The anti-inflammatory drug that athletes routinely use — and that gets them banned from competition — is a class of medications sitting in millions of medicine cabinets right now: glucocorticoids. Cortisone, prednisone, dexamethasone, methylprednisolone, and triamcinolone all fall under this umbrella. Listed under Section S9 of the World Anti-Doping Agency’s Prohibited List, these corticosteroids are banned in-competition when taken orally, injected, or administered rectally. They reduce muscle swelling, boost available glucose during exercise, decrease fatigue, and even produce euphoria through central nervous system effects — a cocktail of benefits that makes them irresistible to athletes looking for an edge. French cyclist Bernard Thévenet won the Tour de France in both 1975 and 1977 while using cortisone, later admitting after his 1982 retirement: “I was doped with cortisone for three years and there were many like me.
The experience ruined my health.” For readers of a brain health and dementia care site, this matters more than you might think. Glucocorticoids don’t just affect muscles and joints. Long-term use is linked to bone density loss, immune suppression, adrenal insufficiency, and metabolic disruption — conditions that compound the challenges facing aging adults already managing cognitive decline. If you or someone you care for uses these drugs for arthritis, chronic pain, or inflammatory conditions, understanding the risks that led sports authorities to restrict them is directly relevant to long-term brain and body health. This article covers what glucocorticoids actually do, why WADA tightened the rules in 2022, the health consequences of prolonged use, and what caregivers and patients should know about balancing the genuine medical benefits of these drugs against their serious downsides.
Table of Contents
- Why Are Glucocorticoids the Most Banned Anti-Inflammatory Drug in Competitive Sports?
- The 2022 Rule Change That Closed the Injection Loophole
- From the Tour de France to Your Medicine Cabinet — Notable Cases and What They Reveal
- Glucocorticoids and Brain Health — What Dementia Caregivers Should Know
- The Hidden Risks of Long-Term Glucocorticoid Use in Aging Adults
- Why the 40 Percent Retroactive TUE Rate Should Concern Everyone
- Moving Beyond Glucocorticoids — What the Future Holds
- Conclusion
- Frequently Asked Questions
Why Are Glucocorticoids the Most Banned Anti-Inflammatory Drug in Competitive Sports?
Glucocorticoids hold a peculiar distinction in anti-doping enforcement: they consistently account for the largest share of Therapeutic Use Exemptions granted through WADA’s system. that means more athletes seek permission to use these drugs than any other banned substance. The reason is straightforward — glucocorticoids treat real conditions that athletes genuinely suffer from, including joint inflammation, tendinitis, asthma, and chronic arthritis. The line between legitimate medical treatment and performance enhancement is thinner here than with almost any other prohibited substance. What pushes these drugs into banned territory is their systemic effects when injected or swallowed.
Beyond calming inflammation at an injury site, glucocorticoids flood the body with cortisol-like activity that increases glucose availability during exercise, masks pain that would normally force an athlete to slow down, and triggers a mild euphoria that can push someone through exhaustion barriers. WADA classifies them under Section S9 of the Prohibited List, and as of January 1, 2022, significantly expanded restrictions so that all injectable routes — including intra-articular, epidural, peritendinous, and subcutaneous injections that were previously allowed — became prohibited during competition. The 2026 Prohibited List, which came into force January 1, 2026 after approval by WADA’s Executive Committee on September 11, 2025, maintains this same framework. The distinction matters: topical creams, inhaled forms, nasal sprays, eye drops, and ear drops remain permitted even during competition, as long as they stay within manufacturer’s licensed doses. Outside of competition windows, athletes can use glucocorticoids by any route. The issue isn’t the drug itself — it’s the method and timing of delivery that determines whether an athlete crosses the line.
The 2022 Rule Change That Closed the Injection Loophole
Before 2022, athletes and their medical teams exploited a significant gap in anti-doping rules. While oral and certain injectable glucocorticoids were prohibited in competition, local injections — a cortisone shot into a sore knee, for example — were perfectly legal. The problem was that even “local” injections produce systemic effects. The drug enters the bloodstream, circulates throughout the body, and delivers the same fatigue-reducing, glucose-boosting benefits that make oral doses problematic. WADA’s decision to ban all injectable routes in competition closed this loophole, but it created new complications for athletes managing legitimate injuries. However, if an athlete genuinely needs a cortisone injection for a serious injury close to competition, the situation becomes more nuanced. Athletes must now observe minimum washout periods between the time of injection and the start of in-competition testing windows.
These periods vary depending on which specific glucocorticoid was used and the route of administration. The urine reporting threshold is set at 30 nanograms per milliliter to help distinguish between permitted topical or local use and banned systemic administration. Getting this wrong — even unintentionally — can end a career. The retroactive TUE numbers tell a revealing story about how these rules play out in practice. Approximately 40 percent of glucocorticoid Therapeutic Use Exemption applications are filed retroactively, meaning the athlete used the drug first and sought permission afterward. That’s a staggeringly high number that suggests either widespread confusion about the rules, deliberate gaming of the system, or some combination of both. For the broader population, including older adults managing inflammatory conditions, the takeaway is clear: these are potent systemic drugs even when injected locally, and treating them as simple spot treatments understates their reach throughout the body.
