Anti-doping Research Articles

Engaging community pharmacists to eliminate inadvertent doping in sports: A study of their knowledge on doping.

This study aimed to evaluate the community pharmacists' knowledge of tackling the issue of inadvertent doping in Malaysia. A cross-sectional survey was conducted among 384 community pharmacists working in Malaysia using a self-administered questionnaire. All the respondents were pharmacists fully registered with the Pharmacy Board of Malaysia and had been working in the community setting for at least one year. Of the 426 community pharmacists approached, 384 community pharmacists participated in this study, giving a response rate of 90.14%. The majority of the respondents were females (63.5%), graduated from local universities (74.9%), with median years of practising as a community pharmacist of six years (interquartile range, IQR = 9 years). The respondents were found to have moderate levels of doping-related knowledge (median score of 52 out of 100). Anabolic steroids (95.8%), stimulants (78.6%) and growth factors (65.6%) were recognised as prohibited substances by most of the respondents. Around 65.9% did not recognise that inadvertent doping is also considered a doping violation. Most of them (90%) also have poor levels of knowledge of doping scenarios in the country. Community pharmacists in Malaysia have limited knowledge in the field of doping. More programmes and activities related to doping and drugs in sports should be held to enhance the community pharmacists' knowledge on the issue of inadvertent doping.

From Doping Allegations to Fundamental Rights Protection: A Case Study of the European System

This article will illustrate the legal options and protections available in sporting disputes under the European system, by reference to the case of Claudia Pechstein, (a speed skater aiming for the Olympics and accused of doping violations) against the International Skating Union. The article provides an overview of the legal framework governing all Olympic speed skater athletes and the bodies in charge of implementing the rules and regulations. It then studies Pechstein’s position, the processes available to her, and the path she had to take as she negotiated the slippery curves of the rinks of the Court Arbitration for Sport, the Swiss Federal Tribunal, German national courts, and European Human Rights courts.

Renoprotective and hepatoprotective activity of Lepidium draba L. extracts on oxymetholone-induced oxidative stress in rat.

Misuse and abuse of anabolic androgenic steroids (AAS) such as oxymetholone (OM) cause side effects such as male infertility, cardiovascular disorders, musculoskeletal, and hepato-renal dysfunctions in athletes. The aim of this study was to evaluate the protective effects of Lepidium draba L. (L. draba) extract on OM-induced hepato-renal toxicity. Thirty adult male Wistar rats into six groups (n=5) were randomly divided as follows: control (normal saline), OM (5 mg/kg/day), L. draba-treated (100, 200, and 400 mg/kg/d) plus 5mg/kg/day OM, and L. draba (400 mg/kg/d) groups. Normal saline, OM and L. draba extract were orally administered for 30 days. On day 31 of the study, hepatic and renal biochemical parameters were measured. Serum cytokines (IL-1β, IL-10, IL-6) tumor necrosis factor- α (TNF-α) and nitric oxide, levels alongside catalase, glutathione peroxidase, and superoxide dismutase activity were evaluated. Also, changes in liver and kidney histopathology were evaluated. Finally, the anti-oxidant properties of the extract were determined. The results of this study showed that in the groups treated with the L. draba extract, hepatic-renal biochemical parameters improved and also the level of nitric oxide and inflammatory cytokines decreased and the activity of anti-oxidant enzymes increased compared with the OM group. These findings revealed that L. draba, due to its high anti-oxidant properties and high content of polyphenols (especially flavonoids), can improve OM-induced hepato-renal oxidative damages. PRACTICAL APPLICATIONS: L. draba due to its remarkable anti-oxidant and anti-inflammatory properties can protects the kidney and liver injuries against oxymetholone. These features are attributed to the presence of phenolic and flavonoid components. This fidings would be helpful to desgin new therapeutic agents for treating and preventing liver/kidney injuries.

Cardiovascular phenotype of long-term anabolic-androgenic steroid abusers compared with strength-trained athletes.

