I am not a doper, even if I feel like it. Experiences?
OK Gents.... (not to exclude the ladies, but read on)
As I'm sure just about everyone in EN knows, about 1.5 years ago, I lost my teenage son in a car/bike accident while he was training with a coached group to learn draft-legal riding for youth triathlons. (By the way...thanks again to all of you for your support... Our first TRJMS winner was last spring, and he has done some really awesome things since then!)
Unsurprisingly, I've had some issues since, which I mainly wrote up to grieving and related depression. I've gotten counseling and have done my share of antidepressants, etc. Nonetheless, certain physical symptoms remained (and have gotten somewhat worse), and my GP out of the blue suggests that I get my testosterone checked. Lo and behold, it's well under the threshold for normal, and significantly lower than it was when it was checked routinely a year ago during a physical associated with the antidepressants (and even then it was on the very low end of normal, below normal by some descriptions).
So today I saw a urologist, and he asks me about my lingering symptoms that bother me, and I name about 5...he asks me non-leading questions that lead us to discuss about 3 more...many of which are vaguely related to getting older, and many of which are vaguely related to depression, but they all lead to a diagnosis of genuinely low testosterone (short list: unexplained increase in body fat, excessive fatigue and need for sleep, less ability to concentrate, low libido that ED drugs don't help, loss of high end strength). So, after further examination, he's totally up front that I should try androgel (testosterone supplement). I explained about my athletic endeavors asked him if I could get a letter [on the very slim chance of drug testing] expressing my "therapeutic exception" or whatever might be needed — and he was very up front about saying yes. Essentially, the whole point is to get me in the normal range, not high.
OK, so everything is cool on paper, but I still feel a little bit like THAT GUY who is looking for the loophole by finding some sleazy anti-aging clinic.
As we all in EN are, I'm highly data driven. I know my strength is down from where it should be by more than it should be, unless aging is catastrophic rather than gradual. I can still bike and run at my moderate paces pretty well, but I've rally dropped off the highest intensity. Similarly (and perhaps even more tellingly), my "fastest 50" or "fastest 100" time in the pool is significantly slow. But honestly, if I became a mediocre triathlete, that's nothing compared to wanting to sleep 9 hours a day and not having a libido.
So there...I've vented... and now comes the big ask... is there anyone out there that has any experience with this that you're willing to share? Any advice?
If you want to go private with it, feel free to PM me or send me an email at wsjinames@gmail.com.
PS I do know a lot of you in locations outside EN. I am not discussing this publicly in places like FB and so on.
Thanks.
Comments
Just my 2 cents as I'm not (yet) needing any Testosterone supplement. I think u should not feel any guilt about taking supplement to bring u to "normal level", everybody does it all the time for vitamins and what not, why shoud it be different for TRT? As u mentioned, it's not even a sport driven decision as your quality of life is the major factor in this.
I wouldn't skip a beat over doing TRT in your case.
Now doing TRT when everything is fine...that is cheating...again, not your case at all.
Good luck
ps: hope u won't take it the wrong way, but u and your family are a lot on my thoughts and prayers as I see my twins (1 boy and 1 girl, like u) grow up too fast. God bless u
As a lifelong endurance athlete, I can't help but notice how my performance is declining especially the past couple of years. I am more tired, I am slower, I am weaker, and the body fat is stuck with superglue. So I am trying harder than ever fighting the good fight. To stay healthy and slow the decline I'm always looking for any permitted protocol that boosts natural testosterone as opposed to exogenous methods against the rules although I have no way of knowing whether it is effective, since I can't both use them and be a control.
My list includes rotating once a week through 'legal' supplements like Tribulus Extract, Horny Goat Weed, Rhodiola Rosea extract, and a couple others I can't remember. I take each just 1 time a week on different days so the body doesn't get use to the same thing. And it's not expensive since a 60 pill bottle is going to last more than 1 year on that rotation. I'm considering adding Longjack to the list. I looked on the WADA prohibited list the other day and am pretty sure it's a clean product but I need to do more research. Other methods that supposedly help include lifting weights more often, getting more sleep, more sex, eating nuts (nuts are good for your nuts!), reduce sugar consumption, etc. The key here is that these methods lift your own production of T, instead of replacing it with a shot, cream, or whatever. Besides being against the rules, exogenous supplementation should scare the crap out of men. This may not apply to your doctor but there are too many that have a tremendous conflict of interest in pushing this on guys and the longterm impacts should scare the bejeebers out of everyone. I knew aging clinics had run their course when the ads for Androgel were largely replaced by ads from lawyers looking for people harmed by it.
