A level playing field is whatever we define it to be. If we include drugs safely administered by our doctor, then that would be part of the level playing field.

Absolutely true. But they didn't do that for testosterone so it's illegal to use unless you get a TUE. You can still drink coffee though.

I'm not an expert in TUEs, but it would seem reasonable that individual circumstances guide who gets an exemption. For instance: if 2 men of the same age, weight, etc both have identical borderline low lab values, but one is a professional triathlete and the other is a recreational or bop "participant;" then it would be my opinion that the pro should not get a TUE while the other guy maybe should. I know some may argue that if he beats even 1 person as a result of his juice then he is performing unethically, but I just find it unnecessary that he should be forced to choose between a potentially indicated treatment and participation in a healthy and fun activity. Whereas the pro or a competitive racer could be expected to have to make this choice, and therefore sacrifice one or the other (testosterone or competition)

Look, I don't know about getting this drug. I'm not "about" to get it either. I was under the impression the many, many people who determine, with their doctor, that the benefits of testosterone therapy outweigh the risks will not be able to receive a TUE. If that is wrong, then I apologize. However, if it is correct, then you are missing my point.

I misunderstood what you meant by "governing bodies." I was still stuck in medicine, when you were talking about USADA. My mistake. It was a long day. :) I agree that either you should have a system in place that's available to provide TUEs that are actually evaluated and not rubber-stamped. If not, then the rules should be different on the amateur level or something. For instance, a physician's prescription could serve as a de facto TUE so that USADA can focus on testing the athletes that they need to focus on, i.e. pros and top AGers. Sure, there'll be some folks whose doctors are overusing testosterone, but I'd rather accept that some people are willing to do anything for 35th place and pay a reasonable USAT/race fee than pay tons of money to bust every middle-aged guy who sees the "anti-aging specialist."

Totally disagree.

This creates a nightmare for enforcement and a slippery slope that leaves everyone worse than before. What do you do with the naturally talented low-T guy that's supplementing his way up the ranks, then shuts down as he gets up near the pro ranks? That fitness isn't exactly going to leave him after he goes off T (if he even can). Disaster ensues.

If you wish to argue that the amateur ranks should be entirely unregulated, then so be it, but that change must happen at the NGO level. TUEs should be very difficult to get (read: targeted for those that *truly* need them). Until those rules are changed, being on a non-permitted drug without a TUE means one should not participate in the sport. There are a thousand other things he/she can do; go enjoy them instead if being on testosterone (or whatever it may be) is so important.

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The question of who is right and who is wrong has seemed to me always too small to be worth a moment's thought, while the question of what is right and what is wrong has seemed all-important.

-Albert J. Nock

I don't have a problem with this outlook actually. I just think it's on the wrong side of history. Drugs are going to get better and safer. They will help us more and harm us less. Prejudice against performance and life enhancement will give way. I am leading the way. =)

The bolded part simply isn't true. The conditions for granting a TUE are based on a biological reason for the deficiency. Functional deficiencies are not granted a TUE under any circumstance.

And the biological reason for the deficiency results in...?

I think you/we are splitting hairs.

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This is from the TUE


USADA is splitting hairs.

+1. it's part of the medicalization of life. and of course testosterone is pro growth (in terms of certain cancers) similar to estrogen.

Interesting discussion. A few additional thoughts:


I agree with previous comments about individuals with true hypogonadism (and subsequent testosterone deficiency syndrome - TDS), even with testosterone replacement they will not have performance enhancing effects in this group.


A question was asked before about whether or not someone on testosterone should be banned from USAT triathlon. VERY interesting question, more importantly...how is testosterone measured by the triathlon governing bodies? Is it truly a 8am total and free testosterone? Near impossible that someone with TDS will have supra-therapeutic levels of testosterone with testosterone replacement therapy.


I disagree with HRT (estrogen) study confirming that it is unsafe. You are likely referring to WHI (Women's health initiative) trial which was largely misinterpreted. Medical community is well aware of this. Certain populations definitely will benefit from HRT safe and effectively.

This is an over simplified and inaccurate statement.

Estrogen may feed certain estrogen-related cancers - endometrial and breast, for example. HRT is contraindicated if someone has breast cancer or undiagnosed vaginal bleeding. Again, risks would outweigh benefits and thus not indicated. In someone with no strong risk factors for breast cancer, and in right age group, HRT is definitely safe. Let's not forget major risk factors for breast cancer - obesity, smoking, family history, personal history, BRCA1/2 mutation. HRT itself doesn't come close to those.

Exactly. In another thread on this I compared the practice to alchemy. It's a practice as old as humanity; except that instead of scruffy dudes mixing potions in shadowy dungeons we now have squeaky clean MDs in lab coats giving injections. But the aim is the same: to outfox aging, and by extension death.

