The need for ‘T’ — amateur cycling and testosterone TUEs
The man who helped beat the U.S. Anti-Doping Agency transports his performance-enhancing drugs in an orange bag meant to hold his morning newspaper. Jeff Hammond slowly unrolls the plastic sack and places its contents on the table of this suburban coffee shop outside Golden, Colorado. “Here it is,” Hammond says.
“This is what all the fuss is about.”
A syringe sits next to a clear glass vial about the size of a spool of thread. The label reads Testosterone Cypionate Injection, 200 milligrams. An average sports fan might recognize the liquid as the preferred performance enhancer of Floyd Landis, Alex Rodriguez, and East Germany’s Olympic track and field team from the 1970s.
To Hammond, the chemical represents something else entirely. Hammond is 61, with a thatch of silver hair sprouting from under his ball cap, and a face that bears the familiar deep creases of a lifelong outdoor enthusiast. He’s trim and athletic, the byproduct of the 10 hours he spends each week training on his bike for masters races.
Without his weekly testosterone injection, Hammond says, he would barely be able to get out of bed, let alone ride and race his bicycle. At age 57, Hammond noticed a sudden drop in energy. Blood tests revealed that his bones were as brittle as those of a 90-year-old woman. After months of doctor’s visits, Hammond went to an endocrinologist who told him that his natural testosterone level was abnormally low and diagnosed him with hypogonadism.
As a cycling fan, Hammond was well aware of testosterone’s reputation as a performance enhancer. He was also cognizant of the uptick in amateur athletes being caught for using banned substances, and the stigma that followed amateur dopers. Hammond applied with the U.S. Anti-Doping Agency for a Therapeutic Use Exemption (TUE) — the document that allows an athlete to use a banned substance for medical reasons. When USADA denied his request, Hammond quit racing altogether.
“It broke my heart to have to stop racing,” he says. “Even though the chances were slim I’d ever be tested, I didn’t want to break the rules.”
Hammond seemed resigned to live in exile from his sport, until he met two other men who had run afoul of USADA’s hardline stance against prescription testosterone. Triathlete and cyclist Dr. Sloan Teeple had repeatedly applied with USADA for a TUE and was denied no less than three times. Oklahoman Roger Wenzel, a track and field athlete, had applied for a TUE after USADA busted him for taking testosterone to treat his Parkinson’s disease.
Over the course of several years, the three men waged a small war against the doping authorities, hoping to win the right to use testosterone. Every effort failed, until finally the issue went to court. Then, in mid 2015, USADA quietly reversed its course. The agency created a new document, called the Recreational Competitor Therapeutic Use Exemption (RCTUE), aimed at average Joe athletes like Hammond, Teeple, and Wenzel.
When Teeple received his RCTUE, he proudly posted the document on his personal website. When Hammond received his RCTUE, he started crying. Wenzel never got his. After serving a two-year ban, the 65-year-old grandfather died of liver cancer in early 2015.
“I thought a lot about Roger during this whole thing,” Hammond says. “It feels a lot like he was vindicated and he never got to see that.”
PRIOR TO 2012, most Americans saw doping as a problem contained within the highest echelon of pro sports. That perception changed after organizers of the Gran Fondo New York paid to have drug testing at their inaugural event. Cycling journalists scoffed at the decision — why pay upward of $15,000 to patrol a bunch of enthusiast riders? So when the tests caught two athletes for using EPO, the media jumped on the story.
Ensuing stories in The New York Times and The Wall Street Journal revealed that USADA was already catching and banning age-group athletes for PED use in low-level events. These athletes were buying and using powerful drugs, such as EPO, human growth hormone, and testosterone.
“We’re hearing from athletes at all levels of sport that they want anti-doping,” USADA CEO Travis Tygart said in a 2012 interview. “Maybe they’re not professional, but they’re putting too much hard work in to be cheated.”
Almost overnight, amateur doping became the hot topic within America’s endurance sports community. Across the country, online message boards morphed into platforms for accusation. The usual ride banter transformed into speculation as to which riders in the local scene might be using. “You see some guy in his fifties on the front of the group just drilling it, and people start to wonder,” says Jared Zimlin, president of Florida’s bicycle racing association. “At a certain point it stops being gossip.”