My understanding is that it is a permanent decision, not a temporary Band-Aid. Your body will shut down whatever T production it is doing now when it discovers it no longer needs it since you have an outside source. Shrunken nads and the possibility of growing breast tissue for a time being if you ever stop (due to the imbalance of estrogen/testosterone) makes it a last resort decision. Whatever you do I wish you the best. And if you go the TRT route, just make sure you never step foot on the podium. Best of luck!!
I don't know much about it, but here are a few resources: http://members.endurancenation.us/Forums/tabid/57/aft/8227/Default.aspx#8227
http://www.bengreenfieldfitness.com/2014/06/testosterone-heart-attack/
http://www.bengreenfieldfitness.com/?s=testosterone
I am a urologist, the kind that does cancer mostly, but we all have an experience with this because TRT is sought after so much. Sounds like the doc you saw said all of the right things and the advice is most reasonable.
You would not be a doper. Period.
If I have one reservation about triathlon its the nearly total lack of resistance training we do in general. It seems like a set up for the aging male. When a man comes to me with this story, unless there is an orthopedic issue, I advise weight lifting for an hour 3 times a week. Cardiovascular training is not equvalent with regard to T response, to my knowledge. (of course that will undermine speed to some extent). My experience on the prescribing end of this conversation is that TRT is not the panacea we want it to be, though it is safe.
If you have not read it yet, a fairly important article was published last week on this subject (in men older than you): http://www.nejm.org/doi/full/10.1056/NEJMoa1506119
This will be the first of several articles on the topic of efficacy. Interesting story behind the article. The authors were primarily interested in studying the safety profile of TRT, but were urged by FDA to NOT study safety first, rather to study "does TRT work?" first - this is a major departure for the FDA who are generally obsessed with safety.
I have read the posts about your son, all of them. I have never responded because the story strikes such a deep fear/sadness/despair in me I have never had the courage to say anything. Denial I think. You are an exceptional person. A role model. Thank you.
DS
Paul - although I have read "on the internet" about the permanence issue you discuss, I got a very different impression from my physician. His advice was to try this particular dose (evidently it comes in different concentrations) and see what happens. If the symptoms didn't change, he was 100% for just going off it, regardless of whether the testosterone number went up or not. There was absolutely no indication that this was necessarily a permanent thing. I wonder if this is a matter of refined usage, compared to the early versions. (You may recall that the formulations for female contraception have changed dramatically from the early years of that, too. Same general hormonal system...) The plan would be to do some testing on levels after a month.
Regarding some of your other suggestions... just so you know. I am a nut fiend. :-) My problem right now is that I sleep too much, not that I don't sleep enough. Getting more sex is ... well ... my fault. To put it kindly, when I go to bed, I pretty much want to go to sleep. ;-) And, I think you know me well enough to know that, in general, I'm (as you put it) fighting the good fight.
As a chemist, though, my bejeebers are a lot more scared by unregulated, untested supplement bottles than they are by pure substances. Most of the time, when these extracts do something, it's because they contain either the exact same drugs you're considering taking, or a precursor to them. If you were getting tested for something that would come up positive for "the drug", you would come up positive just the same if you took some supplement. And a lot of the supplements either have none of the main ingredient or have something put into them that isn't what you expected. (e.g., there are a lot of them that are found to contain ephedrine). So if I understood the mechanism by which some of those supplements worked, I'd be all for them, particularly if I could get a measured, clean dose. But short of that, I gotta say that taking an aspirin from Bayer is more appealing than downing a spoonful of something that's claimed to be willow bark, but who knows... Does that make sense?
But this said, assuming I follow through, I am entirely cool with doing whatever paperwork I need to do to get a therapeutic exemption for its use. I am assuming for now that such things are given...if anyone knows otherwise, I'd like to hear.
I should have also mentioned: apparently there is a correlation between low testosterone and very low PSA test values that my case follows.
WJ,
By all accounts, it's nearly impossible to get a TUE for low testosterone. So, by the letter of the law, if you were competing while on testosterone, even if given by prescription by your doctor, with a TUE you would be cheating.
