Beijing Olympics, TE Ratio, And A Level Playing Field?
As the world gets ready to descend on Beijing for the 2008 Olympic
Games, new concerns have arisen about the reliability of the urinary testosterone/epitestosterone
doping test. These concerns, quite ironically coming in a year when the
Olympics are hosted by an Asian nation, focus on racial differences in the
reliability of this test that may favor Asian competitors. The paper appears in
the Journal of Clinical Endocrinology and Metabolism (ePub March 11, 2008) and comes
from an investigation at the Karolinska University Hospital in Stockholm,
Sweden.
To give you a little background, testosterone can be a difficult steroid
to detect in athletes because our bodies naturally make this hormone already.
This is opposed to say, dianabol, which any finding of in the urine would be
indicative of a doping violation. To test for testosterone in this day and age
sports agencies rely on a two-step approach. First, the urine is examined for
the ratio of testosterone to epitestosterone. Normally the body makes these two
hormones in a close ratio. Injection of testosterone usually does not entail
also injecting the clinically inert hormone epitestosterone, so an imbalance is
looked at to indicate a potential doping issue. If the ratio is above 4:1, step
two comes into play. This concerns a very detailed examination of the
testosterone molecule itself. This procedure looks at the weight and
composition of different carbon isotopes on the testosterone backbone and can
determine if the hormone was actually made by the body or not. Because it is so
complex, this test is not used as a first line of defense. Passing the
testosterone/epitestosterone ratio test is, therefore, the only real hurdle to
evading the testosterone screening process.
As it turns out, there are genetic differences in the way we humans
excrete testosterone that can affect the reliability of the testosterone-doping
test. And as the scientists in Stockholm have made note, these differences can
be huge. What they have honed in on in particular is a gene known as UGT2B17.
This gene is important in the glucuronidation and excretion of testosterone.
The study looks at a group of people known to have a certain genetic variation
where no allele of the UGT2B17 gene is present (referred to as del/del). This
genotype is actually very common in Asians, and appears in 66.7 percent of the
population. It appears in 9.3 percent of Caucasians.
The researchers in Sweden wanted to see what would happen if you gave a
whopping 500mg dose of testosterone enanthate to subjects with or without this
genetic mutation. The subjects (55 healthy male volunteers) were monitored two,
six and 11 days after the drug was given to see how common a break in the 4:1
threshold (a step one potential doping violation) would be across groups. As it
turned out, subjects with two normal alleles (ins/ins) noticed a 20 times
greater average maximum increase in the testostereone/epitestosterone ratio
compared to the del/del group. Forty-one percent of the del/del group was
actually able to maintain a ratio below 4:1 for the entire 15-day window. None
would have been flagged for a violation, even after a 500mg injection. On top
of that, over 70 percent of these subjects were testing clear 11 days after the
injection. As for the control (ins/ins) subjects, none of them were able to
maintain a ratio that was below 4:1 at any time during the investigation. All
of them had failed two, six and 11 days post-injection. Given the obviously
high dose applied, the potential for clearing the T/E ratio and improving
performance with synthetic testosterone is obviously high for this genetic
group. With the Olympics still three months away, it also makes one wonder if
self-testing for this UGT2B17 gene variant is going to be (or already is) an
exploited loophole.
The Latest Steroid Horror Stories
Regular
readers will know that I am not one to perpetuate common myths and
misconceptions about the dangers of anabolic steroids. Steroids, at least in an
acute (short term) sense, are remarkably safe drugs. At the same time, however,
I am very realistic about the potential for harm when these drugs are abused,
especially when carried over to the long term. I do fear at times that a
growing “steroids are harmless” attitude will have unfortunate consequences for
the community in the long run. If bodybuilders do not respect the benefits and
risks of these agents equally, the sensational media may actually wind up
getting the horror stories they so desperately grasp for. Therefore, when I see
reports like the following three, which appeared in accredited journals this
past month, I believe it is important to pass them along. Mind you, these
reports are not meant to serve as case studies of abuse, or “proof” that
steroids will cause a certain result in you. Little detail is known of the
background of these cases, so they are here to serve only as reminders of what
has happened to other people using these drugs, and that care and respect
should always be taken with their use.
