The growth hormone/insulin-like growth factor-I axis in exercise and sport / James Gibney, Marie-Louise Healy, Peter H. Sönksen. - (Endocrine Reviews 28 (2007) 6 (1 October); p. 603-624)

• PMID: 17785429
• DOI: 10.1210/er.2006-0052

Abstract

The syndrome of adult GH deficiency and the effects of GH replacement therapy provide a useful model with which to study the effects of the GH/IGF-I axis on exercise physiology. Measures of exercise performance including maximal oxygen uptake and ventilatory threshold are impaired in adult GH deficiency and improved by GH replacement, probably through some combination of increased oxygen delivery to exercising muscle, increased fatty acid availability with glycogen sparing, increased muscle strength, improved body composition, and improved thermoregulation. In normal subjects, in addition to the long-term effects of GH/IGF-I status, there is evidence that the acute GH response to exercise is important in regulating substrate metabolism after exercise. Administration of supraphysiological doses of GH to athletes increases fatty acid availability and reduces oxidative protein loss, particularly during exercise, and increases lean body mass. Despite a lack of evidence that these metabolic effects translate to improved performance, GH abuse by athletes is widespread. Tests to detect GH abuse have been developed based on measurement in serum of 1) indirect markers of GH action, and 2) the relative proportions of the two major naturally occurring isoforms (20 and 22kDa) of GH. There is evidence that exercise performance and strength are improved by administration of GH and testosterone in combination to elderly subjects. The potential benefits of GH in these situations must be weighed against potential adverse effects.

The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men / Anna L. Goldman, Harrison G. Pope, Shalender Bhasin

• Journal of Clinical Endocrinology & Metabolism 104 (2019 4 (April), p. 1069-1074
• PMID: 30239802
• DOI: 10.1210/jc.2018-01706

Abstract

Context: The prevalence of body image disorders and anabolic-androgenic steroid (AAS) use is increasing, despite the evidence of their serious adverse health effects and despite the passage of laws regulating their sales. Here we review the evolution of the dual emerging epidemics of body image disorders and AAS use, adverse health effects of AASs, and the need for an integrated health policy and regulatory response.

Evidence acquisition: We searched for studies published prior to June 2018. Quality of evidence was low to moderate because of its observational nature; heterogeneity of eligibility criteria; variable doses; reliance on retrospective self-reported data in many studies; and variable quality of outcome ascertainment.

Evidence synthesis: Most AAS users are nonathlete young men, who use these substances to look lean and more muscular. Some of these men suffer from "muscle dysmorphia," a form of body dysmorphic disorder. AASs has been associated with cardiovascular disorders, psychiatric disorders, AAS-withdrawal hypogonadism, infertility, neurotoxic effects, musculoskeletal injuries, liver toxicity, and needle-borne infections. Potential adverse effects may be compounded by the use of other substances (e.g., opioids) and high-risk behaviors. Unregulated Internet sales of AASs and selective androgen receptor modulators, which are easily purchased without a prescription, are of concern because of their potential to fuel the epidemic among adolescents and the military.

Conclusions: Integrated nationwide efforts are necessary to raise public awareness of this epidemic, to study long-term health effects of AASs and treatment strategies, and to reform regulations to stem the epidemics of AAS use and body image disorders.

The hunt for gene dopers / Mai M.H. Mansour, Hassan M.E. Azzazy. - (Drug Testing and Analysis 1 (2009) 7 (July); p. 311-322)

• PMID: 20355209
• DOI: 10.1002/dta.52

Abstract

Gene doping, the abuse of gene therapy for illicit athletic enhancement, is perceived as a coming threat and is a prime concern to the anti-doping community. This doping technique represents a significant ethical challenge and there are concerns regarding its safety for athletes. This article presents the basics of gene doping, potential strategies for its detection and the role of promising new technologies in aiding detection efforts. These include the use of lab-on-a-chip techniques as well as nanoparticles to enhance the performance of current analytical methods and to develop new doping detection strategies.

