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Is it medicine or dope? A cat. 4 vs. the USADA

A masters racer is on the outside looking in, sidelined by his medical need to take testosterone. Is it right?

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ARVADA, Colorado (VN) — Jeff Hammond could be anyone.

Any bike racer in America, anyway. You have no reason to know his name. He’s never won a race, and he probably never will, by his own admission.

But you know Jeff Hammond, or someone like him. He’s lined up next to you at a race a hundred times. He’s the guy who loves racing, loves being a part of something; the guy who gets dropped, but doesn’t mind.

Because he isn’t racing to beat you — he’s racing to beat himself.

“I’m a cat. 4. I’m mid-pack, if lucky,” Hammond said. “I never did any sports in high school. The only position I played on the football field was the bass drum in the marching band.

“But it’s something I always wanted to do. It was a bucket-list type of thing.”

Hammond, who lives on the outskirts of Denver, was always interested in cycling.

“I was on the Wall watching Greg LeMond battle the big bad Russians in one of those classic Morgul-Bismark races,” he recalled.

Finally, nearly 10 years and 45 pounds ago, he jumped in, buying a bike for $300 on eBay, “an old aluminum Cannondale ass-hatchet with down-tube shifters,” he said, somehow fondly.

Before he knew it, he was a 50-something racing for a small Colorado team, afflicted with the same sickness that keeps husbands from telling their wives how much their bikes actually cost, or keeps college kids eating rice dinners, paying for race weekends with ones and fives and tanks of gas.

“When I get out on my bike, I don’t have a mortgage payment. I don’t have bills. I don’t have career worries. It’s that kind of freeing — and I think I’m not really a religious person at all — but I think it’s the most spiritual thing that I do,” Hammond said.

“In fact, I remember the first time I ever rode up [Golden’s] Lookout Mountain without stopping. I’m sure it was painfully slow, but it was one of the greatest memories that I ever had.”

Hammond is handsome in the way lots of older racers are: lean, graying temples, faces that show the miles in the legs below. You’d be hard pressed to know he had any medical troubles at all.

But he does — conditions that deplete his testosterone levels and nibble away at his bone density. He pieced it together after years of feeling tired, though he never really knew the cause of his fatigue when he worked odd hours in broadcasting.

After he started working normal hours as a professor in media at a nearby university and didn’t feel any better, Hammond went to the doctor. The diagnosis was hypogonadism, and now he takes supplemental testosterone to raise his levels to average for a man of his age, 58. He also takes the medication to combat low bone density.

The recovery was slow, and Hammond says that now he only feels like a normal version of himself. But since starting the testosterone therapy last spring, he hasn’t raced in a USA Cycling-sanctioned event, which most races in Colorado are.

“It was heartbreaking. It really was,” Hammond said. “But that was the right thing to do. If I wanted to, I could have just not told anyone. I could have continued to race, and truth be told I probably never would have been tested. But there was a chance.”

On a table in front of Hammond on this rainy, monochrome Colorado afternoon are stacks of papers — articles he’s printed and researched, sections of World Anti-Doping Agency code, letters from the U.S. Anti-Doping Agency.

“Testosterone is an anabolic steroid and has been shown scientifically and medically to improve muscle strength, recovery, and performance. As such it is included on the WADA Prohibited List as a substance prohibited at all times,” reads a letter Hammond received from USADA, explaining why he wouldn’t be given a therapeutic-use exemption, or TUE.

He’s highlighted the parts he finds important: “Justification for the use of testosterone must meet the standard of demonstrating an organic cause of androgen deficiency/male hypogonadism. A diagnosis based simply on a functional disorder does not meet this standard … rather, functional diagnoses often focus solely on low testosterone levels and generalized symptoms.”

And so, the very medication that keeps him healthy now prevents him from competing, from earning mid-pack finishes in category 4 races. He was formally denied that honor on April 18, 2013.

The TUE process

USADA has the unenviable chore of reviewing medical conditions and their treatments, analyzing causes for diseases, and — in some cases — telling athletes that they won’t be granted exemptions to compete while taking certain substances.

According to the 2012 annual report, the anti-doping body received 409 requests for TUEs last year, either directly or though athletes’ federations. Just 218 were granted. One hundred and forty eight required no action, meaning the application was for a permitted medication, the athlete withdrew the application after the submission, or the athlete was not actually required to obtain a TUE due to his or her competition level. Thirty-nine applications were denied, and four were listed as pending.

Fifty-two of the applications for TUEs were for anabolic agents like testosterone. The greatest frequency of requests came for stimulants, at 115. Forty-three percent of the calls USADA received in 2012 were related to medications, and 32 percent had something to do with therapeutic use exemptions.

It’s clearly a topic on the minds of competitors nationwide. But why?

USADA science director Matthew Fedoruk says athletes have simply become more aware of the anti-doping rules under which they compete.

