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4) Metabolic Endocrinology > 2) Endocrine Doping in Sports > Flashcards

2) Endocrine Doping in Sports Flashcards

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1
Q

What does Wampole’s Preparation contain?

A
  • Strychnine (muscle contractant)

- Alcohol (tranquilizer)

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2
Q

What substances were tested positive in Lance Armstrong’s blood and urine tests?

A
  • EPO

- Growth hormone

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3
Q

Which country is banned from the 2018 Winter Olympics?

A
  • Russia

- “Clean” Russian athletes can compete

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4
Q

Define doping.

A

The USE and ABUSE of performance-enhancing substances in elite sport

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5
Q

When did doping become a current term?

A

At the start of the 20th century, in reference to illegal drugging of racehorses

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6
Q

What are examples of doping in history?

A
  • Egyptian slaves fed elixirs

- Slaves of the Incas worked better after chewing coca leaves

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7
Q

When did the IAAF ban doping?

A

In 1928

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8
Q

When did the testing for illegal drugs by the IOC begin?

A

In 1979

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9
Q

How may doping enhance performance? What does it increase? What does it decrease?

A
  • Increased strength, endurance, alertness, and aggression

- Decreased reaction time, fatigue, anxiety, and muscle tremors

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10
Q

What are other motivations for use of doping?

A
  • Drive to win
  • Relaxation
  • Financial incentives
  • Belief that others are using PES
  • Coping with pain and injury rehabilitation
  • Weight control
  • Hiding the use of other drugs
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11
Q

Why must elite athletes resort to the use of PES, if they are already “genetic freaks”?

A
  • Because they must be able to win against other “genetic freaks”
  • PES may be the edge they need to win
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12
Q

Why may adolescent athletes resort to the use of PES?

A
  • Peer, coach, and/or parental pressure
  • Ignorance of facts about PES
  • Self-doubt
  • To avoid the hard work they need to succeed
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13
Q

What is Cenegenics?

A
  • Anti-aging system

- Hormone replacement therapy (mostly testosterone, GH, and nutritional supplements)

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14
Q

What are common excuses to being caught using PES?

A
  • Over-the-counter remedies have different ingredients depending on the country of origin
  • Spiking
  • Testing procedures
  • Natural occurrence
  • Pre-existing medical condition
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15
Q

Why is it unlikely that athletes accidentally use PES?

A

Because a large majority of these substances have to be taken by injection, so it is unlikely that they will know nothing about it

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16
Q

What are the seven common drug categories used in sports?

A
  • Stimulants
  • Build muscle/bone
  • Relaxants
  • Mask drug use
  • Reduce weight
  • Increase oxygen delivery
  • Mask pain
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17
Q

What are examples of stimulants?

A
  • Caffeine
  • Amphetamines
  • Cocaine
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18
Q

What are examples of drugs to build muscle/bone?

A
  • Anabolic steroids
  • hCG
  • LH
  • IGF-1
  • Insulin
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19
Q

What are examples of relaxants?

A
  • Alcohol
  • Beta-blockers
  • Cannabinoids
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20
Q

What is the primary class of drug used to mask drug use and reduce weight?

A

Diuretics

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21
Q

What are examples of drugs to increase oxygen delivery?

A
  • EPO

- Blood doping

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22
Q

What are examples of drugs to mask pain?

A
  • Narcotics

- Cortisone

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23
Q

What are the benefits of stimulants in sports?

A
  • Increase alertness
  • Reduce fatigue
  • Increase competitiveness and aggressiveness
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24
Q

What are the side effects of stimulants in sports?

A
  • Nervousness
  • Insomnia
  • Irritability
  • Irregular heartbeats
  • High blood pressure
  • Convulsions
  • Sudden death
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25
Q

What class of stimulant is caffeine?

A

Methylxanthine

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26
Q

What is the effect of caffeine on calcium?

A

Translocation of calcium for more muscle availability

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27
Q

What is the effect of caffeine on cAMP?

