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Testing for testosterone: A fairer playing field, but not perfect

Justin Gatlin has come back from two doping bans and continues to compete with the best. (AFP PHOTO/JEWEL SAMAD)
Roar Guru
24th June, 2015
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According to Victor Conte, who now offers ideas about how to diminish banned dug use in sport after serving time in prison in 2005 for distributing steroids to top athletes, the World Anti-Doping Agency (WADA) “cares more about their sponsorship dollars than they do about athletes using PEDs” (performance enhancing drugs).

Dick Pound, a former WADA chairman, also declared in 2013 that “nobody wants to catch anybody. There’s no incentive. Countries are embarrassed if their nationals are caught. And sports are embarrassed if someone from their sport is caught.”

Such pessimistic sentiment towards sports drug testing may be fuelled by data which reveals fewer tests by some important sporting organisations and sports. For example, the number of total tests by the International Association of Athletics Federations (IAAF) declined from 5,817 in 2012 to 4,736 with athletics falling from 27,836 to 24,942.

But sports drug testing has indeed improved in recent years, at least for elite sportspeople subject to stringent testing under the WADA code, as evident by superstars of sport being caught in recent years. This includes testosterone use by a world champion sprinter (Tyson Gay), and the Olympic champion freestyle swimmer (Park Tae-hwan).

This article discusses drug testing for synthetic testosterone, given that athletes with a testosterone/epitestosterone (T/E) ratio greater than four represented 59.6% (1,859 of 3118 tests) of Adverse Analytical Findings and Atypical Findings for anabolic agents during 2013 according to WADA data from the Anti‐Doping Administration and Management System (ADAMS).

But with such a small proportion of athletes banned for drug use in 2013, including just a 1.2% rate for athletics, some commentators call for greater Gas Chromatograph/Carbon/Isotope Ratio Mass Spectrometer (IRMS) tests, also known as the Carbon Isotope Ratio method, to confirm the presence of synthetic testosterone.

With athletics known to have a higher banned drug use rate, with WADA initiated research estimating that 29 per cent of the athletes at the 2011 world championships had doped during the previous year, some argue that greater use of IRMS testing could extend the detection period for fast-acting testosterone gels and creams from a few hours to several days.

Such sentiment is inspired by the reality that IRMS testing caught out Justin Gatlin in 2006 after he passed the T/E ratio, and would have complicated the ability of Lance Armstrong to pass 275 drugs tests given his admitted use of testosterone during the Tour De France.

And along with some athletes having greater opportunity to exploit the T/E ratio because they have two copies of a particular version of a gene called UGT2B17, David Epstein(an American expert on genetics) recommended during August 2013 that IRMS testing be used on everyone, although acknowledging that the ‘test is costly and laborious’.

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The importance of IRMS testing is evident in a report to the WADA Executive Committee on 16 April 2013 concerning the ‘Lack of Effectiveness of Testing Programs’ which included recommendations that IRMS  testing for artificial testosterone ‘be increased forthwith for samples provided by male athletes’, and that ‘rules should be established to permit testing during the periods when detection is possible’ to help detect the increasing trend of micro dosages.

As a result of such sentiment, the number of IRMS tests did increase in 2013 from 2012 despite falling total test numbers: from 5,724 in 2012 (2,944 OCT) to 6,085 (OCT 2,975) in WADA laboratories, and from 591 (410 OCT) to 941 (448 OCT) for athletics.

This does not imply that there is no room for improvement.

For example, there is a huge discrepancy between WADA laboratories with regard to the number of IRMS tests conducted in 2013. When compared as a proportion of total IC and OOC Samples Analyzed per Laboratory (as reported in ADAMS), IRMS tests ranged from 0.06% for Bangkok (2 of 3227) to 7.36% for Salt Lake City (429 of 5823) with Lausanne 7.1% (438 of 6165).  Only Montreal, Paris, Los Angeles, London, and Beijing had a rate above 4%, with Sydney at just 1.51%.

