# Is HRT "doping"!



## trhoppe (Dec 21, 2009)

I'm curious on your guys' thoughts.

For a number of reasons, I got some blood work (couple of times) and my testosterone has come back around 200 each time. My doctor is putting me on gels with the desire to get it to 500 as that is a "normal" level. 

Is that "doping"? I compete in amateur bike races. If I got tested would I be labeled a "doper"? Or would the fact that I have a prescription and reasons override that?


----------



## jswilson64 (May 20, 2008)

You'll need a Therapeutic Use Exemption. Get the form here. You could do the right thing and get the form completed now, or be like Lance and wait until you fail a test and get a back-dated one.


----------



## The Weasel (Jul 20, 2006)

Yes. Is your health at risk if you were not to do HRT?

HRT is notorious for being overprescribed.

Just my opinion.


----------



## svrider (Jan 14, 2009)

WADA gives therapeutic use exemptions (TUE's) for substances that are taken for legitimate medical purposes. So it depends on the specifics in your case. But you need to have it cleared before hand.

Whether or not you'd be considered a doper is impossible to say. Some folks consider replacement therapy doping. Some don't. If I'm racing a guy that is on gels, and legitimately has low T, I don't care. If his numbers are normal, and not elevated, I don't have an issue with it. But that's strictly my opinion. Someone else may consider it dopoing....


----------



## Creakyknees (Sep 21, 2003)

I'd get a 2nd opinion, for sure. Make sure you understand the long-term plan and implications on your body, medically speaking.

As to racing, yes, do the TUE, just to be legal. None of your fellow racers need to know or care, as long as you are secure in your mind that it is truly a medical necessity.


----------



## svrider (Jan 14, 2009)

Creakyknees said:


> I'd get a 2nd opinion, for sure. Make sure you understand the long-term plan and implications on your body, medically speaking.


+1

I'd get a 2nd opinion as well. There are long term health implications with HRT. Whether or not its legal for racing would be the last of my concerns.


----------



## trhoppe (Dec 21, 2009)

Probably TMI, but I'm all for disclosure, and would be if someone asked IRL. This was the 2nd opinion, and the 3rd blood test over a 3 month period, as this doc wanted to make sure. My PCP found the data as part of me complaining about the things you'd complain about if you had no testosterone. 200 is way below normal levels and certain things stop working. This is also in direct effect to me getting on propecia for a few months. Unfortunately we didn't test my test numbers before propecia, wish I did, as things were normal back then. PCP doc didn't see it as a risk......

I'm in for the HRT, especially if it will restore those things. The doc is requiring me to come back every month to start with to get the blood work re-done to make sure that we hit the 500 number and don't go over. Both he and I want to not go past 500 as I don't want to be a "doper", but there are things that are more important than bike racing too 

-Tom


----------



## trhoppe (Dec 21, 2009)

Doc knows I race bikes, so I'm sure he would be cool with putting his name on the TUE. I'll go ahead and get that knocked out so I'm on the up and up.


----------



## mpre53 (Oct 25, 2011)

I wonder whether someone with ADHD could get a TUE to use Ritalin or another amphetamine-like substance?

And IMO, it's also often mis-diagnosed in kids, and often needlessly prescribed. My ex convinced herself that our son had it, related the classic symptoms of it to a doctor, who then wrote the script without ever examining, or even talking to, the kid.


----------



## trhoppe (Dec 21, 2009)

From doing a quick read of the TUE, the doc has to stamp his name on it that he got your diagnosis right, did his due diligence, etc. I'm ASSuming that most doctors would not fill that form out unless they had their **** together in terms of diagnosis/proof of health issue.


----------



## Local Hero (Jul 8, 2010)

trhoppe said:


> From doing a quick read of the TUE, the doc has to stamp his name on it that he got your diagnosis right, did his due diligence, etc. I'm ASSuming that most doctors would not fill that form out unless they had their **** together in terms of diagnosis/proof of health issue.


It sounds like your doc did his due diligence prior to writing the prescription (and he plans on practicing sound medicine with the ongoing blood work). It should not be any trouble for him to complete the TUE form. 