Report #1: Stroke in a 26-Year-Old
The first report appears in the Clinical Neuropharmacology journal (2008 Map-Apr; 31(2):80-5).
It comes from the neurology department in the Hospital Privado, located in Mar
del Plata, Argentina. The man in the report was a 26-year-old amateur athlete.
The paper describes the event as a posterior territory ischemic stroke. This is
just a fancy way of explaining that an artery was blocked in the back area of
the brain. Ischemic stoke is by far the most common kind of stroke (over 85
percent) and is usually what is being referred to when something is simply
described as a “stroke.” Clearly, this is a very serious and potentially
life-threatening situation. This occurrence in a 26-year-old man, of course, is
alarming.
The report explains that an examination of the patient was conducted to
look for underlying risk factors. This included not only blood work, but an
angiograph and echocardiograph as well. The doctors noted that no abnormalities
were found in his blood profile, nor the angiograph or echocardiograph. They
concluded that the only significant risk factor present in the young man
appeared to be his nonmedical use of stanozolol (Winstrol). The drug was being
used in performance-enhancing doses measurably in excess of the normal clinical
threshold, which usually extends only to 6mg per day. The doctors speculated
that the event was a result of the drug use, particularly because of the their
“known effects on vascular tone, arterial tension, and platelet aggregation.”
Obviously, no conclusions can be drawn from an isolated case study, but the
report is worth noting nonetheless.
Report #2: Heart Attack in a 31-year-old
This next report comes from the medical journal Angiology (2008 Apr 2, Epub). It comes as a
brief online abstract, with notes that it is appearing ahead of official
publication. As a result, there are going to be little details found on this
case until it actually appears in full in the published written journal. Still,
the brief report is of concern. It explains, very simply, that myocardial
infarction (heart attack) was reported in a 31-year-old male steroid-using
bodybuilder. No mention concerning the use of other drugs was made. Admittedly,
cases of heart attack in a young man like this are not impossible to find where
there are no links to anabolic steroids. But the fact that this was a young
steroid-using bodybuilder is difficult to ignore and certainly gives cause for
concern. Again, even with details, no conclusions can be drawn from isolated
case studies. Still, the report is definitely worth noting (and remembering)
given the known negative cardiovascular implications of steroid abuse.
Report #3: Embolism in 56-Year-Old Male
The last case concerns a pulmonary embolism in a 56-year-old male (European
Journal of Internal Medicine, 2008 May;19(3) 214-5). This incident is quite different from
the two above, however, in that it concerns the medical use of anabolic/androgenic
steroids. In particular, this patient had been given injections of both
testosterone and nandrolone. The drugs were being given to aid the healing of a
muscle injury. This was only the third time the man had been given these
injections, and again, they were administered under the care of a physician.
The drugs were administered in this case in the leg muscle. After the medical
event, doctors examined the man and noticed with ultrasound that a blood clot
had formed in a vein of the leg. Detailed chest imaging confirmed pulmonary
embolism. Pulmonary embolism occurs when fat globules block blood vessels in
the lungs. This sometimes occurs with the incorrect or high-volume injection of
oil-based drugs intended for deep intramuscular use. In such cases, the oil may
make its way to circulation rapidly via a blood vessel, causing the problem.
Symptoms of pulmonary oil embolism may include chest pain, labored breathing
and fits of coughing. In severe cases it can lead to death. This report was
included because it reminds us that injections can be tricky, and care should
always be taken. High-volume injections are never advisable, and can result in
the same event. It is also included because it furthers the focus of this
month’s article (recent adverse event reports).
Editor’s Note: William Llewellyn’s critically acclaimed steroid
reference guide ANABOLICS 6th Edition (2007) can be ordered by calling
888-828-8008, or visiting www.anabolicsbook.com.