PITTSBURGH, PENNSYLVANIA - Adam Gusky never contemplated using performance-enhancing drugs, or PEDs, while he was a top high school football player in Pittsburgh, Pennsylvania, 20 years ago — but that changed when he turned semi-pro.

"I thought to myself, what can I do to make myself a better player on the field while not affecting myself generally as a person off the field," Gusky said.

The dilemma is not uncommon for high-level athletes, who must weigh the potential edge the drugs can bring against the consequences, which include bans at the highest levels of competition.

Orthopedic surgeon Dr. Evan Argintar of the Orthopedic Institute at MedStar Washington Hospital Center said there is an advantage to using PEDs.

"Performance-enhancing drugs absolutely give athletes advantages in strength and endurance, which helps them both in the preparation for their sport as well as the actual implementation of the skills needed in many ways for the different sports," he said.

Anything for an edge

Gusky did not use needles or steroids, but rather pills that he bought at a store without a prescription. The drugs he used, while legal, are banned in major competitions like the Olympics or professional football.

"I would do anything to give me an edge to try to make me as good of a football player as could be," Gusky said. But he had his limits. He refused to break the law and, although he wasn't using anything banned by his league, he said the drugs changed him on game day.

"Basically, what I was doing was something that gave me increased testosterone for a short period of time, made me more aggressive for a short period of time, made me able to hit harder, to be stronger for a short period of time," he said.

But hyper-aggression turned into mood swings and ultimately ended his career after a concussion sustained from a violent helmet-to-helmet injury. Gusky says he stopped using PEDs the day he stopped playing football.

"I don't want to kill myself,” he said. “I have a family. I have a wife. I have parents.”

World stage

The performance-enhancing drugs are not something he wants for himself anymore, nor is it something he wants for kids starting out.

PEDs have been a big topic at this year's Summer Olympics in Rio de Janeiro, Brazil, where more than 100 Russian athletes were barred from competition because of a state-approved doping scandal.

There were no Russian track and field, rowing or weightlifting teams this year, and the country fielded its smallest Olympic team since 1912.

The International Olympic Committee banned the Russian athletes after it was revealed many of them had taken performance-enhancing drugs with the approval of the Russian Sports Ministry, along with evidence that Russian officials tried to cover up the allegations.