IntroductionAbuse of anabolic‐androgenic steroids (AAS) has been linked to a variety of different cardiovascular (CV) side effects, but still the clinical effects of AAS abuse on CV risk are not clear. The aim of this study was to assess the CV phenotype of a large cohort of men with long‐term AAS use compared with strength‐trained athletes without AAS use.MethodsFifty one strength‐trained men with ≥3 years of AAS use was compared with twenty one strength‐trained competing athletes. We verified substance abuse and non‐abuse by blood and urine analyses. The participants underwent comprehensive CV evaluation including laboratory analyses, 12‐lead ECG with measurement of QT dispersion, exercise ECG, 24 h ECG with analyses of heart rate variability, signal averaged ECG, basic transthoracic echocardiography, and coronary computed tomography angiography (CCTA).ResultsHemoglobin levels and hematocrit were higher among the AAS users compared with non‐users (16.8 vs. 15.0 g/dl, and 0.50% vs. 0.44%, respectively, both p < 0.01) and HDL cholesterol significantly lower (0.69 vs. 1.25 mmol/L, p < 0.01). Maximal exercise capacity was 270 and 280 W in the AAS and the non‐user group, respectively (p = 0.04). Echocardiography showed thicker intraventricular septum and left ventricular (LV) posterior wall among AAS users (p < 0.01 for both), while LV ejection fraction was lower (50 vs. 54%, p = 0.02). Seven AAS users (17%) had evidence of coronary artery disease on CCTA. There were no differences in ECG measures between the groups.ConclusionsA divergent CV phenotype dominated by increased CV risk, accelerated coronary artery disease, and concentric myocardial hypertrophy was revealed among the AAS users.

Behaviours and Beliefs Related to Whistleblowing Against Doping in Sport: A Cross-National Study.

BackgroundWhistleblowing has been recognized as an important deterrent of doping in elite competitive sport. The present study examined athletes’ knowledge of external whistleblowing channels and on how and where to report doping misconduct, perceived trust in different whistleblowing reporting channels, whistleblowing behaviour and athletes’ reasons for reporting (or not) doping misconduct.MethodsAthletes from Greece (n = 480), the Russian Federation (n = 512) and the United Kingdom (n = 171) completed a structured questionnaire on demographics, knowledge of different whistleblowing channels, perceived trust in internal and external whistleblowing channels, past whistleblowing behaviour and reasons for reporting (or not) doping misconduct.ResultsThe British athletes reported greater awareness of whistleblowing reporting channels (e.g., WADA’s Speak Up and IOC’s reporting platform) than did athletes from Greece (all p < 0.001) and Russia (p = 0.07, and p = 0.012) respectively. However, British athletes reported the lowest scores on knowledge of how and where to report doping misconduct, as compared to athletes from Greece and Russia. The majority of respondents reported greater trust to their coach or a club manager than to other whistleblowing channels, however, responses regarding other channels varied by country. Among athletes who detected doping misconduct 62% of athletes did not report it, while 38% reported it. Reasons for and against reporting doping misconduct reflected in eight themes that were identified using thematic analysis.ConclusionAthletes showed low awareness of external whistleblowing channels and they predominantly trusted internal whistleblowing channels. Sportspersonship, confidence in resources and personal benefits were among the reasons that facilitate reporting doping misconduct. The present findings indicate that cultural context may play a role in the ways athletes perceive whistleblowing, and this should be taken into account by future interventions to promote the reporting of doping misconduct.

Use of liquid chromatography-tandem mass spectrometry for determination of higenamine in urine following oral administration of traditional Chinese medicine.

