England could legally use viagra to combat Aztecs altitude in World Cup clash with Mexico

England’s medical staff are permitted to use Viagra to help players cope with the punishing altitude of Mexico City’s Estadio Azteca, as the drug does not appear on the World Anti-Doping Agency’s (WADA) 2026 prohibited list.

The Three Lions face co-hosts Mexico in Sunday’s World Cup round-of-16 tie at the iconic Azteca, which sits 2,240 metres (7,220ft) above sea level. At that elevation, the air is thinner and each breath delivers significantly less oxygen to the bloodstream—a challenge England manager Thomas Tuchel has called a “big disadvantage”. “We have only three days in between these matches. It’s physically just not possible to adapt to the altitude,” Tuchel said. Mexico, by contrast, have played all four of their World Cup matches at high altitude and are thoroughly acclimatised. Their record at the Azteca is formidable: 70 wins from 89 competitive games, with only two defeats.

How Viagra could help

Originally developed to treat high blood pressure, Viagra (sildenafil) widens blood vessels in the lungs, reducing pulmonary arterial pressure. At high altitude, the body experiences hypoxic pulmonary vasoconstriction—a defence mechanism where lung arteries narrow, reducing oxygen uptake and causing premature fatigue and dizziness. By relaxing these vessels, sildenafil improves blood flow, enhances gas exchange and allows more efficient oxygen delivery during exercise.

WADA-funded research has examined sildenafil’s potential as an altitude aid. Studies show it can improve exercise performance at extreme altitudes above 3,800m—in some athletes by more than 35%. However, WADA’s research concluded the drug is unlikely to provide significant benefits below 4,000m for the vast majority of endurance-trained athletes. The Azteca’s 2,240m elevation sits well below that threshold, meaning any physiological advantage would likely be marginal.

Not a new idea—and not official policy

The concept is not unprecedented. In 2019, Argentine club Unión de Santa Fe used Viagra to prepare for a match in Quito, Ecuador (2,850m), and mountaineers have long employed it for high-altitude ascents. Before the 2010 World Cup in South Africa, reports suggested Fabio Capello’s England were considering the drug—a claim the Football Association firmly denied.

Crucially, there is no evidence that Tuchel’s squad actually plan to use Viagra in Mexico City. The story, first reported by talkSPORT, has generated significant headlines, but it remains a theoretical option rather than a confirmed strategy. England are already taking other precautions: the team’s hotel location is being kept secret to avoid disruptive fans, and players are being offered sleep aids to counter noise interference.

As one observer put it, while the medication could offer some relief, it would likely come with “unhelpful side effects for a football match”. For now, England’s best hope may lie in tactical adaptation rather than pharmaceutical intervention.