It is manufactured in South Africa and is available on the black market. The source of the hemoglobin in Hemopure, before modification, is cattle. It stimulates the breakdown of fat into energy. Because it is a naturally occurring hormone, additional amounts are undetectable in urine or blood tests. Visible signs of extended use are bone and muscle disfigurement, jutting forehead and elongated jaw.
Users also can suffer heart problems.
Like hGH, no reliable test has been developed for IGF-1, which increases stamina or muscle growth. Testosterone levels have to be extraordinarily high to render a positive test. It received a lot of publicity when it was revealed that baseball slugger Mark McGwire had used it. They fend off fatigue and were the first generation of drugs that the IOC began testing for, in 1968. Stimulants can be masked with diuretics, which dilute urine.