Purpose of Review <p>This review explores the growing use of performance enhancing supplements (PES) with a focus on those used among recreational athletes. We discuss the mechanisms of action, benefits, and cardiovascular risks associated with these substances to inform safe practices and address an important area in sports cardiology.</p> Recent Findings <p>Anabolic–androgenic steroids (AAS), used to supplement testosterone levels beyond physiological levels, are increasingly popular among recreational athletes, with their misuse linked to serious cardiovascular and metabolic disease, including dyslipidemia, hypertension, arrhythmias, coronary artery disease, and cardiomyopathy. Recent large observational data suggest a more than twofold increase in mortality risk among AAS users. By contrast, randomized clinical data suggest relative cardiovascular safety of testosterone replacement therapy (TRT) in older hypogonadal men, despite a mildly elevated risk of thromboembolic events and arrhythmias. For postmenopausal women, hormonal therapy (HT) may offer improvements in exercise performance and possibly cardiovascular health when initiated early but may increase cardiovascular and thrombotic risk in older women or those with comorbidities. Beyond AAS and hormonal therapies, pre-workout supplements and creatine are widely used among athletes to improve focus, strength, and aid in recovery. Although their excessive use raises concerns, low to moderate consumption of caffeine and creatine appears to carry minimal cardiovascular risk.</p> Summary <p>PES are increasingly prevalent in sports, offering potential performance benefits but also posing significant cardiovascular risks when misused. Each PES category has unique mechanisms of action and safety profiles. Raising awareness of PES and their cardiovascular risk among athletes and sports cardiologists is critical to mitigate adverse events and maintain athlete health.</p>