Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Advertise | Login 
Search Article 
Advanced search 
  Users Online: 2346 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

Table of Contents
Year : 2013  |  Volume : 17  |  Issue : 7  |  Page : 18-22

Detecting growth hormone misuse in athletes

Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, United Kingdom

Date of Web Publication11-Oct-2013

Correspondence Address:
Richard I. G. Holt
IDS Building (MP887), Southampton General Hospital, Tremona Road, Southampton SO16 6YD
United Kingdom
Login to access the Email id

Source of Support: World Anti-Doping Agency, United States Anti-Doping Agency, and Partnership for Clean Competition, Conflict of Interest: None

DOI: 10.4103/2230-8210.119494

Rights and Permissions

Athletes have been misusing growth hormone (GH) for its anabolic and metabolic effects since the early 1980s, at least a decade before endocrinologists began to treat adults with GH deficiency. Although there is an ongoing debate about whether GH is performance enhancing, recent studies suggest that GH improves strength and sprint capacity, particularly when combined with anabolic steroids. The detection of GH misuse is challenging because it is an endogenous hormone. Two approaches have been developed to detect GH misuse; the first is based on the measurement of pituitary GH isoforms and the ratio of 22-kDa isoform to total GH. The second is based on the measurement of insulin like growth factor-I (IGF-I) and N-terminal propeptide of type III procollagen (P-III-NP) which increase in a dose-dependent manner in response to GH administration. Both methodologies have been approved by the World Anti-Doping Agency (WADA) and have led to the detection of a number of athletes misusing GH.

Keywords: Athletes, clinical trial, discriminant function, growth hormone, IGF-I, misuse, performance, P-III-NP

How to cite this article:
Holt RI. Detecting growth hormone misuse in athletes. Indian J Endocr Metab 2013;17, Suppl S1:18-22

How to cite this URL:
Holt RI. Detecting growth hormone misuse in athletes. Indian J Endocr Metab [serial online] 2013 [cited 2020 Jul 9];17, Suppl S1:18-22. Available from: http://www.ijem.in/text.asp?2013/17/7/18/119494

   Introduction Top

Growth hormone (GH) is secreted by the anterior pituitary gland and plays an important role in maintaining body composition, well-being, physical performance, and cardiovascular health in adults as well as children. [1],[2] These features have led to its misuse by professional sportsmen and women who wish to improve their athletic performance. [3] GH use was prohibited by the International Olympic Committee (IOC) in 1989 and it appears on the current World Anti-Doping Agency (WADA) list of prohibited substances. [4] The true prevalence of GH misuse is unknown because of the secrecy that surrounds its misuse but there are sufficient high profile cases to suggest that the scale of misuse warrants the concern of WADA. It is unclear when GH was first used to enhance performance but "The Underground Steroid Handbook" was the earliest publication to describe the potential beneficial effects of GH, [5] at least 10 years before clinical endocrinologists started treating adults with GH deficiency. [6],[7]

This review will examine whether GH is performance enhancing properties and will discuss the challenges involved in the detection of exogenous GH administration and the work undertaken to develop a robust test to detect its misuse.

   Why Athletes Misuse GH? Top

Exercise depends on an adequate supply of nutrients and oxygen to the muscle fibers. Glucose for short-term high-intensity activity and free fatty acids (FFAs) for more prolonged activity are combusted to release kinetic energy. GH has a number of effects on protein anabolism and intermediate metabolism that may improve exercise performance through increased fuel and oxygen delivery to exercising muscle, increased muscle strength or any combination of these factors. [8] In addition, it may improve cardiovascular function [9],[10] and thermoregulation. [11]

The potent physiological actions of GH have been demonstrated through a series of randomized controlled trials of GH replacement in people with GH deficiency. Prior to treatment, adults with GH deficiency lose lean tissue while accumulating fat, in particular visceral fat. [12],[13] Skeletal muscle mass and strength [14],[15],[16] is reduced with a consequent impairment of physical performance, exercise capacity, and VO 2 max (aerobic capacity or the maximum ability to take in and use oxygen). [17] Following treatment with recombinant human GH (rhGH), body composition normalizes [6],[7] and physical performance improves. [18]