The IAAF Arbitration Panel : The Heritage of Two Decades of Arbitration in Doping-Related Disputes / Christoph Vedder. – (International Sports Law Journal (2005) 3-4 : p. 16-23)

Content:
1.) Introduction
2.) The legal Basis
2.1.) The Formation and Composition of the Arbitration Panel
2.2.) The Independence of the Arbitration Panel
2.3.) Jurisdiction of the Arbitration Panel
2.4.) The Procedure before the Arbitration Panel
2.5.) The Effects of the Awards
3.) The Doping Offence
3.1.) The Elements of Doping
3.2.) The Burden of Proof
4.) Major Achievements
4.1.) Doping Offence
4.2.) Prohibited Substances, Food Supplements
4.3.) Endogenously Produced Substances
4.4.) Strict Liability, Burden of Proof
4.5.) Sanctions, Length of the Period of Ineligibility
4.6.) Procedural Issues
5.) At the End: an Oulook

In summer 2001, the 43rd Congress of the International Association of Athletics Federations (IAAF) during its Edmonton session decided to discontinue its Arbitration Panel and to join the arbitral dispute settlement system provided by the Court of Arbitration for Sport (CAS). However, according to a transitory provision several cases still came before the Arbitration Panel in 2002 and 2003 while the very last dispute to be decided by it was referred to the Panel as late as in 2004. Having been established in 1982, the Arbitration Panel operated since 1984 when the first list of arbitrators was composed.
Now, we are able to look back on two decades of settlement of sport-related disputes by arbitration, in particular in doping matters, within the framework of a major International Federation. In August 2003 as a next step the 44th IAAF Congress in Paris amended the IAAF’s constitutional rules on doping to bring them into line with the WADA Code. The overall result was a streamlining of the IAAF’s anti-doping policy both in substance and procedure, in accordance with the general trend of international and inter-sports harmonisation.

The illicit medicines trade from within : An analysis of the demand and supply sides of the illicit market for lifestyle medicines : dissertation / Rosa Marthe Koenraadt. - Utrecht : Utrecht University, 2018. - (Pompe reeks ; 89). - ISBN 9789462368262. - With Dutch Summary. - De illegale geneesmiddelenhandel van binnenuit : Een analyse van de vraag- en aanbodzijde van de illegale lifestyle geneesmiddelenmarkt

Abstact:

Although the existence of illicit medicines is not new, all sorts of these medicines, ranging from antibiotics to weight loss drugs, antimalarial tablets to steroids, are increasingly traded worldwide. As the illicit medicines market is associated with considerable health risks for its users, it is important to gain extensive criminological insights into this global market. Previous studies have expressed concern regarding a perceived growing degree of criminal organization, but, with a few exceptions, little criminological research has been conducted on the nature and dynamics that actually take place on the supply and demand sides of the illicit pharmaceutical market.

The current thesis aims to engage directly with these perceptions as it fills gaps in the literature, by providing in-depth and empirically grounded theoretical insights on the online and offline trade in illicit pharmaceuticals, with particular reference to lifestyle pharmaceuticals. Trade in the Netherlands and manufacturing in China are taken as extended case studies. The main focus lies on the structure, dynamics and activities of actors on both the demand and supply sides of the illicit medicines market in the Netherlands, and on the production and transnational distribution of illicit medicines in and from China. The central research question of this thesis is: how are actors involved in the illicit medicines trade, and how is the illicit market structured.

Contents:

Chapter 1 Introduction and background
Chapter 2 Theoretical perspectives on illicit markets and medicines
Chapter 3 Methodological issues: researching the illicit market for lifestyle medicines
Chapter 4 Trends, prevalence and types of illicit medicines traded in the Netherlands
Chapter 5 Understanding the demand for (illicit) lifestyle medicines
Chapter 6 Retail level of the market: buyers, sellers and trust
Chapter 7 Social organization of the market
Chapter 8 Manufacturing level: a case study on China
Chapter 9 Conclusion

Aim
The broad aim of this project was to explore the use of over-the-counter (OTC) medication, amongst athletes, from four nations and across 10 sports, with specific reference to stimulants on the Monitoring Program and Prohibited List.

Methodology
1. A review of the scientific literature was undertaken to establish current evidence with regards to the physiological and performance enhancing properties of OTC medication and their desirability as drugs of abuse.
2. A questionnaire was developed to assess respondents:
i. demographics;
ii. use of OTC drugs;
iii. knowledge and understanding of OTC medication in reference to anti-doping measures; and
iv. views and opinions regarding changes to the Prohibited List.
It was administered to elite athletes from Australia, Canada, the UK and the USA representing 10 Olympic sports, including: track and field athletics, canoeing, cycling, gymnastics, hockey, rowing, swimming, triathlon, volleyball and weightlifting.
3. Data from WADA-accredited laboratories was obtained to assess current proportions of urine samples testing positive for stimulants on the Monitoring Program and Specified Substance List.

