Wall St Journal looks at Houston Doc who treats Rupp, other thyroid users

excellent post, thank you for breaking it down.

Yes, this is what the sport has come to. Take a step back, though, because in fact this is what our SOCIETY has come to. You can not separate sport from society, and that is why the anti-doping crusade will die in the next 20 years; we are a society that takes great pride in our scientific advances. You will see a major tipping point when genetic modification becomes cheap, safe, and easy. Currently doping is somewhat sketchy, but when it is mastered genetically everyone IS going to do it. Those who do not will simply be left behind, far, far behind in fact, but they will be the exceedingly few. All of those currently on the anti-doping or anti-enhancement bandwagon are going to change their tune massively once the prevailing opinion is that it is safe to do so. Personally, I can't wait.

We will all be able to break Bekele's WR someday, and at that point, nobody will care about sport anymore, and that will be a really beautiful artistic world where nobody is trapped inside a clumsy half-rate broken down obese, etc., body. Understanding our hormones is a critical part of the process to get there, so try not to be hating too much, especially if you aren't competing for a paycheck with these uber-elite athletes.

fair enough--

It seems to me that you are missing something critical.

As you say, most people have no established baseline.

ONE possible outcome of this is that if their numbers are normal, they won't receive treatment.

ANOTHER possible outcome of this is EXACTLY THE OPPOSITE--that even if their numbers are normal but they present complaining of all of the symptoms to a high degree, treatment can be justified on the totality of the evidence because, after all, it is unknown what their individual baseline would be--and given the symptomatology with which they present, it could be reasonable to infer that their baseline would, in fact, be outside the norm, and that they therefore merit treatment.

This would be especially true if your last recommendation--that diagnosis needs to be weighted more in favor of symptoms than numbers--were to be accepted.

************************

However, you do raise a point that I find interesting: that maybe the endocrinal and hormonal effects of training are permanent.

I have been arguing that the reason for any deficiency should be critical in determining the permissibility in competition of medication via controlled substances or purified and concentrated forms. This position has so far relied on the assumption that the changes would be reversible by training modification, even if those changes required complete and extended, perhaps permanent, cessation of the training that was their initial cause.

Assuming that the changes can sometimes in fact be irreversible, should that change the above analysis? Put a different way, if an athlete actually makes themselves sick rather than just making themselves overtrained, should they receive different consideration?

That is a tough question to answer. Type II diabetes comes to mind. Bad habits necessitating organ failure, transplant, and subsequent anti-rejection drugs also come to mind.

However, the range of such situations seems to me quite narrow. I would be inclined to answer that if it was demonstrable or likely that the condition was due primarily to training activities, then medicated competition should not be permissible.

Of course, that question is almost impossible to answer. I would hesitate to move the goalposts, to some criterion that would be easier to fulfill, like there being a mere "possibility" that the condition was due primarily to training activities, which would in effect be a presumption that certain activities led to certain conditions. Any such presumption would then shift the burden onto the athlete to rebut that presumption, which does not seem to me like a reasonable burden.

So I would keep the threshold at the above. It would be more of a statement of principle than anything else, as maybe only a tiny number of athletes would ever be successfully banned on any such basis.

Difficulties also arise in the definition of "permanent". Is 6 months long enough to wait? 1 year? 5 years? How could cessation of training activities possibly be enforced?

Maybe adult athletes, upon entering the senior/open ranks, should all have a baseline done at that time, by a governing body or doping authority. If there is an indication at that time, fine. If not, then it will be up to the athlete to prove that future need wasn't occasioned primarily by training activities, whether the future need was "temporary" or "permanent", because it is difficult if not impossible to distinguish between the two.

How would existing users be treated? Not much you could do about that, except establish a baseline upon program implementation. That is the drag of cheating, because some will always get by on technicalities. It is the Mennea effect.

Whoops...embarrassing :( Hope it doesn't render the rest of the post useless.Anyways, we'd all be better off if "A Duck" was mute. We're all stupider for having subjected ourselves to reading his posts in this thread...

30th Avenue homey wrote:

oh brother wrote:

If you can't answer that question, then your arguments are all mute.

I can hear A Duck's arguments loud and clear. Therefore, whether or not I agree with them, they are NOT all mute.