Since higenamine (HG) was first included in the World Anti‐doping Agency (WADA) 2017 Prohibited List, an increasing number of plants have been found to contain this ingredient. As a result, doctors are hesitant to prescribe traditional Chinese medicine (TCM) to athletes. Thus, it is very important to assess the risks of doping violations due to HG following the oral administration of TCM. We determined the drug concentration‐time curves for HG in urine by liquid chromatography–tandem mass spectrometry (LC–MS/MS) after single or multiple administrations of lotus seed powder on volunteers, the single dose was equivalent to 750 μg of HG, and the multiple doses were equivalent to 90 μg of HG each, 3 times daily for 5 consecutive days. For the single‐dose group, the HG could be detected in urine 0.5 h after administration and reached a maximum concentration of 16.5 ng/mL 1 h after administration. For the multiple‐dose group, the HG concentrations in urine showed two peaks at 29 and 77 h post‐administration with 22.6 and 23.1 ng/mL, respectively. At the dosage used in this study, the maximum concentration of HG in some urine samples exceeded the WADA limit of 10.0 ng/mL; the risk was still very high, so athletes must avoid this amount of HG when using TCM. In addition, our study provided further data supporting the presence of sulfonated metabolites of HG in urine samples.

Сonsiderations regarding ethics and integrity in the prevention and fight against doping in romanian sport

The reason that led to this paper to be written is to explain the new meanings of the notions of ethics, integrity, responsibility and accountability - in order to hold accountable those involved, directly or indirectly, in sports. Ethics management, “as one of the disciplines of management”, deals with the development of those leadership tools that contribute to the ethical development of an organization, as well as the methods that can be used to determine in which direction organizations should develop. Sport, already considered a notable social phenomenon, requires a real “legalization” able to frame it harmoniously and consciously in the context and rigors of a civilized conduct, of the highest morality, but also of strict legality and responsibility. The author argues that ethical management seeks to improve decision-making processes, procedures and organizational structures, so that the activities of the organization are as closely related to ethical principles.

Self-Affirmation and Image/Performance Enhancing Drug Use in Recreational Exercise

ABSTRACT Objectives: The use of image and performance enhancement drugs (IPEDs) in recreational sport represents an emerging public health and societal problem. The present study investigated whether self-affirmation changed exercisers’ intentions to use IPEDs, via the effects of mental construal and message acceptance. Method: Sixty-eight exercisers who self-reported IPEDs use participated in the study and were randomly assigned to either a self-affirmation or a control group. All participants read a health-related message about the 10 consequences of IPEDs and subsequently completed a survey measuring message acceptance, mental construal, doping intentions and IPEDs-related social cognitive variables. Results: There were no significant differences between the self-affirmed and the control groups. Hierarchical linear regression analysis further showed that message acceptance, subjective norms, and situational temptation were significantly associated with intentions to use IPEDs. Conclusion: Our findings raise the possibility that for recreational exercisers IPED’s use is seen mostly as a health-related matter than a socio-moral transgression.

Anabolic-Androgenic Steroid Use is Associated with Major Depressive Disorder and Suicide Attempt: Analysis of a Multi-National Database

