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. 2025 Jun 16.
doi: 10.1007/s40279-025-02258-7. Online ahead of print.

Health and Performance Challenges in the Era of Human Enhancement: Insights from Sport Medicine Professionals

Ke Hu  1 , Christian Schneider  2 , Mark R Hutchinson  3 , Emin Ergen  4 , Michael Geistlinger  5 , Iain Killoughery  1 , Klaus-Michael Braumann  6 , José Kawazoe Lazzoli  7 , Jane Seto  8   9 , Xavier Bigard  10 , André Debruyne  11 , Anna Jegier  11   12 , Theodora Papadopoulou  11   13 , Pedro Manonelles  11   14 , Francisco Arroyo  15 , Mourad Ghrairi  16 , Ana V Cintrón  11   17   18 , Petra Zupet  19 , Marcelo Bichels Leitão  20 , Umutcan Kayikci  21   22   23 , Daniel Arkader Kopile  24 , Fabio Pigozzi  25 , Chiara Fossati  25 , Alessia Di Gianfrancesco  25 , Luigi Di Luigi  25 , Kirill Micallef Stafrace  26   27 , Anca Ionescu  11   28   29 , Bernd Wolfarth  30   31 , Metin Ergün  32 , William O Roberts  33 , Konstantinos Natsis  34 , Camille Tooth  35   36 , Sandra Rozenštoka  37   38   39 , José Antonio Casajús  40   41   42   43 , Borja Muniz-Pardos  43 , Roberto Lohn Nahon  44 , Malav Shroff  45 , Minhao Xie  46 , Demitri Constantinou  47 , Dina CJanse van Rensburg  48   49 , Bülent Ülkar  50 , Andrew Jowett  51 , Victoriya Badtieva  52   53 , Jean-François Kaux  35   36   54 , Peter Baumgartl  55 , Clea Hadjistephanou Papaellina  56 , Jürgen Steinacker  57   58 , Julio Motta-Pensabene  59 , Rüdiger Reer  6   11   31 , Norbert Bachl  60 , Sergio Migliorini  61 , Maher Zahar  62 , Mark Stuart  63 , James Bilzon  64   65 , Giuseppe Massazza  66 , Bruno Di Pietro  67 , Khaled Massoud Hassan  68   69 , Felix Albuquerque Drummond  70 , Bertrand Fincoeur  71 , Andrea Petróczi  72 , Yannis Pitsiladis  73
Affiliations
Free article

Health and Performance Challenges in the Era of Human Enhancement: Insights from Sport Medicine Professionals

Ke Hu et al. Sports Med. .
Free article

Abstract

Background: In the pursuit of sporting success, some elite athletes prioritise peak performance over long-term health, frequently resulting in significant and enduring health consequences. The Enhanced Games (TEG) position themselves as a bold experiment in transhumanism, advocating for the use of performance-enhancing drugs (PEDs), including methods banned by World Anti-Doping Agency (WADA), to push the boundaries of human athletic potential.

Objectives: The aim of this study is to explore the perspectives of sport physicians, sport scientists, physiotherapists and other allied healthcare professionals on treating and supporting "enhanced athletes", with the view of informing future guidelines.

Methods: Participants were invited via email and personal contacts within sport medicine communities to complete a brief anonymous survey via QuestionPro™. Descriptive statistics were performed using Excel™ and RStudio™.

Results: A total of 323 healthcare professionals responded (82% were sport physicians), among whom 74% expressed a willingness to treat acute lesions and/or chronic diseases in "enhanced athletes". In comparison, a considerable minority (30%) expressed support for assisting athletes in their use of PEDs and methods under medically supervised conditions, with high consistency across professional roles. A relatively high readiness was observed in sport physicians treating acute (77% versus 58%; p < 0.01) and chronic (75% versus 63%; p = 0.11) diseases for "enhanced athletes". As far as WADA rules and/or national anti-doping laws apply, this support presupposes compliance with the code and the respective national laws to protect physicians from serious professional, legal and personal consequences.

Conclusion: The preliminary findings align with the broader goal of fostering a sport culture that values both peak performance and the short- and long-term health of all participants. These results emphasise the necessity of implementing professional guidelines and comprehensive support systems designed to safeguard the long-term well-being of all athletes and underscore the urgent need for further research into the impact of TEG on sport and its community.

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Conflict of interest statement

Declarations. Competing Interests: The authors declare that there are no competing interests related to this study. Funding: This study was conducted without funding, grants or awards. No author has received any payment, or benefits from any public, commercial or not-for-profit sectors for the preparation of this manuscript. Data Availability: The data supporting this study, which include de-identified data, are available upon reasonable request. Interested researchers can obtain the data by contacting the corresponding author (Y.P.) at ypitsiladis@hkbu.edu.hk. Ethics Approval and Consent to Participate: The study complied with the Declaration of Helsinki and was approved by the Hong Kong Baptist University Research Ethics Committee (FASS-SPEH-2024-25_041). Implied consent was given by active participation via completing and submitting the survey responses. Consent for Publication: Not applicable. Author Contributions: All authors meet the criteria for authorship as defined by the journal. Specifically, each author made substantial contributions to the conception or design of the work, or to the acquisition, analysis or interpretation of data; participated in drafting or critically revising the manuscript for important intellectual content; approved the final version for publication; and agreed to be accountable for all aspects of the work. This study is the result of a global collaboration, with the majority of contributors affiliated with the FIMS Collaborating Centres of Sports Medicine (CCSM) network ( https://www.fims.org/about/ccsm/ ). Authors from the CCSM network were instrumental in the collection of data from all centres and were actively involved in key aspects of the study, including ethical approval, participant recruitment, translation and ensuring the cultural and contextual relevance of the data. Code Availability: Not applicable.

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