The problem with a lot of academics postulating we end the prohibition on PEDs is that their arguments are always theoretical and not pragmatic.
For example if we legalize the use of PEDS, BUT at the same time regulate a limit on their use, to safeguard the health of the athlete, obviously it will be necessary to establish another broad host of regulations setting out the limits on legitimate PED use. Because these regulations will have to be medically based (for health reasons), they will of necessity have to be significantly more complex than the current system of just simply banning PEDs.
Thus even more complex rules will have to be enforced, which is just the opposite effect of what legalizing PEDs will do. No matter what the rules are, and no matter how hard athletic federations, the IOC, WADA and national anti-doping agencies try to enforce them there will always be legions of athletes who will flaunt whatever regulatory system is in place. (e.g. thresholds on certain PEDS such as clenbuterol). Athletes will always cheat if it means they can secure an performance enhancing benefit leading to that win, gold medal, money, fortune and fame. This is pure human nature as demonstrated for centuries and back in the days of testicle eating!
The real question therefore, is not so much a medical health concern (although the health of the athlete is always very NB), but rather is an ethical one. And this is a question the academics always dodge.
And by ethical, I distinguish between a hard line moral stance rooted in self righteous indignation (The so called "War on Drugs" in the non-sport world) and ethics that athletes define for themselves that are reasonable and appropriate to sport. Like any profession, it is the members of that profession who must set the ethical rules, and not some overlying administrative body, although once the athletes set the ethical rules, every profession will need some organisation to regulate the ethics.
The seminal issue always comes back to the issue of whether or not it is ethical to take a drug, that has proven performance enhancing benefits (e.g. EPO) for the express purpose or with the express intent of gaining a performance enhancing benefit over one's competitor!
This intent is substantially different than the reason or intent people in the non-sporting world take drugs. In the non-sporting world drugs are taken for hedonistic reasons. These reasons include to get high, pleasure, to enhance sexual pleasure, to be social, to be a renegade against society's norms etc. People who consume drugs in the non sporting world use drugs that no sane athlete would ever use to enhance performance - cocaine, heroin, marijuana, fentanyl, crystal meth etc. These consumers simply do not use EPO, blood transfusions, steroids, HGH etc. except incidentally and not for performance enhancing reasons.
In sport the intent for the use of the drug is not the same as is the reason people take drugs recreationally. In sport it is to secure a performance enhancing benefit over one's competitor i.e. an advantage. This is not a medical issue, it is an ethical issue (with obvious medical considerations as to how the unfair advantage is to be achieved). For example, a non sporting cocaine user does not take heroin to "one-up" their buddy who prefers to stay in cocaine. And if they do it is because of the additional pleasure one gets from heroin and not a performance enhancing benefit! Or for example, state sponsored doping was (is) to demonstrate that one's political system, national pride or method of coaching is superior to that of another nation - East Germany, Russia etc.
The next question sports ethicists have to ask themselves (i.e. the athletes) is whether or not this is fair in the context of sport. Fair generally means that which is reasonable and just in the circumstances. Is it reasonable and just in the context of sport, that a fellow athlete wins a competition because s/he defeats a non PEDs user, as a result of using PEDs. If the answer to this question is no, it is not fair, then PEDs should be banned. Ask this question of any clean athlete who lost a medal at the Olympics due to their competitor using a PED for the express purpose of gaining an unfair advantage over them (e.g. Becky Scott in cross country skiing (an IOC athlete representative)).
IMHO too many academics who blame the system for athletes use of PEDs (the Olympic motto for example of "higher, faster and stronger") fail to place any responsibility on the athlete for their own conduct. Instead they put the blame on the media's preoccupation with winners, peer pressure, recovery from injury, the medicalization of society etc. Ask any athlete who used PEDS to gain an unfair advantage and every one of them will admit they were cheating becuase they used PEDs to gain an unfair advantage! Otherwise why would they use the PED in the first place.
Therefore if the intent of using PEDs has everything to do with cheating to win, and the athlete takes PEDS with the attitude that the potential health downside of their using PEDs be damned, because winning is too important to worry about one's health, then it is not a health issue (at least to the athlete) but rather it is an ethical issue that needs to guide the policy about PEDS in sport.
Let the athletes determine this for themselves. If athletes choose to legalize PEDS then every elite athlete on the planet will use them. This is an absolute certainty with very few exceptions. The risk is, will fans watch any sport that is a chemical arms race? As Don Catlin says about his loss of interest in Olympic Sport - "I lost my taste" because "I saw everybody that doped."