Key findings
The current research has generated several key findings with regards to the use of OTC drugs amongst elite athletes across four major sporting nations:
i. Athletes who had used OTC products containing substances present on the Monitoring Program over the preceding 12 months accounted for 38 percent of all respondents.
ii. A small proportion of athletes used OTC products for their reputed ergogenic properties.
iii. Athletes demonstrated limited knowledge relating to the penalty incurred following a doping violation involving a banned OTC stimulant; the terms Monitoring Program and Specified Substance List; and the status of substances in relation to the Prohibited List.
iv. If unsure of the prohibitive nature (or otherwise) of an OTC product almost all athletes would consult someone for advice.
v. Both WADA and individual NADOs were the choice by many athletes in terms of whom they would consult for advice. A significant proportion of younger athletes stated that they would consult an individual such as their coach, training partner or team doctor.
vi. Athletes representing cycling and triathlon were most likely to be dissatisfied with anti-doping education within their sport.
vii. The development of a list according to ailment, highlighting OTC products that do [not] contain prohibited substances was deemed an appropriate measure to improve the information available to athletes.
viii. Data from the Monitoring Program supports that of the questionnaire with regards to pseudoephedrine use, however data that pertains to phenylephrine is difficult to interpret.
ix. As a whole, athletes were of the opinion that: OTC stimulants were not performance enhancing; they posed a risk to health; their use was against the spirit of sport; and yet should remain off the Prohibited List.

Conclusions
Whilst the balance of scientific evidence would promote the use of caffeine as an ergogenic aid, the evidence for the use of other stimulants found in OTC medication for the treatment of the symptoms associated with upper respiratory tract infection is less convincing.
The use of OTC products amongst elite athletes is significant, however the evidence suggests that use of such preparations is primarily for therapeutic purposes.
An overall limited knowledge and awareness of OTC medication in reference to anti-doping was evident amongst elite athletes, suggesting that ignorance remains an important factor in the use of drugs by athletes. This is only tempered by their willingness to seek advice from reliable sources.
The inability of the Monitoring Program to provide valid evidence to support the misuse of substances contained in OTC medications highlights the need to expand the current programme to all WADA-accredited laboratories and to include continual qualitative assessment of the situation.

Coombs RH, Coombs CJ.
Int J Addict. 1991 Sep;26(9):981-92.
UCLA School of Medicine 90024.

The impact of drug testing on the morale of mandatory participants was assessed through interviews and questionnaire responses of 500 intercollegiate athletes required to participate in a urine testing program. Subjects varied widely in their experiences. Most were not greatly affected, but some were embarrassed, humiliated, upset, and anxious about being inaccurately identified as drug users. Others experienced positive benefits: new information, a novel and interesting conversation piece, and a socially acceptable way to refuse drugs offered in friendship. Some said that testing benefited their athletic performance and school work. A number of recommendations were made to humanize and improve the experience: a better orientation about what to expect, more effective educational sessions, a warmer, more comfortable testing setting, more reasonable drug testing objectives, and more rigorous testing standards.

PMID:
1743826
[PubMed - indexed for MEDLINE]

The impact of genetics and hormonal contraceptives on the steroid profile in female athletes / Jenny J. Schulze, Jenny E. Mullen, Emma Berglund Lindgren, Magnus Ericsson, Lena Ekström, Angelica Lindén Hirschberg. - (Frontiers in Endocrinology (2014, 10 April); p. 1-6)

