Creatine and other nonsteroidal strength-enhancing aids

Although most discussions of ergogenic supplements to enhance strength focus on anabolic steroids, there are several nonsteroidal supplements of importance. These agents, including creatine, beta-hydroxy-beta-methylbutyrate (HMB), chromium, human growth hormone, and insulin-like growth factor are popular, easily accessible, sometimes impossible to detect, and (in some cases, ie, creatine) not banned by official sports organizations. They are purported to be natural and safe because they are not anabolic steroids, have at least a theoretic basis for potential benefit, and in some cases, have data suggesting athletic improvement in certain controlled conditions. They also have a significant potential for causing at least bothersome if not dangerous adverse effects. Studies to date have generally addressed efficacy, with little data to support effectiveness in unmonitored, uncontrolled use. Human growth hormone is officially banned. In general, none of these agents can be recommended at present.