On 23 February 2017 the World Triathlon Corporation decided to impose a 4 year period of ineligibility on the Athlete Murizio Carta for his refusal to provide a blood sample. Here the Athlete explained that he had a phobia of needles and he offered the USADA Doping Control Officer to provide a urine sample instead which was not acceptable to the WTC.

Hereafter in March 2017 the Athlete appealed the WTC decision and the Sole Arbitrator settled the case based on the written submissions of the parties.

The Athlete admitted that he refused to provide a blood sample and denied that this refusal was without compelling justification. He stated that he immediately said that he had a phobia of needles as confirmed by the medical certificate from October 2016. He says that he cooperated proactively by not only explaining his refusal to provide a blood sample, but offering repeatedly to provide a urine sample.
He argued that in the circumstances of his refusal to provide a blood sample no suspension was warranted or alternatively a 2 year period of ineligibility should be imposed.

The Arbitrator holds that the Athlete’s previous anti-doping rule violation is significant since it demonstrates his familiarity with anti-doping testing. In light of this previous violation in 2005 and the decision of the CAS arbitrator, and his acknowledgement that he previously had undergone numerous anti-doping controls, he must have known that anti-doping testing at the 2016 World Championships was a possibility.

The Sole Arbitrator concludes that the Athlete failed to provide compelling justification for his refusal to provide a blood sample, as requested. The Arbitrator deems that it is clear that the Athlete was negligent in not taking steps to address his alleged phobia of needles in advance of the 2016 World Triathlon Championships so as to be able to provide a blood sample if required. He then knowingly or intentionally refused to provide a sample when requested to do so.

Therefore the Sole Arbitrator decides on 26 June 2017:

1.) Mr. Carta's appeal from the WTC's Charge of Anti-Doping Rule Violation and Notice of Sanction under the IRONMAN Anti-Doping Rules, dated 23 February 2017 is dismissed;
2.) the Suspension and Sanction set out in the Charge of Anti-Doping Rule Violation and Notice of Sanction remain in place;
3.) each Party shall bear its own costs; and,
4.) all other or further claims are dismissed.

Related case:

CAS 2020_A_6892 Andrew Starykowicz vs USADA
August 5, 2020

In October 2019 the American triathlon Athlete Andrew Starkowics suffered from an acute respiratory infection with bronchoconstriction. He underwent medical treatment and used several prescribed medication including the prohibited substances Methylprednisolone (Medrol), Glucocorticoids including Fluticasone Furoate and Vilanterol inhalation powder (Breo).

The Athlete applied for a TUE for the use of Medrol and Breo and on 8 November 2019 the USADA TUE Committee granted the use of Medrol.

Before the approval of the TUE the Athlete had participated in an IRONMAN triathlon on 2 November 2019 and was subjected to sample collection. Consequently in December 2019 the World Triathlon Corporation (WTC) reported an anti-doping rule violation against the Athlete after his A and B samples tested positive for the substance Vilanterol without a valid TUE. After notification in December 2019 a provisional suspension was ordered.

At the time of the notification the Athlete had no TUE for Vilanterol due to his applications for Breo had been repeatedly denied by the USADA TUE Committee and finally by the WADA Therapeutic Use Exemption Committee. Both Committees deemed that suitable permitted alternatives were available but were not prescribed by his pulmonologist.

In March 2020 the Athlete appealed with the Court of Arbitration for Sport (CAS) challenging the denial of his TUE applications for Breo. However on 5 August 2020 CAS dismissed the Athlete's appeal and deemed that the Athlete failed to demonstrate that the existing alternative therapies suggested by USADA were not reasonable.

Hereafter WTC resumed the proceedings against the Athlete and contended that the Athlete had committed an anti-doping rule violation on two occasions without a valid TUE. In view of the amendment in the WADA Prohibited List regarding Vilanterol, WTC requested for a reduced sanction of 2 years.

