Tiger Woods, Arnold Schwarznegger and Performance Enhancing Drugs (part 1)

While playing golf this past week one of the topics that kept coming up in the clubhouse and on the course was Tiger Woods. I guess with all that’s gone on with him lately that’s no big surprise, but what was interesting was the nature of the conversation centered on him and performance enhancing drugs. I googled the topic online and there are even sites that follow his size increase from his early days until present times and I guess it is somewhat interesting. Especially now that his physician has been criminally charged, and implicated with distributing performance-enhancing drugs to patients.

I have talked about this topic before with relation to baseball and Bonds, Clements and so on, where there is the same issue. I guess anytime you have a performance aberration you need to take a look and see if it’s natural or artificially enhanced. As a physician myself and somewhat of an expert in the field I feel in a good position to discuss the issue. When in the past there were congressional hearings on steroid use in baseball, now that was a little out there, but the broader question for a society of what constitutes performance enhancement and what is medically indicated is sometimes a blurry line with shades of gray. There are also huge advances in training capabilities, which offer a large advantage to athletes. Even in the old days of the cold war when the Russian and Eastern European athletes were selected and trained starting at very young ages for things like gymnastics at “professional” government run schools gave an unfair advantage.

Taking a look at Lance Armstrong who had a testicular tumor and needed to be on testosterone supplementation for health reasons after surgery raises the question from a different vantage point. What about those who are on medications to help them focus and perform better mentally with attention deficit disorder that are being tremendously overprescribed. Drugs like Addaril are commonplace in poker and used in other competitive sports as well. In LA it’s used as an appetite suppressant to help facilitate weight loss. Human Growth Hormone or HGH as it is commonly known is another such drug which may help slow the aging process according to some, but definitely can help maintain lean body mass as you age.

All of us as we age undergo physiologic changes to our hormone production. In men testosterone production usually starts to decline in the thirties and continues declining as we age. Testosterone which is responsible for mediating a variety of functions including bone density, red blood cell mass, sexual potency, as well as maintaining and building lean body mass. If you look at standard laboratory tests for serum testosterone the “normal” range is quite large and is not commonly age adjusted. So is the 20-year-old athlete with a level of 800 versus a still normal level of say 400 in another athlete at a competitive advantage?

There is a great short story by Kurt Vonnegut Jr. in his collection of stories Welcome to the Monkey House, called Harrison Bergeron, where social equality is achieved by handicapping the more athletic, intelligent or attractive people so that everyone is brought to the same mediocre level and are on a “level” playing field..

As science progresses and the ability to provide more and better drugs and biological agents, stem cells and other advancements that are still science fiction how do you decide what is performance enhancement and what is scientific advancement?

Look at the current Governor of California, Arnold Schwarzenegger, who in his day had to be on mega doses of anabolic steroids. His use of anabolic steroids, which were in a large part responsible for enabling him win body building events which then catapulted him into a movie career, marrying a Kennedy and now politics, steroids are in a large part responsible for his success. Where would we be without all the Terminator movies (which I have to admit I am a huge fan of)?

There are nutritional supplements up the yin yang available, which may or may not offer some advantage. There is a whole new class of drugs in the statin family like Crestor and Lipitor, which can slow, and possibly reverse atherosclerotic cardiovascular disease. (part 2 coming soon)