“As a consequence of that, I think we’re seeing more athletes that are at that masters level realizing that they were perhaps taking a prohibited substance, and that they need to go through legitimate channels in order to get that approved, if that’s what they want to do and continue competing in sanctioned events and not risk testing positive,” he said. “I think it’s a product of overall greater awareness, not necessarily contributed to one particular substance, per se.”

USADA cannot comment on specific cases due to medical privacy laws and therefore could not discuss Hammond’s case specifically. Asked if it’s difficult to enforce and apply TUE standards when medical conditions themselves can be inherently subjective, Fedoruk said it was largely not, because his agency takes its cues from WADA, the world body. Applications go through independent panels of physicians and specific endocrinologists, Fedoruk said.

“Our bar is naturally set very high. And so despite what the rules may be in specific sports that maybe aren’t under the WADA code, the bar that we have delineates very specifically what’s acceptable and what’s not,” he said.

There is little flexibility in that regard, as Hammond has learned.

His doctor, Michelle Cassara, sent VeloNews an e-mail confirming Hammond’s need for treatment.

“It appears he has been accurate and forthcoming with regard to his issues and need for therapy,” she wrote.

But in some cases, that’s not enough.

For hypogonadism and androgen deficiencies, there’s a document USADA uses to ensure consistency across applications, and it “applies equally to a 20-year-old as to an 80-year-old,” Fedoruk said.

“There’s not an ability to kind of do age-graded evaluations, or different, based on … specific competition criteria,” he added. “The rules are, fortunately or unfortunately, depending on what side of the fence you’re on, applied equally.

“There has to be more than just generalized symptoms, or a single low blood test, a single low value. They have to be able to show a diagnosis and pinpoint a reason for why they have hypogonadism. So without that, it’s impossible for us to grant a TUE. Then you would be opening up, essentially, a Pandora’s box if you lowered the bar on the TUE criteria.”

Treating patients vs. curing a sport

Part of the problem is that while physicians are focused on treating their patients, USADA is charged with ensuring a level playing field in sport. And as the racing population ages, situations like the one in which Hammond finds himself could become more common.

“I think there’s a real cultural shift that we’re going through in our society around aging and well-being,” said Fedoruk. “And I think it’s our job in sport to make sport fair to all athletes equally.

“What may be acceptable outside the realm of sport is different, because these substances are performance-enhancing. They build muscle. They increase hematocrit and hemoglobin, which allow an athlete to work harder. And so there’s a potential for these athletes to go beyond what may be bringing them back to a normal state of health and go into that realm of performance enhancement.”

When USADA receives a request for a therapeutic use exemption. Fedoruk said, the agency relies on strict criteria and trusts its TUE committee members, “with their medical and professional judgment, to look at each athlete’s application individually, and within the criteria decide if it’s appropriate.”

And when a request is denied, as Hammond’s was, it’s often just the first step in a process.

“I feel very strongly about allowing the athlete to come back with more medical information,” said Fedoruk. “And they’re provided very extensive commentary on the reasons for denial as well, if their application is denied … it’s a denial letter with a very detailed opinion as to why the athlete doesn’t meet the criteria.”

But Hammond thinks there may be some flexibility in the WADA code that USADA is missing, noting minute differences in the wording the two bodies use in some of their rules.

“They’re treating us the same as they treat 20-year-old Olympians,” he said. “Something that’s considered a performance-enhancing drug for an 18-year-old may be a necessary … life-saving medication for a senior athlete. I think it’s very unfair.”

Hammond knows that a group like USADA is necessary.

“I think they probably do more good than bad. I don’t think they’re bad people … I’m sure their intentions are noble,” he said. “I just think that in some ways they have tunnel vision, and they paint every athlete and every substance with the same broad brush.”

Racing ahead?

Hammond clearly has not become Superman as a consequence of the therapy. He thinks he can recover faster, but it’s hard to tell — he’s used to not sleeping much, and is better rested now than in the years before he began treatment. His time for a long local climb did drop, but only by a minute.

“I didn’t feel like Jens Voigt,” Hammond said. “I felt like me.”

He’s reached out to public officials, lobbying for support in his case. So far, nothing has changed — except, perhaps, his desire to continue testosterone treatments.

Hammond is considering going “off the gel” next season so that he may compete, or even attempting to go through an anti-doping agency outside the U.S. in hopes that one would look upon his condition more favorably.

His doctor doesn’t think he should abandon the testosterone, due to his bone-density issues. But not pinning on a number gnaws him down, maybe more than fragile bones ever would.

“I’ll probably never stand on a USA Cycling podium regardless of whether I get an exemption or not. [But] in racing there are all sorts of these little victories that you look for,” he said. “Maybe you did a little better than last year. Maybe you beat a guy this year that you noticed was ahead of you in the standings last year. And it doesn’t matter if it’s for 10th or 30th or 50th place for me. It was those little victories.”

One thing he won’t do for those little victories? Cheat.

“If I can’t race, I won’t cheat. I just won’t. I’ve thought about it and I won’t. My health is too important. The reputation of my team and our sponsors is too important, too. I’ll try to find alternative ways of riding my bike, live with it, and move on.”