The Athlete admitted the violation and the use of Vilanterol in and out of competition between October and November 2019. He requested for a reduced sanction based on No Significant Fault or Negligence. He acknowledged that pending his TUE application he was warned by USADA when participating in a competition without a TUE he would commit an anti-doping rule violation.

The Sole Arbitration regards that the Athlete is highly experienced and fully aware of his anti-doping obligations. Further he establishes that at the relevant time USADA timely had processed and granted the Athlete's TUE application and that significant delays in the application were attributed to the Athlete.

Considering the Athlete's conduct in this case the Sole Arbitrator concludes that the he had acted negligently while he was duly informed by USADA about permitted alternative medication. As a result the Athlete failed to establish that he bears No Significant Fault of Negligence.

Due to the Vilanterol amendment of the WADA 2021 Prohibited List the Sole Arbitrator decides on 25 November to impose a reduced period of ineligibility on the Athlete. The period of ineligibility will start on the date of the provisional suspension, 5 December 2019, and end on 1 Januari 2021.

β2-Agonists at the Olympic Games / Kenneth D. Fitch. - Clinical Reviews in Allergy & Immunology
1-Oct-2006, Volume 31, Issue 2-3, pp 259-268

The different approaches that the International Olympic Committee (IOC) had adopted to β2-agonists and the implications for athletes are reviewed by a former Olympic team physician who later became a member of the Medical Commission of the IOC (IOC-MC). Steadily increasing knowledge of the effects of inhaled β2-agonists on health, is concerned with the fact that oral β2-agonists may be anabolic, and rapid increased use of inhaled β2-agonists by elite athletes has contributed to the changes to the IOC rules. Since 2001, the necessity for athletes to meet IOC criteria (i.e., that they have asthma and/or exercise-induced asthma [EIA]) has resulted in imporved management of athletes. The prevalence of β2-agonist use by athletes mirrors the known prevalence of asthma symptoms in each country, although athletes in endurance events have the highest prevalence. The age-of-onset of asthma/EIA in elite winter athletes may be atypical. Of the 193 athletes at the 2006 Winter Olympics who met the IOC's criteria, only 32.1% had childhood asthma and 48.7% of athletes reported onset at age 20 yr or older. These findings lead to speculation that years of intense endurance training may be a causative factor in bronchial hyper reactivity. The distinction between oral (prohibited in sports) and inhaled salbutamol is possible, but athletes must be warned that excessive use of inhaled salbutamol can lead to urinary concentrations similar to those observed after oral administration. This article provides justification that athletes should provide evidence of asthma or EIA before being permitted to use inhaled β2-agonists.

β₂-Agonists and physical performance : a systematic review and meta-analysis of randomized controlled trials / Babette M. Pluim, Olivier de Hon, J. Bart Staal, Jacqueline Limpens, Harm Kuipers, Shelley E. Overbeek, Aeilko H. Zwinderman, Rob J.P.M. Scholte. - (Sports Medicine 41 (2001) 1 (January) p. 39-57)

• PMID: 21142283
• DOI: 10.2165/11537540-000000000-00000

Abstract:

Inhaled β₂-agonists are commonly used as bronchodilators in the treatment of asthma. Their use in athletes, however, is restricted by anti-doping regulations. Controversies remain as to whether healthy elite athletes who use bronchodilators may gain a competitive advantage.

The aim of this systematic review and meta-analysis is to assess the effects of inhaled and systemic β₂-agonists on physical performance in healthy, non-asthmatic subjects. To this end, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to August 2009. Reference lists were searched for additional relevant studies. The search criteria were for randomized controlled trials examining the effect of inhaled or systemic β₂-agonists on physical performance in healthy, non-asthmatic subjects. Two authors independently performed the selection of studies, data extraction and risk of bias assessment. Parallel-group and crossover trials were analysed separately. Mean difference (MD) and 95% confidence intervals were calculated for continuous data and, where possible, data were pooled using a fixed effects model.