Zero Tolerance: "Some of you people need to look at it from the athletes angle. This board continues to act like they never would consider taking thyroid medicine but if you were having trouble training and your livlihood was dissapearing are all of you really just going to retire and stop racing? Give me a break!"

Speaking for myself, absolutely I would retire and stop racing.

Your post does bring up another issue for me: I was pretty good until I tore up my knee skiing. I had it rebuilt, but during that time life changed and other things came into the picture like family, grad school, etc.. What about a person who needs surgical intervention, rather than pharmacologic, due to a training-induced injury?

With most surgery, it is relatively easy to demonstrate that an individual is being returned only to their pre-surgical state, or to some level lower than that state, because the baseline is generally ascertainable and the normal state is generally agreed-upon. Are there any surgeries that are performed simply to enable athletic performance, in excess of that required for daily function? I know that tons of swimmers have multiple shoulder surgeries.

Tough questions.

Zero Tolerance? wrote:

Who would ever think that a doctor would try something new that could help someone.

Is he actually benefiting for the patient or for himself? (meaning...he has knowledge on how to manipulate/discover a way to treat athletes thyroid conditions so effectively that a big sponsor company is paying him big bucks?)

Not trying to accuse anyone here of misconduct but certainly sounds like this doctor likes to keep patients on meds (due to reading some feedback from patients) that might necessarily need them. Trust me, I've worked with some doctors who only look out for themselves.

eurodonkey--

I was thinking not about prolonged training and recovery, but rather about competitions where pain could cause a lack of confidence or distraction. Less pain could definitely permit a higher workload in some people during a race or competition. Of course, that could likely lead to injury, but it is generally hoped that said injury will manifest only after the medal is already won.

Sprintgeezer wrote:

eurodonkey--

I was thinking not about prolonged training and recovery, but rather about competitions where pain could cause a lack of confidence or distraction. Less pain could definitely permit a higher workload in some people during a race or competition. Of course, that could likely lead to injury, but it is generally hoped that said injury will manifest only after the medal is already won.

If you read old threads, you will find lots of people saying they take Tylenol or ibuprofen "preventatively" before a marathon, even leaving aside people taking pain relievers to reduce the pain from a specific muscle strains, plantar fasciitis, etc. It is not at all uncommon.

A quick search of cyclingnews.com turns up some interesting results.

Apparently Floyd Landis had a "thyroid problem."

And Victor Conte came forward in 2008 to outline "a performance enhancing regime that included seven banned drugs including the designer steroid known as "the clear", THG, as well as testosterone/epitestosterone cream, EPO, HGH, insulin (Humalog), modafinil and liothryonine (a synthetic form of the T3 thyroid hormone)"

http://www.cyclingnews.com/news/balco-head-reveals-methods-offers-anti-doping-advice

That Landis was diagnosed with a "thyroid problem" is perhaps the most damning evidence yet. It is becoming increasingly clear that thyroid treatment in elite athletes is a canary in the coal mine warning that the athlete is on a cocktail of PEDs. The thyroid meds are to counter act the side effects of PEDs.

NTHXC wrote:

A quick search of cyclingnews.com turns up some interesting results.

Apparently Floyd Landis had a "thyroid problem."

And Victor Conte came forward in 2008 to outline "a performance enhancing regime that included seven banned drugs including the designer steroid known as "the clear", THG, as well as testosterone/epitestosterone cream, EPO, HGH, insulin (Humalog), modafinil and liothryonine (a synthetic form of the T3 thyroid hormone)"

http://www.cyclingnews.com/news/balco-head-reveals-methods-offers-anti-doping-advice

"I was suffering from a thyroid problem and I was thinking of going to Ferrari to resolve the problem."

http://velonews.competitor.com/2012/10/news/liquigas-cannondale-denies-staff-knew-riders-worked-with-michele-ferrari_256724

He said he and his personal doctor, Dr. Brent Kay, were looking for possible explanations. Among them, they speculated, were Landis’s use of thyroid medicine for previously diagnosed hypothyroidism and his consumption of alcohol the night before Stage 17. http://www.nytimes.com/2006/07/28/sports/28cnd-landis.html?ei=5094&en=7746221f59e07ec3&hp=&ex=1154145600&adxnnl=1&partner=homepage&adxnnlx=1154103885-U7DMsKlrPNqbf20KqGdi6w&_r=0

NTHXC wrote:

"I was suffering from a thyroid problem and I was thinking of going to Ferrari to resolve the problem."

http://velonews.competitor.com/2012/10/news/liquigas-cannondale-denies-staff-knew-riders-worked-with-michele-ferrari_256724

Would love to see Victor Conte comment on this article.