It does not necessarily follow, however, that the administration of supraphysiological GH doses will lead to further performance advantage in healthy adults. Indeed the opposite is suggested by acromegaly, which is characterized by marked abnormalities in protein and carbohydrate metabolism, [19],[20] muscle weakness rather than excessive strength, [21] and cardiomyopathy. [22] A systematic review of 44 articles describing 27 studies reported that although GH administration was associated with increase in lean body mass and decrease in fat mass, it did not improve a number of measures of performance. [23]

Most recently trials have begun to show a performance benefit for GH. The first was undertaken in abstinent anabolic steroid users and demonstrated significant improvements in strength, peak power output, and VO 2 max as well as the expected changes in body composition. [24] It is possible that the prior use of steroids may have rendered the athletes particularly sensitive to the anabolic actions of GH. A further randomized, placebo-controlled trial of 6-weeks' treatment with rhGH demonstrated a short-lived improvement in sprint capacity in both men and women with GH and a synergistic effect with testosterone in men. [25]

   Potential Adverse Effects of GH Misuse Top

The side effects associated with GH administration in GH deficiency are well-documented and may affect any athlete receiving GH; [26] however, as anecdotal evidence suggests that many athletes are taking much higher doses than those used therapeutically, it is possible that features of acromegaly may become apparent with prolonged use. Additional long-term effects may include fluid retention, which may lead to ankle swelling, hypertension, headache, diabetes, and cardiomyopathy. There is also a potential for increased risk of certain cancers; including colorectal, thyroid, breast, and prostate cancer. [27] Cadaveric GH, with its attendant risk of the prion-induced  Creutzfeldt-Jakob disease More Details, is still available in the black market. [28]

   Challenges in the Detection of GH Misuse Top

Detecting the misuse of exogenous GH poses a formidable challenge for several reasons. [3] rhGH has an identical amino acid sequence to the native 22-kDaisoform of the hormone, while cadaveric GH is indistinguishable from endogenous GH. It has a short half-life (<20 min) and is secreted in a pulsatile manner leading to widely varying circulating GH concentration throughout the day. Exercise and stress are potent stimulators of GH secretion [29],[30] and so high GH concentrations in the post-competition setting would be expected.

   Development of A Test to Detect GH Misuse Top

Two different yet complementary approaches have been investigated to detect GH misuse; the first, pioneered by Christian Strasburger, Martin Bidlingmaier and Zida Wu in Germany, is based on the detection of different pituitary GH isoforms, while the second, which was developed by the GH-2000 and GH-2004 teams, utilizes the measurement of GH-sensitive markers.

   The Isoform Method Top

Endogenous pituitary GH occurs in multiple isoforms of which 70% is in the form of a 22 kDa polypeptide. [31] By contrast, rhGH comprises solely the 22-kDa isoform. When rhGH is administered, endogenous pituitary secretion is downregulated through negative feedback and the concentration of non-22-kDa isoforms is suppressed. The isoform method relies on the measurement of the ratio of 22 kDa GH to total GH. [32]

The proportions of GH isoforms are unaffected by age, sex, sporting discipline, and pathological states, [33],[34] but exercise causes a transient relative increase in the 22-kDa isoform, thereby reducing the sensitivity of the test if samples are taken immediately after competition. [35],[36] This method was introduced prior to the 2004 Athens Olympic Games and subsequently improved when the assays used for the method were commercialized. [37]

After testing over 1,000 samples, the first adverse analytical finding came in February 2010 when the British Rugby League player, Terry Newton, tested positive. [38] Since then, several other positive tests have been reported including the announcement in September 2010 from the Canadian Center for Ethics in Sport that Matt Socholotiuk, a University of Waterloo football player, had tested positive for GH use on 31 March 2010. [39] The following year, Colorado Sky Sox first baseman Mike Jacobs became the first baseball player to test positive for GH and was subsequently suspended for 50 games by Minor League Baseball. [40]

