Effects of erythropoietin abuse on exercise performance

13 Nov 2021

Effects of erythropoietin abuse on exercise performance / Paolo Sgrò, Massimiliano Sansone, Andrea Sansone, Francesco Romanelli, Luigi Di Luigi. - (The Physician and Sportsmedicine 46 (2018) 1 (13 November); p. 105-115)

  • PMID: 29113535
  • DOI: 10.1080/00913847.2018.1402663


The present review provides a comprehensive overview on the erythropoietic and non-erythropoietic effects of rHuEpo on human sport performance, paying attention to quantifying numerically how rHuEpo affects exercise performance and describing physiological changes regarding the most important exercise variables. Much attention has been paid to treatment schedules, in particular, to assess the effects of microdoses of rHuEpo and the prolonged effects on sport performance following withdrawal. Moreover, the review takes into account non-erythropoietic ergogenic effects of rHuEpo, including cognitive benefits of rHuEpo. A significant increase in both Vo2max and maximal cycling power was evidenced in studies taken into account for this review. rHuEpo, administered at clinical dosage, may have significant effects on haematological values, maximal and submaximal physiological variables, whereas few reports show positive effects on exercise perfomance. However, the influence of micro-dose rHuEpo on endurance performance in athletes is still unclear and further studies are warranted.

Social Media, Body Image and Resistance Training: Creating the Perfect 'Me' with Dietary Supplements, Anabolic Steroids and SARM's

10 Nov 2021

Social Media, Body Image and Resistance Training : Creating the Perfect 'Me' with Dietary Supplements, Anabolic Steroids and SARM's / Luuk Hilkens, Maarten Cruyff, Liesbeth Woertman, Jeroen Benjamins, Catharine Evers. - (Sports Medicine - Open 7 (2021) 1 (10 November); 81)

  • PMID: 34757466
  • PMCID: PMC8579410
  • DOI: 10.1186/s40798-021-00371-1


Background: Few studies have assessed the use of dietary supplements, anabolic androgenic steroids (AAS) and selective androgen receptor modulators (SARM) in male gym users. The comparison of physical appearance with others on social media and the exposure to fitness-related content on social media (i.e., image-centric social media use) may have a profound role in using these compounds due to its role in creating negative body images in male gym users.

Objective: Provide contemporary data on the use of dietary supplements, AAS and SARM among young male gym users, and test the hypothesis that social media is associated with the use of dietary supplements, AAS and SARM, as a result of a negative body image.

Methods: In this cross-sectional study, conducted in the Netherlands, male gym users (N = 2269; 24 ± 6 years) completed an online questionnaire including self-reported measures regarding resistance training participation, image-centric social media use, dietary supplement intake, and body image. The prevalence of AAS and SARM use was assessed with randomized response, a technique to ask sensitive questions indirectly.

Results: Of all participants, 83% used ergogenic dietary supplements (mainly protein and creatine), and an estimated 9 versus 2.7% had ever used AAS versus SARM. Image-centric social media use was positively associated with the use of dietary supplements (r = .26; p < 0.01) and AAS (p < 0.05), but not SARM. Image-centric social media use was associated with a more dissatisfied body image (r = .34; p < 0.01). Body image did not mediate the relationship between image-centric social media use and the use of doping compounds.

Conclusions: The use of dietary supplements in young male gym users is exorbitant, with the use of AAS and SARM being substantial. Image-centric social media use is positively associated with the use of dietary supplements and AAS.

Investigations into the elimination profiles and metabolite ratios of micro-dosed selective androgen receptor modulator LGD-4033 for doping control purposes

4 Nov 2021

Investigations into the elimination profiles and metabolite ratios of micro-dosed selective androgen receptor modulator LGD-4033 for doping control purposes / Felicitas Wagener, Sven Guddat, Christian Görgens, Yiannis S. Angelis, Michael Petrou, Andreas Lagojda, Dirk Kühne, Mario Thevis. - (Analytical and Bioanalytical Chemistry (2021) 4 November)