Now...
Clearly medical science (?), or at least medicine in general has placed a significant focus on "anti-aging" protocols, of which supplementing with testosterone is, so I've heard, a large component. However, the rules of endurance sports are still the rules and so age group athletes are often faced with two choices:
And there's the 3rd choice, which is to supplement with testosterone with the clear intent of knowingly gaining an unfair advantage over your competition. I quite certain this is going on as well.
In my opinion, your case clearly has many facets, not the least of which is simply wanting to improve your quality of life by medically addressing a deficiency. However, without a TUE (or is it TEU, I'm confused now
) to be competing while on testosterone is against the rules. It seems to be the honorable, no gray area thing to do would be compete and then ask the RD to disqualify you.
In short, I think the rules of sport will soon need to be adapt to the changing landscape of medicine and technology, or else risk labeling it's participants as cheaters.
But I can tell you that what I am experiencing is not (entirely) about aging. Undoubtedly, there is some fraction that is, but there is a hell of a lot that's not...the whole sleep thing being the most obvious of these.
For the purposes of argument, let's assume there is no TUE to be had... but if there is a legitimate "disease condition" (for lack of better term...and I mean this for me or for anyone else), undoubtedly, I agree with part of your option 1. To the extent that is is against the rules, you are cheating. But I'm not sure I buy part 2 of that...if you are behaving ethically with respect to the condition, you are "removing a disadvantage specific to you", not gaining an advantage relative to the field. That doesn't mean it's not cheating. But in an ethical sense, I don't understand why it has to be different than taking asthma medication, which is widely done and entirely legal...other than it dealing with this particular condition is arbitrarily against the rules. I understand why that probably is, i.e., the easy potential for abuse. However, philosophically, I want someone to explain why the asthma comparison doesn't hold.
I guess this is part of the point of the "biological profile" or whatever they call it that the cyclists are supposed to be doing...showing what your normal is and that you aren't changing your normal.
Anyway, lots to think about here. Thanks all for the feedback.
@ Paul Fair enough, particularly with respect to contamination.
I don't know if I'd go as far as "not prohibited = not effective". But I would say that if it's not prohibited and it is effective, then from an ethical standpoint (apart from the literal rules), it stands no different than an ethical use of legitimate pharmaceuticals. "Supplements" are just chemicals that are still in the leaf/bark/whatever. That said, the rules are the rules, whatever the underlying ethics.
But what are you going to do instead?
Are you going to endure physical symptoms of a "disease condition" impacting many aspects of your life that may be perfectly treatable...because of your sense of fair play in triathlon which you do as one hobby? Are you going to stop doing endurance sports - which in addition to physical also probably has enormous mental health benefits for you?
Of course not. That would be silly. You have been through a lot. You have endured something I hope I never have to endure. I think you should focus on yourself. Your own physical and mental health is the important thing. I don't think you should feel guilty about that at all.
Rich's very last point is key. USAT will need to reconcile TRT at some point - there very clearly is a cohort of men who are insufficient, who will go on to develop metabolic syndrome and all that goes with that awfulness. TRT can change that in some men. Hard to imaging USAT turning their "anything is possible" mindset against that evidence.
I agree with Matt. Do what is best for your physician situation. And if you ever have a non-USAT tri to honor your son, count me in.
Interesting problem William. The variety of responses are really thought provoking too. As far as the American Association for Orthopedic Sports Medicine's position, if the T is low, supplementing to the normal range is safe and commonly used when symptoms of deficiency are present and present a problem.
As far as the USAT thing goes, I really feel that it in some ways it makes a difference where in the pack you race. As a middle of the pack kind of guy who races predominantly against my own prior performances, I really would have no moral problem with taking a supplement to get my values into the appropriate range (yes, I know that the range is for younger guys but that is the "normal range"). This is a safe and accepted medical treatment.
If, However, I was up near the pointy (front) end of the field, I think I might have some concerns about not competing on an equal basis with my competitors. While there is a lot of information that suggests that age group doping for performance enhancement occurs, I wouldn't want to be in a position where I might actually finish near the front and have my results questioned.
I guess that is not really a definite answer but I do think that there is some difference in the intent in those two different scenarios and at the end of the day, it is not like they are going to test you so the only person that you have to live with is yourself. The fact that you are putting it out here for discussion just indicates to me that you are not going to be "that guy" who is so intent on winning that he would put his body at risk to enhance performance. While the rules are very specific, I think that they are mostly meant to keep things clean on the podium.