But numbers do not tell the whole story. As WADA’s Technical Document on IRMS indicates, such analysis can be used beyond being a Confirmation Procedure when a laboratory receives an ‘Atypical Passport Finding Confirmation Procedure Request’, or a ‘Suspicious Steroid Profile Confirmation Procedure’, unless the Testing Authority can justify that the GC-C-IRMS analysis is not necessary within 7 calendar days. Additional IRMS analysis can be performed on any urine Sample when requested by the Testing Authority, the Athlete Passport Management Unit, or WADA, ‘even if the Markers of the “steroid profile” are within the normal ranges’.

Most importantly, WADA has added the Steroidal Module program to the Athlete Biological Passport since early 2014 through longitudinal profiling of “an athlete’s normal physiological levels” by “analyzing an athlete’s steroidal variables which are collected over a period of time through traditional urine testing.”

By using the athlete’s own values rather than population values as a basis for evaluation, given that there is some variation with regard to the T/E ratio, IRMS tests are then done when an athlete records “an atypical pattern based on the athlete’s own expected values” regardless of a low or high T/E level.

But how can one prove that the system working, especially with the 2014 and 2015 success of Justin Gatlin who is now running faster than ever after previously been banned for testosterone use, as revealed by IRMS testing?

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After asking USADA (email sent 16 June 2015) how many times IRMS testing was used to test Gatlin in 2014 and 2015, USADA (Annie Skinner) responded that it is ‘not able to share specific testing information about individual athletes’, but that “CIR is regularly used, and is not used only as a follow-up to T/E ratio.” Gatlin faced 15 USADA tests during 2014 alone.

While it may be possible to still beat testing for PED use, an improving testing regime may help explain why Adverse Analytical Findings from IRMS decreased from 5.75% in 2012 to 3.2% in 2013.

What is most important with regard to testosterone testing is closing any opportunity for micro-dosing. While the IAAF Registered Testing Pool’s whereabouts information allows for ‘a specific 60-minute time slot (between 0500 and 2300 hours) where they will be available and accessible for testing at a specific location’, this does not prevent the IAAF testing an athlete “anytime, anywhere.”

What should also be considered in 2015 when assessing the effectiveness of the testing regime is its impact on nations which previously did not provide extensive scrutiny of their athletes.

For example, while the Jamaican Anti‐Doping Commission conducted just 23 OCT in 2013 and just one OCT between March and July before the London Olympics, WADA praised Jamaica’s efforts during February 2015 to establish an effective drug-testing program after collaboration with the Canadian Center for Ethics in Sport.

During 2012 and 2013, the Jamaican Anti‐Doping Commission conducted zero blood tests, with this form of testing crucial to the detection of growth hormone which can also assist power events. However, the latest GH test, which caught two powerlifters at the 2012 Paralympics, is said to now detect use up to two weeks after administration by measuring several lasting markers, including insulin-like growth factor I (IGF-1) produced by the liver.

But 2015 will be an interesting year for understanding whether drug testing is effective, perhaps highlighted best by the clash between Bolt and Gatlin at the 2015 World Championships.

While some describe Bolt as the saviour of the sport, against Gatlin who has served drug bans, others point to Bolt having worked with Angel Hernandez (formerly known as Angel Heredia) who had admitted to helping clients use performance-enhancing drugs and avoiding detection.

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As other commentary suggests, if Gatlin is the subject of “unprecedented scepticism” as a former doper, why can’t scepticism be directed at a man who beats Gatlin by 0.16s in terms of personal bests.

Prior to the 2008 Olympics, Heredia told Germany’s Der Spiegel that, regarding the 100-metre final, “the winner will not be clean. Not even any of the contestants will be clean. There is no doubt about it, the difference between 10.0 and 9.7 seconds is the drugs.”

We shall see what happens in 2015, especially since Bolt’s best yearly times have declined since his world records during the 2009 world championships. Whereas Bolt ran 9.58 and 19.19 in 2009, his best times since January 2013 have been 9.77 and 19.66, which includes one world championship year.

However, what is needed now is greater transparency of all national and international testing by following the lead of USADA which discloses the number of tests for each athlete and sport for every quarter of the year. Perhaps this could be improved by disclosing dates and test results (such as T/E ratios and whereabouts attendance) to promote a perception that everything is above board.

But contrary to the cynical views of Conte and others, the ability of athletes to use testosterone without detection has become much harder in recent years, although one would be brave to rule out the capacity of some athletes to stay one step ahead of the testers.