ABSTRACT Introduction Anabolic-androgenic steroids (AAS), synthetic derivatives of the male sex hormone testosterone, are often used to enhance athletic performance and physical appearance. Long term use of AAS can be associated with mood destabilizing effects and psychotic behavior. We hypothesized that AAS use is an independent risk factor for mental health disorders. We investigated AAS use and associations with major depressive disorder (MDD), suicide attempt (SA)/intentional self-harm (ISH), and body dysmorphic disorder (BDD) by querying TriNetX, a global health research network that provides data on large cohort of patients from multiple centers across the United States. Objective To determine the association between AAS use with MDD, SA/ISH, and BDD. Methods To evaluate the psychiatric risk of AAS use two cohorts of adult men, aged 18-50, without history of gender dysphoria (F64, Z87.890) (1) history of documented AAS use, inclusive of testosterone prescriptions (2) history of a visit to a healthcare organization and no history of AAS use. We accounted for confounding variables known to be associated with a risk of mood disorders through propensity score matching by logistic regression for age, race, ethnicity, male hypogonadism (E29.1), history of nicotine dependence (Z87.891), or alcohol-related disorder (F10). We evaluated the association between steroid use and subsequent diagnosis of MDD (F32-33), SA/ISH (T14.91, X71-83, T36-65 and T71 ISH codes), or BDD (F45.22) as a primary outcome through regression analysis with statistical significance assessed at p&amp;lt;.05. Results We identified 159,717 cis-men between age 18-50 who used AAS and following propensity score matching for confounding variables, we compared them to an equal-sized cohort of men without AAS use. AAS use was independently associated with all of the psychiatric outcomes that we studied (MDD OR 2.96 95% CI 2.88-3.04 p&amp;lt;.0001, SA/ISH OR 1.37 95% CI 1.25-1.50 p&amp;lt;.0001, BDD OR 5.37 95% CI 2.82-10.21 p&amp;lt;.0001). Strengths of the study include a large sample size, propensity score matching to adjust for confounding variables, and high strength of association. Limitations include lack of information regarding indication for steroid prescription or details regarding severity, duration, withdrawal, or possible steroid abuse. Conclusions AAS use appears to be an independent risk factor for MDD, BDD, and/or SA/ISH. Future studies are necessary to elucidate whether a dose-response association exists, withdrawal from AAS plays a role, and if patient selection or preventative measures can mitigate the risk. Men with suicide attempt, BDD, or MDD should be investigated for a history of AAS use. Further, men receiving AAS should be counseled on the possible risk of developing MDD in the future. AAS use can lead to profound and complex psychiatric complications which should be discussed in patient counseling. Disclosure No

The influence of the Olympic Games on the formation of the image of Russia

In recent years, Russia has been paying great attention to the Olympic Games. The Olympic Movement plays an important role in shaping the country's foreign policy image and promoting national interests. The purpose of this article is to determine what impact the Olympic Games have on the formation of the image of the Russian Federation. The main stages of Russia's participation in the Olympic Games in 1994-2022, forming the image of the country, are highlighted. The study showed that the first two stages, including the period from 1994 to 2012 and the 2014 Olympic Games in Sochi, were extremely successful in forming a positive image of Russia, which was constructed thanks to the successes of Russian athletes, the construction of a "Russian House" in Olympic parks, the opening and closing ceremonies at the Sochi Olympics, as well as the Sochi 2014 Cultural Olympiad project. The image of Russia as a great sports power was strengthened. However, Russia's participation in the Olympics from 2016 to 2022 was not so successful and affected the image of our country. The deterioration of the image was caused by various doping scandals related to Russian athletes. The authors came to the conclusion that the Olympic Games from 1994 to 2012 and the Olympic Games in Sochi – 2014, which we refer to the first two stages, had a steady positive effect on the image of Russia. However, the negative factors that have arisen since 2016 partially offset the successes achieved in this direction in previous years. Due to the current geopolitical situation, holding another Olympic Games in Russia is not expected in the foreseeable future, so at the moment the best option is to focus on the development of sports within the country. Also, to create a positive image of Russia, it is important to revive the practice of creating a "Russian House" in Olympic parks.

Equine metabolism of the growth hormone secretagogue MK-0677 in vitro and in urine and plasma following oral administration.

Ibutamoren mesylate, or MK-0677, is an orally active, nonpeptide growth hormone secretagogue that has been developed to stimulate excretion of endogenous growth hormone. It has been evaluated for the treatment of a range of clinical conditions but is not available therapeutically. Nonetheless, MK-0677 is widely available to purchase online, sold as 'supplement' products. The mode of action and relative ease of purchase make MK-0677 a potential threat with regard to sports doping. The aim of this study was to investigate the metabolism of MK0677 in the horse following in vitro incubation and oral administration to two Thoroughbred racehorses, in order to identify the most appropriate analytical targets for doping control laboratories. Liquid chromatography high resolution mass spectrometry was used for metabolite identification, and subsequently, liquid chromatography-tandem mass spectrometry was used to generate full metabolite profiles for post-administration urine and plasma samples. Fourteen phase I metabolites were identified in vitro; 13 of these were subsequently detected in urine and nine in plasma collected post-administration, alongside the parent compound in both matrices. In both urine and plasma, the longest duration of detection was observed for an O-dealkylated metabolite of MK-0677, and therefore, this would be the best target for the detection of MK-0677 administration. MK-0677 and the O-dealkylated metabolite were found to be excreted largely unconjugated in urine and plasma.

