Abstract
Incidence
of anabolic steroid use among college athletes is about 1%,
with another 12% considered at-risk in that they would use
such drugs under the right circumstances. This study aimed
to determine if volunteer drug testing, without fear of penalty,
would result in positive identification of drug use, or if
the testing alone is a deterrent. A group of 197 college athletes,
all of who denied drug use, voluntarily and anonymously supplied
urine samples. Average T/E ratio was 1.33 ± 0.86, with
two cases (1.1%) above the accepted ratio. We conclude that
T/E ratio testing is effective in detecting use of performance-enhancing
drugs and that testing itself, although an effective deterrent
to drug use, may not eliminate drug use among college athletes.
Introduction
Athletes
have used performance-enhancing drugs for decades. In 1968
the International Olympic Committee (IOC) banned the use of
performance-enhancing substances to promote fair play in competition.
At that time the banned substances were primarily anabolic
steroids and amphetamines. Other athletic associations and
sport governing bodies soon followed suit by adopting similar
bans, including the National Collegiate Athletic Association
(NCAA) which adopted a drug-testing program to promote fair
and equitable competition and to safeguard the health and
safety of student-athletes. Since then the specified number
of banned substances has risen dramatically as athletes are
driven to finding new ways to obtain a competitive edge and/or
to avoid detection. Currently the NCAA promotes drug education
and mandates that each athletic department conduct a drug
and alcohol education program once a semester, presumably
to increase the athletes’ understanding of the drug-testing
program and to promote the avoidance of drug use.
Despite
these regulations, the incidence of anabolic steroid use among
athletes has not decreased, and, in some instances, has increased
(Catlin & Murray, 1996). In general, the decision to not
use drugs is felt to be related more to the fear of reprisal
than to health issues, and users continue to look for ways
to avoid detection rather than decide not to use these banned
substances. Tricker and Connolly (1997) reported an 8% rate
of anabolic steroid use in college athletes over a lifetime
and a 1% use within the past six months. In addition they
identified about 12% at-risk athletes, i.e., they would use
steroids under the right circumstances. Those circumstances
were largely defined as the ability to achieve their athletic
potential without testing positive for use.
The
purpose of this study was to examine T/E ratios in a group
of college athletes who volunteered for testing under the
conditions of anonymity and therefore had no fear of reprisal.
The T/E ratio was chosen because of its low false-positive
rate (0.1%). We aimed to determine if the anticipated results
of no positive test results would occur, or if there might
be any positive test results with the threat of reprisal removed.
Method
Subjects
A
group of 206 male varsity or junior varsity NCAA Division
I college athletes identified themselves as not currently
taking nutritional supplements or performance-enhancing drugs
and volunteered to provide a urine sample for testing. Because
the testing was done anonymously, there was no fear of reprisal
from submitting to the testing. Nine samples were contaminated
during processing and were eliminated, leaving a study group
of 197 college athletes, all of whom would presumably have
negative test results.
Testing
Procedure
Urinary
specimens were examined for the ratio of testosterone (T)
to epitestosterone (E). The accepted standard for identifying
anabolic steroid use was used with a T/E ratio above 6:1 as
a positive indication of doping (Catlin et al.,1996; International
Olympic Committee, 1982). All urine specimens were run on
HP 599SC gas chromatography – mass spectrometry (Hewlett Packard
Company, Avondale, Pennsylvania) using standard testing procedures
(Borts & Bowers, 2000; Dehennin, 1994; Ismail & Harkness,
1966; van de Kerkhof, De Boer, Thijssen, & Maes, 2000).
Because there is a small incidence of false positive results,
it is recommended that additional testing be done on those
whose T/E ratios exceed 6:1 before legal action is considered
(Dehennin & Scholler, 1990). However, in this study, no
additional testing was done as the athlete could not be identified
and there would be no punitive action. It is also known that
there are athletes who use exogenous testosterone, yet their
T/E ratio never exceeds 6:1 (Garle, Ocka, Palonek, & Bjorkhem,
1996).
Results
The
average testosterone/epitestosterone (T/E) ratio was 1.33:1
± 0.86 (mean ± standard deviation). Two of the
197 (1.1%) athletes tested had T/E ratios greater than the
accepted international standard (12:1 and 9:1) and, thus,
had positive test results. Thus, the specificity of the T/E
testing in this study group was 195/197 (98%) as all subjects
were presumably drug-free.
Discussion
Our
data confirms that the T/E ratio testing is at least 98% accurate,
depending upon the true drug status of the two individuals
who had abnormal T/E ratios in this study. The two specimens
with ratios higher than the accepted norm were not verified
with further testing, and, therefore, it is not know whether
these two cases represented true or false positives. If we
assume that those two athletes were, in fact, taking performance
enhancing drugs, the accuracy, sensitivity, specificity, of
the T/E ratio testing becomes 100%.
The
fact that two athletes tested positive under the study conditions
is interesting. Although only those who professed that they
did not use any performance-enhancing drugs were recruited
for the study, perhaps those two athletes thought they might
draw attention by their lack of participation and possibly
be singled out for sanctioned testing in the future if they
chose not to participate. Since there was no fear of personal
identification or of reprisal for positive test results, they
may have felt participation was risk-free regardless, or they
simply may have felt that they could beat the system or wanted
to test the system to see if they might go undetected.
