avoiding a positive aas test: strategies used by athletes

a common argument put forth by proponents of easing performance drug testing is that it is ultimately a losing battle. many people have suggested that the doctors and athletes that are engaged in doping behaviors are so far ahead of the drug testers, that the amount of funds spent on battling against this world is not warranted. but how are these athletes actually evading the drug tests, designed and implemented by some of the top anti-doping professionals in the world? a paper by alqurani and auchus (2017) recently explored this, and presented some of the strategies that athletes have employed to evade anabolic-androgenic steroid (aas) testing.

the testosterone to epitestosterone ratio (t:e) has been discussed here before, and is still commonly used to test for aas. typically a ratio of < 4:1 is deemed acceptable, so athletes injecting t will increase this ratio and be subsequently flagged for a positive test. as the authors explain, to combat this test, athletes can inject epitestosterone to normalize this ratio. of course, the administration of both t and e must be monitored closely, but for athletes and doctors with access to lab equipment, this is relatively easy.

another biochemical strategy used by athletes is to administer human chorionic gonadotropin, which acts to stimulate endogenous t production. of course, hcg itself can be tested for in urine, making it potentially counterproductive. moreover, since hcg remains active longer than luteinizing hormone (lh), it will increase the t:lh ratio which can also be monitored in athletes [1].

the article also discusses masking agents, such as 5a-reductase inhibitors. these agents interrupt the normal metabolism of testosterone and are thus used to manipulate the biological passport to avoid detection.

of course, this is not an exhaustive list of strategies used by athletes. in particular, it does not address how athletes may avoid testing positive if a carbon isotope test is employed, or how the biological passport can remain unflaggged through manipulation of the mathematics behind the test.

references

1. alquraini, hussain, and richard j. auchus. “strategies that athletes use to avoid detection of androgenic-anabolic steroid doping and sanctions." molecular and cellular endocrinology (2017).