Growth hormone in sportsJulyVolume 16, Number 7: While it may be tempting to consider the use of performance-enhancing drugs PEDs in sports as a modern phenomenon, the taking of substances to beat the competition has been going on for hundreds if not human growth hormone testing in sport of years. There is evidence that the Ancient Greeks and Romans gave their athletes special potions to improve their performance , and this steroids vs creatine continues to the present day, albeit with more sophisticated methods. One of the unfortunate realities associated with this drive to gain steroids before and after athletes advantage is that physicians have frequently been complicit, if not essential, in working with athletes to violate both the rules of sport and medical regulations. The sophisticated doping programs of the former East German Democratic Republic and the Tour de France would not human growth hormone testing in sport been possible without physician assistance .
HGH Testing - Human Growth Hormone (HGH) Testing Procedures
July , Volume 16, Number 7: While it may be tempting to consider the use of performance-enhancing drugs PEDs in sports as a modern phenomenon, the taking of substances to beat the competition has been going on for hundreds if not thousands of years.
There is evidence that the Ancient Greeks and Romans gave their athletes special potions to improve their performance , and this trend continues to the present day, albeit with more sophisticated methods.
One of the unfortunate realities associated with this drive to gain an advantage is that physicians have frequently been complicit, if not essential, in working with athletes to violate both the rules of sport and medical regulations. The sophisticated doping programs of the former East German Democratic Republic and the Tour de France would not have been possible without physician assistance .
Surveys of National Collegiate Athletic Association athletes report that physicians are among their leading sources for obtaining anabolic steroids . In addition to sports, PED use has now spread beyond competitive athletes into the general population . Throughout the centuries, athletes have used many different PEDs with varying amounts of success.
One of the more recent drugs to gain popularity among both athletes and nonathletes is human growth hormone, hGH. Before , patients with growth-hormone deficiency had to rely on cadaver pituitary extract for their treatment. Supplies were necessarily limited, costs were high, and use posed the danger of fatal viruses such as Creutzfeldt-Jakob disease.
Fortunately for these patients, recombinant hGH rhGH was developed and has been available in the United States since This has increased the supply of hGH for GH-deficient patients, but also increased the possibilities for abuse. It is not allowed to be used off-label for any other conditions or purposes, such as anti-aging interventions or performance enhancement. There are also very strict regulations for the diagnosis of adult GH deficiency.
Despite these regulations, anecdotal stories of athletes abusing hGH have been known since the s. There has been a constant battle in sports between PED use and attempts to curtail it.
Testing for anabolic steroids has improved, and athletes are trying other, less detectable substances. Testing for hGH is yet one more chapter in this story. Recombinant hGH is a amino-acid single-chain polypeptide that is very similar to native hGH, which makes detection a challenge.
The initial test developed in the mids for rhGH detection took advantage of the fact that native hGH is made up of multiple isomers, while rhGH contains only the 22kD isomer. When someone takes rhGH, the natural production of hGH is suppressed and the percentage of the 22kD isomer relative to the other isoforms increases.
Although this test is accurate and there have been several confirmed cases of athletes who have admitted the use of hGH, the isoform test has a limited window of detection, usually on the order of one or two days following administration of the hormone.
But is the presence of hGH worth testing for? First, no studies have conclusively demonstrated that hGH alone improves performance or has positive effects that would theoretically affect exercise. Indeed, the only studies in which hGH was shown to have a positive effect on athletic performance were in anabolic steroid users [6, 7]. There are several possible reasons for this, however, that point to divergent possible underlying factors: Secondly, studies may be statistically underpowered to demonstrate small differences that are clinically insignificant but athletically important.
For example, the winning time in an Olympic race can be determined by a difference of hundredths of seconds, and proving that a change in speed that tiny is occurring at statistically significant rates would require almost a billion subjects. But there are other indications that hGH by itself is not effective. I have reviewed hundreds of patient files from physicians and clinics across the United States in my role as a consultant to law enforcement agencies investigating physicians.
These physicians and clinics purported to practice in areas such as anti-aging medicine, hormone replacement therapy, and rejuvenation, by prescribing hGH, anabolic steroids, and related compounds—probably prescribing more hGH in a week than most physicians do in a lifetime.
Although most of the prescriptions were illegal, these physicians had a very good working knowledge of hGH and anabolic steroids, and I have yet to see that even one patient was given hGH by itself. Every patient who received hGH also received testosterone, synthetic anabolic steroids, or combinations of the two.
Thus it seems unlikely that hGH has undemonstrated effectiveness when used by itself, so testing for it may not be accomplishing the intended goal.
A second, recently validated test, however, measures not the presence of hGH but rather its biologic effects. When rhGH is given to a patient, it has a variety of metabolic effects that produce an increase in several markers. The concentrations of these analytes have been studied extensively in a variety of medical conditions and subjected to intensive statistical analysis .
Although this is an indirect test, it has the advantage of being able to detect rhGH use up to two weeks after administration of the hormone and to measure the effect of rhGH and, potentially, other compounds that increase growth factors. Some athletes and nonathletes will always seek out physicians willing to provide them with illegal and illegitimate drugs. Given this reality, many have wondered about the utility, expense, and effort involved in curtailing the use of PEDs.
Although PEDs like rhGH do pose health risks to athletes , sports in general pose many health risks that athletes willingly accept, some far more likely and more significant than those associated with PED use. This raises the question: The answer is complicated and beyond the scope of this article, but it can be summarized thusly: PED use has the potential to alter a sport so significantly that results are determined by who has the best chemist rather than who is the best athlete.
Secondly, if there were no rules restricting PED use, sports would rapidly deteriorate, as in the former East German Democratic Republic. In addition, sports without PED regulations would pose an ethical quandary for athletes.
They would be faced with three options: I would argue that all three are unethical or unfair alternatives, as well as unappealing to competitors: In my extensive work with competitive athletes, the overwhelming majority have been in favor of antidoping regulations as long as they are accurate, universal, and applied uniformly.
The ultimate purpose of antidoping regulations is not to catch cheating athletes; it is to protect the athletes who want to compete fairly. Although the concept of cheating through the use of PEDs goes back thousands of years, it is also true that valuing honorable competition is at least that old.
Green , MD, is a clinical professor in the UCLA Division of Sports Medicine, the head team physician at Pepperdine University, the medical director and a consultant on anabolic steroids and performance-enhancing drugs for Major League Baseball, and a member of the scientific advisory board of the Partnership for Clean Competition.
Physicians and the Sports Doping Epidemic , July Messages from the Bodybuilding Subculture , July Performance-Enhancing Drugs in Sports , July Unpacking the Claims , November State of the Art and Science. Larger Questions Some athletes and nonathletes will always seek out physicians willing to provide them with illegal and illegitimate drugs. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA. Green, MD While it may be tempting to consider the use of performance-enhancing drugs PEDs in sports as a modern phenomenon, the taking of substances to beat the competition has been going on for hundreds if not thousands of years.
Share References World Antidoping Agency. A brief history of antidoping. Accessed May 8, Seminole County Medical Society. Sir William Osler, MD. Franke WW, Berendonk B. Hormonal doping and androgenization of athletes: National Collegiate Athletic Association.
Adverse health consequences of performance enhancing drugs: Physical effects of short-term recombinant human growth hormone administration in abstinent steroid dependency. Recombinant human growth hormone in abstinent androgenic-anabolic steroid use: Growth hormone doping in sports: Stobaeus, Florilegium , V, Unpacking the Claims , November The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.