Ty Johnston, PharmD Candidate
Competitive Edge
For as long as sports have been around, so has been the desire to gain a competitive edge. With huge financial incentives and relentless pressure from the sports industry, the use of performance-enhancing drugs (PEDs) has been increasing.2 In the light of Robinson Cano’s game suspension,1 part one of this two-part series will cover masking agents, followed by an article on performance enhancing drugs – both of which are commonly abused by professional athletes and have important uses in medicine.
What is a Performance-Enhancing Drug?
PEDs, as the name suggests, are substances that are used to improve any form of activity performances. The use of PEDs by athletes is commonly referred to as “doping” and is considered unethical by most professional sports organizations, including the International Olympic Committee. Therefore, its use is prohibited, and some examples of PEDs but are not limited to:
- physical enhancers, such as anabolic steroids
- mental enhancers, such as stimulants
While they may be prohibited, it’s important to keep in mind that they play an integral role in various common medical conditions.
What is a Masking Agent?
A masking agent is a type of medication used to prevent the detection of PEDs. Naturally, masking agents are commonly used to show false-negative drug tests issued in professional and olympic sports. Different agents have varying mechanisms of action, but essentially, they all work to prevent an illegal substance from being detected in the body.
Commonly Banned Masking Agents
#1 Diuretics
This is a class of medication that is commonly used to treat medical conditions such as high blood pressure, liver failure, kidney disease, and heart failure.3 As you can imagine, it’s unlikely that any professional athlete would be using the medication for these reasons; however, it would be possible to obtain a medical use exemption if the athlete has a condition that requires its use. Diuretics that are frequently prescribed include:
- Furosemide
- Hydrochlorothiazide
- Spironolactone
One of the ways that sports organizations detect the use of banned substances, such as anabolic steroids, is by identifying the substance in the urine. What diuretics do is they increase the amount of water being eliminated through the urine. Since many medications and PEDs are often eliminated in the urine, this makes the amount of PED in the urine less concentrated and harder to detect by drug tests.3 They were first banned from use in athletes in 1988 for two reasons:
- They are used to mask other illegal substances, such as anabolic steroids and stimulants
- They help to rapidly reduce an athlete’s body weight by flushing water out of the body. This becomes a problem because this allows athletes to compete in a lower weight-class or simply allow the athlete to perform at a faster speed due to their reduced weight.3
This is the type of medication, specifically furosemide, that Robinson Cano tested positive for and resulted in his 80 game suspension.
#2 Plasma Expanders
Similar to diuretics, plasma expanders work to dilute the concentration of PEDs. However, rather than diluting the urine, plasma expanders work to increase the volume of blood in the body, thereby reducing the concentration of PED and making it harder to detect.4 The specific mechanism of action gets a little complicated, but essentially, they work to bring fluid from your tissues into your blood. Just like diuretics, plasma expanders may be used in multiple medical conditions, such as those that result in low blood volume in your body. Plasma expanders that are frequently used for medical use include:
- Dextran
- Albumin
As masking agents, plasma expanders are commonly used to hide the use of a common PED that goes by the name erythropoietin (EPO). Use of EPO is often referred to as “blood doping”.5 Stay tuned for part two to hear more about blood doping with EPO as a performance enhancer.
#3 Epitestosterone
Unlike diuretics and plasma expanders, epitestosterone does not work to dilute the presence of banned substances in the body. Instead, epitestosterone specifically works to mask the use of an anabolic steroid, testosterone. PED screening methods typically include a test that measures a ratio of two substances, testosterone and epitestosterone, otherwise known as T/E ratio.7 When an athlete artificially boosts the amount of testosterone in the body, the T part of the T/E ratio goes way up and is easily detected. But when the athlete also takes epitestosterone it counterbalances the E portion of the ratio to make high levels of testosterone less detectable. Unlike the first two masking agents, epitestosterone does not have any medical uses; however, it’s a natural hormone found in the body.
Robinson Cano Story
Yes, Robinson Cano tested positive for furosemide, a masking agent, and was suspended 80 games. But does this mean he was purposefully cheating the rules and abusing performance-enhancing drugs? Using masking agents does not necessarily mean that an athlete is using a substance to enhance their performance. Cano claims that the medication was prescribed to him by a licensed physician in the Dominican Republic for treatment of a medical ailment, and that he was unaware the medication was prohibited by Major League Baseball.1 As we now know, diuretics are frequently used for a variety of medical conditions; but we also know that there is a valid reason why substances like furosemide are prohibited by professional sports leagues.
Bottom Line
With increasing pressures on professional athletes, the desire to gain an edge and use a performance-enhancing drug is also increasing. Abused substances are prevented from being detected in the body by certain lab tests through the use of masking agents, which also serve as vital treatments for serious medical conditions. In addition to performance-enhancing drugs, masking agents are also prohibited by professional sports organizations. When masking agents are detected, regardless of the reason, athletes may expect severe consequences, such as suspension in the case of Robinson Cano of the Seattle Mariners.
Did you enjoy this article? Stay tuned for part 2 of the series focusing on performance-enhancing drugs.
As always, we hope you took away something valuable from this piece. If you have any questions or concerns regarding this article or others, feel free to reach out to us on Instagram, Facebook, or at ask@orbishealth.ca with your feedback. We’d love to hear from you.
RESOURCES
- https://www.mlb.com/news/robinson-cano-suspended-80-games/c-276822884
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2962812/
- Lexi-Comp: Furosemide
- https://www.addiction.com/3357/masking-agents-for-drug-tests/
- https://www.wada-ama.org/en/questions-answers/blood-doping
- https://www.cnn.com/2013/01/15/health/armstrong-ped-explainer/index.html
- https://www.sciencedirect.com/topics/neuroscience/epitestosterone
