Prevalence of prescription and over-the-counter drug misuse for performance enhancement in Jordanian gyms: a cross-sectional study

Abstract Background The non-sporting gym-goers are also turning to the use of performance-enhancing substances (PES) without medical guidance; according to recent statistics within the Middle East, there is also a rising pattern of abuse. Methods Following the escalating popularity of performance-enhancing substances among physically active groups, we conducted a cross-sectional survey of 300 gym users in Jordan between October 2023 and January 2024 via an Internet-based survey. The questionnaire, in a structured format, touched on sociodemographic factors, physical activities, knowledge, and information on performance-enhancing drugs, their actual use, and perceived negative health consequences. The statistical associations were tested using Fisher's exact tests, and multivariate logistic regression models were used to obtain adjusted odds ratios. Results Overall, 35.3% reported PES use. Use concentrated among males (48.9% of men vs 13.8% of women) and professional-level trainees (63.3% vs 19.7% of amateurs). Common products included protein and amino acids; 7.3% reported testosterone-based agents and 4.7% clenbuterol. Users more frequently reported heart palpitations and digestive complaints; the rate of any adverse event was 28.6% in users vs 6.2% in non-users. In adjusted models, male sex and professional training level remained strong predictors of PES use (AORs with 95% CIs reported in Table 1). Conclusions PES misuse is common in Jordanian gyms and clusters among higher-intensity male trainees, with non-medical information sources predominating. Findings support gym-linked pharmacist counseling, targeted education for high-risk groups, and stronger JFDA oversight in fitness settings.