• PMID: 24782830
• PMCID: PMC3989562
• DOI: 10.3389/fendo.2014.00050

Abstract

The steroid module of the Athlete Biological Passport, the newest innovation in doping testing, is currently being finalized for implementation. Several factors, other than doping, can affect the longitudinal steroid profile. In this study, we investigated the effect of hormonal contraceptives (HC) as well as the effect of three polymorphisms on female steroid profiles in relation to doping controls. The study population consisted of 79 female elite athletes between the ages of 18 and 45. HC were used by 32% of the subjects. A full urinary steroid profile was obtained using World Anti-Doping Agency accredited methods. In addition all subjects were genotyped for copy number variation of UGT2B17 and SNPs in UGT2B7 and CYP17. Subjects using HC excreted 40% less epitestosterone as compared to non-users (p = 0.005) but showed no difference in testosterone excretion. When removing individuals homozygous for the deletion in UGT2B17, the testosterone to epitestosterone (T/E) ratio was 29% higher in the HC group (p = 0.016). In agreement with previous findings in men, copy number variation of UGT2B17 had significant effect on female urinary testosterone excretion and therefore also the T/E ratio. Subjects homozygous for the T allele of CYP17 showed a lower urinary epitestosterone concentration than the other CYP17 genotypes. It is of great importance that the athlete's steroidal passport can compensate for all possible normal variability in steroid profiles from women. Therefore, considering the large impact of HC on female steroid profiles, we suggest that the use of HC should be a mandatory question on the doping control form.

The Impact of the COVID-19 Pandemic on Male Strength Athletes Who Use Non-prescribed Anabolic-Androgenic Steroids / Barnaby N. Zoob Carter, Ian D. Boardley, Katinka van de Ven

• Frontiers in Psychiatry 12 (2021) 636706 (22 March); p. 1-11
• PMID: 33828494
• PMCID: PMC8019803
• DOI: 10.3389/fpsyt.2021.636706

Abstract

Background: One sub-population potentially affected by the COVID-19 pandemic are strength athletes who use anabolic-androgenic steroids (AAS). We examined links between disruption in AAS use and training due to the pandemic and mental health outcomes in this population, hypothesising: (a) the pandemic would be linked with reduced training and AAS use; and (b) athletes perceiving greater impact on their training and AAS use would report increases in detrimental mental health outcomes.

Methods: Male strength athletes using AAS (N = 237) from 42 countries completed an online questionnaire in May 2020. A sub-sample (N = 90) from 20 countries participated again 4 months later. The questionnaire assessed pre-pandemic and current AAS use and training, alongside several mental health outcomes.

Results: At Time 1, most participants perceived an impact of the pandemic on AAS use (91.1%) and/or training (57.8%). Dependent t-tests demonstrated significant reductions in training frequency (t = 7.78; p < 0.001) and AAS dose (t = 6.44; p < 0.001) compared to pre-pandemic. Linear regression showed the impact of the pandemic on training was a significant positive predictor of excessive body checking (B = 0.35) and mood swings (B = 0.26), and AAS dose was a significant positive predictor of anxiety (B = 0.67), insomnia (B = 0.52), mood swings (B = 0.37). At Time 2, fewer participants perceived an impact of the pandemic on AAS use (29.9%) and/or training (66.7%) than at Time 1. Training frequency (t = 3.02; p < 0.01) and AAS dose (t = 2.11; p < 0.05) were depressed in comparison to pre-pandemic. However, AAS dose had increased compared to Time 1 (t = 2.11; p < 0.05). Linear regression showed the impact of the pandemic on training/AAS use did not significantly predict any mental-health outcomes. However, AAS dose was a significant negative predictor of depressive thoughts (B = -0.83) and mood swings (B = -2.65).

Conclusion: Our findings showed impact of the pandemic on the training and AAS use, reflected in reduced training frequency and AAS dose. However, whilst we detected some short-term consequential effects on mental health, these did not appear to be long-lasting.

Blog Symposium: The impact of the revised World Anti-Doping Code on the work of National Anti-Doping Agencies / Herman Ram. - Asser international sports law blog

The 2015 World Anti-Doping Code is not a new Code, but a revision of the 2009 Code. In total, 2.269 changes have been made. Quite a number of these changes are minor corrections, additions and reformulations with little or no impact on the work of NADOs. But the number of truly influential changes is still impressive, which makes it hard to choose.

Luckily, WADA has identified the – in their view – more significant changes in a separate document and I have used this document to bring some order in a number of comments that I want to make on the impact of those revisions on our daily work.

Part of what follows is based on our experiences with the implementation of the revised Code so far, but quite a bit of what follows cannot be based on any actual experience, because the revised Code has only been in place for seven months, and only a rather small number of disciplinary procedures in relatively simple cases have come to a final decision under the revised rules. As a result, and because I am not in the business of predicting the future, on this occasion I have decided to share some of my expectations with you. Only the future can tell whether I am right on those issues.