My question to the forum is this: What if it is a legitimate diagnosis and WADA, USAC, Etc says no to the TUE?

Has anyone had their TUE denied?

(This is just for academics. I'm not worried about me personally, as I'm still young enough for them to make testosterone gel from my sweat and distill cialis from my blood.)


----------



## svrider (Jan 14, 2009)

Doubt anyone other than elite/pro riders bother with filling out paper work for a TUE. Especially for local/amatuer level racing.

I take allergy meds during the spring and I'm not about to fill out WADA paperwork to do so.....


----------



## spade2you (May 12, 2009)

trhoppe said:


> I'm curious on your guys' thoughts.
> 
> For a number of reasons, I got some blood work (couple of times) and my testosterone has come back around 200 each time. My doctor is putting me on gels with the desire to get it to 500 as that is a "normal" level.
> 
> Is that "doping"? I compete in amateur bike races. If I got tested would I be labeled a "doper"? Or would the fact that I have a prescription and reasons override that?


Your doc is taking you for a ride.


----------



## trhoppe (Dec 21, 2009)

You say that because?


----------



## spade2you (May 12, 2009)

trhoppe said:


> You say that because?


All of a sudden everyone over 50 has low testosterone. So now you have a prescription and have to come in to his office all the time for lab draws. 

Get a 2nd opinion. A good friend of mine was told he was told his level was extremely low. The second doc said he was fine.


----------



## trhoppe (Dec 21, 2009)

Ahh I see. You actually forgot to read the thread. 

FYI, I'm 32 with a 200 testosterone level.


----------



## vetboy (Oct 11, 2005)

Can you actually get a TUE for testosterone? I didn't think you could. I thought some substances just weren't allowed while holding a license.


----------



## Local Hero (Jul 8, 2010)

trhoppe said:


> Ahh I see. You actually forgot to read the thread.
> 
> FYI, I'm 32 with a 200 testosterone level.


According to this graph**, 200 is the correct level










...for a 70-80 year old man!




**graph picked at random from google image search. There are many other graphs which show a similar age/level line


----------



## mpre53 (Oct 25, 2011)

It's a different equation at age 30, than it is for me at 59. Do you have kids already? If not, or if you do have some, are you planning on any, or more, down the road? Low sperm count is one effect of low testosterone. But the drugs have some side effects. I have all the kids I want, and more body hair than I want. So low T for me isn't that big an issue, as I don't believe that it's negatively affecting my energy level, or what's left of my libido. Assuming that my slight anemia is related in any way to low testosterone.

There is a lot of medical evidence that you can naturally increase testosterone levels with resistance training, too.

Before you start with the gel, you might (if you haven't done this already) discuss with your doc what will happen if you stop taking replacement testosterone.


----------



## kmak (Sep 5, 2011)

Here is a story I read recently on Kevin Moats, an age grouper in the Ironman; if you read the transcript of the podcast you will see a lot of information about HRT and it's requirements for amateur racers.
Age Group Drug Testing


----------



## The Weasel (Jul 20, 2006)

trhoppe said:


> This is also in direct effect to me getting on propecia for a few months. Unfortunately we didn't test my test numbers before propecia, wish I did, as things were normal back then. PCP doc didn't see it as a risk......
> 
> Both he and I want to not go past 500 as I don't want to be a "doper", but there are things that are more important than bike racing too
> 
> -Tom


Wait... So the HRT may be to combat the side effects of Propecia? And your body may be able to produce normal testosterone levels? I said 'may' because you said you hadn't been tested per-Propecia, but felt normal prior to. If that the case, then the fair thing to do would be to discontinue the Propecia and get restested prior to seeking a TUE. And if you find that levels become normal again, you need to choose between hair/no racing and no hair and racing.
Sorry, just my opinion, but I don't think a TUE should be granted just because you want to have a thick head of hair. Otherwise Levi and Valvpitti would be all over this.


----------



## trhoppe (Dec 21, 2009)

Sorry, didn't post the timeline. 

