Clomiphene, Anastrozole, Letrozole, Exemestane.

Possible side effects/risks to health:
Fatigue, Headaches, Joint Pain, Muscle Aches, Osteoporosis, Heart & Cardiovascular Disease, Hypertension, Depression, Anxiety

Diuretics & Other Masking Agents

What are they?
Diuretics are a class of drug that help to remove water from the body by increasing the amount of urine produced by the kidneys. They are routinely used medically to reduce blood pressure, and to treat oedema (excess fluid in body tissues) and kidney disease.

The use of diuretics in football is limited. However, footballers may wish to use them to aid weight loss during the pre-season period.

Masking agents (such as plasma expanders) are biological substances which are used to hide or disguise the use of other banned substances, and as a result, are also prohibited.

How do they work?
Diuretics reduce the amount of water and sodium (salt) that is absorbed by your kidneys. More water and sodium therefore passes out with the waste products into your urine. Your body then produces more urine, helping to flush out your system.

Masking agents operate via a wide range of mechanisms which are specific to the agent itself, and to the substance which its use is aimed to disguise.

Typical Routes of Administration:
Oral, Injection.

Common types:
Amiloride, Finasteride, Dutasteride, Epitestosterone, Plasma Expanders, Thiazides, Metolazone, Acetazolamide, Bumetanide

Possible side effects/risks to health:
Dehydration and all its associated effects (headaches, tiredness, dizziness, fainting), Heart Disease, Kidney Disease.

Prohibited Methods

Enhancement of Oxygen Transfer

This method is divided into two key sections:

Blood Doping

This section primarily deals with the attempted use of blood transfusions (either using a player’s own blood, or that from a donor) to boost the oxygen carrying capacity of the blood, thereby improving endurance and performance.

Artificially enhancing the uptake, transport or delivery of oxygen

This heading covers the use of synthetic substances aimed at artificially and illegally increasing the ability of the body to utilise oxygen during sport. Such substances include Haemoglobin Based Oxygen Carriers (HBOC’s) which can be used as a substitute for blood in clinical settings, and efaproxiral (RSR13), a drug which alters the way haemoglobin (the oxygen carrying substance in the blood) binds to oxygen.

Chemical and Physical Manipulation

Attempting to tamper with a sample at any point during the testing process is strictly prohibited. This section covers all methods that a footballer (or any other individual) may use to hide the presence of a prohibited substance, or to disrupt the drug testing process. Such methods include catheterisation and urine substitution.

Gene Doping

The manipulation of an athlete’s genes (the building blocks of the human body) is banned in sport. Genetic engineering is being developed by the medical profession to help cure some of our most devastating diseases such as diabetes and AIDS. Compared to other performance enhancing techniques, gene doping is still in its infancy, and as a result, is very dangerous and open to abuse and miss-use.

Stimulants

What are they?
Stimulants are a broad group of drugs that act to temporarily increase alertness and suppress feelings of tiredness/lethargy. The use of many of these drugs is banned, not only in sport, but also in every day life (such as cocaine).

However, they also come in numerous other forms, many of which are used perfectly legally on a daily basis, such as caffeine and nicotine. A large number are also found in over-the-counter cold and flu remedies (such as ephedrine). It is important to remember that many of these substances are still on the banned list and their use requires a therapeutic use exemption.

How do they work?
Stimulants act upon the activity of the body’s autonomic and central nervous systems. One of the ways they do this is to increase the amount of chemicals, called neurotransmitters, in our brain. Subsequently, brain activity increases, sending signals throughout the body to raise functions such as blood pressure, heart rate, and breathing.

Typical Routes of Administration:
Oral, Injection

Common types:
Adrenaline, Amphetamines, Cocaine, Caffeine, Ephedrine, Methylephedrine, MDMA (Ecstasy), Nicotine.

Possible side effects/risks to health:
Over-heating (leading to possible organ failure), Liver damage, Insomnia (difficulty sleeping), Anorexia, Increased Cardiovascular disease risk immediately following use (i.e. heart attack), Paranoia, Mood/Personality Changes, Sexual problems.

Narcotics

What are they?
Made from the opium poppy plant, Narcotics are a group of substances that help to reduce/disguise feelings of pain. Narcotics such as heroin are also illegally used for recreational purposes to promote feelings of euphoria, and as such, are highly addictive.

Narcotics, due to their potent pain relieving properties, are also routinely administered to hospital patients following accidents or surgery.

How do they work?
Narcotics primarily affect the central nervous system, brain and spinal cord. The body and the brain contain something called opioid receptors. These are cells which are meant to attract the body’s natural pain-killer; endorphins. Narcotics mimic these endorphins and attach themselves to the opioid receptors, providing a sudden rush, or a “high”.

Typical Routes of Administration:
Oral (in a pill), Transdermal (skin patches), Injectable, Suppository, Smoked, Snorted, Subcutaneous, Intravenous.

Common Types:
Diamorphine (heroin), Fentanyl, Methadone, Morphine, Oxymorphone, Pethidine.

Possible side effects/risks to health:
Nausea, Delirium, Memory Loss, Vomiting, Drowsiness, Loss of concentration, Loss of co-ordination, Overdoses can cause coma & death.

Cannabinoids

What are they?
Also known as marijuana, hashish, cannabis and pot, cannabinoids provide the largest number of positive findings in the FA Doping Control Programme. Cannabis is made from the dried flowers, leaves or resin of the cannabis plant and its use elicits relaxation, reduced anxiety and sensory enhancement.

How do they work?
The chemical in cannabis that causes the above effects is called THC (delta-9-tetrahydrocannabinol). This is absorbed in the blood and travels to the brain. Here, it binds to tiny cells in the brain called receptors. This then alters the brain’s function, which leads to changes in your mood and behaviour.

Typical Routes of Administration:
Smoking, Eating (in preparations such as “hash cakes”).

Possible side effects/risks to health:
Paranoia, Reduced Concentration, Sensory Confusion, Distorted Perception, Increased Risk of Cardiovascular Disease Immediately Following Use (i.e. heart attack).

Glucocorticosteroids

What are they?
Glucorticosteroids are powerful anti-inflammatory agents that are often administered to treat chronic inflammatory conditions such as arthritis and asthma. They are also used to treat acute injuries, such as ankle sprains.

Due to their use in the ongoing treatment of asthma, most therapeutic use exemptions received by UK Sport for professional footballers involve the use of glucocorticosteroids.

How do they work?
Glucocorticosteroids act on the immune system by blocking the production of substances that trigger inflammatory responses due to allergens such as pollen or dust (common causes of asthmatic attacks). In much the same way, injections of specific glucocorticosteroids into injured joints help to reduce swelling and inflammation associated with acute injury.

Typical Routes of Administration:
Oral (in a pill and inhaler), Injectable (intra-muscular, intra-articular or intravenous), Nasal Sprays, Topical Creams, Opthalmologic (eye-drops).

Common Types:
Prednisolone, Prednisone, Hydrocortisone, Methylprednisolone, Beclometasone, Aldosterone, Triamcinolone, Betamethasone.

Possible side effects/risks to health:
Weight Gain, Stomach Ulcers, Hypertension, Diabetes, Oedema, Osteoporosis, Thinning of the Skin, Suppressed Immune Function, Depression, Mood Swings.