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Furosemide is included in the World Anti-Doping Agency's (WADA) list of prohibited substances because it can be used by athletes to mask the presence of performance-enhancing drugs in urine and/or excrete water for rapid weight loss. But how effective is furosemide in masking prohibited substances in urine? Based on the pharmacology and the available literature, we conclude that the masking effect of furosemide is limited. Furosemide is a doping agent that is mainly relevant for sports with weight categories.

Physicians should possess specific diagnostic and pharmacotherapeutic skills in order to recognize symptoms associated with doping use. It is important to be on the alert in athletes and fitness enthusiasts for physical and psychological changes due to use of anabolic steroids such as acne, stretch marks, gynecomastia, signs of acromegaly, irascibility and lethargy. Stimulants such as amphetamines, ephedrine and cocaine lead to fat loss and increased alertness; their main side effects are cardiac problems, behavioural changes and addiction. In addition to anabolic steroids and stimulants, erythropoietin, growth hormone, diuretics and glucocorticoids are regularly used to improve sport performance. In cycling, a biological passport will be used in an attempt to detect doping use. In future, the Olympic motto 'citius, altius, fortius' (faster, higher, stronger) will have ground-breaking consequences for the performance and health of top athletes.

In the Netherlands an estimated 20,000 people use anabolic androgenic steroids (AAS). The use of AAS is particularly common in regular visitors to gyms and fitness centres. AAS are usually synthetic derivatives of testosterone with both an anabolic and an androgenic effect. AAS have many side effects like liver damage (oral use) or infections (intramuscular use), which can be explained partly by the androgenic effect and partly by the manner of use. Many of these side effects are only reported in case studies and have not been systematically investigated.

Androgenic anabolic steroids are compounds with a chemical structure and clinical effect very similar to those of the male hormone testosterone. Since their introduction these substances have been misused in an effort to improve athletic performance. Detection of misuse has long been inadequate. For this reason a state doping programme was developed by the government of the former German Democratic Republic (GDR). Systematic doping abuse ended with the collapse of the GDR and the introduction of out-of-competition surprise drug testing. The performance-enhancing effects of doping and the introduction of intensive doping surveillance are reflected in the decline in performance in several women's track and field events.

After recent scandals in cycling involving doping, it has been asserted that top-level cycling is impossible without pharmacological support. An important prerequisite for successfully completing the Tour de France is maintaining energy balance. To compensate for the daily caloric expenditure of 23-25 MJ, conventional food must be supplemented with liquid food. Quick administration of liquid carbohydrates is essential for optimal recovery of glycogen stores in the liver and skeletal muscle. Androgenic anabolic steroids are a frequently used form of doping. In endurance sports, these drugs have not been shown to affect endurance performance, and there is little evidence to suggest that they enhance recovery. Although epoetin use can increase maximal oxygen uptake, its effects on maximal power output are less pronounced than what is generally assumed. A relationship between haemoglobin concentration and sport performance has not been proved. It has been found that growth hormone rather has a negative than a positive influence on the sport performance. The doping problem is due in part to superstition, hearsay and insufficient knowledge among the athlete's support personnel, which frequently leads to medical malpractice in sport. Education and quality control for sport professionals, including sports physicians, may help to control the doping problem.

In sports, medical drugs are applied for supposedly ergogenic effects. Forbidden drug use (doping) implies that the drug enhances performance, which is not always the case. Amphetamines are ergogenic particularly during short-term, explosive exercise. Amphetamines exert an ergolytic effect on high-intensity endurance exercise. Caffeine has an ergogenic effect on endurance performance in dosages of 3 to 6 mg/kg. Doping regulations allow a small amount of caffeine intake. Androgenic and anabolic steroids elicit an increase in muscle growth and strength. In females low doses appear to be ergogenic in all sport types. beta 2-adrenergic agonists appear to have a positive effect on strength and muscle growth. The effects on endurance performance are still unknown. Although growth hormone is used in sports, scientific studies show that compared with placebo no difference in strength and muscle volume is observed. Blood doping and administration of erythropoietin are effective in enhancing endurance performance.