  • PMID: 34734312
  • DOI: 10.1007/s00216-021-03740-7


LGD-4033 (ligandrol) is a selective androgen receptor modulator (SARM), which is prohibited in sports by the World Anti-Doping Agency (WADA) and led to 62 adverse analytical findings (AAFs) in 2019. But not only deliberate doping with LGD-4033 constitutes a problem. In the past years, some AAFs that concerned SARMs can be attributed to contaminated dietary supplements (DS). Thus, the urgency to develop methods to differentiate between inadvertent doping and abuse of SARMs to benefit from the performance-enhancing effect of the compound in sports is growing. To gain a better understanding of the metabolism and excretion patterns of LGD-4033, human micro-dose excretion studies at 1, 10, and 50 µg LGD-4033 were conducted. Collected urine samples were prepared for analysis using enzymatic hydrolysis followed by solid-phase extraction and analyzed via LC-HRMS/MS. Including isomers, a total of 15 phase I metabolites were detected in the urine samples. The LC-HRMS/MS method was validated for qualitative detection of LGD-4033, allowing for a limit of detection (LOD) of 8 pg/mL. The metabolite M1, representing the epimer of LGD-4033, was synthesized and the structure elucidated by NMR spectroscopy. As the M1/LGD-4033 ratio changes over time, the ratio and the approximate LGD-4033 concentration can contribute to estimating the time point of drug intake and dose of LGD-4033 in doping control urine samples, which is particularly relevant in anti-doping result management.

Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review

3 Nov 2021

Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances : A Narrative Review / Jana Daher, Dalia El Khoury, John J.M. Dwyer. - (Nutrients 13 (2021) 11 (3 November); 3935)

  • DOI: 10.3390/nu13113935


The misuse of dietary supplements and doping substances is commonly associated with toxicity, nutritional imbalances, and health and psychological consequences. This is alarming especially in light of the increasing prevalence of the use of dietary supplements and doping, particularly among young adults including athletes. There is evidence that education interventions can lead to improved knowledge, intentions, and practices. However, no review has summarized and evaluated the effectiveness of such interventions. The aim of this article is to review the characteristics, contents and effects of education interventions that were designed and implemented to improve knowledge, attitudes, beliefs and intentions with respect to the use of dietary supplements and doping agents in different populations. PubMed, Scopus, CINAHL, PsycInfo and Google Scholar were searched for English-language education interventions targeting dietary supplements and doping substances. A total of 20 articles were identified and have generally provided consistent findings. Most interventions reported a significant improvement in knowledge on dietary supplements and doping agents. Unfortunately, the heavy reliance on self-reported assessment tools limits the validity of these interventions, with almost all articles targeting athletes and adolescents. 

Exploring user narratives of self-medicated black market IPED use for therapeutic & wellbeing purposes

1 Nov 2021

Exploring user narratives of self-medicated black market IPED use for therapeutic & wellbeing purposes / Luke A.Turnock. - (Performance Enhancement & Health (2021) 8 November; 100207)

  • DOI: 10.1016/j.peh.2021.100207


With the rising use of IPEDs, it is important to understand how user motivations and practices influence harms, in order to formulate effective harm reduction policy. Existing work has consequently developed user typologies to address this need for specific interventions for differing users. Within this, the ‘wellbeing’ user type is one of the most prominent, however this broad category encompasses a range of users with distinct motivations and needs. This paper consequently explores the subcategory of therapeutically-motivated IPED users, whose IPED use is targeted at repair, rehabilitation, and self-medicating for health conditions, and considers the specific needs of this user category.

Findings are drawn from a connective ethnography of gyms in South-West England, and digital fitness platforms, to analyze the motivations of therapeutically-oriented users, and how their behaviors and experiences are important to formulating interventions and broader policy discussions.

Motivations explored include: (1) repair and injury rehabilitation, including those who access IPEDs for repair relating to sporting or competitive endeavors, as well as those whose IPED use is self-medicating for chronic health conditions. (2) General ‘wellbeing’ motivations for which participants self-medicated with IPEDs, including: health-oriented fat loss, rehabilitation for sleep, irritable bowel syndrome, and offsetting the negative health effects of hard sporting training. And (3) self-medicated testosterone replacement therapy (TRT) to offset negative symptoms ascribed to ‘low testosterone’, in both older gym participants whose natural levels were declining and who were looking to offset this, as well as men who experienced mental health difficulties such as depression, and sought to restore wellbeing through use of black market testosterone.

This article demonstrates the breadth of therapeutic motivations for IPED use, and points to the ways in which the specific needs of this user category may be distinct from broader ‘wellbeing’ users. Significantly, participant narratives regarding the medical community's perceived unwillingness to treat them, and their feelings that this pushed them to access illicit IPEDs, indicate the importance of understanding the specific needs in relation to harm reduction policy formation.

WADA - Summary of Operation Hercules

21 Oct 2021

Summary of Operation Hercules / Intelligence and Investigations (I&I) Department. -- Montreal : WADA, 2021

The World Anti-Doping Agency’s (WADA’s) independent Intelligence and Investigations (I&I) Department has published its summary report following an investigation into allegations that the National Anti-Doping Organization of Ukraine (NADC) engaged in practices that contravened the International Standard for Testing and Investigations (ISTI).