A

Increase in cAMP by inhibition of phosphodiesterase (which breaks down cAMP)

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28
Q

What is the effect of caffeine on adenosine?

A

Blockage of adenosine receptors, which blocks the sedative properties of adenosine

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29
Q

What is the legal limit of caffeine in sports? What is that equivalent to in terms of cups of coffee?

A
  • 15 mg/mL

- 6-8 cups of coffee in one sitting

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30
Q

What is the maximum legal limit of caffeine in mg/kg? What dose is required to see benefits?

A
  • Legal limit: 17 mg/kg

- Benefits: 5 mg/kg

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31
Q

What are beta blockers used for medically?

A
  • Reduce blood pressure
  • Migraine headaches
  • Heart arrhythmia
  • Alcohol withdrawal
  • Anti-anxiety
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32
Q

What are the advantages of beta blockers in sports? What sports are they used for?

A
  • Reduces anxiety, jitters, and slows the heart rate

- Sports that require a steady-hand (golf, archery, curling)

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33
Q

What hormones are produced during heightened arousal? How does that influence the heart rate? What are the effects of beta blockers on this system?

A

1) Epinephrine and norepinephrine is produced by the adrenal medulla
2) Heart rate and blood pressure increases
3) Beta blockers block the beta receptor on the muscles of the heart, which reduces these effects

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34
Q

What secretes GH?

A

Anterior pituitary

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35
Q

What are the two ways that GH may be used by athletes?

A
  • Indirect (stimulating the GH axis by GHRH)

- Direct (injecting recombinant GH)

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36
Q

What are side effects of GH?

A
  • Acromegaly
  • Peripheral neuropathy
  • Coronary artery disease
  • Cardiomyopathy
  • Diabetes, hypothyroidism, arthritis
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37
Q

What is acromegaly?

A

The increase in size of certain bones, including the hands, feet and face

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38
Q

How is the usage of GH detected?

A
  • No available urine test

- Blood test is available

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39
Q

When is EPO released? By what organ? What does it stimulate?

A
  • Released by the kidneys
  • In response to low hematocrit
  • Stimulates RBC production from the bone marrow
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40
Q

What sports is EPO used for?

A

Endurance sports (marathons, cycling)

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41
Q

What is induced erythrocythemia?

A

An increase in hemoglobin following re-infusion of an athlete’s blood

42
Q

What is the goal of blood doping?

A

To increase the oxygen-carrying capacity of hemoglobin

43
Q

What are the two ways that blood doping may be achieved?

A

1) Adding RBCs to the blood from another individual (heterologous transfer)
2) Extracting and storing your own blood to induce elevated EPO, and re-injecting the frozen blood (autologous transfer)

44
Q

How does EPO induce a higher yield of ATP?

A
  • EPO increases oxygen-carrying capacity

- Aerobic metabolism induces a higher yield of ATP

45
Q

What is the protocol for autologous reinfusion of blood?

A
  • 4-8 weeks prior to the competition: 2 units of blood are removed
  • 1-7 days prior to the competition: blood is reinfused
46
Q

How may blood doping improve endurance? Which groups show the greatest benefit?

A
  • 25% improvement in endurance

- Poorer conditioned athletes showing

47
Q

What stimulates the release of EPO?

A
  • Decreased RBC count
  • Decreased availability of O2 to blood
  • Increased tissue demands for O2
48
Q

What is EPO used to treat legally?

A

Anemia

49
Q

What are the effects of heterologous transfers of blood?

A
  • Transfusion reactions (3-10%)
  • Hepatitis (10%)
  • HIV (?%)
50
Q

What is the primary danger of autologous blood transfer?

A

Bacterial infections

51
Q

What is polycythemia? What may cause polycythemia?

A
  • Increased blood viscosity, which can lead to decreased cardiac output and decreased aerobic performance
  • May be caused by blood doping
  • Most young healthy athletes show no side effects
52
Q

What are the side effects of EPO?