Florida’s growth in anti-aging clinics made it a testing ground for efforts to combat amateur doping. In 2012, Zimlin launched a grassroots fundraiser to pay USADA to conduct limited testing across Florida. Other organizations soon followed. New York’s bicycle racing association launched an amateur doping program in 2013, as did Colorado’s American Cycling Association. Later that year USA Cycling launched the Race Clean program, which matched those funds to pay USADA for more testing. The following year, incoming USA Cycling CEO Derek Bouchard-Hall tacked a $3 fee onto most amateur racing licenses to bring USADA to more amateur races.
“I solicited feedback from our membership; the No. 1 complaint was that we had to do something about doping in the amateur ranks,” Bouchard-Hall told VeloNews at the time.
The rush to fight amateur doping brought powerful changes into regional sports communities, as well as some unintended consequences. Tens of thousands of new athletes became part of USADA’s semi-regular testing pool. Unlike professionals, amateur athletes, especially masters racers, aren’t always in tip-top shape. Many suffer ailments that one does not see in the elite ranks, and they require medication that elite athletes do not. And while professionals must be cognizant of the substances on WADA’s banned list, amateurs are often unaware that a specific medication they are taking is forbidden.
“It broke my heart to have to stop racing.”
Officials from USA Cycling and USADA recognized a looming conflict. As the amateur doping umbrella spread, the two organizations embarked on aggressive messaging campaigns, distributing literature about which substances were acceptable and which were banned. USA Cycling’s then CEO, Steve Johnson, said in 2013 the governing body was prepared to give first-time offenders a warning if they tested positive for a prescribed medication that was on the banned list.
“We want to be fair,” Johnson said.
Not everyone received a warning. In some instances, the new rules ensnared amateurs whose doping infractions did not look like cheating. Wenzel was an early casualty. The Oklahoman had been diagnosed with Parkinson’s in 2000, and his doctor, an authority on Parkinson’s treatment, prescribed a laundry list of medications, including testosterone. A lifelong athlete, Wenzel competed in Oklahoma’s Senior Games in track and field. After winning several throwing events, he decided to participate in USA Track and Field’s masters nationals in 2012.
Before the event, Wenzel reached out to USATF’s doping specialist to inquire about whether his medication would prevent him from competing. Wenzel said the organization gave him “vague and misleading answers.”
“One of the questions [USATF] did not answer directly was ‘Is simply taking a testosterone supplement illegal even if I am still in the low normal range?’” Wenzel wrote in an email to Hammond. “[Their] reply led me to believe that, if my level was not elevated I was okay.”
When Wenzel competed at nationals, he was subjected to a doping test, which came back positive for synthetic testosterone and the stimulant Modafanil. After the positive test, Wenzel applied for backdated Therapeutic Use Exemptions for his medications. USADA granted him a TUE for Modafanil but denied his request for testosterone. In March of 2013, USADA distributed a press release announcing Wenzel’s two-year ban for doping.
After the news broke, Wenzel gave an interview to The Oklahoman justifying the use of the banned drugs. Parkinson’s had eliminated his body’s ability to naturally produce testosterone, he said. The lack of testosterone left him horribly fatigued. He had twice fallen asleep while driving due to the lack of the hormone. The supplemental testosterone, he said, had nothing to do with sports.
“This is not optional,” Wenzel told the newspaper. “I shouldn’t have to be fighting like crazy because I take meds to stay alive.”
Hammond read the newspaper story and reached out to Wenzel. The two men started a semi-regular email correspondence, sharing their respective stories with each other. Wenzel told Hammond about his failed attempts to win a TUE and the confusion with USATF. Hammond told Wenzel about his own frustrations with USADA and put Wenzel in touch with doping specialist Dr. Paul Dimeo, who was writing a book on amateur PED use.
Months went by, and Wenzel’s ban stuck. According to his widow, Jane Wenzel, the ban cut her husband off from his social group at the local masters track and field club. He still attended track meets, but only as a spectator. “Roger couldn’t understand why if a doctor told him he could have [testosterone], it was still illegal,” Jane Wenzel said. “It frustrated him until he died.”
