As part of the Certificate of Integrative Sports Nutrition course (CISN), I am scheduled to lecture in September on the subject of performance-enhancing drugs (PEDs) in elite and recreational sport.

My main brief in this lecture is to provide a background story for the subject and then attempt to put the use of these substances into a clinical setting; how general nutritional practitioners may well come across them, and how they may influence testing procedures, results of those tests and the action to be taken.

I have recently come across a classic case study, which I thought I would share, as this will give a perfect example of the type of situation that may arise within sport. As a background to the case, the guy in question used to train at one of the gyms that I regularly use. He was a young (late 20s, early 30s) South African, and to the best of my knowledge, in robust health.

I was not involved with his training or nutrition at this stage, although he did ask the occasional question. He was not involved in any structured sport and followed what I would describe as a loose bodybuilding lifestyle, purely for health/aesthetic reasons. I was unaware of his dietary protocols and certainly was not involved in any supplementation programme that he may have been following.

A few years ago, he moved from East London to somewhere more rural in Surrey. At this point, we lost contact apart from remaining 'friends' on social media. A few weeks ago, I received a message to the effect that he was trying to get to grips with a hormonal problem that had arisen and that his NHS endocrinologist simply seemed to be sending him for more and more tests, without being able to even define the problem, let alone come up with a solution.

Long story short, the couple seemed to be having trouble conceiving and he was seen to be the problem due to a low or ineffective sperm count and, according to the client, low testosterone. At this point, I was supplied with some of the latest correspondence between specialists in which he had been copied.

When dealing with hormonal issues, I am always drawn to the approach taken by Pete Williams, who I have had the pleasure of studying under, in both a group setting and privately. Pete uses the initials PTSD as a check list of areas to thoroughly investigate:

  • - Production
  • - Transport
  • - Sensitivity – of the receptor
  • - Detoxification

Reading the reports my client supplied, I noted that various medical procedures were being considered to evaluate possible pathology of his pituitary and that an ultrasound scan was also being recommended.

However, on reading the results of his initial blood tests, the answer seemed a little more straightforward. Both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were very low, while testosterone, rather than being low, was actually much higher than the general reference range. The report also carried the sentence; “the other interesting point was that his haemoglobin was 192 and the normal level for a man is 170”.

This sounded like a classic case of HPG axis disruption; as you will no doubt be aware, the Hypothalamic-Pituitary-Gonadal axis works on a negative feedback loop, with gonadotropin–releasing hormone, LH and FSH all being subject to the levels of circulating testosterone. The comment on haemoglobin was pretty much the clincher for me: one effect that external androgen use potentially has is an increase in red blood cells, which in turn leads to a performance advantage in a sporting context.  

My first question to the client was: “your testosterone levels are shown as high, not low as you suggested. Have you been using any supplement that may account for this?” The answer was basically yes: testosterone enanthate, which is a long-acting form of testosterone.

I am not expecting this gentleman’s natural testosterone or sperm levels to return to normal for some time after the exogenous source has been discontinued and internal levels have stabilised. It is, however, an interesting study on how mainstream medicine is quite likely to miss something outside of their somewhat narrow beam and the unexpected effects that this may have on the casual user.