Confirmation
or refutation in the two positive cases was not pursued. However
it is felt that most likely these were true positives. The
reasons for this assumption are based on known percentages
of drug use among college athletes and previous reports of
the incidence of false positive results on initial testing.
Tricker and Connolly (1997) reported a 1% use of anabolic
steroids within the past six months in their survey of 563
college athletes. Catlin and Murray (1996) reported a similar
percentage in Olympic athletes over a nine-year period and,
over a three-year period in NCAA football players, the average
was also approximately 1%. On the other hand, Dehennin and
Scholler (1990) reported the incidence of false positives
at 15 per 10,000 (0.15%). The two positive results in this
group of 197 college athletes represented 1.1% of the study
group, and this percentage would be consistent with the anticipated
number of positive results in a random sample of male college
athletes.
The
more important issue is that the use of anabolic steroids
among athletes, although not increasing, has not diminished
under the current testing programs. Even in this study, where
volunteer athletes were recruited to participate only if they
were non-users, positive test results occurred. This is not
to say that the testing programs are ineffective, but they
are not entirely effective in acting as a deterrent to drug
use. The fear of testing positive and risking disqualification
or sanction clearly deters a certain percentage of athletes
considered at risk for drug use, but others continue to use
drugs and either hope to or try to beat the system. Testing
programs vary among sports governing agencies. At the 1996
Olympics Games in Atlanta, approximately 18% of athletes were
tested after their events including all medallists and one
or two others at random (Catlin and Murray, 1996). Random
testing leaves a chance for an athlete to avoid detection,
yet testing of all athletes one or more times during a season
is cost-prohibitive. In addition, those motivated to gain
a competitive edge, legal or otherwise, will seek novel ways
to avoid detection, including taking masking substances.
Drug
use is a serious concern, not only for the concepts of integrity
and fair play in competitive sports, but because of the health
threats to the athletes. Certainly drug testing programs should
continue with increasing numbers of athletes being tested
and increasing penalties for detection, since these are most
likely means of deterrence. Drug education programs must also
continue in a further attempt to curtail the use of illegal
performance-enhancing drugs by empowering the young athlete
with the information and skills to make responsible and healthy
decisions.
Conclusion
Drug
testing programs are designed to promote fair play and deter
drug use among athletes. Under conditions of anonymity a group
of professed non-user athletes volunteered for drug testing.
Two positive results were identified indicating the importance
of continued testing and need for further testing and education,
as testing alone is not a sufficient deterrent to eliminate
drug use among college athletes.
Acknowledgement
This
study was supported by a student institutional grant by and
performed at Brigham Young University in Provo, Utah.
References
- Borts, D. J., & Bowers, L. D. (2000). Direct measurement
of urinary testosterone and epitestosterone conjugates using
high-performance liquid chromatography/tandem mass spectrometry.
Journal of Mass Spectrometry, 35, 50-61. - Catlin, D. H., Cowan. D.A., De la Torre. R., Donike, M.,
Fraisse, D., Oftebro H., Hatton, C.K., Starcevic, B., Becchi,
M., de la Torre, X., Norli, H., Geyer, H., & Walker,
C.J. (1996). Urinary testosterone (T) to epitestosterone
(E) ratios by GC/MS. I. Initial comparison of uncorrected
T/E in six international laboratories. Journal of Mass Spectrometry,
31, 297-402. - Catlin, D. H., & Murray, T. H. (1996). Performance-enhancing
drugs, fair competition, and Olympic sport. Journal of the
American Medical Association, 276, 231-237. - Dehennin, L. (1994). On the origin of physiologically high
ratios of urinary testosterone to epitestosterone: consequences
for reliable detection of testosterone administration by
male athletes. Journal of Endocrinology, 142, 353-360. - Dehennin, L., & Scholler, R. (1990) Detection of self-administration
of testosterone as an anabolic by determination of the ratio
of urinary testosterone to urinary epitestosterone in adolescents.
Pathologie Biologie (Paris), 38, 920-922. - Garle, M., Ocka, R., Palonek, E., & Bjorkhem, I. (1996).
Increased urinary testosterone/epitestosterone ratios found
in Swedish athletes in connection with a national control
program. Evaluation of 28 cases. Journal of Chromatography
B Biomedical Applications, 687, 55-59. - International Olympic Committee. (1982). International Olympic
Committee Definition of Doping and List of Doping Classes
and Methods. Lausanne, Switzerland. - Ismail, A. A., & Harkness, R.A. (1966). A method for
the estimation of urinary testosterone. Biochemistry Journal,
99, 717-725. - Tricker, R., & Connolly, D. (1997). Drugs and the college
athlete: An analysis of the attitudes of student athletes
at risk. Journal of Drug Education, 27,105-119. - van de Kerkhof, D.H., de Boer, D., Thijssen, J. H., &
Maes, R. (2000). Evaluation of testosterone/epitestosterone
ratio influential factors as determined in doping analysis.
Journal of Analytical Toxicology, 24,102-115.
Russell
Meldrum, MD, and
Judy R. Feinberg, PhD
Indiana University
School of Medicine
Department of Orthopedic Surgery
541 Clinical Drive
Suite 600
Indianapolis, IN 46202-5111
Phone: 317-274-8318
Fax: 317-274-3702
Email: rmeldrum@iupui.edu