A
  • Kidney damage
  • Jaundice
  • Blood clots
  • Stroke
53
Q

What is the arbitrary limit on hematocrit, set by the IOC?

A
  • 50%

- Above which athletes cannot compete

54
Q

How is blood doping detected?

A
  • Urine tests are NOT reliable

- Blood tests are the best method (measuring hematocrit above 50%)

55
Q

What substances may be measured in serum to detect RBC transfusion?

A
  • Serum ferritin and bilirubin are measured

- They are hemolysis products, which may occur from RBC transfusion

56
Q

What are anabolic steroids derived from?

A

Testosterone

57
Q

What are the two main effects of anabolic steroids?

A
  • Anabolic effects

- Androgenic effects

58
Q

How are pure anabolic steroids derived?

A
  • There are NO pure anabolic steroids

- Various levels of androgenic effects

59
Q

What are the anabolic effects of steroids?

A
  • Increased skeletal muscle mass

- Anti-catabolism properties

60
Q

What are the androgenic effects of steroids?

A

Secondary sexual characteristics (pubic hair, genital size)

61
Q

Define cycling, in terms of steroid-use.

A

Taking multiple doses over a specified period of use, then stopping for an equal or longer time (prevent the development of tolerance)

62
Q

What are the benefits of cycling, in terms of steroid-use?

A
  • The short period of use affects anabolism, but is not long enough to affect the reproductive axis (maintains HPG axis)
  • Prevents the development of tolerance
63
Q

What is the major problem with the ingestion of steroids in terms of reproduction?

A
  • Steroids inhibit the release of LH and FSH from the pituitary
  • NO testosterone is produced by the testes, which shrink and become infertile
64
Q

Define stacking, in terms of steroid-use.

A

Using a combination of anabolic steroids, often in combination with other drugs

65
Q

What is the benefit of stacking, in terms of steroid-use?

A

To avoid tolerance developing against any one type of drug

66
Q

Define plateauing, in terms of steroid-use.

A

When a drug becomes ineffective at a certain level

67
Q

Define tapering, in terms of steroid-use.

A

Slowly decreasing steroid intake

68
Q

Define pyramiding, in terms of steroid-use.

A

Gradual increase, then decrease, in doses during a SINGLE cycle

69
Q

What dose of anabolic steroids do athletes typically take?

A

Up to 40 to 100 times the therapeutic dose

70
Q

What are examples of illicit steroids?

A
  • Nandrolone
  • Stanozolol (Winstrol)
  • Methelone
  • Tibolone
  • Oxandrolone
71
Q

What are examples of medical steroids?

A
  • Testosterone
  • Enanthate
  • Undelanoate
  • Dehydrotestosterone (patch)
72
Q

What are the desired effects of steroids?

A
  • Increase in strength
  • Increase in weight
  • Increase in aggressiveness
  • Increased capability of sustaining repetitive, high intensity workouts
  • Enhanced performance
73
Q

What are side effects of steroid use in men?

A
  • Development of breasts
  • Shrinkage of testicles
  • Reduced sperm count
  • Enlarged prostate
74
Q

What is required for spermatogenesis? How do steroids impair spermatogenesis?

A
  • FSH is required

- Steroids negatively feedback to the pituitary, decreasing the release of FSH and LH

75
Q

What are overall side effects of steroid use?

A
  • Strokes and blood clots
  • High blood pressure and heart disease
  • Aggressive behaviour
  • Impotence
76
Q

What was the 2015 testosterone rule change?

A
  • The ruling found that there was a lack of evidence provided that testosterone increased female athletic performance
  • Prior to these games, women had to take drugs to decrease their testosterone levels
77
Q

Which population does androgen doping affect the most?

A
  • Individuals who exercise only see a 10% increase in performance
  • Individuals who do NOT exercise see a 10 to 20% increase in performance
78
Q

What is the typical hypothalamic/pituitary/gonadal axis?

A
  • Hypothalamus releases GnRH
  • Pituitary releases LH and FSH
  • Testes release testosterone and estrogen
  • Hormones negatively feedback on the hypothalamus
79
Q

What are the effects of using hCG LH in males? How may it be detected?