The motor in the bike... now I do have a problem with that even if you finish last.
Yeah, this is part of my problem too. I'm not stellar or anything, but I have been fairly consistently in the top 10% for the last 5 years. In the last 18 months, I placed 11th (3rd "fastest" run) at IMWI, mid-pack somewhere in a smaller half-distance race that just turned out to be stacked in MN, and first (all in my 50-54 AG) in another smaller half-distance race that wasn't stacked (obviously). I ran a couple of sub-3:15 marathons within the last 3 years, and I've been in the top 10 in a few 70.3 races in that same time range. So if not exactly at the pointy end, I've had some good results. If I'm in very good shape and get lucky, it's not completely ridiculous that I "place" in a big race....but I'll never win or anything.
But what's hard about this is that it isn't about the racing, even if that's a potential "side effect" of what I'm considering. It's about trying to be normal again.
I have no plans to do an IM in 2016 because we committed to supporting our daughter this year. Perhaps one reasonable compromise is just to stay out of any races that have any "stakes" to them...to do races like the ones I did last year..."off-branded" where the prize for winning is a tacky medal or mug...or maybe an extra slice of pizza. :-)Anyway, at this stage, I *have* downloaded the TUE application form, and I can clearly make the case on every question it asks to my own satisfaction, whether it's to USADA's or not. I am considering starting the treatment,a nd if it works for me sending in the form. If I get denied, I can be open about having the paperwork and recent test results and inform RDs as Rich suggests.
Thanks for this discussion and helping me work it through.
Talking about testosterone as a performance aide has me thinking about handicap scores and golf. What if, for example, I am not a good triathlete… I just have abnormally high testosterone? I train less than everyone else, but I'm faster. It's not cheating because it's "natural" even though I'm not taking any supplements to bring it down into a regular range. How about athletes with low testosterone? Can they get a letter from the doctor which they can present to the race director asking them for 15 minutes off their time relative to everyone who is "normal?"
As science continues to unearth more about the human body, we will undoubtedly learn more about what makes us tick…and what makes some people better athletes than others. I'm sure that this information will have a profound effect on how we perceive what is "fair" and "unfair."
I don't have the answers to any of these questions but I do know that often governing bodies of sports lag far behind the requirement for solid personal ethics and decision-making. Thank you for sharing this journey with us... I know you're not alone.
I don't think it's accurate to imply that middle of the pack athlete don't care about their overall placing, or that MOP performances are someone different from FOP performances and therefore could possibly get a bit of a pass, so to speak, with regards to the use of PEDs. Many, many MOP athletes take their performances and placings very seriously. If I got 100th place clean and Timmy beat me to 99th but was doping, he still cheated to beat me and I'd be pissed.
Sorry, but I wanted to make the clear distinction that there really shouldn't be any distinction in the rules as a function of placings.
The larger question is about your life and the satisfaction you gain from it. If this chemical deficiency is impacting your mental well being and the quality of your martial relationship and can be fixed, fix it.
I wouldn't give triathlon a second thought if this could fix the other issues impacting your life.
Agree with Dino! My only concern is the dark side of hormone replacement. I really doubt you are going to see much of a performance kick from improving levels into the normal range. If you decide to trial this and it improves your well being and your life then enjoy the results.
The rules are the rules. The problem with rules is that there is the black and white and then there is the intent. I know people who are taking blood pressure medication that are banned. They are doing tri to get off the meds. Is their intent to cheat? NOPE. Neither is yours.
It turns out that I am also chronically anemic. I can't remember when I first got the diagnosis, but it's probably been 15 years. I am not grossly anemic, but most of my blood tests come out ~10-15% below the "anemic" threshold, although once in a while I get lucky and am in the bottom of the normal range. Because being anemic when you are a man approaching 40 (who was not doing long distance triathlon at the time) is uncommon and because it can be the result of some Very Bad Things, I got tested up the wazoo, including a bone marrow biopsy out of my hip. I have also been on all the low end therapies: diet, exercise, different kinds of iron supplementation. None of it worked. It just seems I'm the Lucky Guy who has a genetic predisposition to be anemic.
