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A performance-enhancing effect of creatine supplementation has been demonstrated in certain contexts. In a meta-analysis of 16 controlled trials, creatine supplementation was found to increase maximal weight lifted by young men, but had no effect on women or persons older than 60 years. A meta-analysis of 100 studies of varying designs found a performance benefit in the context of repetitive bursts of exercise lasting less than 30 seconds each, but no improvement in running or swimming ability. Adverse effects of short-term (three to five days) creatine supplementation include an increase in weight attributable to an increase in total body water. Abstract Amino Acids Anabolic Steroids Androstenedione and Dehydroepiandrosterone Beta-hydroxy-beta-methylbutyrate Blood Transfusions and Erythropoietin Caffeine Carbohydrate-Electrolyte Beverages Chromium Creatine Ephedrine and Pseudoephedrine Human Growth Hormone Iron Sodium Bicarbonate Final Comments References. Although ephedrine and pseudoephedrine are classified as stimulants, they have different effects on performance. Ten-kilometer run time was decreased with ephedrine supplementation30 and anaerobic performance was improved31; however, a meta-analysis of eight studies found insufficient evidence to support a performance benefit with ephedrine, propionat 100 mg injectable steroids testosterone propionate. Serious adverse effects of these stimulants primarily involve the cardiovascular and central nervous systems. An analysis of 50 trials and 71 case reports of adverse events related to ephedrine reported a two-to threefold risk of psychiatric symptoms (e. Abstract Amino Acids Anabolic Steroids Androstenedione and Dehydroepiandrosterone Beta-hydroxy-beta-methylbutyrate Blood Transfusions and Erythropoietin Caffeine Carbohydrate-Electrolyte Beverages Chromium Creatine Ephedrine and Pseudoephedrine Human Growth Hormone Iron Sodium Bicarbonate Final Comments References. Popular over-the-counter supplements are often marketed as being able to increase endogenous levels of human growth hormone. However, human growth hormone is an injectable medication that is only available as a prescription. It has not been shown to have a performance-enhancing effect. A recent systematic review of randomized controlled trials concluded that human growth hormone increases lean body mass, but has no beneficial effect on strength or exercise capacity in trained athletes. One risk associated with the use of cadaveric-derived human growth hormone is Creutzfeldt-Jakob disease. Abstract Amino Acids Anabolic Steroids Androstenedione and Dehydroepiandrosterone Beta-hydroxy-beta-methylbutyrate Blood Transfusions and Erythropoietin Caffeine Carbohydrate-Electrolyte Beverages Chromium Creatine Ephedrine and Pseudoephedrine Human Growth Hormone Iron Sodium Bicarbonate Final Comments References. No performance benefit has been noted with iron supplementation in athletes who were not iron deficient. However, female athletes, distance runners, and vegetarians are often at risk of iron deficiency. A study of swimming performance during six months of training and iron supplementation in adolescents without iron deficiency failed to note a performance enhancement over placebo. A decrease in serum ferritin (a measure of iron status) without anemia commonly occurs in female athletes, but it has not been shown to negatively effect performance and usually can be corrected by careful dietary changes to increase iron intake. Iron supplementation may result in hemochromatosis in susceptible persons, and it commonly causes constipation. In the context of deficiency or anemia, supplementation may be necessary, but only after nutritional consultation and dietary adjustments. Iron supplements are not prohibited by any sports governing agencies. 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