EPO

EPO (erythropoietin) is an endogenous hormone that stimulates the production of red blood cells. Medically, recombinant EPO is used mainly against anemia, for example in kidney disease or under chemotherapy. In endurance sport it is infamous as a doping agent, because more red blood cells mean more oxygen transport.

Important and honest up front: EPO thickens the blood and has serious cardiovascular risks. It is not a harmless performance agent.

EPO binds receptors in the bone marrow and stimulates the production and maturation of red blood cells there. More red blood cells means more hemoglobin and thus more oxygen transport, which can increase endurance performance. But exactly this raised hematocrit is also the problem: the blood gets thicker and the risk of clots rises.

• The EPO vial (labeled in IU, often 3000 IU).
• U-100 insulin syringes, alcohol swabs.

EPO is given in IU (international units), not in mg. Many EPO preparations come as a ready solution or with a defined IU per vial (e.g. 3000 IU per vial).

• The IU count per vial is on the label, the partial amount follows from that.
• Dose precisely, EPO is very potent in small amounts.

Subcutaneous into the subcutaneous fat. Disinfect the site, pinch a skin fold, rotate sites.

EPO is very well understood as a hormone and drug (overview: Jelkmann, 2013): it is the central regulator of red blood cell formation and medically established against anemia. The performance-enhancing effect in endurance sport is real, but so are the documented cardiovascular risks from the thickened blood.

• Central risk: blood too thick (high hematocrit), causing thrombosis, heart attack, stroke.
• High blood pressure.
• Flu-like symptoms, local reactions.

• Without regular hematocrit control EPO is especially dangerous.
• Enough fluids, do not thicken the blood further.
• With cardiovascular risk, leave it alone.
• Banned in official competition (WADA S2).

EPO is very delicate: keep refrigerated throughout (2 to 8 degrees), do not freeze and protect from light.