Performance-enhancing drugs?

I find the bans on performance enhancing drugs in sports puzzling. Is insulin considered a performance-enhancing drug? Or glasses? To my knowledge, neither is banned by most sports bodies. Yet, they must certainly be considered performance enhancers for the people with diabetes and myopia.

We know that some people are born without myostatin, thereby allowing their muscles to grow much larger than normal. Others are born with multiple muscles. No doubt others are born with higher than normal RBC counts, and more efficient hearts and lungs. Why shouldn't other athletes be allowed to compensate for these genetic advantages?

If it's okay for a diabetic to take insulin, why isn't it okay for someone with over-expressed myostatin to take steroids to compensate?

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