Scientific efforts to enhance human performance were carried on throughout the 20th century, but most people hear about this work only in the context of criticizing "steroid cheats" in their favorite sports.

Testosterone is an old drug, synthesized in the 1930s by Croatian scientist Leopold Ruzicka and later deployed to considerable effect by the Soviet and East German Olympic teams. Growth hormone research began in the 1950s and was used to treat people with developmental disabilities; later, pioneering amateur steroid researcher Dan Duchaine wrote about the drug's potential for strength gains and bodily rejuvenation. Even stem cell treatments, in the form of bone marrow transplants, have been performed since the 1960s.

Outside of a purely medical context, attempts to utilize these drugs have been met with intense criticism. John Hoberman's book Testosterone Dreams details many of the fallacious claims made about that sex hormone, such as its potential to eradicate impotence and male homosexuality, while also noting that until 1984, the American Academy of Sports Medicine denied that anabolic-androgenic steroids had any impact whatsoever on athletic performance. Steven Ungerleider's Faust's Gold offers a detailed look at East Germany's state-run performance enhancement, offering many reproductions of the precise drug schedules that East German athletes followed, but is deeply critical of the government doctors who oversaw the program and avowedly opposed to performance enhancement.

"What is performance enhancement, exactly?" steroid-using powerlifter Mark Bell asked me when I interviewed him last year. "All exercise, all training, is a kind of performance enhancement. What makes one thing good and another thing bad?"

Confusion about terminology such as "performance enhancement," as well as concerns about drug side effects and public disapprobation for the swollen, hypertrophied bodies of professional bodybuilders, have combined to consign much worthwhile research involving testosterone, growth hormone, and even stem cells to the sidelines, or, in the case of black-market personal usage of steroids, to the shadows.

"We did this work on ourselves," physique athlete and trainer Douglas Alexander told Motherboard. "From Dan Duchaine's Underground Steroid Handbook to today's performance-enhancing drug forums, lifters and bodybuilders have been testing and experimenting with drugs, determining what works and what doesn't. It's part of what makes this such a close-knit community, that knowledge base."

Cass Almendral, a 56-year-old business consultant who discussed his growth hormone usage in a recent New York Post feature, believes that performance enhancement and anti-aging treatments should be normalized rather than stigmatized. "I'm under a doctor's supervision and I've never been in better shape," he said. "What's dangerous, in my opinion, is selling people exercise products or diets that don't work, that make them become discouraged and depressed while chasing results they cannot achieve due to the effects of the aging process."

Cass Almendral, 56, after six months of anti-aging treatment involving physician-supervised injections of HGH. (image: Cass Almendral)

Brian Mehling, an orthopedic surgeon and founder of Blue Horizon International, a charitable foundation focused on regenerative medicine, has conducted extensive stem cell and growth hormone research. Mehling believes public misperceptions and regulatory hurdles have unduly complicated that process. "On the one hand, you have people who think of strengthening and improving the body, and what immediately comes to mind are these huge bodybuilders who are taking dangerous amounts of anabolic drugs, who are quite frankly suffering from some kind of psychosis related to body image," he said. "And then you have drug companies that are very satisfied with the profits from their cholesterol pills and antidepressants and don't want to see these symptoms alleviated, merely treated."

Roughly six months separate each of the images in the photo: top left in early 2015, bottom left in late 2015, right in early 2016 (Image: Douglas Alexander).

Mehling is unsatisfied with the pace of change. "We are on the cusp of breakthroughs in multiple areas related to injury and aging, from CTE to Alzheimer's, and it is unfortunate that much of this work has to be done overseas because of the glacial pace at which the FDA moves."

Almendral, for his part, sees the process of public acceptance of performance enhancement as unavoidable. "Everyone is entitled to experience a high quality of life and athletic performance. It shouldn't be something available only to wealthy people, something kept far out of reach because taking pills and feeling bad as your body weakens with age is a more 'natural' state."

Oliver Bateman in 1992 (left, with donuts) and 2015 (right) (Image: Oliver Bateman).

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Why the Science Behind Athletic Performance Enhancement Remains So Controversial - Motherboard