To those who knew him, Wenzel was a casualty of the system. To a casual reader on USADA’s website, Wenzel was just another name on the growing list of convicted dopers.
PERHAPS THE BIGGEST HURDLE standing in Wenzel and Hammond’s path was testosterone’s history as a PED. The anabolic agent is one of the most commonly abused PEDs in history, thanks to its potent ability to build muscle and boost energy.
For decades, elite athletes tried in vain to use testosterone legally. Dr. Don Catlin, who oversaw the International Olympic Committee’s anti-doping efforts in the 1980s and ’90s, said dozens of athletes applied for TUEs, claiming to be suffering from a wide range of ailments. Lacking a proper test to assess each man’s need, Catlin simply denied all of the requests.
“We had so many applications with non-specific symptoms that the athletes claimed was due to testosterone deficiency,” Catlin says. “We had conferences with endocrinologists around the country and there was just no justification for giving a TUE for testosterone to a young, healthy population. We just couldn’t see any way to do it fairly, so we didn’t do it at all.”
In recent years, the science and understanding around testosterone has improved. These days, USADA has softened its hardline stance on the drug. While it does not publish specific data on the number of TUEs it grants for testosterone, agency spokesman Ryan Madden said USADA does occasionally approve exemptions for the drug.
Still, a TUE for testosterone is one of the hardest documents to receive from the doping authorities. An athlete must submit multiple blood tests taken early in the morning over the course of several weeks, as well as examination records from a doctor and an endocrinologist, among other documents. A four-person panel of USADA-approved doctors and endocrinologists scrutinizes each application.
“It’s the most abused steroid that we see,” says Dr. Daniel Eichner, who examines TUE applications for USADA and operates the Sports Medicine Research Testing Lab in Salt Lake City, Utah. “If you use steroids, your body suppresses your natural testosterone production. An athlete who has used steroids over years will have low testosterone. So you have to prove that it’s not due to steroid abuse.”
Another member of USADA’s testosterone panel, Dr. Bradley Anawalt of the University of Washington, says a man must not only prove that he has low testosterone in order to receive a TUE, but he must also show a medical reason for the low numbers. Damage to the pituitary gland, the removal of a testicle, a tumor, or even the presence of a congenital disorder are all appropriate signs. Showing symptoms is not enough.
“There is a burgeoning group of men that have testosterone levels that are just slightly low, but not low enough,” Dr. Anawalt says. “And it’s not clear that they have a well-established medical cause for their testosterone deficiency.”
Dr. Anawalt says the majority of applications he receives show symptoms but not an explanation for hypogonadism. In fact, most come from men with just a slight deficiency in the hormone. In the eyes of USADA, that’s not good enough. “You can’t just say you have low testosterone,” Dr. Eichner says. “Establishing a reason for deficiency isn’t easy.”
Both Wenzel and Hammond assumed they met USADA’s requirements for a testosterone TUE, due to their respective medical histories. Testosterone is a common prescription for Parkinson’s, which is known to cause hormonal problems. When Wenzel’s application was denied in 2013, he applied again, citing Parkinson’s as his ailment and hypogonadism as merely a symptom. The second TUE was also denied.
Hammond’s TUE application went a similar route. He submitted 66 total pages of information, including an MRI of his pituitary gland, the results of multiple blood tests, a bone density scan, medical records going back five years, and letters from his doctor and endocrinologist. Still, he was rejected. A rejection letter said that a diagnosis of hypogonadism based “simply on a functional disorder” did not meet USADA’s rules.
Hammond disagrees with USADA’s assessment. In his eyes, his testosterone deficiency is a textbook example of why the TUE system was created. “They just thought I was some guy trying to recapture his youth,” Hammond says. “I have a hormone deficiency. I don’t build muscle or recover compared to [a racer] with normal testosterone. I’m at a disadvantage.”
USADA does not comment on specific TUE cases and, thus, did not discuss why it rejected Wenzel and Hammond. A plausible explanation for the denial, however, is rooted in the recent uptick in testosterone prescriptions for middle-aged men. The anti-aging industry is soaring, and testosterone therapy has become a regular prescription for men over 50 who show signs of low libido or fatigue. According to a 2013 study by the JAMA network, the number of men taking exogenous testosterone in the U.S. increased nearly threefold between 2001 and 2011. Anti-aging clinics and even family doctors are quick to jot down a prescription if a man exhibits a few telltale symptoms.
