Erythropoietin is not a steroid, but it is a glycoprotein that acts upon the bone marrow to produce more red blood cells. Various stimuli such as bleeding or higher altitudes trigger the body’s own release EPO. Because EPO increases the hematocrit, it enables much more oxygen to be delivered to skeletal muscle, which has made EPO very popular among endurance athletes in the past for blood doping. EPO is produced primarily by the kidneys, secondarily by the liver, and tertiarily by the brain, but a synthetic or recombinant version of EPO is available in 1 mL vials. A typical dose of EPO will last one day but the effect is seen 5 days later when the red blood cell proliferation it has induced is mature enough for release into circulation. Doses are initially given subcutaneously 3 times per week with an iron supplement taken orally, but EPO is a dangerous drug that can have serious side acute problems to occur. The smallest side effect of concern is increased blood pressure, but there are many other side effects that are much more serious. Keep in mind that athletes (endurance and weightlifters) already have an above average red blood cell count so increasing the hematocrit more can lead to fatal problems if EPO is used unwisely. When the hematocrit becomes too high, arteries can literally clog, can cause heart attacks, cardiac failure, and pulmonary edema (common with vertical altitude limit exposure). If EPO should ever be used, extreme caution is a necessity.
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