Testosterone Replacement Therapy Vs. Performance Enhancing Drugs: A Whole Different Ball Game


Recently, an appeals court ruled that Alberto Contador, the three-time winner of the Tour de France, was guilty of “doping,” the use of anabolic steroids to gain an athletic advantage.  This was an additional blow to a sport that has been repeatedly tarnished by doping scandals involving the most elite cyclists in the world.  The court ordered Contador to be stripped of his victory in the 2010 Tour de France as well as twelve subsequent victories.

Doping is by no means unique to cycling, as professional athletes in many different sports—weightlifting, bodybuilding, baseball, football, martial arts, etc.—have tested positive for performance-enhancing substances in the last few years. Doping is banned by all of the major sporting governing bodies.  Not limited to professional athletes, many amateur athletes and bodybuilders have used anabolic steroids to try to improve their game and gain a competitive edge.

Many years before Barry Bonds became involved with doping, it was recognized that the male sex hormone testosterone played a major role in muscle mass and strength.  In the early 1950’s, Soviet Union and other Eastern Bloc Olympic weightlifting teams made use of such androgens, isolated from the testicles of animals, in order to enhance their performance in Olympic events.  Over the subsequent 60 years, the use of synthetic anabolic steroids increased substantially.  Anabolic steroids mimic the effects of testosterone, increasing protein synthesis in cells, causing muscle growth and an increase in lean body mass that results in a gain in muscle strength and thus, a competitive edge.

Anabolic steroids have two different types of effects—anabolic and androgenic.  Anabolic refers to the promotion of cell growth and includes the following effects: increased appetite, increased muscle and bone growth and increased production of red blood cells by the bone marrow, all of which result in increased strength. Androgenic refers to the development of masculine characteristics including oil gland production, libido and sexuality, deep voice and male-pattern hair growth.  Many effects and side effects of anabolic steroids are dose-dependent, in other words, in proportion to the doses used.

Along with the escalating use of synthetic androgens in athletes, there has been a parallel increasing awareness of testosterone deficiency and its treatment, particularly over the last couple of years.  Since testosterone (T) and performance enhancing drugs (PEDs) are both classified as anabolic steroids and each increases muscle mass and strength, they are often incorrectly thought to be one and the same.

T and PEDs differ in structure, biochemistry and use.  The medical use of T is for men with testosterone deficiency, usually manifested by fatigue, diminished sex drive and a constellation of other symptoms.  The goal of treatment is to improve symptoms by getting the testosterone into a normal range.  There are a variety of means of testosterone replacement including gels, creams, trans-dermal patches, pellets and injections.  All of these formulations are FDA approved and provide testosterone that is identical to that of the testosterone that is present in our bodies under normal circumstances.  Testosterone levels are checked periodically to ensure that the testosterone is in the normal range.

PEDs are most often manufactured clandestinely at small labs to avoid FDA scrutiny; they are sometimes obtained through veterinarians, pharmacists or physicians, and are often procured on the black market.  They are intended solely to build muscle mass, strength and improve athletic performance, so their use is beyond the domain of standard medical practice.  PEDs favor anabolic (muscle building) over androgenic (pertaining to the development of male characteristics) effects.

The vast majority of the time, PEDs are provided illicitly by a trainer without special expertise in this area.  The goal is a super-high testosterone level, often ten times or more than normal levels.  Dopers often use the equivalent of 1000 mg or greater of T per week.  PEDs are not the chemical equivalent of T and there is no medical monitoring of users.   Popular PEDs include nandrolone and stanozolol, which were FDA approved years ago, but now have no medical indications.  “Designer” PEDs are often concocted by modifying T; their advantage is that monitoring organizations lack the wherewithal to detect them because of their unique chemical formulations.   The two common patterns of PED usage are stacking and cycling.  Stacking is using two or more PEDs simultaneously whereas cycling is an on—off schedule of use.

PEDs have no medical indications and a risk profile that includes the following: elevated blood pressure; abnormal cholesterol and lipid profiles; altered blood glucose; cardiac muscle enlargement; mood disorders including aggression and violence (“steroid rage”); increased rates of homicide and suicide; liver dysfunction; spontaneous tendon rupture; and endocrine issues including severe and irreversible testicular dysfunction. This contrasts with the use of T, which provides medical benefits and a relatively benign safety profile.  Adverse effects of testosterone may include the following: acne; male breast growth; high red blood cell counts; testicular atrophy; prostate enlargement; decreased sperm production; ankle swelling.

In summary, testosterone deficiency is a genuine problem that can cause a myriad of quality of life as well as quantity of life issues.  When deficiency symptoms are apparent and blood testing confirms the deficiency, testosterone replacement with careful physician monitoring is capable of improving or resolving these issues.  On the other hand, the use of performance enhancing drugs for purposes of achieving anabolic benefits and thus conferring a sports advantage or edge is a very risky business and is not recommended.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food


Now available on Amazon Kindle

To view my ten-minute video on testosterone deficiency, go to the following link:

Credit to Dr. Abraham Morgentaler, Harvard Urologist and author of a good little book entitled Testosterone For Life, for providing much of the factual info for this blog.

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