Twenty-six studies involving 403 participants (age range 7-30 years) compared inhaled β₂-agonists with placebo. No significant effect could be detected for inhaled β₂-agonists on maximal oxygen consumption (VO₂(max)) [MD -0.14 mL · kg⁻¹ · min⁻¹; 95% CI -1.07, 0.78; 16 studies], endurance time to exhaustion at 105-110% VO₂(max) (MD -1.5 s; 95% CI -15.6, 12.6; four studies), 20-km time trial duration (MD -4.4 s; 95% CI -23.5, 14.7; two studies), peak power (MD -0.14 W · kg⁻¹; 95% CI -0.54, 0.27; four studies) and total work during a 30-second Wingate test (MD 0.80 J · kg⁻¹; 95% CI -2.44, 4.05; five studies). Thirteen studies involving 172 participants (age range 7-22 years) compared systemic β₂-agonists with placebo, with 12 studies involving oral and one study involving intravenous salbutamol. A significant effect was detected for systemic β₂-agonists on endurance time to exhaustion at 80-85% VO₂(max) (MD 402 s; 95% CI 34, 770; two studies), but not for VO₂(max) (placebo 42.5 ± 1.7 mL · kg⁻¹ · min⁻¹, salbutamol 42.1 ± 2.9 mL · kg⁻¹ · min⁻¹, one study), endurance time to exhaustion at 70% VO₂(max) (MD 400 s; 95% CI -408, 1208; one study) or power output at 90% VO₂(max) (placebo 234.9 ± 16 W, salbutamol 235.5 ± 18.1 W, one study). A significant effect was shown for systemic β₂-agonists on peak power (MD 0.91 W · kg⁻¹; 95% CI 0.25, 1.57; four studies), but not on total work (MD 7.8 J · kg⁻¹; 95% CI -3.3, 18.9; four studies) during a 30-second Wingate test. There were no randomized controlled trials assessing the effects of systemic formoterol, salmeterol or terbutaline on physical performance.

In conclusion, no significant effects were detected for inhaled β₂-agonists on endurance, strength or sprint performance in healthy athletes. There is some evidence indicating that systemic β₂-agonists may have a positive effect on physical performance in healthy subjects, but the evidence base is weak.

Δ-4-Androstene-3,17-Dione Binds Androgen Receptor, Promotes Myogenesis in Vitro, and Increases Serum Testosterone Levels, Fat-Free Mass, and Muscle Strength in Hypogonadal Men / Ravi Jasuja, Pandurangan Ramaraj, Ricky Phong Mac, Atam B. Singh, Thomas W. Storer, Jorge Artaza, Aria Miller, Rajan Singh, Wayne E. Taylor, Martin L. Lee, Tina Davidson, Indrani Sinha-Hikim, Nestor Gonzalez-Cadavid, Shalender Bhasin. - (Journal of Clinical Endocrinology & Metabolism 90 (2005) 2 (1 February); p. 855-863)

