Erythropoietin (EPO) and Blood Doping in Sports

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If you follow sports, you've undoubtedly heard about athletes who have been caught using performance-enhancing drugs (PEDs). Anabolic steroids are some of the more well-known PEDs, but erythropoietin (EPO)—a drug used to boost red blood cell counts in a practice called "blood doping"—falls under the same umbrella of forbidden substances. In fact, EPO has been a source of widespread abuse and controversy among professional cyclists since the 1980s.

What Is "Blood Doping?"

Blood doping refers to any attempt to improve athletic performance by artificially increasing your red blood cell count. Red blood cells are responsible for carrying oxygen molecules throughout the body. The more red blood cells you have, the greater your energy expenditure and the slower you will "burn out" during extreme physical activity.

Methods of blood doping include:

  • Transfusions of someone else's blood
  • Re-infusion of one's own red blood cells
  • Administration of enhancement drugs such as EPO

Blood doping is in violation of standards set by the World Anti-Doping Agency (WADA) and is banned in professional sports. Even with rigorous testing among athletes, that hasn't stopped some from doing it anyway.

EPO Controversies

EPO has been banned since the early 1990s, but the first tests did not become available until the 2000 Summer Olympics.

Abuse of EPO made world headlines when Floyd Landis, the 2006 Tour de France winner, was stripped of his title after testing positive for doping. Having confessed to using PEDs for years, Floyd went even further by accusing 17 other cyclists of doping, including seven-time Tour de France titleholder Lance Armstrong.

In 2005, a year after his seventh Tour de France win, Lance Armstrong was accused of using EPO, a claim that was eventually confirmed in 2012. After publicly admitting to EPO use, Armstrong was stripped of all of his cycling titles.

Other cyclists caught in the crosshairs of the EPO controversy were champions Willy Voit, David Millar, Phillipe Gaumont, and Jesus Manzano.

Effect on Athletic Performance

EPO is a naturally occurring hormone that can be synthesized in the lab and injected directly into the skin or bloodstream. In term of sports performance, it has been shown to increase the proliferation of red blood cells and increase the amount of oxygen carried to muscles.

Increased availability of oxygen is believed to slow the progression of muscle fatigue and increased endurance during performance athletic events.

The ability to exert force for longer periods of time is what makes blood doping so appealing for professional athletes. Doing so may help reduce the recovery time between workouts, increase muscle power, and maintain an edge during competitions.

With that being said, there is evidence that EPO injections may deliver fewer benefits than initially thought.

A 2017 study published in Lancet Hematology concluded that cyclists given a subcutaneous injection of EPO for eight weeks performed no better in exercise tests or road race performance than cyclists given a placebo.

Potential Dangers

EPO has been shown to induce hypertension (high blood pressure) by literally crowding plasma with excessive red blood cells. This serves to "thicken" the blood, increasing vascular constriction and the overall blood pressure. Greater blood viscosity puts a strain on the heart, increasing the risk of blood clots, heart attacks, and stroke.

Drug interactions may occur between EPO and medications used to treat hypotension (low blood pressure), including Astonin (fludrocortisone) and midodrine. Taking EPO with these drugs may amplify their effect, leading to drug-induced hypertension.

EPO can cause severe lung toxicity if taken with cancer drugs used to treat leukemia, lymphomas, and breast cancer, such as Cytoxan (cyclophosphamide).

EPO and other banned PEDs are under constant scrutiny by sporting agencies. Athletes are regularly tested to detect their presence. Athletes who test positive for EPO face possible suspension, the withdrawal of competition titles, and even a lifetime ban from sports if the PED abuse is especially egregious.

A Word From Verywell

Despite the temptation to use PEDs, the risks to your health and reputation far outweigh any possible benefit. If you feel that you are underperforming as an athlete, don't let supplements be your first choice of treatment.

Instead, talk to your coach about safer options, such as nutrition, alternate forms of training, or the implementation of sports psychology techniques. If you need to increase your red blood cell count for medical reasons, consult with your doctor to develop a treatment plan that makes sense for you.

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