The French National Institute of Health and Medical Research (Inserm) states that it is impossible to reduce doping to a universal percentage. Data from anti-doping tests typically show around 1 to 2% positive results. However, Inserm points out that these numbers are misleading as they reflect sample numbers, not individual numbers. An athlete under regular observation can appear ten times in the statistics. Moreover, the tests are focused on certain sports, such as cycling and athletics, and almost absent in others.
The biological passport suggests much higher rates. In endurance sports, some studies indicate between 15 and 18% abnormal biological profiles, though this is not direct proof of doping. Innovative investigative methods like “random response” also inflate estimates, with rates ranging from 20 to over 40% in anonymously surveyed athletes. However, the report recommends caution in using this as a reference due to significant biases.
The central idea lies in the impossibility of isolating an objective rate: each method sheds light on a different aspect of the problem, none capturing it entirely.
Contrary to common belief, doping extends beyond elite sports. Gymnasiums, fitness centers, and amateur sports now serve as major grounds for using substances to enhance performance or appearance.
An international meta-analysis estimates that 3.3% of the global population has already used anabolic steroids, but this figure rises to over 18% among bodybuilders or fitness enthusiasts. A culture of muscular bodies, amplified by social media, leads to early spread: in certain cohorts of North American adolescents, experimentation can start as early as 16 or 17.
Additionally, practices not commonly associated with doping, like the widespread use of anti-inflammatories, paracetamol, or opioid analgesics in endurance sports, are observed. During ultra-trails, more than 20% of participants may consume NSAIDs before or during the event, with rates exceeding 60% on extreme distances surpassing 100 km.
Para-sports also present distinct risks. The practice of “boosting,” a particularly dangerous technique to artificially induce autonomic dysreflexia for enhanced performance, affects around 17% of Paralympic athletes according to international surveys.
The report highlights a gray area of significant concern surrounding dietary supplements. Up to 60% of athletes, amateur and professional, regularly use such products. However, the risks of contamination are real. Several studies cited by Inserm indicate that 10 to 30% of products contain undisclosed substances, sometimes prohibited by the World Anti-Doping Agency (WADA).
Recent cases of “non-intentional” doping, leading to severe consequences on sports careers, are linked to this industrial practice. While European standards exist, controls are weak, and many online-sold products evade regulations.
A more fundamental question arises as certain demographics, especially adolescents, associate dietary supplements with doping substances in a progressive journey where the pursuit of performance or aesthetics leads to stronger products. This “escalation theory” is debated, but Inserm confirms statistically significant associations.
Scientific evidence reveals a growing body of proof on the detrimental effects of anabolic steroids on the heart, liver, fertility, mental health, and risk of addiction. Cardiomyopathies, fibroses, arrhythmias, and some ventricular hypertrophies are well-documented. Hepatic risks like cytolytic, cholestatic, and peliosis emerge frequently in clinical observations. Severe renal or muscular issues, and even cases of pancreatitis, are also identified.
Mentally, the report confirms known observations: anxiety disorders, depressive symptoms, manic episodes, increased aggressiveness, and in some cases, suicidal risks. Addictive mechanisms linked to AAS – impacting reward circuits, body image dependency, hypogonadism syndrome during withdrawal – are now undeniable.
One of the most striking findings is the lack of national coordination in doping prevention. Efforts are fragmented among ministries, federations, private structures, health agencies, and associations without a cohesive approach. Inserm recommends establishing an inter-ministerial mission dedicated to harmonizing actions and integrating health, education, justice, interior, and sports.
The report also suggests expanding health surveillance, improving the regulation of the dietary supplement market, involving the sports circle in prevention programs, and developing risk reduction-based approaches – currently absent from the anti-doping framework.
Surprisingly, Inserm calls for a deep ethical discourse renewal around doping, deeming the current rhetoric centered on sportsmanship and moralization ineffective. Autonomy of judgment, collective accountability, and consideration of sport’s socioeconomic realities should guide future anti-doping efforts.
France is at a critical juncture with the Inserm’s assessment. Following the Paris 2024 Olympics, the French sports model is undergoing significant changes: ministry reorganization, closer ties between elite sports and professional sports, the boom in the fitness market, growth of emerging disciplines, and the rise of unregulated practices. The report provides a detailed map of risks and blind spots.
The issue transcends fraud prevention, touching on public health, economic models of sports organizations, global governance of anti-doping, and how societies value performance – be it in sports, aesthetics, or social spheres.
