What Doping has Taught us - Re-Defining the Role of Physicians in Sports Medicine

I started my PhD thesis in Biomedical Ethics and History of Medicine at the University of Zurich about a decade ago as a medical student. Since graduating from medical school, I have been working on an ongoing basis as a sports physician (full- and part-time) in male and female leisure and elite sports on both a national and international level. Admittedly, I have never been employed by a club on a full-time basis. Initially, my intrinsic motivation in applying for this PhD was “to be prepared” for the discussions and incentives in reference to doping in sports which I was sure would come. Therefore, the basic principle during these years has always been “the will to prepare is vital”. Consequently, the evolution of this PhD thesis is very closely related to my personal experiences and thoughts on my path to becoming a Swiss Board Certified Sports Physician in 2020. Over the last two years, sports medical practice, in the face of to the COVID-19 pandemic, has further shaped my personal attitude towards sports medicine, doping, and the physician’s role. The table of contents of this thesis (see page 1) to a great extent reflects the timeline of my education and as such answers the “research” question “what the role of the physician might be with regard to doping”, as well as within a sports medical framework in exercise medicine, leisure sports, and high-performance professional sports. The reader will be introduced to the “physician’s role in sports medicine and doping” in a step-by-step approach. Initially, the playing field will be defined by reflecting on the past, followed by current epidemiological facts on doping in sports. Furthermore, the rules of the game will be determined by portraying the ethics of doping in sports, and outlining the toolbox of bioethical theories which could be used by medical professionals in sports medicine. With the knowledge of the playing field, as well as the rules of the game the author will define challenging constellations within a sports medical framework which might help to shape the role of the physician when it comes to doping. Finally, the thesis will be rounded off by identifying future challenges to the physician’s role in sports medicine, for example gene doping and transgender athletes

Recognizing IPED Use in Clinical Practice

Die nicht-medizinische Anwendung von form- und leistungsfördernden Medikamenten (Image- and Performance-Enhancing Drugs, IPED) ist in der Fitness- und Bodybuilding-Szene weit verbreitet. Die Gründe für den IPED-Gebrauch sind oft hedonistischer Natur, und die Anwendung erfolgt oft in mehrwöchigen sogenannten «Kuren». Die häufigsten Nebenwirkungen während einer IPED-Anwendung sind: Hodenschrumpfung, Akne, Hypersexualität, Bluthochdruck, Gynäkomastie, Lipidstoffwechselstörungen, Stimmungsschwankungen, Haarverlust und Polyglobulie. Häufige Folgen nach einer IPED-Anwendung sind: Reduktion der Libido, Oligo- oder Azoospermie und erektile Dysfunktion. Um unerwünschte Nebenwirkungen und Folgen von IPED zu reduzieren, werden oft Medikamente zur Selbstbehandlung eingenommen und gelegentlich auch in der allgemeinärztlichen Praxis angesprochen und nachgefragt. = The non-medical use of image- and performance-enhancing drugs (IPEDs) is widespread in the fitness and bodybuilding scene. The reasons for IPED use are often hedonistic in nature and they are used in so-called “cycles” over several weeks. The most common side effects are: testicular atrophy, acne, hypersexuality, hypertension, gynecomastia, lipid metabolism disorders, mood swings, hair loss, and policythemia. Common consequences following IPED use are: decreased libido, oligo- or azoospermia, and erectile dysfunction. To reduce undesirable side effects and consequences, IPED users often take medications for self-treatment; occasionally IPED users also mention such medications and ask for them in the general medical practice