From the Tour de France to Your Medicine Cabinet — Notable Cases and What They Reveal
The history of glucocorticoid abuse in sports reads like a cautionary tale about what these drugs do to the human body over time. Bernard Thévenet’s admission remains one of the most candid in cycling history. After winning two Tours de France on cortisone, he didn’t sugarcoat the aftermath — his health was ruined. He wasn’t alone. He explicitly said “there were many like me,” pointing to a culture where corticosteroid use was endemic in professional cycling during the 1970s and beyond. Lance Armstrong’s case added another dimension. During the 1999 Tour de France, traces of a corticosteroid were found in his urine. At the time, his team attributed the positive test to a prescription skin cream used for saddle sores, and he was cleared.
It wasn’t until 2012 that Armstrong was stripped of all seven Tour de France titles for systematic doping — a saga that revealed how easily corticosteroid use could be masked or explained away under the older, looser rules. The cream excuse, whether true for that particular test or not, highlighted exactly the gray area that WADA spent the next two decades trying to close. What connects these elite sports cases to everyday health is the underlying pharmacology. The same drug that let Thévenet push through pain on Alpine climbs is the cortisone injection your orthopedist offers for a bad knee. The same prednisone that can mask fatigue in a cyclist is prescribed to millions for arthritis, lupus, and inflammatory bowel disease. The difference isn’t the drug — it’s the dose, duration, and monitoring. Elite athletes were using these drugs aggressively, often without adequate medical supervision, and the consequences caught up with them. For older adults, especially those with or at risk for dementia, the parallel concern is that long-term glucocorticoid use may carry cognitive costs that aren’t immediately obvious.
Glucocorticoids and Brain Health — What Dementia Caregivers Should Know
The connection between chronic glucocorticoid use and brain health deserves more attention than it typically gets. Cortisol — the natural hormone that synthetic glucocorticoids mimic — plays a well-documented role in hippocampal function, the brain region most associated with memory formation and one of the first areas damaged in Alzheimer’s disease. Chronically elevated cortisol levels have been associated with reduced hippocampal volume in multiple studies. When someone takes exogenous glucocorticoids for months or years, they’re essentially flooding their system with synthetic cortisol, and the brain doesn’t distinguish between the natural and pharmaceutical versions. The tradeoff is real and sometimes unavoidable. For a person with severe rheumatoid arthritis or a dangerous autoimmune flare, glucocorticoids can be genuinely lifesaving.
The inflammation they suppress can itself damage organs, including the brain. So refusing corticosteroids isn’t automatically the safer choice — uncontrolled systemic inflammation carries its own cognitive risks. The question for caregivers and patients is whether the lowest effective dose is being used, whether the duration is as short as possible, and whether alternative anti-inflammatory approaches have been adequately explored. Compared to NSAIDs like ibuprofen or naproxen, glucocorticoids are far more potent but carry a heavier side-effect burden. NSAIDs work primarily at the site of inflammation and have their own risks — stomach ulcers, kidney problems, cardiovascular concerns — but they don’t produce the same systemic cortisol-like effects that make glucocorticoids problematic for brain health. For older adults managing chronic pain alongside cognitive concerns, this comparison matters when discussing treatment options with a physician.
The Hidden Risks of Long-Term Glucocorticoid Use in Aging Adults
The health risks that ended Bernard Thévenet’s sense of well-being don’t require athletic-level doses to manifest. Long-term glucocorticoid use — even at doses commonly prescribed for chronic conditions — carries serious risks including bone density loss, weakened tendons, immune suppression, adrenal insufficiency, weight gain, and metabolic disruption. For older adults, bone density loss is particularly dangerous because it compounds the already elevated fracture risk that comes with aging, and a hip fracture in someone with dementia can be catastrophic for both physical recovery and cognitive trajectory. Adrenal insufficiency is another underappreciated risk. When someone takes glucocorticoids for an extended period, the body’s own cortisol production slows down. Stopping the drug abruptly can trigger an adrenal crisis — a potentially life-threatening drop in cortisol that causes severe fatigue, low blood pressure, and confusion.
For a person with dementia, the confusion of adrenal insufficiency can be mistaken for disease progression, leading caregivers and even physicians down the wrong diagnostic path. Any tapering of glucocorticoids in an older adult with cognitive impairment needs to be done gradually and with careful monitoring. Immune suppression adds yet another layer of concern. Glucocorticoids dampen the immune system broadly, which is useful for autoimmune conditions but dangerous for people already vulnerable to infections. Older adults with dementia are at elevated risk for pneumonia, urinary tract infections, and other infections that can accelerate cognitive decline. A drug that further weakens immune defenses in this population requires careful justification and vigilant oversight.