“Many men who receive [testosterone] therapy are not properly screened for hypogonadism,” says Dr. Jacques Baillargeon, who oversaw the study.
USADA has also seen a slight uptick in TUE applications for testosterone therapy, Dr. Anawalt says. In any given year, he could see as many as six TUE requests. Many of the applications are submitted incomplete or lack important information, he said. How many of those prescriptions were for men who met USADA’s requirements for a TUE, however, are unknown.
OF COURSE, NOT EVERY testosterone patient is simply trying to defeat old age.
Sloan Teeple, of Amarillo, Texas, started taking testosterone at age 32, well below the age at which a normal man’s testosterone begins to fade. Having recently completed medical school, Teeple was a urology resident. He and his wife had two children and hoped to have a third. So when Teeple’s libido took a nosedive in his early 30s and he began to feel tired all the time, he assumed the stress of his medical residency and fatherhood were to blame. When his libido never returned, Teeple’s wife, Susan, urged him to see a doctor.
“The sex drive did it,” Teeple says. “When it started to really impact my marriage, she knew something was wrong, and it was like, ‘You better get checked out.’”
Like Hammond, Teeple spent several weeks undergoing blood tests before doctors diagnosed him with hypogonadism and prescribed him supplemental testosterone. He knew this put him afoul of drug testers. Teeple completed an Ironman triathlon while taking supplemental testosterone and, afterward, began participating in amateur road and mountain bike races. In 2011, he applied for a TUE for his testosterone and was denied. A letter from USADA explained that Teeple failed to prove his low testosterone was due to natural causes.
“Their explanation wasn’t satisfying,” Teeple says. “I realized this whole thing was a much different beast than I initially thought.”
Teeple continued to race. He knew he was breaking the rules, but usually finished mid-pack. And instead of hiding his testosterone use, Teeple decided to adopt a motto of transparency. He began telling his fellow competitors that he was taking testosterone before the events. Teeple even had bicycle jerseys with the words “Teeple Testosterone” printed in block lettering on the chest and arms. He sponsored a local mountain bike race under the same name.
“I got zero pushback from the [cycling] community,” Teeple says. “People were more curious why a guy taking testosterone was sponsoring the mountain bike series.”
In June 2012, drug testers from USADA arrived at a local mountain bike event, which happened to be sponsored by Teeple. He was chosen as a random testing subject. Teeple told the testers that he was on testosterone and gave them the name and dose of the topical gel he used. Then he peed in their cup.
A few weeks later USADA contacted Teeple to let him know he tested positive. He hired a local lawyer, who argued the ban down to 18 months. Teeple then applied for a backdated TUE and was again denied. He applied then again in October 2013 and was denied a third time. After that denial, his frustration with the system turned to anger. “I was fed up,” he says. “I felt I wasn’t doing anything morally or ethically wrong. At that point, I wanted to make myself a target.”
BY EARLY 2014, Hammond had also reached his breaking point. He had written letters to his local congressman, Rep. Ed Perlmutter (D-Colorado) as well as the American Civil Liberties Union to plead his case against USADA. Hammond says a staffer from Perlmutter’s office wrote to USADA on his behalf. Since the agency was only partially funded by the federal government, Hammond was told the politician’s office would have little sway.
Hammond was already in regular email contact with Wenzel at that time. Both men had subsequently done interviews with Dimeo, who was researching USADA’s work with amateurs. “It was like we were this small trade union of people talking about TUEs,” Dimeo says. “These guys seemed really shaken that nobody was listening to them.”
In 2014 Hammond gave an interview with VeloNews.com. After reading the story, Teeple contacted him. The two linked up for a phone call to talk about their respective interactions with USADA and the TUE process. Hammond marveled at Teeple’s story of racing in the testosterone-themed jersey and learned that Teeple and his wife had written a book about their experience with testosterone therapy. He told Teeple to contact Dimeo and that maybe his story could shed light on their dilemma. In Teeple, Hammond saw someone with the outgoing personality and financial resources to make a legitimate challenge to USADA’s system.