• PMID: 15522925
• DOI: 10.1210/jc.2004-1577

Abstract

Previous studies of Delta 4-androstene-3,17-dione (4-androstenedione) administration in men have not demonstrated sustained increments in testosterone levels, fat-free mass (FFM), and muscle strength, and failure to demonstrate androstenedione's androgenic/anabolic effects has stifled efforts to regulate its sales. To determine whether 4-androstenedione has androgenic/anabolic properties, we evaluated its association with androgen receptor (AR) and its effects on myogenesis in vitro. Additionally, we studied the effects of a high dose of 4-androstenedione on testosterone levels, FFM, and muscle strength in hypogonadal men. We determined the dissociation constant (K(d)) for 4-androstenedione using fluorescence anisotropy measurement of competitive displacement of fluorescent androgen from AR ligand-binding domain. AR nuclear translocation and myogenic activity of androstenedione were evaluated in mesenchymal, pluripotent C3H10T1/2 cells, in which androgens stimulate myogenesis through an AR pathway. We determined effects of a high dose of androstenedione (500 mg thrice daily) given for 12 wk on FFM, muscle strength, and hormone levels in nine healthy, hypogonadal men. 4-Androstenedione competitively displaced fluorescent androgen from AR ligand-binding domain with a lower affinity than dihydrotestosterone (K(d), 648 +/- 21 and 10 +/- 0.4 nm, respectively). In C3H10T1/2 cells, 4-androstenedione caused nuclear translocation of AR and stimulated myogenesis, as indicated by a dose-dependent increase in myosin heavy chain II+ myotube area and up-regulation of MyoD protein. Stimulatory effects of 4-androstenedione on myosin heavy chain II+ myotubes and myogenic determination factor expression were attenuated by bicalutamide, an AR antagonist. Administration of 1500 mg 4-androstenedione daily to hypogonadal men significantly increased serum androstenedione, total and free testosterone, estradiol, and estrone levels and suppressed SHBG and high-density lipoprotein cholesterol levels. 4-androstenedione administration was associated with significant gains in FFM (+1.7 +/- 0.5 kg; P = 0.012) and muscle strength in bench press (+4.3 +/- 3.1 kg; P = 0.006) and leg press exercises (+18.8 +/- 17.3 kg; P = 0.045). 4-androstenedione is an androgen that binds AR, induces AR nuclear translocation, and promotes myogenesis in vitro, with substantially lower potency than dihydrotestosterone. 4-androstenedione administration in high doses to hypogonadal men increases testosterone levels, FFM, and muscle strength, although at the dose tested, the anabolic effects in hypogonadal men are likely because of its conversion to testosterone.

‘Bali over the Counter’ : Exploring the Overseas Use and Acquisition of Anabolic-androgenic Steroids / Matthew Dunn, Kyle J.D. Mulrooney, Dean Biddau, Fiona H. McKay, Richard Henshaw

• Deviant Behavior 43 (2022) 4, p. 447-460
• Volume 43, 2022 - Issue 4 447-460

ABSTRACT

In the bodybuilding and fitness communities, anecdotal evidence suggests that some take ‘steroid holidays’, traveling to and living in foreign countries so as to have greater access to performance and image enhancing drugs (PIEDs). This study aimed to explore this phenomenon. Discussions in bodybuilding, fitness, and PIED forums formed the basis of this study. Several websites were identified and keyword searches were used to identify potential ‘threads’, which were downloaded and thematically analyzed. Twenty-two threads consisting of 254 posts from 188 individual forum members were included. Two themes were identified: (1) Product purchasing and (2) Logistics. In the first theme, the purchase of the products for individual use was a key feature, with their motivations centered on perceptions of legality, purity, and risk. In the second theme, discussions focused those members who sought to use the PIEDs they sourced in a foreign country within that country versus using foreign-sourced PIEDs in Australia. The perception that steroids may be cheaper, more readily accessible, or of better quality in countries in close proximity to Australia may lead some to travel to low- or middle-income countries to use or access PIEDs which could lead to legal and health risks.

‘It was my thought … he made it a reality’ : Normalization and responsibility in athletes’ accounts of performance enhancing drug use / Evdokia Pappa, Eileen Kennedy. - (International Review for the Sociology of Sport 48 (2013) 3 (1 June); p. 277-294)

• DOI: 10.1177/1012690212442116

Abstract

Despite the widespread interest in athletes’ use of performance-enhancing drugs (PEDs) in track and field, the voices of the athletes who use banned substances have seldom been heard. Interviews with competitive athletes were conducted to explore their relationship to doping. Two themes emerged from the interviews. Firstly, the athletes presented doping as a normalized part of competitive sport, inevitably involving the participation of coaching staff. Secondly, and in contrast to the first theme, athletes maintained that they alone were responsible for the decision to use PEDs. The study supports the ‘networked athlete’ explanation of PED use, while highlighting the individualist explanation of doping offered by the athletes themselves. Foucault’s concept of governmentality is used to explain this contradiction, by suggesting that athletes’ internalization of responsibility for doping is part of the art of governing competitive sport.