WADA I&I’s investigation, known as ‘Operation Hercules’, was launched in 2019, and has uncovered evidence to suggest that since 2012 NADC has conducted unjustified advance-notice sample collections, arranging to test athletes – including groups of athletes – by appointment at the NADC offices. The ISTI states that, save in exceptional and justifiable circumstances, sample collection must take place with no advance warning to the athlete – a fundamental feature of an effective, unpredictable testing program.

‘Operation Hercules’ has compelling evidence to suggest that in 2021, NADC knowingly reported at least six in-competition samples as out-of-competition samples, in contravention of various articles of the World Anti-Doping Code and the ISTI. The Doping Control Forms (DCFs) for the six misreported samples confirm they were collected in competition but, in each instance, the DCFs listed the sample as being collected “out-of-competition”.

WADA I&I commissioned a re-analysis of these six samples through the in-competition laboratory analysis menu, which includes more prohibited substances than the out-of-competition analysis menu. All sample results were returned negative (i.e. without a prohibited substance).

“‘Operation Hercules’ has raised serious questions about the integrity of NADC’s testing practices, and the competence of some staff. Moreover, the apparent longevity and brazenness of these practices suggests significant organizational failings within NADC.”

Due to the gravity of the allegations and the risk posed by any continuation of the alleged non-compliance by NADC, ‘Operation Hercules’ provided all pertinent information from its investigation to the relevant entities prior to the finalization of this report. This included the relevant departments of WADA, namely, the Compliance, Rules and Standards Department and the Testing Department, for their immediate action. A compliance process has been initiated regarding NADC, under the provisions of the International Standard for Code Compliance by Signatories.

‘Operation Hercules’ also investigated allegations that a doping and protection scheme existed within the Ukrainian Athletics Federation (FLAU) but found no evidence to support this charge. However, potential evidence of erythropoietin (EPO) trafficking was identified against an individual from within FLAU. The individual in question has denied the allegation and ‘Operation Hercules’ has reported this matter to the Athletics Integrity Unit for its consideration.

The forensic response after an adverse analytical finding (doping) involving a selective androgen receptor modulator (SARM) in human athlete

18 Oct 2021

The forensic response after an adverse analytical finding (doping) involving a selective androgen receptor modulator (SARM) in human athlete / Pascal Kintz. - (Journal of Pharmaceutical and Biomedical Analysis 207 (2022) January: 114433)

  • PMID: 34715583
  • DOI: 10.1016/j.jpba.2021.114433


Selective androgen receptor modulators (SARMs) are a class of drugs presenting identical anabolic properties to anabolic steroids in addition to marked reduced androgenic effects. These drugs have emerged in the doping area within the early 2000's. Ligandrol, ostarine, RAD-140 and andarine are the most popular agents belonging to this class. According to the world anti-doping agency (WADA) prohibited list, SARMs are prohibited at all times (i.e. in and out-of-competition) and are listed under the section S1.2 (other anabolic agents). The compilation of the WADA testing figures reports from 2015 to 2019 has indicated a regular increase of adverse analytical findings (AAF) due to SARMs, particularly with ostarine and ligandrol. The implementation of highly sensitive chromatographic anti-doping analyses has induced high-profile challenges of anti-doping rules violations as athletes have claimed in numerous occasions that contamination was the reason for their AAF. Since the early 2000's, it has been accepted by the Court of Arbitration for Sports (CAS) in Lausanne (Switzerland) that, under some specific circumstances, unusual explanations can be provided to the Panel to explain an AAF. This was the open door for forensic investigations, as it is done in criminal Courts. A forensic approach can include testing for SARMs in food, drinks, but mostly in dietary supplements. As most anti-doping rules violations are only known several weeks after urine collection, this biological matrix is seldom use for further tests, despite the fact that most SARMs can be detected for several weeks in urine. Luckily, hair or nail testing can be a complement to document the claim of the athlete but of course, it cannot be considered as an alternative to urinalysis. This is because a negative hair or nail result cannot exclude the use of the detected drug and cannot overrule the urine result. To date, all methods for SARMs identification in various matrices involve liquid chromatography coupled to tandem mass spectrometry or high-resolution mass spectrometry. The aim of this paper is to review the scientific literature on the analytical possibilities of testing SARMs in dietary supplements, urine and hair or nail clippings after an AAF to document the claims of an athlete or his/her legal team.