Pharmacists supporting athletes: a scoping review exploring the knowledge, role and responsibilities of pharmacists in preventing the unintentional use of prohibited substances by athletes.

Following the establishment of the World Anti-Doping Agency in 1999, the International Pharmacy Federation (FIP) published guidelines - The Role of the Pharmacist in the Fight against Doping in Sport (2014) - intended for implementation into national standards of practice, to clarify pharmacists' roles in supporting athletes. Despite 7 years since the publication of these guidelines, the extent of practice and knowledge regarding sport pharmacy remains unclear. To explore the literature to ascertain knowledge held by pharmacists and pharmacy students regarding anti-doping and to determine current/potential roles and responsibilities for pharmacists in the dissemination of information about, and the reduction in unintentional use of, prohibited substances by athletes. A literature search of five databases utilising terms such as athlete, performance-enhancing and pharmacist was undertaken. Relevant articles published since 1999 were searched for knowledge, roles and responsibilities of pharmacists. We identified 16 research studies outlining knowledge, as well as roles and responsibilities of pharmacists in assisting athletes. Pharmacists reportedly had limited knowledge of anti-doping organisations and prohibited substances. Roles identified included counselling, education, advice about prohibited substances and dispensing. Responsibilities included medication review and assisting athletes to avoid unintentional ingestion of prohibited substances. Pharmacists, by training, can play a role in providing accurate medication-related information to athletes to avoid prohibited substances. Key barriers identified were pharmacists' lack of knowledge and the absence of guidelines articulating specific roles and responsibilities for pharmacists, highlighting the need for educational programmes and inclusion of specific responsibilities in national guidelines.

Competition, Gender Equality, and Doping in Sports in the Red Queen Effect Perspective

The nature of sports is characterized by a strong competitive component that generates inequalities among athletes at different levels, specifically in relation to gender, technology, and doping. These inequalities can be represented according to the Red Queen effect perspective, which has been previously hypothesized in other competitive environments (evolutionary biology and economics, for instance). The Red Queen effect considers each competitive environment to require a constant effort to maintain a position of competitive advantage in order reach the best result possible. Therefore, the aim of the current paper is to provide an innovative perspective for the understanding of competition in sports, identifying factors (i.e., physical appearance for gender equality, socioeconomic status of a sport team for technology, and antidoping rules for doping) influencing athletes’ possibilities to win a competition. Concerning gender differences, the disparity between genders reflects a lower coverage in sports news, and media are more likely to focus on female athletes’ physical appearance than their performance in sports. Therefore, women struggle more with increasing their visibility and in affirming their status as an athlete. On the other hand, the introduction of science and technological innovations in sports has generated economic interests in sport competitions, which reached superior performance levels compared to the past. Teams that cannot afford financial burdens of technological innovation risk being left out from sport competitions. Finally, doping creates a Red Queen environment since antidoping rules catch a small portion of athletes using performance enhancement drugs.

