Professor Ian Boardley warns the Enhanced Games risk normalising doping and misleading people about the serious long-term harms of PED use
Photo by Victor Freitas on Unsplash
Article by Adam Green, freelance journalist.
In Las Vegas May 2026, athletes compete in an international sporting event that explicitly allows them to use performance-enhancing drugs (PEDs). The Enhanced Games openly encourages competitors to use substances banned in virtually every mainstream sport, including anabolic steroids, erythropoietin and peptide hormones. Organisers have claimed that with proper medical supervision, this is safe. It is a bold proposition and, according to Professor Ian Boardley of the University of Birmingham, a dangerous one.
He argues that events like the Enhanced Games send a message that pharmacological enhancement is not just acceptable but encouraged — a narrative that risks normalising substances that can have serious long-term health consequences. "They’re [Enhanced Games] giving the impression that this can be done safely because it is medically supervised," says Boardley. "It’s incorrect and misleading."
Boardley’s work draws on more than 15 years of rigorous research, funded by the World Anti-Doping Agency (WADA), the International Olympic Committee (IOC), and the Economic and Social Research Council (ESRC).
Boardley argues that the Enhanced Games seeks to legitimise its safety model through two oversight bodies: a Medical Commission and an Independent Scientific Commission. The implication is that qualified experts can provide independent scrutiny of medically supervised PED use. Boardley, however, remains unconvinced.
Elite sports are governed by the World Anti-Doping Code, but there are no regulations to prevent recreational gym-goers and amateur bodybuilders from using anabolic steroids. Ian Boardley argues that for the non-elite exercise community, harm reduction is preferable to prohibition. But the evidence base for monitoring the physiological effects of these products in this community to help ensure safe use does not exist. Given that people are already using these substances, his question is pragmatic: how do we reduce the harm PEDs cause?
Boardley’s doctoral research focused on moral disengagement — the psychological mechanisms by which people rationalise engaging in behaviours they know to be harmful or against the rules. Applying this framework to both doping in sport and anabolic steroid use in exercise communities, Boardley identified similar psychological mechanisms across both populations. If an athlete believes that everyone at their level is using performance-enhancing substances, the psychological barrier to use is lowered. Boardley has identified eight such mechanisms operating in sporting contexts, tracing how people draw on social norms, peer behaviour and cultural expectations to justify choices that they might otherwise not engage in.
Establishing precisely how many people in the UK use anabolic androgenic steroids (AAS) outside of sport is difficult. General population surveys are unreliable because AAS use is comparatively rare and associated with stigma, leading to under-disclosure. Monitoring in needle and syringe programmes tells a different story: up to 80% of clients attending such services are now anabolic steroid users, compared with less than 1% in the 1980s. Research that Boardley contributed to puts the likely number of AAS users in the UK somewhere between 400,000 and 600,000 — substantially higher than the 66,000 suggested by population surveys.
Recent research suggests that anabolic-androgenic steroid use may also be affecting an older group of men, including some aged over 40, with motivations that can extend beyond sport performance to concerns such as muscularity, appearance, ageing and body image. This new demographic of older men, motivated by a desire to feel younger rather than to perform athletically, is poorly served by existing information and services.
The health risks of anabolic steroid use are well-documented. AAS users face a three-fold increased risk of acute myocardial infarction (heart attacks) and a nearly nine-fold higher risk of cardiomyopathy compared to age- and sex-matched controls. Left ventricular function is significantly impaired, and autopsy studies repeatedly identify cardiomegaly and myocardial fibrosis. The damage can be permanent.
AAS users may also experience impaired sexual and reproductive function that persists long after stopping, as well as hepatotoxicity and hepatic tumours. There is also emerging evidence of neurological impact: one neuro-imaging study found that prolonged AAS users showed a significantly larger brain age gap compared to non-using controls, and a 2019 review proposed an association with abnormalities similar to those seen in people at risk of developing Alzheimer’s Disease.
However, there remain gaps in our knowledge because the evidence base is limited by various factors. AAS dosages used in clinical research tend to be far lower than those used by people seeking performance enhancement, and research typically isolates individual substances while real-world users combine multiple drugs simultaneously. The interactive effects of such combinations are almost entirely unknown. Individual responses are also “very idiosyncratic”, as Boardley puts it. A dose that is harmful for one person may not be for another. Some harms can take years to manifest. The short-term medical monitoring proposed by the Enhanced Games would be unable to detect early-stage mechanisms leading to significant harm a decade or more later.
Even some figures associated with the Games have acknowledged limitations in the evidence base. Cardiologist Guido Pieles, a medical advisor to the event, has noted a lack of high-quality research in this area. This concern led Boardley and colleagues to criticise the Enhanced Games’ proposed harm prevention model.
“In my view, there is currently insufficient robust evidence to conclude that high-dose, multi-drug use of this kind can be undertaken safely,” Boardley says.
Photo by Braden Egli on Unsplash
The UK continues to see a rise in anabolic steroid-using clients attending harm reduction services such as needle and syringe programmes, yet those services remain underfunded and narrowly focused. The predominant intervention is needle exchange, which is a vital service, but a scant form of support. Given the role of psychological drivers in PED use, it is striking that the UK has just one NHS service that explicitly offers therapeutic psychological interventions for anabolic steroid users. Boardley’s priorities are clear: greater investment in harm reduction services, a more consistent government approach to a problem that crosses national boundaries, and more research to understand which interventions actually work.
The arrival of the Enhanced Games makes this more urgent. Backed by high-profile investors Peter Thiel and Donald Trump Jnr, and social media content that seems aimed to reach the precise demographics in which AAS use is already growing, the Games carry a powerful message: this can be done safely.
Professor Boardley’s concern is not just what happens in Las Vegas, but what happens next: ordinary people see elite competitors apparently thriving on banned substances and conclude they can do the same without serious risk. “There’s a very strong message being put out that this can be done safely,” Boardley says. “Monitoring cannot guarantee safety - and for most people who go on to use these substances, there will be no monitoring at all.”
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Head of Research
Professor Ian Boardley is conducting research aimed at establishing whether the psychological processes that promote antisocial conduct also facilitate doping in sport.