This does NOT change my every day life. I do not go around feeling out of breath all the time. The worst thing I have is that same thing a lot of people with low blood pressure get: I nearly faint and experience temporary blindness frequently when I stand up. It's not a big deal. You grab the chair and wait 10-15 seconds and life goes on.
However, there is no doubt that anemia affects my competitive ability. I have a lower VO2 max than I would if I were normal. I have a lower "aerobic threshold" than I would if I were normal. I clearly can't swim or run indefinitely at quite the same pace that I could if I could process oxygen more efficiently.
But I don't pursue treatment (whatever that would mean) beyond the attempts I described above because it doesn't matter to my life. It doesn't change the number of hugs I can get from my daughter or the quality of work I can do at my job. Probably whatever those meds would be are on the banned list..for obvious reasons.
The competitive advantage for me taking something banned to get my anemia fixed and to get my testosterone fixed might lead to different levels of competitive advantage, but clearly both would either lead to advantage or no particular advantage but no harm (and lots of suspicion).
The why I am pretty sure I am going to do this is that I want a big part of my life back and my wife wants me back. She is not being pushy, but she's clearly way on board.
I just have to figure out how to figure out how to go about doing that and behaving ethically in my hobby. Probably Rich has it right. I just don't want to get to a place where they don't let me on the starting line.
If anything, you identifying yourself to an RD after the fact as having taken a banned substance without a TUE and therefore wanting to be removed/disqualified from the results would start a discussion on this issue, where the letter of the law is being challenged by the state of modern medicine, and the ethical dilemmas faced by good people in this sport.
However, I'd do it after I crossed the finishline, not before because, fuggit, it's my money and I've trained for the race, I don't want to risk the RD not letting me start.
Bottomline is that this will always be messy. For every WJ there is a DB juiced to the gils for all the wrong reasons.
Interesting thread.
William with all of these issues it is complicated. Curious, with the current issues you layout well below, what is your current age/Vdot and how do think that might improve following the Dr.'s recommendations?
SS
I will turn 52 in a few months, and my current dot is 51 (5K of 19:40). It has been 50-53 for the last 5 years or so. Last year was not my best by any means, but a couple years ago, I was running mid-1:30s in my HIM runs and 1:29 in my half marathons. I had a stress fracture last year that hampered my running.
I was not an active athlete in my youth except as a below-average some-time swimmer, so my marathon PR of 3:13.x was set when I was 49. I've never run under 19:00 for a 5K, but the vast majority of my 5Ks are solo efforts on a track. If I was suddenly running 18:30 5Ks, I would know that this was "unnatural".
- I support @ Dino's and the others comments regarding the importance placed on quality of life. If you have the opportunity to improve the quality of your life through chemicals, (given your incredibly complex case) you do it. You don't think twice about it. We cannot allow competing in potential triathlons (where the gun has not gone off) to dictate the quality of life decisions.
- Unfortunately, I am lock stock and barrel with Coach Rich on this issue. (Please forgive me if this is harsh). It seems like you are asking the same question in different ways hoping to get your predetermined answer. The reality is the rules are static and black/white. The rules just cannot provide the flexibility your (again incredibly complex) case demands and deserves. As coach rich said "For every WJ there is a DB juiced to the gils for all the wrong reasons." By the letter of the law, you would be cheating. The asthma comparison doesn't hold water for you; I respect that. But the reality is it is in the rules this way.
Here's where I am. I have started the treatment. I acknowledge that - by definition - I am (or would be if I were about to race, anyway) breaking the rules. I choose to use that phrase over "cheating" because the latter is an emotive term that connotes intent. I will inform any race director whose race I participate in.
What disappoints me is that there is not a different rule that could accommodate therapeutic treatment at some reasonable level. It bothers me emotionally that some dude can intentionally try to "enhance" himself through any number of mysterious herbs or products that are not on a list that may or may not contain either a real banned substance or something that "should" be....and that since enforcement is only through the very unlikely event of testing...he can race legally and I cannot.
In the end, these rules are arbitrary, though hopefully reasonable. Caffeine is undeniably a PED but many people use it fairly, because fairly high doses remain legal. It's just s thing. The equivalent effect could be achieved through a smaller dose of amphetamines, but that's illegal.
In the end, the rules are the rules, and we agree to play by them. I still find it personally disappointing that I am put in this position.