What's the Right Role for Performance-Enhancing Drugs?

Neil Chesanow; Don H. Catlin, MD

Disclosures

August 26, 2016

Editor's note: Don H. Catlin, MD, founded the UCLA Olympic Analytical Laboratory, the first antidoping lab in the United States, in 1982. It is now the world's largest testing facility for performance-enhancing drugs (PEDs). He served as the lab's director for 25 years.

Dr Catlin, known as the "father of drug testing in sport," has overseen testing for PEDs at the three most recent Olympics held in the United States, starting with the 1984 Summer Games in Los Angeles. He developed the carbon isotope test for detecting anabolic steroids (1991); reported darbepoetin alfa, a form of the blood booster erythropoietin (EPO), for the first time in sport (2002); identified norbolethone, the first reported designer steroid used by an athlete (2002); identified and developed a test for tetrahydrogestrinone (THG, also known as "The Clear"), the anabolic steroid at the heart of the Bay Area Laboratory Co-operative (BALCO) scandal (2003); and identified madol (DMT), the third reported designer anabolic steroid (2004), among other important discoveries.

An internist by training, Dr Catlin is professor emeritus of Molecular and Medical Pharmacology at the UCLA David Geffen School of Medicine. He recently spoke with Medscape about developing the first tests for anabolic steroids and other PEDs, his role in the BALCO affair, his thoughts on doping in the Olympics, and how the problem of PED use in sport might better be addressed.

Medscape: How did you develop the first test for anabolic steroids?

Dr Catlin: In the 1980s and 1990s, sport had an enormous problem detecting testosterone use. We were using the ratio of testosterone to epitestosterone (T/E)—an inactive steroid in human urine. If the ratio exceeded 4 to 1, the presumptive diagnosis was pharmaceutical testosterone use. However, a few athletes had T/E ratios higher than 4 but had not used testosterone. I applied the carbon isotope ratio test to distinguish whether the testosterone in urine was from normal human metabolic processes or from pharmaceutical sources.

Pharmaceutical testosterone is synthesized from a precursor in plants. The testosterone from plants contains a carbon isotope ratio that is different from normal testosterone synthesized in the human body. With this information, one could determine whether the testosterone was pharmaceutical or natural. This solved the testosterone problem for sport: If the T/E ratio was greater than 4:1, a carbon isotope ratio test was performed to determine the source of the testosterone.

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