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21.02.2015, admin  
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TORONTO -- Health Canada is warning consumers and health-care providers about a potential risk of serious and life-threatening cardiovascular problems linked to testosterone replacement therapy for men. Testosterone replacement products are used in men whose bodies don't make enough of the hormone, causing such effects as flagging libido, low energy, loss of muscle, mood swings and disturbed sleep. A recent Health Canada safety review found a growing body of evidence suggesting that the use of replacement testosterone may pose an increased risk of heart attack, stroke, blood clots in the lungs or legs, and heart rhythm irregularities. The federal department says testosterone replacement products should not be used in men for non-specific symptoms if lab tests have not confirmed a low testosterone level, nor should they be used in children under 18 nor in women. Men should advise their doctor of any history of cardiovascular disease or symptoms that might indicate such disease before using testosterone replacement therapy.
The agency also says health providers should assess patients for cardiovascular disease risks before prescribing testosterone and closely monitor men who begin hormone replacement. In Canada, 12 testosterone replacement products are approved for sale, including such brand-name products as Androderm, Delatestryl, Androgel and Testim, as well as various generic equivalents. Doctors are increasingly treating below normal testosterone levels with (and Big Pharma is increasingly promoting) testosterone replacement therapy for older men.
For those who race in the masters’ classes, is a TUE available for this therapy, with or without limitations?
Given the threshold method of triggering tests, the ratio of epitestosterone to testosterone, would it even come up in testing if the therapy resulted in levels in the “normal” range? However, it’s important to note that low testosterone levels due to the normal aging process are usually characterized as “functional” hypogonadism and would not qualify for a WADA-issued TUE. Klinefelter syndrome, bilateral anorchia, cryptorchidism, Leydig cell aplasia, male Turner syndrome, Noonan’s syndrome, congenital adrenal hyperplasia. That’s the general list and there are other contributing factors for which WADA – or a national anti-doping agency – could consider a TUE request.
So let’s assume that the members of our hypothetical field of masters racers are not suffering from any of the aforementioned afflictions, but merely “functionally” hypogonadistic. So, would restoring those levels back to the way they were when you were 25 help reverse some of the symptoms of the normal aging process? Exogenous testosterone can contribute to an enlarged (but non-cancerous) prostate, a problem known as benign prostatic hyperplasia (BHP) and some studies indicate that it can also contribute to the growth of cancer cells in the prostate. Exogenous testosterone can also result in a decline in the production of natural testosterone, as the body adjusts in response to unnatural increases in serum levels of the hormone. The natural conversion testosterone to estrogen can also contribute to the growth of the much feared “man boob,” with men experiencing enlarged and tender breast tissue. Indeed, the aforementioned side-effects are to be considered so potentially serious that any male with high risk factors for prostate or breast cancer (hey, it does happen) is automatically off the list of potential candidates for testosterone replacement therapy.
There are other side-effects, including liver toxicity, sleep apnea, fluid retention and increased risks of other cancers. On a somewhat positive note, doctors also warn of one side-effect that would actually play pretty well with our little peloton of aging cyclists, though: Polycythemia. Since we’re in hypothetical mode, though, let’s assume that the NIH study comes back with stellar results and all of the 800 test subjects emerged from their two years with the strength, energy and looks of a 25-year-old.
You asked if they might test positive in the rare event that USADA’s testers show up to request samples from the men’s 55+ field. Further study – using the Carbon Isotope Ratio test – would show that the elevated ratio is due to the presence of exogenous testosterone and that could result in a two-year suspension. So in conclusion, testosterone therapy should probably be considered by a relatively small number of those for whom it might prove beneficial, especially if you want to live by the rules of our sport.
For the rest of us … well, I always like to remember the words of Mark Twain, who observed that “age is an issue of mind over matter.
I would welcome the opportunity to debate this issue in greater detail at some point, but the comments section of a column probably isn’t the place to do it.


