I'll be watching the Olympics again this year whenever I can. I'll watch for the explosive performances and tight finishes on the track and field. I'll look for the photo-finish touch in the pool. I'll be tuning in for gymnastics' superhuman-like shows of power and balance.

And, I'll be watching a new Olympic pastime: seeing who gets caught using performance-enhancing drugs, or PEDs. "Citius, Altius, Fortius"--the Olympic motto--translates to: Faster, Higher, Stronger. Does that sentiment drive some athletes to seek enhanced results?

This post marks the beginning of a blog series covering PEDs and how they have affected Olympic games and athletes. PEDs have profoundly changed modern sporting contests and media coverage of them for decades. In addition to the Major League Baseball steroid scandals and July's renewed accusations of Lance Armstrong's blood doping, there have been instances and investigations of doped Olympians dating back to East German and Soviet-era athletes more than 40 years ago.

Only more recently have governing bodies--namely the World Anti-Doping Agency, "WADA," which tests international contests such as London's 2012 Olympics--attempted to test for and regulate their use and abuse. Along with competitive advantages, PEDs carry severe health risks. They can even kill.

Dr. William Mitchell is an orthopedic surgeon and an expert on this subject, having worked with professional and amateur athletes in greater Boston for more than 25 years and having served as contributing editor to The Encyclopedia of Sports Medicine. Of the many drugs on the black market, Mitchell spotlights "the big three": erythropoietin, or EPO; human growth hormone, also known as hGH; and synthetic testosterone. All are prominently featured on WADA's nine-page list of prohibited substances, which went into effect on January 1 this year. It provides the standard for prohibited chemicals among international athletes and will guide official Olympic testing in coming weeks.

Dr. Mitchell walked me through the first section of WADA on anabolic agents, or synthetic versions of testosterone. At the top of the long list are the lab-made hormones androstenediol and androstenedione. Along with many similar anabolics, these are laboratory-made versions of the body's main strength inducing hormone, testosterone.

Both men and women produce testosterone naturally. It imparts primary sex characteristics in males, like a deep voice, facial hair and sexual organs. In both genders, it metabolizes amino acids from the diet into the proteins that make up muscle fibers. Therefore, the more testosterone in the body, the more muscle building potential.

Athletes take these synthetic forms of testosterone hoping to gain strength and muscle density, decrease recovery time after training, and reduce the incidence of injury during intense workouts.

But side effects of these drugs go beyond the simple risk of being caught using. Rage, depression, severe acne and baldness, in both genders, may be the best-known side effects. Less widely circulated are the more severe repercussions of chronic use, like liver abnormalities and tumors, heart and circulatory impairment, cholesterol risks, and the added danger of contracting infectious diseases, like HIV or hepatitis, from shared needles. Every one of these can be life threatening. Because of these dangers, and the use of anabolic agents across so many athletes in multiple sports, the WADA ranked them at the top of their prohibited list, said Mitchell.

Scrolling down the document, you don't have to go far to find the second and third of Mitchell's "big three," hGH and EPO.

Like the "andro-" drugs, hGH is an anabolic hormone very similar to testosterone. Naturally secreted by the pituitary gland in both sexes, it too increases muscle mass. Mitchell relates it very closely to testosterone in that hGH builds proteins from the food we eat so that bone and muscle can grow in density. Olympians in strength and speed events--sprinting, power lifting, swimming, boxing--may be competing against athletes who have used hGH.

Technically, hGH is available only by doctor's prescription, and it is typically used to help young children with deficiencies leading to inhibited growth. Though it hasn't been studied as a performance-enhancer--the ethical implications of such a study are troubling--baseball fans allegedly saw it in action in Barry Bonds. HGH increased Bonds' muscle mass along with his shoe size and even his skull size, said Mitchell.

"That's human growth hormone," he said. "That's what it does."

HGH brings its own set of risks. Topping the list is cardiomyopathy, an enlarging and thickening of muscles in the heart, that weakens heart function over time. HGH can also impair glucose regulation, leading to type-two diabetes. Over prolonged use, joints, tendons, ligaments and muscles can deteriorate, causing an ironic lack of strength in the aging hGH athlete.

This brings us to the last of the "big three," EPO. The drug, epoietin alpha, is a laboratory version of erythropoietin, a naturally-occurring hormone produced by the kidneys and liver that stimulates red blood cell production by the bone marrow. By helping to increase the number of red blood cells, which contain hemoglobin molecules that transport oxygen from the blood to the muscle, EPO boosts the amount of fuel muscles have to burn for energy. In medical applications, it has been used to treat lack of blood iron, or anemia, in patients with greatly impaired kidney function from diseases like AIDS. It can also be used before surgery, like open-heart procedures, to counter the effects of anticipated blood loss.

But, it has been implicated in the death of at least 18 cyclists during alleged heavy use in the 1990s. These cyclists were victims of bleeding events: stroke, heart attack, and blood clots in the lungs called pulmonary edemas.

With so many grave risks, are the perceived benefits worth it? In fact, none of PEDs' touted performance benefits--taken at high doses acquired on the unregulated black market, and with prolonged use or abuse--have been proven. After all, giving athletes high doses of dangerous drugs for research purposes would be highly unethical.

Mitchell agrees: "Doping increases health risks when doses and amounts of hormonal use is not regulated and can lead to overdosing and catastrophic health risks including death."

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Chris Doorley

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