In 2011, Andrus Veerpalu, an Estonian Olympic gold medal winning skier, tested positive for GH. However, he pleaded his innocence and challenged the laboratory finding in the Court of Arbitration for Sport who subsequently acquitted Veerpalu on 25 March 2013 as the court was not convinced that the threshold for considering an adverse analytical finding was sufficiently reliable to uphold the doping conviction; nevertheless, the court stated "that there are many factors in this case which tend to indicate that the Athlete did in fact himself administer exogenous hGH". [41]

The Achilles' heel of the isoform method is its short window of detection. [42] Recombinant GH, even when injected subcutaneously, is cleared rapidly and GH is frequently undetectable in a blood sample taken the morning after an injection, [43] while spontaneous GH secretion returns to normal within 48 h of the last dose of rhGH. [44] Consequently, any athlete who ceases GH several days prior to a competition will not be detected. As such, the optimal use of this method is likely to be in unannounced 'out of competition' testing, as happened in the case of Terry Newton. A further disadvantage of this method is that it will not detect the use of cadaveric GH or GH secretagogues as these do not alter the isoform profile.

   The GH-2000 Marker Method Top

The GH-2000 marker method measures two serum proteins, insulin-like growth factor-I (IGF-I) and N-terminal propeptide of type III procollagen (P-III-NP), both of which increase in a dose-dependent manner in response to GH administration and therefore act as "markers" of GH administration. This method was first conceived by Peter Sönksen who established the large multicenter GH-2000 project, with funding from the European Union under their BIOMED 2 initiative, the International Olympic Committee and GH manufacturers Novo Nordisk and Pharmacia. Initially, 25 potential markers of GH action were considered; [45],[46] but IGF-I and P-III-NP were chosen for the GH-2000 test because these provided the best discrimination between individuals receiving GH or placebo during a 28-day randomized controlled GH administration trial. [47] Both IGF-I and P-III-NP have little diurnal or day-to-day variation, low intraindividual variation [48] and only change minimally in response to exercise. [45],[46] The markers are used in conjunction with the use of gender specific equations, "discriminant functions", to improve the sensitivity and specificity of the test compared with single-marker analysis [Table 1]. [47] The markers decline with age as endogenous GH secretion declines and a factor relating to the inverse of age is also included in the formulae. [49]
Table 1: GH-2000 discriminant function equations

Click here to view

Although the principle of the method was approved at an IOC workshop in Rome in March 1999, [50] further work has been needed to ensure that a number of confounding factors including ethnicity, [51],[52] injury, [53] sporting discipline, [49],[54] exercise, [45],[46],[55] and body habitus [49],[54] would not invalidate the test. The test has subsequently been validated in independent laboratories in Germany [56] and Australia. [57]

Although IGF-I and P-III-NP are more stable than GH, the markers still exhibit a wide interindividual variability that could mean that those with lower baseline marker concentrations are potentially harder to catch. Within individuals, however, there is much less variability which raises the possibility of the use of a biological "athlete passport" or "profiling" to improve the test sensitivity. [48]

The test was introduced at the London Olympic and Paralympic games which led to the disqualification of Nikolay Marfin and Vadim Rakitin, two Russian powerlifters, who admitted to misusing GH after an adverse analytical finding. [58]

   Conclusion Top

It is widely believed that athletes are misusing GH for its anabolic and metabolic effects. Recent studies suggest that GH has a modest performance benefit in amateur athletes, particularly when combined with anabolic steroids. Over the last decade, there have been major advances in methodologies to detect GH and this should mean that athletes will no longer be able to take GH with impunity.

   Acknowledgements Top

The author is the co-principal investigator of the GH-2004 project which is funded by the World Anti-Doping Agency, United States Anti-Doping Agency, and Partnership for Clean Competition. I would like to acknowledge the rest of the GH-2004 team and support from UK Anti-Doping. I would like to thank all the athletes, both amateur and professional, who volunteered to take part in the GH-2000 and GH-2004 studies. I thank the nurses of the Wellcome Trust Clinical Research Facility and medical students at the University of Southampton for their assistance in recruitment and follow-up of the GH-2004 subjects. The GH-2004 team is indebted to the GH-2000 team who left us a legacy of invaluable samples.