‘I’d struggle to see it as cheating’ : the policy and regulatory environments of study drug use at universities / Matthew Dunn, Phillip Dawson, Margaret Bearman, Joanna Taia

• Higher Education Research & Development 40 (2021) 2 (23 March), p. 234-246
• DOI: 10.1080/07294360.2020.1738351

ABSTRACT

Students use various licit and illicit substances to enhance their academic performance. As yet, no study has explored whether this is an issue of concern for those working in the higher education sector. This study aimed to explore study drug policy, regulatory environments and responses within Australian universities. Semi-structured interviews were conducted with 14 participants from five Australian universities. Nine participants were based in school/department, faculty, or institutional head of teaching and learning roles; six participants were in student support roles. Eight participants had direct teaching experience. Three themes emerged from the data analysis. Study drug use was seen as a health problem rather than a threat to academic integrity. Participants believed that attributes of the university setting may facilitate study drug use, but also considered that some attributes may prevent the uptake of use, such as a stronger emphasis on universities promoting the benefits of a balanced lifestyle.

‘Shades of Grey’: The Ethics of Social Work Practice in Relation to Un-prescribed Anabolic Androgenic Steroid Use / Orlanda Harvey

• Practice : Social Work in Action 30 (2019) 4, p. 239-258
• DOI: 10.1080/09503153.2018.1510480

Abstract

This paper reflects on some of the ethical dilemmas that social workers face when assessing risk in relation to those using substances. It explores how legislation and societal factors can impact not just on people’s choices and decisions but also on their ‘vulnerability’ and access to services. Vulnerability, a contested term, is linked, in this paper, to assessment of risk. There are ethical issues that arise when assessing risk with people who use Anabolic Androgenic Steroids (AAS) from both service user and professional perspectives. These ethical issues concern a person’s right to choose and make potentially harmful decisions. The paper argues that using substances such as AAS in and of itself does not suffice to make a person vulnerable but this does not mean that people using AAS are not in need of support. It suggests that there may be some groups of people who are more at risk to starting AAS use and that social workers should be aware of these. It also recommends the need for further qualitative research to understand the reasons for starting use and support to help people stop using AAS.

Keywords:

Anabolic Androgenic Steroids (AAS) Image and Performance Enhancing Drugs (IPED) social work substance use ethics vulnerability body imageme dialegislation risk

‘Steroids, it’s so much an identity thing!’ perceptions of steroid use, risk and masculine body image / Signe Ravn and Julia Coffey
In: Journal of youth studies, 2015 [published online]
DOI:10.1080/13676261.2015.1052051

This paper explores how taste and distaste, body image and masculinity play into young people’s perceptions of risk related to steroid use.
Data is drawn from a qualitative study on risk-taking among 52 Danish youths enrolled in high school or vocational training. A number of ‘risky’ practices such as drug use, fights, speeding etc. were discussed. In contrast to these practices which were primarily described in relation to ‘physical risks’, steroid use was understood as part of an ‘identity’ or ‘lifestyle’ in a way these other risks were not. Few interviewees had used steroids, and the large majority distanced themselves from the practice. Reasons for not wanting to use steroids were related to a) perceiving the drug to be part of a broader lifestyle and identity that they are not interested in committing to or embodying and b) finding the body image, physicality and associations with steroid use ‘fake’, ‘gross’ and distasteful. We draw on recent developments in feminist sociological theory related to the gendered body as both a performance and process to understand steroid use as a practice through which the body and self is produced. More than a one-dimensional ‘risky’ practice, we argue that gendered and embodied identities are crucial to understanding the dynamics of steroid use.