Androstenedione (a Natural Steroid and a Drug Supplement): A Comprehensive Review of Its Consumption, Metabolism, Health Effects, and Toxicity with Sex Differences

14 Oct 2021

Androstenedione (a Natural Steroid and a Drug Supplement) : A Comprehensive Review of Its Consumption, Metabolism, Health Effects, and Toxicity with Sex Differences / Marwa T. Badawy, Mansour Sobeh, Jianbo Xiao, Mohamed A. Farag. - (Molecules 26 (2021) 20 (14 October) 6210; p. 1-16)

  • PMID: 34684800
  • PMCID: PMC8539210
  • DOI: 10.3390/molecules26206210


Androstenedione is a steroidal hormone produced in male and female gonads, as well as in the adrenal glands, and it is known for its key role in the production of estrogen and testosterone. Androstenedione is also sold as an oral supplement, that is being utilized to increase testosterone levels. Simply known as "andro" by athletes, it is commonly touted as a natural alternative to anabolic steroids. By boosting testosterone levels, it is thought to be an enhancer for athletic performance, build body muscles, reduce fats, increase energy, maintain healthy RBCs, and increase sexual performance. Nevertheless, several of these effects are not yet scientifically proven. Though commonly used as a supplement for body building, it is listed among performance-enhancing drugs (PEDs) which is banned by the World Anti-Doping Agency, as well as the International Olympic Committee. This review focuses on the action mechanism behind androstenedione's health effects, and further side effects including clinical features, populations at risk, pharmacokinetics, metabolism, and toxicokinetics. A review of androstenedione regulation in drug doping is also presented.

Determination of ghrelin and desacyl ghrelin in human plasma and urine by means of LC-MS/MS for doping controls

11 Oct 2021

Determination of ghrelin and desacyl ghrelin in human plasma and urine by means of LC-MS/MS for doping controls / Andreas Thomas, Sophia Krombholz, Carina Wolf, Mario Thevis. - (Drug Testing and Analysis (2021) 11 October)

  • PMID: 34633773
  • DOI: 10.1002/dta.3176


The hunger hormone ghrelin (G) is classified as prohibited substance in professional sport by the World Anti-Doping Agency (WADA), due to its known growth hormone releasing properties. The endogenous bioactive peptide consists of 28 amino acids with a caprylic acid attached to serine at position 3. Within this study it was aimed to develop methods to determine G and desacyl ghrelin (DAG) in plasma and urine by means of LC-MS/MS. Two strategies were applied with a bottom-up approach for plasma and top-down analyses for urine. Both sample preparation procedures were based on solid-phase extraction for enrichment and sample clean-up. Method validation showed good results for plasma and urine with limits of detection (LODs) for G and DAG between 30 and 50 pg/mL, recoveries between 45-50 %, and imprecisions (intra- and inter-day) between 3 - 24 %. Plasma analysis was also valid for quantification with accuracies determined with ~100 % for G and ~106 % for DAG. The minimum required performance level for doping control laboratories is set to 2 ng/mL in urine, and the herein established method yielded acceptable results even at 5 % of this level. As proof-of-concept, plasma levels (G and DAG) of healthy volunteers were determined and ranged between 30 and 100 pg/mL for G and 100 - 1200 pg/mL for DAG. In contrast to earlier reported studies using ligand binding assays for urinary G and DAG, in this mass spectrometry-based study no endogenous urinary G and DAG were found, although the LODs should enable this.

ST 2021_03 DFSNZ vs Mahdi Namdari

11 Oct 2021

In May 2021 Drug Free Sport New Zealand (DFSNZ) has reported an anti-doping rule violation against the wrestler Mahdi Namdari after his A and B samples tested positive for the prohibited substances Stanozolol. After notification the Athlete gave a prompt admission, accepted a provisional suspension and filed a statement in his defence.

The Athlete denied the intentional use of the substance and explained that he suffered from a knee injury and that he had accepted pills from a gym member in orde to recover. He asserted that he has never been prescribed with Stanozolol and with limited English he did not understand the risk.

The parties in this case reached an agreement and filed a joint memorandum in relation to the sanction for approval into a decision of the Sports Tribunal of New Zealand. The Tribunal considers that the Athlete gave a prompt admission for the imposition of a reduced sanction.

Therefore the Sports Tribunal of New Zealand decides on 11 October 2021 to impose a 3 year period of ineligibility on the Athlete starting on the date of the provisional suspension, i.e. on 11 May 2021.

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