A
  • Greater quantity of testosterone produced
  • Greater negative feedback on the hypothalamus
  • May be detected in urine
80
Q

What are the effects of using an estrogen blockage in males?

A
  • Estrogen blockage blocks the negative feedback on the hypothalamus by estrogen
  • These inhibitors keep the axis functioning longer
81
Q

What are the effects of using a GnRH analog in males?

A
  • Increased production of LH and testosterone

- Greater negative feedback on the hypothalamus

82
Q

What are direct measures to increase testosterone?

A
  • Testosterone

- DHT

83
Q

What are indirect measures to increase testosterone?

A
  • hCG
  • LH
  • Estrogen receptor blockers
  • Aromatase inhibitors
84
Q

What is used to rapidly dilute the PES?

A

Diuretics

85
Q

What is the range of detection times for steroids?

A

4 days to 18 months

86
Q

What is Andriol? What is its half-life?

A
  • Orally available testosterone

- Half-life: 3-5 hours

87
Q

What does Andriol bypass? What is the benefit?

A
  • Andriol bypasses the liver, and is absorbed through the lymph
  • Steroids are inactivated in the liver
  • So, more Andriol can get into your system in a biologically active form
88
Q

What is “The Clear”?

A
  • THG (Tetrahydrogestinone)
  • A designer steroid, tweaked to make it undetectable
  • Potent anabolic steroid used for years without detection
89
Q

How was THG discovered?

A

Syringe containing THG was mailed to the drug lab by a coach

90
Q

How is synthetic testosterone detected?

A

Urine sample

91
Q

What ratio is analyzed to detect synthetic testosterone?

A

Ratio between testosterone and epitestosterone

92
Q

What is epitestosterone?

A

Natural but inactive epimer co-synthesized with testosterone

93
Q

What is the normal T/E ratio in the population? What is the T/E ratio allowed by the IOC Medical Commission?

A
  • 1:1

- However, 4:1 ratio is allowed by the IOC, given individual differences in the population

94
Q

What is the disadvantage of the IOC’s T/E ratio?

A
  • If you have a naturally low T/E ratio, you may take synthetic testosterone and remain undetected, as long as you’re below the 4:1 ratio
  • Athletes may also take epitestosterone to “correct” the ratio
95
Q

What are methods used by athletes to “beat the system”?

A
  • Insert bogus urine into bladder through a catheter
  • Drink copious amounts of water and use diuretics
  • Ineffective drug testing (athletes know when they are going to be tested)
  • Accidental drug use
96
Q

How many times is accidental drug use permitted?

A

Only once (one-time basis)

97
Q

Why are drugs, such as EPO, difficult to detect? How do athletes “beat the system” with protein hormones?

A
  • Protein hormones have a short half-life, and are cleared within a week
  • Athletes use microdosing for EPO (taking small doses on a regular basis)
98
Q

Why are drugs, such as GH, difficult to detect? How do athletes “beat the system” with protein hormones?

A
  • GH clears within 3 days to a week
  • Blood test is used to detect for GH
  • Athletes take GH up until the test date, which makes you clear for your test, but your body has benefitted from GH prior to the event
99
Q

What is the methodology used to detect for PES?

A

1) Sample preparation (urine or blood)
2) Initial testing procedure (A sample)
3) Confirmatory analysis (same sample is re-tested to confirm that it is not a false positive)
4) B sample confirmation (another sample, taken at the same time, is tested)

100
Q

What is a biological passport?

A
  • Electronic document about the athlete that contains certain biomarkers throughout their career
  • If these markers change dramatically, it alerts officials that the athlete might be doping
101
Q

How long are samples kept for testing?

A

8 years

102
Q

How many athletes said “Yes” in response to the question “Would you be willing to take a special pill that would guarantee you an Olympic gold medal, even if the pill would kill them within a year?”

A

50% of athletes surveyed said yes

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