Why the 40 Percent Retroactive TUE Rate Should Concern Everyone
The statistic that roughly 40 percent of glucocorticoid TUE applications in elite sports are filed retroactively isn’t just a sports governance problem — it reflects how casually these powerful drugs are administered. Among U.S. elite athletes who used two or more prohibited substances, 22.2 percent reported using glucocorticoids, compared to only 3.8 percent among single-substance users.
That pattern suggests glucocorticoids often enter the picture as part of a broader pharmacological approach to managing the body, rather than as a one-time targeted treatment. The parallel in general medicine is the patient who receives a cortisone shot at every visit for chronic joint pain, with each injection treated as an isolated event rather than part of a cumulative exposure pattern. Physicians managing elderly patients — particularly those with cognitive impairment who may not fully track their own medication history — should maintain a running tally of glucocorticoid exposures across all providers and formulations. What looks like a simple knee injection in isolation may represent the fifth or sixth systemic glucocorticoid exposure that year.
Moving Beyond Glucocorticoids — What the Future Holds
The sports world’s tightening restrictions on glucocorticoids reflect a broader medical reassessment of how freely these drugs should be used. Newer biologic therapies for inflammatory conditions — drugs targeting specific immune pathways like TNF-alpha or interleukin-6 — offer more precise inflammation control without the broad systemic effects of corticosteroids. While these biologics are expensive and not without their own risks, they represent a direction that could eventually reduce reliance on glucocorticoids for both athletes and the general population. For dementia caregivers navigating inflammatory conditions in the people they care for, the practical message is to ask questions.
Ask whether a glucocorticoid is truly necessary or whether alternatives exist. Ask about the cumulative dose over time. Ask about the plan for tapering. The same scrutiny that led WADA to reclassify these drugs as prohibited in competition should inform how we think about them in clinical care — not as harmless anti-inflammatory tools, but as powerful systemic medications that demand respect and restraint.
Conclusion
Glucocorticoids occupy a complicated space in both sports and medicine. They are genuinely effective at reducing inflammation, managing pain, and treating serious autoimmune conditions. They are also powerful enough to enhance athletic performance, risky enough that WADA bans them in competition, and potentially harmful enough that a two-time Tour de France champion said they ruined his health. For older adults and people living with or at risk for dementia, the stakes are compounded by the drugs’ effects on bone density, immune function, adrenal health, and potentially the brain itself.
The key is informed vigilance, not blanket avoidance. Some people truly need glucocorticoids, and the inflammation these drugs control can itself be destructive. But every prescription, every injection, and every refill should come with a clear understanding of cumulative risk, a plan for the shortest effective duration, and an honest conversation about alternatives. What elite sports learned the hard way about glucocorticoids — that convenience and effectiveness don’t equal safety — is a lesson worth carrying into every doctor’s office and every caregiver’s medication review.
Frequently Asked Questions
Are glucocorticoids the same as anabolic steroids?
No. Glucocorticoids (cortisone, prednisone, dexamethasone) are corticosteroids that suppress inflammation and immune response. Anabolic steroids (testosterone, nandrolone) build muscle mass. They are entirely different drug classes with different effects, different risks, and different reasons for being banned in sports. Both appear on WADA’s Prohibited List but under separate sections.
Can someone using a cortisone cream or inhaler still compete in sports?
Yes. WADA permits topical skin applications, inhaled forms, nasal sprays, eye drops, and ear drops even during competition, as long as the athlete stays within the manufacturer’s licensed dosing. The ban applies specifically to oral, injectable, and rectal routes of administration during the competition period.
How long do glucocorticoids stay in the body after an injection?
It varies by the specific drug and injection route, which is why WADA requires athletes to observe minimum washout periods before competition. The urine reporting threshold is set at 30 nanograms per milliliter. Patients and athletes should consult their physician about clearance times for their specific medication and dosage.
Should a person with dementia stop taking prescribed glucocorticoids?
Never stop glucocorticoids abruptly without medical supervision. Long-term use suppresses the body’s natural cortisol production, and sudden withdrawal can cause adrenal crisis — a dangerous condition involving severe fatigue, low blood pressure, and confusion. If there are concerns about glucocorticoid use in someone with dementia, discuss a gradual tapering plan and potential alternatives with their physician.
What are the alternatives to glucocorticoids for managing chronic inflammation?
Options include NSAIDs like ibuprofen or naproxen for milder inflammation, disease-modifying drugs such as methotrexate for autoimmune conditions, and newer biologic therapies targeting specific immune pathways. Physical therapy, weight management, and dietary approaches can also help manage inflammatory conditions. Each alternative has its own risk profile, and the best choice depends on the specific condition and the patient’s overall health.
