Drugs of abuse and the adolescent athlete

Doping with endocrine drugs is quite prevalent in amateur and professional athletes. The World Anti-Doping Agency (WADA) has a list of banned drugs for athletes who compete and a strategy to detect such drugs. Some are relatively easy, anabolic steroids and erythropoietin, and others more difficult, human growth hormone (rhGH) and insulin like growth factor I (IGF-I). The use of such compounds is likely less in adolescent athletes, but the detection that much more difficult given that the baseline secretion of the endogenous hormone is shifting during pubertal development with the greatest rise in testosterone in boys occuring about the time of peak height velocity and maximal secretion of hGH and IGF-I

Bio-Banding in Youth Sports::Background, Concept and Application

Inter-individual differences in size, maturity status, function, and behavior among youth of the same chronological age (CA) have long been a concern in grouping for sport. Bio-banding is a recent attempt to accommodate maturity-associated variation among youth in sport. The historical basis of the concept of maturity-matching and its relevance to youth sport, and bio-banding as currently applied are reviewed. Maturity matching in sport has often been noted but has not been systematically applied. Bio-banding is a recent iteration of maturity matching for grouping youth athletes into ‘bands’ or groups based on characteristic(s) other than CA. The percentage of predicted young adult height at the time of observation is the estimate of maturity status of choice. Several applications of bio-banding in youth soccer have indicated positive responses from players and coaches. Bio-banding reduces, but does not eliminate, maturity-associated variation. The potential utility of bio-banding for appropriate training loads, injury prevention, and fitness assessment merits closer attention, specifically during the interval of pubertal growth. The currently used height prediction equation requires further evaluation

Pathophysiology of Male Hypogonadism Associated with Endogenous Hyperestrogenism — Evidence for Dual Defects in the Gonadal Axis

FEMINIZING tumors of the adrenal cortex are associated with symptoms that presumably reflect the combined effects of estrogen excess and androgen deficiency — gynecomastia, diminished libido, attenuated potency, and testicular and prostatic atrophy.1 2 3 4 5 Although such tumors are extremely rare, they provide a unique opportunity to appraise the nature of endogenous estrogen action on the gonadal axis in men. In principle, the pathophysiologic effects of estrogen hypersecretion could be expressed at the level of either the Leydig cell or the hypothalamic–pituitary axis (or both), with consequent suppression of androgen production. In the present studies, we investigated the endocrine consequences of reversible endogenous estrogen excess in a patient with a surgically resectable feminizing adrenal cortical tumor

Diagnosis and testing for growth hormone deficiency across the ages: a global view of the accuracy, caveats, and cut-offs for diagnosis

Growth hormone deficiency (GHD) is a clinical syndrome that can manifest either as isolated or associated with additional pituitary hormone deficie ncies. Although diminished height velocity and short stature are useful and important clin ical markers to consider testing for GHD in children, the signs and symptoms of GHD are not always so apparent in adults. Quality of life and metabolic health are often impac ted in patients with GHD; thus, making an accurate diagnosis is important so that appropr iate growth hormone (GH) replacement therapy can be offered to these patients. Scree ning and testing for GHD require sound clinical judgment that follows after obtaining a complete medical history of patients with a hypothalamic–pituitary disorder and a thorough physical examination with specific features for each period of life, while targeted bioche mical testing and imaging are required to confirm the diagnosis. Random measurements of se rum GH levels are not recommended to screen for GHD (except in neonates) as endog enous GH secretion is episodic and pulsatile throughout the lifespan. One or more GH stimulation tests may be required, but existing methods of testing might be inaccurat e, difficult to perform, and can be imprecise. Furthermore, there are multiple caveats when interpreting test results including individual patient factors, differences in peak GH cut -offs (by age and test), testing time points, and heterogeneity of GH and insulin-like g rowth factor 1 assays. In this article, we provide a global overview of the accuracy and cut-o ffs for diagnosis of GHD in children and adults and discuss the caveats in conducting and i nterpreting these tests

Childhood Obesity

In March 2004 a group of 65 physicians and other health professionals representing nine countries on four continents convened in Israel to discuss the widespread public health crisis in childhood obesity. Their aim was to explore the available evidence and develop a consensus on the way forward. The process was rigorous, although time and resources did not permit the development of formal evidence-based guidelines. In the months before meeting, participants were allocated to seven groups covering prevalence, causes, risks, prevention, diagnosis, treatment, and psychology. Through electronic communication each group selected the key issues for their area, searched the literature, and developed a draft document. Over the 3-d meeting, these papers were debated and finalized by each group before presenting to the full group for further discussion and agreement. In developing a consensus statement, this international group has presented the evidence, developed recommendations, and provided a platform aimed toward future corrective action and ongoing debate in the international community

Genes, Gender, Hormones, and Doping in Sport: A Convoluted Tale

We are writing this piece in the aftermath of the 2016 Olympic Games in Rio de Janeiro, Brazil. Each of the words in the title plays a role(s) in deciding who may compete, especially who may compete as a woman. We shall be careful to disentangle the issues of genes and gender from hormonal levels of the potent androgen testosterone, and very clearly demarcate these natural occurrences from those of doping, for which the World Anti-Doping Agency has established strict guidelines. These elements became conflated in the aftermath of the Court of Arbitration of Sport’s decision, now more than 2 years ago, concerning the teenage Indian sprinter, Dutee Chand. Although many people associate hyperandrogenism with doping and gender determination, each is different and has a distinct function