CLINICAL PROFILE, RISK FACTORS AND OUTCOMES IN PATIENTS WITH CEREBRAL VENOUS THROMBOSIS: A STUDY FROM SOUTH TELANGANA, INDIA

BACKGROUND: Cerebral venous and sinus thrombosis is not a rare disease in India and abroad. The present study was undertaken to various clinical and radiological manifestations of the same. METHODS AND MATERIALS: A total 100 patients admitted to SVS Medical college and hospital, Mahabubnagar between September 2013 to September 2020 with a conrmed diagnosis of cerebral venous thrombosis were studied in this study. Detailed clinical examination along with basic investigations including CT/MRI brain and MRV/CTV in all. RESULTS: Headache and seizures are the most common ndings followed by paresis and fever. Alcohol addiction and tobacco consumption were found to be present in 53 and 56% of cases followed by iron deciency in 45, hypertension in 35, pregnancy related cases were only 18. Steroid abuse and hypothyroidism were noted in 18 and 16 instances while evidence of infection was noted in a dozen patients. Cerebral imaging (CT/MRI) revealed venous infarction hemorrhagic or non-hemorrhagic in 67 patients and isolated CVT without infarction in 21 patients. Infarctions were unilateral in 56 patients. Superior Sagittal Sinus in combination with other deep venous sinuses was seen in 54 percent of this study. CONCLUSION: CVST presents in young and equal in frequency in males and females. Headache, seizures are more frequent symptoms. Addiction with alcohol and tobacco are the more frequent risk factors followed by Iron deciency anemia and hypertension. SSS was the most common site of venous sinus thrombosis.

Detection of Homologous Blood Transfusion in Sport Doping by Flow Cytofluorimetry: State of the Art and New Approaches to Reduce the Risk of False-Negative Results.

This article presents the results of a study aimed to give new suggestions and strategies for improving the implementation of the flow cytofluorimetry-based method for the detection of homologous blood transfusions in doping control. The method is based on the recognition of the phenotypic mismatch between minority blood group antigens possessed by the donor and the recipient. Two strategies have been followed to reduce the risk of false-negative results: (i) the monitoring of a broader range of erythrocytes surface antigens; and (ii) the application of different surface erythrocyte staining protocols, tailored on the different antigens and the type of antigenic mismatch that had to be detected (whether it is the donor or the recipient who expresses or not the antigen to be detected). Special attention has also been focused on the time factor, to avoid prolonged sample storage, since hemolysis may have a significant impact on the reliability and quality of the results. Our experimental evidence suggests that the risk of false-negative results can be minimized by (i) the expansion of the antigen panel, with the inclusion of four additional targets; (ii) a more accurate selection of the gating area of the red blood cells; (iii) the choice of a better fluorochrome (alexa fluor 488) to be conjugated to the secondary antibody; and (iv) the implementation of different staining protocols depending on the nature of the double population to be detected (donor expressing vs. recipient non-expressing and vice versa). The combination of the above approaches allowed a significant reduction of false-negative results, assessed on samples simulating a homologous blood transfusion between two compatible subjects.

Are You Game – Theoretically? A Critical Discussion of A Game-theory-based Argument in Favour of Banning Doping

ABSTRACT The aim of this article is to present and critically discuss a game-theory-based argument in favour of the view that sports organizations ought to ban the use of performance-enhancing drugs in sport. After presenting the argument in detail, I try to show that the argument is not convincing. First, the argument cannot be used to argue in favour of WADA’s (World Anti-Doping Agency) current ban on doping, at least if it rests on the assumption, that doping use is always harmful. However, that in itself may not be a problem for adherents of the argument, and they can and should modify the harm assumption to cover only harmful use of doping. Second, even with this modification, it is argued that the harm assumption is flawed, for example, because it is not obvious why we should accept certain harms in sport but not harm to athletes caused by doping. Third, the argument is also flawed because it entails the non-competitive assumption: if all athletes dope, then no competitive advantages are gained by any athletes assumptions. The non-competitive assumption is challenged in view of the observations that doping can have some non-competitive advantages and is, so to speak, not only a positional good and because doping, due to unequal responsiveness, can give some highly responsive athletes a competitive advantage over less responsive athletes.