You assert that “anti drug crusaders want to pretend that what athletes are putting themselves through in the name of better performance is normal and healthy.” Frankly, I am not sure that anyone is claiming that putting the body through the stresses, strains and damage of, say for example, a three-week grand tour is normal or all that healthy. Your let-them-all-dope approach would then put the onus upon those clean athletes, who chose to compete without drugs, to make that horrible choice of either keeping up or taking drugs. If you think I am missing your point, or summarizing your arguments inappropriately, let’s debate this thing in greater detail. The therapeutic use of testosterone is perhaps different than the use of other drugs for performance. I have not yet see a doc to find out my testosterone level is, but I would bet you a beer it’s lower than yours. It seems that as you take the testosterone supplement, your body comes to rely solely on the AndroGel and stops making its own testosterone. So understand, once you start, you can’t go back, much to the delight of Abbot Laboratories.
Therefore, I remain a borderline-low testosterone bike rider, where I’ll probably stay. I look at this slightly differently: young men and women should have a chance to compete without having having to destroy their bodies through chemistry.
The therapy is based on research that tends to show that below normal T levels lead to various premature aging symptoms, low energy levels and low sex drive. Given my relatively short time as an attorney (I’m just three years out of law school), I am always nervous when other lawyers – especially the experienced ones – read this column.
The bottom line, though, is that anyone seeking a TUE for testosterone must submit a detailed diagnosis, with supporting medical evidence, to justify the claim that his low serum testosterone levels are due to one of the medically recognized causes. The theory is that these men, too, would benefit from testosterone replacement therapy and you’re right, Larry, there has been an increase in interest (and marketing) in recent years, especially as we Baby Boomers get older.
While there may be benefits that accompany testosterone replacement therapy for functional hypogonadism, there are risks, too. That can also result in decreased production of sperm to the point that fertility may be put at risk.
There is not a single person participating at high level competition in any sport that would meet the criteria laid out by the Olympic committee from a century ago. At best, modern medicine’s efforts to adjust the human body’s reactions to those stresses is quite crude. Call me an anti-doping crusader, David, but I would much rather do what I can to root out the cheats than to make cheating legal and force the honest competitor into even considering that Faustian bargain. The rules aren’t that difficult, the list is published, if your taking something on the banned list, your cheating.
IF the current study (and others over time) show that testosterone improves health and is safe (when used as they did in the study, etc etc), then that’s markedly different than injecting epo, getting blood transfusions, or taking amphetamines, none of which make you healthier (though the level of hazards with them vary). I take it because it makes me feel marginally less nearly dead, and from what I’ve read it leads to more testosterone production. Allow for mechanized limbs, servo-assisted joints, muscle grafts… Those cyborgs would be very fast, I bet the kilo would be under 50 s. In short, you become completely dependent upon the supplement (see side affects in the story).
In order to post comments, please make sure JavaScript and Cookies are enabled, and reload the page. Like anyone, I appreciate the kudos, but I do want to encourage anyone to send me a note if they notice a bone-headed mistake. The World Anti-Doping Agency does make an allowance for the therapeutic use of testosterone. That number increases to 21 percent for men between 60 and 80 and 35 percent for men 80 and older.


There is a big study going on right now, sponsored by the National Institutes of Health, which involves tracking 800 men over the age of 65 who are using a gel-based testosterone supplement. One key concern is the effect testosterone supplementation will have on the reproductive system, especially the prostate.
Unfortunately, that is also accompanied by an elevated risk of heart attack and stroke, not something you want to toy with in an age group whose cardiac risk factors are already on the increase.
PLEASE NOTE: Understand that reading the information contained here does not mean you have established an attorney-client relationship with attorney Charles Pelkey.
Things that are considered normal and legal now, protein supplements were unavailable then. You stated that you need a doctor and a lawyer on your team to stay on the right side of the rules, I would argue that if you feel you need a doctor and a lawyer, chances are your probably violating at least the spirit of the rules. An easy example are the hematocrit markers; none of the Pro riders are anemic, but their base levels are different. However, before we see the entire middle-aged masters’ peloton veer off to the doc’s office, you need to keep in mind that according to the rules, a Therapeutic Use Exemption (TUE) for testosterone is issued under the narrowest of circumstances. That same level in his 85-year-old grandfather might be considered to be within normal parameters. So, we may have a more definitive answer once all of the data is reviewed in the next year or so. That test, for all of its flaws, is based on the assumption that the body produces testosterone and epitestosterone at about the same levels.
Readers of this column should not act upon any information contained therein without first seeking the advice of qualified legal counsel licensed to practice in your jurisdiction. Remember when all the pro teams had blood centrifuges to make sure the riders made the red blood cell limit? But I promise you johan bruyneel is not scouting the 40-45 looking to fill a spot on his TDF team. Hey, if you want to take testosterone for the perceived health benefits, more power to you, but then don’t compete.
I think I remember Tyler Hamilton testing positive for it, but have not seen it mentioned otherwise. Imagine two athletes; one who started at 42% and another that started at 45% and another whose baseline is to 48%. Because self serving anti drug crusaders want to pretend that what athletes are putting themselves through in the name of better performance is normal and healthy. The consequences – the aforementioned side-effects of drugs – are often more serious than the original illness, leading to the medical issues described in the article and worse. Now take it to an egregious level that’s just below lethal with the proper care (say they take old Riis and blow it, to 65%).
A follow-up with the endocrinologist proved testosterone replacement therapy isn’t quite so cut-and-dried. When we get past all this everyone will be able to ingest whatever they want, the playing field will still be even and the true potential of the human body and spirit will be challenged.
I don’t think anyone wants to return to the late 90s early 00s, where drug use was so rampant in the sport. Remember we’re not dealing with a few pills or injections in the off season, it was doctors IV bags, refrigerated blood.



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