Teeple told Hammond he was prepared to take on USADA. The doping agency allowed athletes to challenge its decision on a TUE, and Teeple had hired sports lawyer Howard Jacobs to work with his personal lawyer and mount a case. In early 2014 he filed an appeal against USADA with the American Arbitration Association and requested a hearing with the agency.
“I wanted a panel of independent arbitrators to hear me out and decide what was right,” Teeple says. “I wanted to be the guinea pig.”
An arbitration meeting was scheduled for July 10, 2014, in Austin, Texas. Each side would argue before a three-person arbitration group. But before the meeting could start, the attorneys for both sides called a truce.
“People were more curious why a guy taking testosterone was sponsoring the mountain bike series.”
After retreating to a conference room outside the court, lawyers from both parties began to negotiate. USADA declined to discuss the details of the meeting. Jacobs said USADA asked to put the process on hold indefinitely. Instead, the doping agency wanted Teeple to reapply for a TUE and to again submit more information about his hypogonadism. Teeple said he was asked to stop his testosterone treatment for six to eight weeks and then have his blood tested to help doctors establish a baseline measurement for his natural testosterone. “I’m not sure what they were expecting to see,” Teeple says. “Everything was already proven by that point.”
In October Teeple received another TUE denial from USADA, so he and his lawyers prepared for another arbitration hearing. In March 2015, USADA asked to delay the arbitration hearing. Several days later, a member of the arbitration panel emailed the doping agency asking it to speed up its case.
Then, on April 10, Teeple received a strange email from USADA. When he opened the attached document, he saw a page that read “Recreational Competitor Only Certificate of Approval for Therapeutic Use.” Neither Teeple nor Jacobs had ever heard of the document. An ensuing statement from USADA to The Wall Street Journal clarified the new document. “Out of fairness to those non-competitive athletes, we put in place a process that allows for them to compete while still requiring a fair and reasonable review of each recreational athlete’s medical situation,” the statement said.
Jacobs, who had represented athletes in doping cases for more than a decade, called the document a compromise. Teeple called it a victory.
“I think [USADA] finally realized they had to get serious about this,” Teeple says. “I’m really proud to have the first [RCTUE] in the world.”
EVERY FRIDAY, JEFF HAMMOND plunges a syringe into his glass bottle of testosterone, sucks out half the bottle’s contents, and injects it into his gluteus muscle. By Sunday, Hammond’s testosterone level reaches its peak. By Thursday, he’s running on empty. The hormonal roller coaster has no impact on Hammond’s mood or energy level, he says. In fact, he feels nothing at all.
“A cup of coffee would change my mood more,” Hammond says. “I don’t feel like the Hulk.”
Like Teeple, Hammond had to go off of his testosterone for several months and then submit blood work before USADA agreed to grant him a TUE. USADA’s rules require Hammond to submit his testosterone levels every three months and a doctor’s report every six months. He is forbidden from competing in the U.S. masters national championship race; only regional races are open to him. USADA also monitors Hammond’s results within Colorado’s masters races. If Hammond starts winning races, he could lose his TUE.
There’s a good chance that more athletes could be operating under USADA’s rules for the RCTUE in the future. At the time of this story’s publishing, USADA had granted four total RCTUE licenses to amateur athletes (Teeple and Hammond included). USADA did not reveal which substances received the RCTUEs.
Hammond says USADA’s guidelines are acceptable. He rarely finishes above mid-pack in road races and has not seen an uptick in his results. “I was away from [racing] for two years and I missed it so much,” he says. “My only goal is to try and beat someone who beat me the last time.”
Hammond says he rarely, if ever, gets push-back from peers who know that he takes a well-known doping product. But he’s also wary of showing any improvement on the bike. He recently started racing on the velodrome to improve his road fitness, and worries that an uptick in fitness could bring criticism. Is his improvement the product of training, or drugs? After all, testosterone’s nefarious public reputation is something that even a TUE will never overcome.
“Everyone’s initial thought of [testosterone] is body builders and Arnold Schwarzenegger,” Hammond says, laughing. “I’m not here to pump you up.”
Listen to our discussion of amateur TUEs on the VeloNews podcast: