The Olympics Don’t Allow Doping. This Competition Will Encourage It.

—
But how will athletes who get a boost to push the limits of achievement fare?

by
Rachael Robertson,

Enterprise & Investigative Writer, MedPage Today

July 18, 2024

Welcome to Culture Clinic, MedPage Today‘s collaboration with Northwell Health to offer a healthcare professional’s take on the latest viral medical topics.

To compete in the 2024 Summer Olympic Games that kick off next week in Paris, the world’s top athletes must follow strict anti-doping rules. But the Enhanced Games, a new competition for elite athletes planned to take place next year, will actually encourage the use of performance-enhancing drugs.

Mike Oakes, director of communications for Enhanced, told MedPage Today that details of the date, location, events, and first cohort of athletes will be released later this year. He noted the organization will also release its medical safety protocol, which is currently being developed, that “will include comprehensive medical oversight, pre-competition health checks, and continuous monitoring.”

Oakes added that the medical safety protocol is unique because it’s being designed under the assumption that athletes are likely using performance enhancements, which the organization “advocates for the safe, responsible, and clinically supervised use of.”

Schedule I drug use is still discouraged in the Enhanced Games.

Giancarlo Carvalho, DPT, a physical therapist at Northwell Health STARS Rehabilitation in Eisenhower Park, New York, said that the Enhanced Games sound like an extension of what many sports fans have long wondered: What happens when you create a playground for the elite athletes already using these substances? He also noted that a lot of athletes use performance-enhancing drugs, although very few get caught. A 2015 paper in Sports Medicine estimated that 14% to 39% of elite athletes dope.

Carvalho explained that the landscape of performance-enhancing drugs is different than in past decades, because a lot of the people who chose to use these substances are doing so under medical supervision. And depending on what kind of athlete they are, they’re likely to use different performance-enhancing substances to reach those goals. Sprinters and marathoners have different physical goals despite both being runners, let alone those in a totally different sport like power lifting.

For instance, endurance athletes may be drawn to erythropoietin (EPO), which the body produces to increase red blood cell production and thus deliver oxygen to the muscles. Some consider taking EPO a form of “blood doping,” which could also include autologous or homologous blood transfusions.

“If you have more oxygen available, you’ll be able to perform better and do endurance tasks for longer with better performance,” Carvalho told MedPage Today.

Oral or injectable anabolic steroids are synthetic testosterone variants that help athletes build lean muscle faster, and they also help them recover faster and thus train harder, Carvalho said.

Another substance prohibited by the World Anti-Doping Agency is human growth hormone, which is naturally produced by the pituitary gland. Some athletes take a synthetic version to increase muscle mass and strength, though there is little research to confirm that it actually enhances athletic performance.

While performance-enhancing drugs can push athletes past their natural limits, the substances come with significant health risks, too. According to the National Institute on Drug Abuse, anabolic steroid misuse can lead to cardiovascular problems, like high blood pressure and stroke, as well as hormonal issues, like shrinking testicles or changes in breast size — and much, much more.

Carvalho said some athletes that dope end up with reduced cognitive abilities, increased aggression, and mental health struggles, while others have fertility issues.

“If you’re on excessive doses [of steroids] for long periods of time, you may never be able to produce testosterone on your own ever again,” he said. “So you’re going to have to be on [testosterone replacement therapy] for the rest of your life essentially, and you could have issues with fertility.”

Plus, these substances can have intense side effects, which people often have to take more medicine to mitigate. For instance, athletes may end up on medication for their blood pressure, cholesterol, hair loss, and liver damage. Some end up on estrogen blockers for gynecomastia.

Despite these risks, many athletes are still drawn to the extra push these performance-enhancing drugs provide.

“All these athletes know what they’re getting themselves into,” Carvalho said. “They want to do it. They want to try and break records. They want to see what the human can achieve. It’s not like they don’t know the risks.”