Ask Vivomed’s Pharmacist – Testosterone abuse in sport

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Ask Vivomed‘s Pharmacist – Testosterone abuse in sport

Testosterone, a naturally produced anabolic sex hormone has long been associated with physical appearance & performance, but how does it work? And what are the potential health implications with prolonged use?
Firstly, lets discuss what testosterone actually is. Testosterone is the primary androgen found in males, stimulating male development by binding directly to androgenic receptors. Males produce testosterone in comparably larger amounts than females who primarily produce progesterone & estrogen. The amount of testosterone produced by the body is governed by a feedback loop involving the stimulation/inhibition of three signalling hormones;

  • Gonadotropin-releasing Hormone (GnRH)
  • Follicle Stimulating Hormone (FSH)
  • Luteinizing Hormone (LH)

Effects of Testosterone

Testosterone levels are commonly elevated during puberty and are involved in;

Testosterone Injection
Testosterone Injection
  • The development of sex organs
  • Increase in muscle mass
  • Growth of facial/body hair
  • Deepening of the voice
  • Increased libido
  • Aggression
  • Increase Strength
  • Stimulation of erythropoietin production & stem cells

Side Effects of Testosterone

  • Nausea/Vomiting
  • Decrease in testicle size
  • Impotence
  • Change in skin colour
  • Liver problems
  • Blood clotting
  • Pain on urination

Long term use or abuse of testosterone can permanently disrupt the “feedback loop” as a result “Testosterone replacement therapy” (TRT) may need to be initiated & adhered to for life.

Testosterone abuse in sport

The first reports of testosterone use in sport dates back to the early 1950’s where it was being used in eastern Europe. The benefits & prevalence associated with its used prompted the introduction of urine testing in the 1968 Olympics. Testosterone use has shown to produce benefits both during & after exercise. Athletes with higher testosterone levels can recover from intense workouts at an accelerated rate while also availing of greater improvements in aerobic function & muscular strength/endurance. This combination allows athletes to train harder, recover faster & thus improve overall performance for their given sport. Increased muscle strength & aggression would have relevance in sports such as weightlifting or boxing. While improved aerobic performance would be beneficial in endurance sports like cycling, athletics & swimming.

Floyd Landis- Phonak Cycling Team
Floyd Landis- Phonak Cycling Team

Detection of Testosterone

Testing for testosterone is based on what is considered a “normal” amount by using the ratio between Testosterone & Epitestosterone. Most individuals have a stable & relatively constant ratio around 1:1-2:1, the World Anti-Doping Agency (WADA) allows a limit of 4:1 i.e. 4 parts Testosterone: 1-part Epitestosterone. In terms of urine testing, only a small amount of testosterone is excreted also making detection difficult. Currently the most effective way of detecting Testosterone abuse is conducting a “Carbon Isotope Ratio Test” (CIR). This test works by comparing the amount of carbon isotopes present in each sample. Endogenous (naturally occurring) testosterone contains the carbon isotopes 12C, 13C & 14C. Synthetically produced Testosterone contains less of the 13C isotope in comparison to the endogenous form, indicating a positive test.
Tour de France winner Floyd Landis tested positive for Testosterone back in 2006. His initial test indicated his Testosterone:Epitestosterone ratio was above 4:1 prompting further tests i.e CIR testing. Any athlete that produces a test above 4:1 must have at least three additional samples tested to provide clarity of such a reading.

For more information about drugs in sport and how to make sure your club and players are staying within the rules please see this article about sports team drug ordering.

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