The recommended dose of T4 is 300 mcg/day and these doses can be taken in divided doses and with or without meals. The hormonal drug is commonly used in steroid cycles involving growth hormone and helps users maintain more muscles when dieting. T4 doses should not be altered at will and must always be preceded by a qualified medical advice else it can lead to side effects such as trembling of the fingers, excessive sweating, diarrhea, nausea, and excessive weight loss.

http://www.ibuysteroids.com/blog/steroids/t4-effective-for-hypothyroidism-and-metabolism.html

Conte seems to think that it is a PED

https://twitter.com/VictorConte/status/322427558161444864

Yeah, I'm not saying Landis was bending the rules. He had a TUE for thyroid medication. And that link to the article about Ferrari was not concerning Landis, but Leonardo Bertagnolli. And maybe Bertagnolli has a true diagnosis of hypothyroidism, but why would he seek out the known drug cheat, Dr. Ferrari?

This, along with a number of other endurance athletes experiencing "hypothyroidism" could stand as evidence that prolonged, intense exercise does result in decreased thyroid production. Was Landis diagnosed with hypothyroidism before he started cycling professionally? I doubt it.

If that is the case, I take the same stance as The Science of Sport guys, and say -- sucks for you, you are not genetically gifted with the ability to adapt to X (without synthetic hormone).

Bodybuilders know T3 is a PED and can be used at low doses effectivelyWhat is T3 used for?Fat-loss: The main use for T3.Increase Nutrient Uptake: Not very well known, but this is a great use for T3. Doses between 6.25-12.5mcg do not shutdown endogenous thyroid output. T3 at this dose can be used to add LBM and help in keeping the fat off. When doses are kept at 6.25-12.5mcg, muscles are full and rock hard, and energy is through the roof. At these light doses, it's common for people to go to the bathroom 5-6 times a day because there bodies are making more efficient use of the food they eat.

IBuySteriods wrote:

The recommended dose of T4 is 300 mcg/day and these doses can be taken in divided doses and with or without meals. The hormonal drug is commonly used in steroid cycles involving growth hormone and helps users maintain more muscles when dieting. T4 doses should not be altered at will and must always be preceded by a qualified medical advice else it can lead to side effects such as trembling of the fingers, excessive sweating, diarrhea, nausea, and excessive weight loss.

http://www.ibuysteroids.com/blog/steroids/t4-effective-for-hypothyroidism-and-metabolism.html

Sprintgeezer--

Your point that the alternative (someone who has a naturally high TSH level could complain of symptoms and receive unnecessary treatment) is well taken. However, many of the symptoms are physically manifested -- hair loss, cold hands/feet, goiter, edema (eg. puffy face), weight gain of 10-20 lbs, dry skin, hypertension, elevated serum cholesterol. If these physical manifestations are taken together with other patient described symptoms by a doctor that knows what to look for, there is much less room for error.

Also, it might be more probable that someone with a natural TSH level of 0.3 (within the AACE limits), but a measure of anything up to 3 forgoes treatment, even though they have a disorder. Your alternative would require someone to have a natural value of more than 3. This value would fall outside of the statistical norm, so it might be less probable (it depends on the standard deviation and whether it's normally distributed, and I haven't been able to find the data in an AACE paper, so I'll get back to you on this).

And again, if you read about Hashimoto's disease, you will find that it is the most common cause of hypothyroidism in North America, and that it's affects are irreversible for most cases. This is pretty well established.

I agree with the rest of what you say -- adding this measure to the biological passport is probably the best solution (is it already included?). A lot of data points over time would be helpful. Little can be done about current athletes, but I think it would be an injustice to ban or stigmatize athletes that actually have the disorder.