Anti-doping Activities and Comprehensive Health Support for Young Athletes

In this study, we conducted a survey and interviews of young athletes to clarify the actual conditions of medication use and nutritional management (supplement use, etc.) with the aim of enhancing their health support. In addition, a second questionnaire was conducted for pharmacists working at medical institutions to clarify the actual situation of anti-doping (AD) activities by pharmacists, and examined the issues they face to support the health of athletes in the future. The results of the athletes' surveys revealed that the roles of pharmacists in AD activities was not recognized by athletes. In particular, the dissemination of AD education by pharmacists is considered to be critical. In future AD education, it will be necessary not only to provide knowledge of prohibited drugs, but also to provide self-medication support tailored to the individual needs of athletes, such as knowledge of nutrition and health. The results of the pharmacist survey revealed that athletes are treated by pharmacists on a daily basis, but for pharmacists, there are difficulties regarding how to provide information on AD, and it is necessary to enhance AD education at schools of pharmacy as well as in lifelong education seminars. Considering the pharmacists' AD activities as part of health support for athletes, it is considered more effective to collaborate with other health professionals such as sports doctors or nutritionists because it requires a wide range of knowledge such as nutrition.

Why Did the Sports Pharmacists Create the Card Game?

Anti-doping (AD) education for athletes is mainly one-way and through passively attended lectures. As such, learning about prohibited substances and highly technical doping rules is often difficult for athletes. Therefore, having athletes passively attending lectures is not enough to prevent unintentional doping violations caused by medicines and supplements. Therefore, it is important for athletes to acquire knowledge about individual prohibited substances as well as active learning and practical knowledge about AD measures. "Doping Guardian" is an educational card game that has been developed to help prevent unintentional doping violations. Participants (pharmacists) of this game can learn how to use medicines and supplements from an AD perspective while simulating the life of an athlete. This presentation will provide an overview of this card game and how it has been used to date.

Anti-doping Activities by Hospital Pharmacists

With the hosting of the Tokyo Olympics, interest in anti-doping (AD) has increased, and at the same time, sports pharmacists (SPs) are expected to play active roles. However, despite the fact that it has been more than 10 years since the SP certification system was launched, the existence and roles of SPs are not well recognized by sports officials, and many SPs feel that there is no place or way for them to contribute. In my case, as a staff member of the federation, I have supported competitions as a referee and secretariat, so I have had opportunities to conduct AD activities such as seminars for athletes and coaches, and to respond to inquiries. Also, in my work as a hospital pharmacist, I have had opportunities to respond to informal inquiries about AD measures from hospital staff. In both cases, I think it was very important to first make people aware of the existence of SPs.The current problem is that it is sometimes difficult for the federation's staff to respond promptly, which puts a burden on their normal work. Therefore, it is important to have pharmacists who are close to the athletes and can provide health consultations on a daily basis in order to share correct information, educate them about AD measures, and help manage their health.

History of testosterone therapy through the ages.

The symptoms of testosterone deficiency have been known throughout history with evidence dating back to the twenty-first century BCE when men were castrated to be docile and obedient servants. Experimentation ingesting mammalian testicles began during the reign of the Roman empire and continued through the nineteenth century with claims that the substance found within these testicles could improve energy, erectile function, and urination. In the twentieth century, studies transplanting animal testes onto other castrated animals suggested that a substance produced in the testicle was responsible for systemic effects. Then in 1929, Adolf Butendant was the first to isolate testosterone and shortly after synthetic formulations of testosterone were created. While testosterone therapy is an important treatment for testosterone deficiency, the history of testosterone therapy has not been without abuse from doping scandals in the twentieth century and the use of testosterone therapy for conversion therapy and treatment of psychiatric disease. Today, there are clear and appropriate clinical uses of testosterone set by the American Urological Association to treat clinically significant testosterone deficiency. Still, even with such guidelines, the potential for misuse and abuse remains high in physicians and athletes. There is a long history that has led to the development of testosterone therapy and when used appropriately can significantly improve the quality of life for men with testosterone deficiency.