Performance-enhancing drug use is a prevalent problem in sports. It is a problem that has captured the world's attention as the media highlights story after story of athletes who have transformed their bodies over a short period of time, those who have simply defied the aging process in an attempt to prolong a career and those whose careers have been tarnished because of drug use. The baseball investigations and the Mitchell Report of 2007 opened our eyes and gave us a glimpse of a secretive underground world. This "world" is much more intelligent and sophisticated than it is given credit for. It is the goal of this article to increase the awareness of the medical provider about the types of steroids and other medications used, the influence these substances have on the athletes, and how and why they use them.