In 1988, it was Canadian sprinter Ben Johnson. In 2000, American track star Marion Jones. In 2004, Russian shot putter Irina Korzhanenko. No doubt there will be at least one in the Olympic Games opening this month in London: a dazzling athlete who wins the gold only to be stripped of it later for using performanceenhancing drugs. The World Anti-Doping Agency (WADA), an international drug monitoring organization, estimates that 10 percent of the athletes in this year’s games may be doping.
“The games will not be kept clean,” says Alan Rogol, M.D., Ph.D., a pediatric endocrinologist and advisor to the U.S. Anti-Doping Association, “but there is not much more that can be legally done than testing.” Rogol, who co-wrote The Endocrine System in Sports and Exercise, adds, “The new drugs that are used are not known until a test is made for them.”
Doping is as old as the Olympics. Ancient Greek and Roman athletes pumped themselves up with herbs and animal extracts before competitions. Over the centuries, cocaine, caffeine, alcohol, and amphetamines have all been used to enhance performance. After World War II, a plethora of modern drugs emerged, including anabolic-androgenic steroids and peptide hormones such as growth hormone and erythropoietin. On the horizon lurk designer drugs, among them selective androgen-receptor modulators (SARMs) and myostatin inhibitors, which can ﬂy under the radar of current-day tests.
Trying to keep the Olympics clean is a daunting task for ofﬁcials. More than 300 performance-enhancing substances are known, but as quickly as WADA, with its 33 testing laboratories, devises a method to detect one, the underground pharmacists and chemists develop new drugs to obscure the banned substance and thwart the tests. “It’s a cat-and-mouse game between the pharmacists who make these things and the anti-doping agencies,” says Rogol.
Ofﬁcials will be gunning for anabolic-androgen steroids, growth hormone, and erythropoietin, the three primary endocrine system offenders in sports doping today. Altered versions of these substances, originally developed by pharmaceutical companies to treat various illnesses, are readily available online at such sites as GetAnabolics. com and houseofmuscle.com. The ethical aspects of the marketplace are fuzzy, and many countries ban the sales of these drugs without a prescription.
In their pure form, anabolic-androgen steroids are metabolic derivatives of testosterone, a major male sex hormone that is best known for building muscle. Bona ﬁde therapeutic use of it includes treatment of male hypogonadism, helping AIDS patients gain weight, or treating anemia and musclewasting diseases. Human and veterinary anabolic-androgenic steroids are used by weightlifters and track stars because these drugs help them enhance their strength. Johnson and Korzhanenko were busted for the anabolic stanozolol.
Testing for steroids involves the use of liquid or gas chromatrography and mass spectrometry, which examines the “signatures” of the testosterone trunk and the chemical groups that make each anabolic steroid unique. The process is a lot like examining a ﬁngerprint in a forensic case by scrutinizing the different parts of it. The problem with this detection strategy is that it’s only as good as what it already knows. Rogue chemists can synthesize new anabolic substances with similar chemical structures that are not detected in the current anti-doping tests. A case in point is tetrahydrogestrinone (THG), which made headlines in the 2004 Olympics. Also known as “the clear” for its initial ability to go undetected, this anabolic steroid, manufactured by the Bay Area Laboratory Co-Operative, brought down numerous Olympians. Among them was Jones, who admitted in 2007 to using THG before competing in the 2000 Sydney Olympics, as well as Major League Baseball players Barry Bonds and Jeremy Giambi. Abuse of THG was widespread among athletes before the U.S. Anti-Doping Agency was able to identify and develop a speciﬁc test for it.
Growth hormone (GH), the pituitary peptide administered to under-statured children and adults, also increases muscle mass and decreases body fat. The word in gyms is that it increases muscle size in a shorter time than the usual training and allows a lifter to bench press more weight. In the scientiﬁc literature, however, the jury is still out as to whether GH actually brings any additional beneﬁt to healthy adults. Only a handful of short-term studies indicate that it increases endurance and strength in older adults.
Olympic ofﬁcials at this year’s Games will try to detect the hormone by measuring and comparing the ratio of human recombinant GH, of which the majority of counterfeit drugs are made, to normal GH levels present in the body. The window of opportunity for detection of GH, however, is just 12–24 hours after the last GH dose. The pulsatile manner in which GH is secreted, with higher levels at night than in the day, also poses problems. A “high” GH could mean that the sample was taken during a peak, not that the athlete was doping.
The illicit drug of choice for cyclists and marathon runners is the kidney-based hormone, erythropoietin, which increases the number of circulating red blood cells, thereby boosting oxygen delivery to muscles and improving endurance. Both blood and urine tests can unmask abusers, but the drug is quickly eliminated from the body, generally within three days after initial injection, which makes detection very elusive.
“The effects of the drug often last longer than the drug can be detected in body ﬂuids, thus an athlete may be enhanced and the test is negative,” explains Don Catlin, M.D., founder of the ﬁrst U.S. anti-doping lab and president and chief operating ofﬁcer of Anti-Doping Research, an organization that strives to improve detection of performance-enhancing drugs.
Soon after Olympic medalists are lauded on the podium, they must give blood and urine samples, usually within two hours after the competition. The sample is divided and one part tested. If it comes back positive, the other portion is tested to conﬁrm the results. If both are positive, the athlete loses the medals and is banned from competition for two years.
Is it possible that an athlete can get snared by innocently ingesting some nutraceutical, such as creatinine or “organic” powder? “The rules are strict,” says Rogol. If a compound’s in your body, you’re responsible. It doesn’t matter how it got there.”
This zero-tolerance attitude led to the near-expulsion of MVP baseball player Ryan Braun in February after he received two positives for anabolic-androgenic steroid. When ofﬁcials discovered that the test collector had taken Braun’s sealed urine sample home for two days before sending it to an anti-doping laboratory, a 50-game suspension was averted, though Braun’s reputation remains questionable. The case, however, underscores just how difﬁcult it can be to sort out who’s cheating and who’s not.
Doping athletes have contrived a roster of ways to beat detection. Hiring a chemist to design a drug for which the anti-doping laboratories do not yet have a test is one of the latest trends. For example, androgens contain many metabolites, not all of which have been identiﬁed and will not be in anti-doping data banks. The new SARMS and myostatin inhibitors, which speciﬁcally target and increase muscle tissue, don’t alter a person’s endocrinology proﬁle and cannot be picked up by the traditional blood or urine test. Antidoping agencies are pursuing alternative methods to trace these new compounds.
Athletes have been known to add chemicals, such as soap detergent, to urine or blood samples to create a false negative. They sometimes try to dilute a banned drug in their urine or blood by drinking enormous amounts of ﬂuids or taking diuretics. The dope busters ﬁght back with sophisticated screening processes. Some athletes even connive to provide someone else’s urine. Bradley Anawalt, M.D., professor of medicine at the University of Washington in Seattle and also a U.S. Anti-Doping Agency scientiﬁc advisor, says that athletes sometimes attempt to conceal a container or bag of clean urine in body cavities or clothing to provide as a sample.
“It’s pretty impressive the lengths athletes have gone through to take an anabolic or prohibitive substance and hide it,” says Anawalt.
Ultimately an athlete may pay a high price for the fame and fortune that comes with winning a medal through substance abuse. A lifetime of health problems can result, from acne and depression to infertility and cardiovascular disease. In a 1995 poll of 198 elite athletes, Chicago physician Bob Goldman discovered that more than half said they would take a banned drug if they were assured of not getting caught and could win their competitions for ﬁve years, even if they then died from the adverse effects of the drug. Says Anawalt, “We are talking about a group of people who are willing to do absolutely anything to win a medal.”