1. Performance Enhancing Drugs in Sports Joseph Kenny, MD Saturday, Dec 3, 2011

2. A little about the history, use, abuse, side effects and folklore of -- Anabolic steroids Stimulants Human Growth Hormone Erythropoietin

3. Full disclosure I have no financial conflicts to report All images used are either in the public domain, images that I created, or subject to the fair use exception All opinions expressed are my own

4. This presentation will have about as much FOLKLORE as it does SCIENCE

5. Objectives Learn a little about the history of the four major classes of performance enhancing drugs Know the main physiologic effects of these drugs Understand the adverse effects of these drugs Review common and not-so-common excuses for failing a drug test in light of the physiology of the drugs

6. "Because they are banned substances in sports, and because they are dangerous substances that can cause irreversible harm, it's not ethical to do true scientific studies of these medications as they actually are being used. So we are kind of stuck on the anecdotal experiences as far as what's going on with illicit use.“ Marc Safran, Sportsmedicine, UCSF

8. Anabolic Steroids The Brown Sequard elixir 1889 May 1935, Testosterone is isolated Dianabol 1958 The cream and the clear, 1999

9. Main effects of anabolic steroids Increase protein synthesis – build muscle All have virilizing effects to some degree Most popularly used steroids have a relatively high anabolic:androgenic ratio There is clearly a psychological effect as well – increased aggression, appetite for competition and hard training

10. 1889 – the Brown-Sequard Elixir

11. Pud Galvin

12. Dianobol 1958

14. Victor Conte Bay Area Laboratory Cooperative (Balco) Formerly bass player for the Tower of Power Developed “the cream” and “the clear” Pioneered “informational” drug testing

15. The cream and the clear The cream – A transdermal steroid preparation of testosterone and epitestosterone designed to evade detection The clear (tetrahydrogestrinone) was a new steroid designed by chemist/bodybuilder Patrick Arnold, also designed explicitly to evade detection

16. Anabolic Steroids side effects Men: Testicular shrinkage, oligospermia, impotence (HCG) Gynecomastia: tamoxifen Women: Facial hair, deepening of voice, shrinkage of breasts, menses disrupted Both: Acne, hypertension, elevated cholesterol, hypercoagulabillity

18. Chris Benoit Professional wrestler who killed his wife and son, 2007, then hung himself. He was using alprazolam, hydrocodone, and testosterone at the time.

19. Steroids for Cosmesis

20. Arnold Schwarzenegger

21. Debbie Clemens

22. Sylvester Stallone

23. Hulk Hogan

24. What do these three have in common?

26. Benzedrine inhaler, 1928

27. Main effects of amphetamine Lessened fatigue Perception of more energy Better ability to concentrate Improved reaction time Euphoria

29. Here I sit All alone with a broken heart Well, I took three bennies Now my semi truck won’t start Need to be in Cincinnati Monday morning to draw my pay!

30. Take three more bennies Then PULL truck to Cincinnati

31. Side effects of amphetamine Aggression Anxiety Tachycardia, arrhythmia Hallucinations, psychosis

32. Can you identify this individual?

33. He was an emergency room doctor Practiced in Fort Bragg, North Carolina, 1970 Graduate of Northwestern Medical School Married, father of two daughters Daily user of amphetamine, which was available in “candy bowls” to be taken ad lib by emergency room personnel

36. Human Growth Hormone Originally harvested from cadaver pituitary glands Recombinant HGH 1981 Creutzfeldt-Jacob Disease in cadaver-derived GH recipients in 1985; product removed from the market There are now at least six different manufacturers of recombinant HGH

37. Growth Hormone and Athletic Performance There is a stunning paucity of evidence that Growth Hormone helps athletic performance Nonetheless, anecdotal data suggest use is fairly widespread Goal is reduced fat and increased muscle Testing is difficult; to date, very few positives in testing

38. Side effects of HGH Arthritis Diabetes Big Jaw Big Hands and Feet Cardiomyopathy Atherosclerosis

39. Andre Roussimoff

41. Blood Doping Can be done via homologous or autologous transfusion More commonly done via erythropoietin, darbopoietin, or CERA (PEGylated epo) High performance endurance athletes can likely tolerate very high hematocrit, nonetheless occasional death due to hyperviscosity

43. Tour of California

45. The Vengeful Massage Therapist

46. Justin Gatlin

47. Photosynthesis My carbon signature is plant - like

48. Floyd Landis

49. It was my oral contraceptive That’s why my testosterone to epitestosterone ratio is 400:1

50. Mary Decker

51. I am a chimera It was my evil twin

52. Tyler Hamilton

53. My drink was spiked By one of my jealous rivals

54. Ben Johnson

55. My toothpaste was adulterated By a late night intruder

56. Dieter Baumann

57. It must have been contaminated beef That’s why I have nandrolone in my system

58. Petr Korda

59. I have narcolepsy That’s why I am on modafinil (and tetrahydrogestrinone and erythropoietin)

60. Kelli White

61. It was that male enhancement pill I am so embarrassed

62. LaShawn Merritt

63. I have a tumor That’s why I tested positive for human chorionic gonadotropin

64. Brian Cushing