I also think its yet more proof of the baby boomer's entitlement culture; it started with unlimited sex in the 60s and 70s, evolved into unlimited money in the 80s and 90s, and now we have them claiming the right to eternal youth. None of these wishes are new by the way. But all this is Lavender Room.

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Citizen of the world, former drunkard. Resident Traumatic Brain Injury advocate.

Estrogen and testosterone replacement therapy don't improve mortality rates. No evidence to suggest it prolongs life. Only indication is to improve quality of life in appropriate patients that fit certain criteria.

People are often way to accepting of diagnosis, and treatment of the latest "problem".

I would be devestated if I was diagnosed with anything that required me to take a drug for the rest of my life. To hell with any performance gains.

I can buy a and ticket to Vegas or Hawaii anytime I want to enjoy a qualifying race that I wasn't able to qualify for.

I think I agree sort of. From a medical standpoint: if someone with a low T is supplemented they will come up to a "regular" T level. Testing will reveal when they cross that threshold (if they abuse) and because T is a regulated (scheduled) drug it can't be prescribed without clinical indication - in short the person who was "low" who isn't low anymore can't get more T, at least legally. Now, to complicate - as a person supplements with natural or manufactured T, the body will indeed shut down or decrease the amount of natural T, so that if someone supplementing were given a blood test, they would actually appear low, since only naturally produced T shows up in blood testing. A saliva test, on the other hand, will show total accumulated T. BTW - once someone stops supplementing, the body goes back to baseline - there is no residual decreased effect on hormone production. If the person was low before they will be low after, if they were borderline normal before they will return to borderline normal.

For women, there are clear and significant health risks of low estrogen (and progesterone, which is actually a bigger deal). It is indeed a case of weighing potential bad outcomes - for both supplementing and not. I think the medical evidence is moving to the position that natural hormone therapy for women is much safer than synthetic HRT WRT adverse outcomes from therapy.

I would like to hear from providers (FP, IM) who are practicing - what do you think clinical indications are? What are you seeing in your clinical practice?

Of course. But that's not the point. The point is that there are a large number of slightly over-the-hill men, that think that there *must* be some magic potion that will keep their belly from sagging, their face from wrinkling, their biceps from shrinking, and their morning wood from softening. And some of those will think that T is that potion. But this is a philosophical standpoint I hold; I don't claim to know for how many of those T is in fact a legitimate drug. I only know that ever since Ugh the Caveman 52 year old guys with softening morning wood and the fear of death in their minds have been looking for that potion.

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Citizen of the world, former drunkard. Resident Traumatic Brain Injury advocate.

Indications for HRT - hot flashes that are functionally impairing. Topical vaginal estrogen cream for atrophic vaginitis. Natural HRT is not safer than estrogel or Premarin tablets. No evidence to suggest this. I use HRT a lot in my practice and frequently attend gynaecology conferences.

Fair point. I see what you're saying.

You've conveniently ignored my post about testosterone clinical trials and the inclusion/exclusion criteria to be in the trials. Is it because it shoots a big hole in your conjecture?

Nobody says it does, but that's part of the perception. Just look at the commercials, and see what they are promoting. They are promoting a return to a persons youth, showing more energy, more sex drive, etc etc. And there are doctors out there (IIRC there is even one on the board that promotes it) that are more than willing to treat/prescribe for T that is within normal levels, even if on the low side.

As far as the TUE's for testosterone, they are notoriously difficult to get by all accounts. Simply having a level on the low side of normal will not get a TUE. Ask TravisT, evidently he knows a pro with a true biologically low T that can't get a TUE.

John

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I ignore a lot of posts that seem tangential to the primary purpose of the thread. Near as I can tell, you don't have a point other than to just argue with me. Your argument is analogous to saying that viagra isn't safe for men who DON'T have E.D. because that group was never tested. Yes, we can't double blind test across every possible group attribute, but we do have a lot of knowledge and experience to add onto these studies.

I'll give you a chance... Are you just nit-picking about the gradations of safety claims here or are you arguing that the doctors prescibing for "low T" are unnecessarily endangering their patients? The former doesn't mean much to the thread. The later would be a pretty bold statement, and would put you on the side arguing against the doctors and the "low T" marketing campaign.

First, I thought that it was understood that drugs were illegal, not because they helped us, but because they were dangerous.

I thought it was because these substances have the *potential* for harm, are expensive to administer properly, and are usually illegal to administer without a definite medical reason.

IMO, T is way over prescribed. You know all those drug ads that have a half page of fine printing detailing all the possible adverse side effects? Down the road we'll just pump them up with other drugs to counteract all the crap they took before. The drug companies and too many docs are pushers...

As I was reading this thread, a commercial cme on for Axiron, THE ONLY UNDERAM APPLICATION FOR LOW-T!!!

Pretty length list of possible side-effects at the end of that commercial. As someone who is on blood thinners because of previous DVT's, sounds like I'll never have to make this choice. ;-)

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