THE PHYSICIAN AND SPORTSMEDICINE - VOL 31 - NO. 12 - DECEMBER 2021
Experts See Silver Lining in THG Scandal
Though the recent scandal involving tetrahydrogestrinone (THG), a previously undetectable steroid, is an explosive development in competitive sports, some physicians who are monitor doping trends see some promising signs.
Several media outlets have reported on wide-ranging drug and financial investigations that were launched after a track coach anonymously sent a syringe containing a purported new "designer steroid" to the United States Anti-Doping Agency (USADA). Upon receiving the syringe, the USADA asked the International Olympic Committee's accredited testing laboratory at the University of California at Los Angeles (UCLA) to analyze the drug. The UCLA lab confirmed that the substance in the syringe was THG, a modified version of an anabolic steroid, and developed a urine test to detect it.
The track coach who sent the syringe to the USADA also identified a San Francisco area lab as the source of the THG, and federal investigators reportedly confiscated containers of steroids, human growth hormone, and synthetic testosterone during a raid of the lab's warehouse. The owner of the lab has denied that his company was the source of the steroids.
Several sports bodies, including the International Association of Athletics Federations, are testing for THG in stored urine samples of athletes who participated in recent track and field championships. Though a few elite track and field athletes have been identified as testing positive for THG thus far, more are expected to be named pending the results of confirmatory B samples.
New Systems Are Working
Gary I. Wadler, MD, a doping expert and associate professor of clinical medicine at New York University School of Medicine in Manhasset, New York, who spoke at a telephone press conference on THG sponsored by the American College of Sports Medicine (ACSM), said he sees some positive effects. "There's no question that this is a real blow to the integrity of sport, but there's a silver lining to the black cloud," he says. "We're seeing collaborative effects between governments and sports organizations." He noted that the USADA had quickly shared the THG findings with the World Anti-Doping Agency (WADA), which then disseminated the information with sports organizations throughout the world.
Andrew Pipe, MD, chair of the Canadian Centre for Ethics in Sport and a physician at the University of Ottawa Heart Institute, said at the press conference that Canadian sports organizations would be retroactively testing their stored samples for THG over the next several weeks. "This is an example of a system being in place and doing what it should," he said.
More Culpability for Others?
Another positive ripple from the THG scandal, Pipe says, is that attention is now being focused on the professional behavior of coaches, athletic trainers, and other groups who help athletes improve their performance. Pipe says that in the past, athletes themselves have generally been the only ones to suffer when drug sanctions are handed down. "It's important that the physicians and scientists in our midst who participate in doping activities be identified, exposed, and eliminated from sports," Pipe said.
William O. Roberts, MD, president-elect of the ACSM and a family physician in St Paul, noted that the alleged relationship between the San Francisco lab and several elite athletes seems unusual because it hints at a conspiracy. "It's not that different from what went on in the past in the former USSR and East Germany," Roberts said at the press conference.
Calls for Legal Clarification
The high-profile nature of the latest doping scandal has caught the attention of federal regulatory agencies and lawmakers. On October 23, US Senators Joe Biden (D-DE) and Orrin Hatch (R-UT) introduced The Anabolic Steroid Control Act of 2021, which would classify anabolic steroids, such as THG and steroid precursors such as androstenedione, as schedule III controlled substances. Wadler says the proposed law addresses many of the loopholes in current controlled-substance legislation.
On October 28, the US Food and Drug Administration (FDA) announced that it had analyzed THG and determined that it is closely and structurally related to two other synthetic anabolic steroids, gestrinone and trenbolone. As such, the FDA states that THG is an unapproved new drug.
Will the anti-doping momentum that has followed the THG scandal produce cleaner competitive sports? Pipe noted that sports will never be perfectly clean. "Humans participate in sport, so predictably we sometimes see some of the more unfortunate dimensions of human behavior," he said. "Our job is to bring doping down to an irreducible minimum."
Wadler said he hopes that new laws and sanctions against anabolic steroids and other drugs will lead to behavior changes that make doping as socially unacceptable as drinking and driving. Professional sports leagues have the ability to sway public opinion against doping agents by adopting drug policies or toughening those that are already in place.
An overarching concern, said Roberts, is the message that young people take from the examples of elite athletes. "Our concerns are so serious because young people may not understand the long-term effects of these drugs," he said.
New York Bans Ephedra
On November 3, New York Governor George Pataki signed legislation banning most ephedra products. New York is the second state to ban ephedra; in May, Florida banned ephedra sales to minors.
According to a press release from Pataki's office, the law does not apply to over-the-counter drugs that fall under the US Food and Drug Administration (FDA) jurisdiction. The law also does not apply to ma huang that is sold or dispensed by practitioners of acupuncture or Chinese medicine.
The New York ban follows recent ephedra-related deaths of high-profile athletes and a recent Rand Corporation report that linked ephedra to higher risks of side effects such as heart palpitations, psychiatric and upper-gastrointestinal effects, tremors, and insomnia. The FDA and the US Department of Health and Human Services are currently seeking comments on ephedra in advance of possibly mandating warning labels on ephedra supplements.
The Ephedra Education Council, a trade group, has said that ephedra is safe when used correctly and that no clinical studies have demonstrated harm.
Psychological Skills Boost Sports Performance
Researchers have found that college athletes perform better in their sports when they take a class to sharpen their mental skills.
The report, published in the July issue of the Journal of Applied Sport Psychology, analyzed results from 168 athletes in a variety of sports who took the class between 1996 and 1999 at a National Collegiate Athletic Association Division 1 college.
The bulk of the class—a sophomore-level course that was also open to nonathletes—consisted of learning mental strategies such as goal-setting, controlling responses to pregame stress and excitement, and pregame rituals. The course also covered on- and off-field problem solving, sports nutrition, and drug and alcohol awareness.
At the end of the 1999 spring semester, coaches reported that the study group achieved more in their sports, played with more confidence, peaked better under pressure, and coped better with adversity.