Before - Everything is hunky dory. Never tested my testosterone as I never needed to

Late 2011 - Take propecia for 3 months, everything goes to hell in a handbasket

End 2011 - Stop taking propecia. Doc says to give it at least 6 months and see if things go back to normal

June / August / October 2012 - I go see my PCP and I get 3 testosterone tests, all at 200, see 2 doctors during this time, one being an "internal medicine" guy

November - doc writes a script for testosterone to get it up to 500

I'll be taking it to see if the rest of my life returns to a healthy normal, as while my physical health has been well, and my training/biking are going well, I do have most of the effects of low t, and those basically hurt the mental health aspects of life, as well as make me not really fell like a "guy". That is more important than cycling FOR ME. 

I was here to get your guys' opinion on how this could be viewed by the cycling community or governing bodies, as I figured you are the closest people that I know in terms of experts on "doping"  Now I don't care about National level stuff, as the most I'll be getting into are things like 100 mile and 6 hour MTB races and Tour Divide type stuff rather than road racing, but I still don't want to doing those races as a "doper". 

Still interesting to see that the UCI/WADA view testosterone as "totally banned" and you have to have a full actual disease vs "low levels" before they consider a TUE for testosterone. I'm going to have the doc run the same test as they do next time, in terms of testosterone level ratios, to see if I'm "under their limit".

-Tom


----------



## Local Hero (Jul 8, 2010)

Tom, I'm sorry that you had those nasty side effects from Propecia. I know a guy who had some sexual side effects from that stuff. From what he told me I will NEVER use it. If I start thinning I'm either going to get plugs or bic my head. Anyway, whatever happens with the TUE or whatever just do what you have to do. Don't forget that you're a guy who rides bikes for fun. Keep it fun.


----------



## spade2you (May 12, 2009)

Propecia is fairly low dose compared to the treatment dose for prostate issues. If you really think it messed you up, your 2nd opinion should come from a urologist to make sure everything is ok down there.


----------



## jspharmd (May 24, 2006)

I have to chime in here, because I think we are seeing the effects of a few bad physicians. The M.D. that writes for testosterone for anyone based on a random blood test (no corresponding symptoms, or really minor symptoms that occur as a natural part of the aging process) is shaping public perception of treatment for patients that may actually be testosterone deficient. We laypersons see this poor medical practice and then assume ANYBODY getting testosterone replacement, MUST be doing it for fabricated symptoms and for the real reason of CHEATING. 

I must say that your later description (more detailed and better timeline) would have stifled some responses suggesting that you are cheating. However, you got your answer about the perception of racers (at least the select subgroup that frequents RBR and the Doping Forum). They will jump to conclusions faster than you think.

I would suggest that when you discuss this with other racers, that you tell them the whole story, starting with your age, the normal testosterone for your age, you Propecia exposure, and the timing of true symptoms following a washout period from Propecia. Only then will you receive a better response about your case, but I can't guarantee that you won't be called out.

Best of luck with your replacement therapy, and I would suggest that you complete the TUE. My guess will be that as your testosterone level returns toward normal, your performance will improve. As your performance improves, other racers will have questions. See where I'm going with this...


----------



## spade2you (May 12, 2009)

jspharmd said:


> I must say that your later description (more detailed and better timeline) would have stifled some responses suggesting that you are cheating. However, you got your answer about the perception of racers (at least the select subgroup that frequents RBR and the Doping Forum). *They will jump to conclusions faster than you think.*


The initial posts lacked certain critical and pertinent pieces of the puzzle.  I still defend my initial point that it's over-prescribed and a means to more frequent office visits. 

Nonetheless, I question how much the low dose Propecia 1mg is responsible, given that the dose for BPH is 5mg. Given that virtually all of those patients are older, they'd be more likely to "go to hell in a handbasket" on it. This is why I'd highly recommend a urologist to inspect the goods to make sure everything is working or to search for alternate causes for low testosterone. 

HRT deals with hormones on a biofeedback loop. This could very likely decrease a person's ability to produce testosterone on their own. This would mean life long replacement would be very likely. Eve though it's job security, I personally try to avoid taking prescriptions whenever possible.


----------



## jspharmd (May 24, 2006)

spade2you said:


> I still defend my initial point that it's over-prescribed and a means to more frequent office visits.


I think this is true for some physicians. I think many are trying to find easy ways to pad the pocket book, or in the case of a GP, trying to makes ends meet.




> Nonetheless, I question how much the low dose Propecia 1mg is responsible, given that the dose for BPH is 5mg. Given that virtually all of those patients are older, they'd be more likely to "go to hell in a handbasket" on it. This is why I'd highly recommend a urologist to inspect the goods to make sure everything is working or to search for alternate causes for low testosterone.


The likelihood is less, but I've found some really strange patient reactions to drugs. If everything the OP stated was true (I'm a glass half full, so I tend to believe him), then this could be one of those really strange cases, and may warrant a case report.



> HRT deals with hormones on a biofeedback loop. This could very likely decrease a person's ability to produce testosterone on their own. This would mean life long replacement would be very likely.


True, but if they aren't producing enough on their own, and it seems their body won't begin to produce the appropriate amount, life long therapy is better than a life with subtherapeutic testosterone levels.



> Eve though it's job security, I personally try to avoid taking prescriptions whenever possible.


Why is it we are the worst at taking medications? I'm the same way, especially about chronic therapy.


----------



## spade2you (May 12, 2009)

jspharmd said:


> True, but if they aren't producing enough on their own, and it seems their body won't begin to produce the appropriate amount, life long therapy is better than a life with subtherapeutic testosterone levels.


I still question the etiology. Maybe if we allow the body to recover from the finastride, the testosterone levels might come back eventually. However, if we hit it with synthetic testosterone now, I think we can almost guarantee that it can't come back on its own. 

I'm truly not against HRT. What are the long term side effects of testosterone, keeping within the new current target range? We don't know. Personally, I wouldn't like that. I think we're well aware of what happened to people who use it well above the therapeutic window. How likely are these side effects at the prescribed levels? Time will tell.


----------



## ms6073 (Jul 7, 2005)

trhoppe said:


> Is that "doping"?


Maybe this will help. I am a masters racer and one of the other members of the masters group I regularly train told me a couple years back that he had also been tested which had indicated that at age 49, he had the t-levels of a 75-80 year old man. He started on testosterone and not long after that I started noticing lots of improvements in his riding performance. Not only did he seem to have more top end endurance, his previously near non-existent hill climbing abilities improved to the point that on high tempo climbs where he previously lagged at or off the back, he was now able to attack and put the hurt on the rest of us. In masters 40+/45+/50+ races, he advanced from a mid-pack to a consistent top 5-finisher week in and week out. Was that doping? Depends on your point of view but from my perspective, it showed that the replacement therapy allowed him to train harder and at more consistent levels than before but it was not doping but as already mentioned, he will have to sustain this therapy for as long as he wants to continue competing at that level.


----------



## Local Hero (Jul 8, 2010)

ms6073 said:


> Maybe this will help. I am a masters racer and one of the other members of the masters group I regularly train told me a couple years back that he had also been tested which had indicated that at age 49, he had the t-levels of a 75-80 year old man. He started on testosterone and not long after that I started noticing lots of improvements in his riding performance. Not only did he seem to have more top end endurance, his previously near non-existent hill climbing abilities improved to the point that on high tempo climbs where he previously lagged at or off the back, he was now able to attack and put the hurt on the rest of us. In masters 40+/45+/50+ races, he advanced from a mid-pack to a consistent top 5-finisher week in and week out. Was that doping? Depends on your point of view but from my perspective, it showed that the replacement therapy allowed him to train harder and at more consistent levels than before but it was not doping but as already mentioned, he will have to sustain this therapy for as long as he wants to continue competing at that level.


Do you think that in his mind, he should have been riding that well the entire time and his "low t" was holding him back?


----------



## LostViking (Jul 18, 2008)

Local Hero said:


> Do you think that in his mind, he should have been riding that well the entire time and his "low t" was holding him back?


Yeah, if the therapy is returning him to normal-t level for his age, I would supect that he is just performing at the level that he should have been at - all other factors being equal.

However, how many other racers may have either undiagnosed or untreated issues and are now at a "disadvantage" because he got the restoritive help he needed and they didn't? Bit of a can of worms.


----------