   References Top

1.Cuneo RC, Salomon F, McGauley GA, Sonksen PH. The growth hormone deficiency syndrome in adults. Clin Endocrinol (Oxf) 1992;37:387-97.  Back to cited text no. 1
2.Carroll PV, Christ ER, Sonksen PH. Growth hormone replacement in adults with growth hormone deficiency: Assessment of current knowledge. Trends Endocrinol Metab 2000;11:231-8.  Back to cited text no. 2
3.Holt RI, Sonksen PH. Growth hormone, IGF-I and insulin and their abuse in sport. Br J Pharmacol 2008;154:542-56.  Back to cited text no. 3
4.World Anti-Doping Agency. The World Anti-Doping Agency International Standard- The 2013 Prohibited List. Available from: http://www.wada-ama.org/en/World- Anti- Doping- Program /Sports-and-Anti-Doping-Organizations/International -Standards/Prohibited-List/. Accessed 26/07/2013.  Back to cited text no. 4
5.Duchaine D. Underground Steroid Handbook. 1982. Venice, California, USA: HLR Technical Books.  Back to cited text no. 5
6.Jorgensen JO, Pedersen SA, Thuesen L, Jorgensen J, Ingemann-Hansen T, Skakkebaek NE, et al. Beneficial effects of growth hormone treatment in GH-deficient adults. Lancet 1989;1:1221-5.  Back to cited text no. 6
7.Salomon F, Cuneo RC, Hesp R, Sonksen PH. The effects of treatment with recombinant human growth hormone on body composition and metabolism in adults with growth hormone deficiency. N Engl J Med 1989;321:1797-803.  Back to cited text no. 7
8.Widdowson WM, Healy ML, Sonksen PH, Gibney J. The physiology of growth hormone and sport. Growth Horm IGF Res 2009;19:308-19.  Back to cited text no. 8
9.Maison P, Chanson P. Cardiac effects of growth hormone in adults with growth hormone deficiency: A meta-analysis. Circulation 2003;108:2648-52.  Back to cited text no. 9
10.Colao A, Marzullo P, Di Somma C, Lombardi G. Growth hormone and the heart. Clin Endocrinol (Oxf) 2001;54:137-54.  Back to cited text no. 10
11.Juul A, Hjortskov N, Jepsen LT, Nielsen B, Halkjaer-Kristensen J, Vahl N, et al. Growth hormone deficiency and hyperthermia during exercise: A controlled study of sixteen GH-deficient patients. J Clin Endocrinol Metab 1995;80:3335-40.  Back to cited text no. 11
12.Cuneo RC, Salomon F, Wiles CM, Hesp R, Sonksen PH. Growth hormone treatment in growth hormone-deficient adults. I. Effects on muscle mass and strength. J Appl Physiol 1991;70:688-94.  Back to cited text no. 12
13.Johannsson G, Marin P, Lonn L, Ottosson M, Stenlof K, Bjorntorp P, et al. Growth hormone treatment of abdominally obese men reduces abdominal fat mass, improves glucose and lipoprotein metabolism, and reduces diastolic blood pressure. J Clin Endocrinol Metab 1997;82:727-34.  Back to cited text no. 13
14.Janssen YJ, Doornbos J, Roelfsema F. Changes in muscle volume, strength, and bioenergetics during recombinant human growth hormone (GH) therapy in adults with GH deficiency. J Clin Endocrinol Metab 1999;84:279-84.  Back to cited text no. 14
15.Rutherford OM, Beshyah SA, Schott J, Watkins Y, Johnston DG. Contractile properties of the quadriceps muscle in growth hormone-deficient hypopituitary adults. Clin Sci (Lond) 1995;88:67-71.  Back to cited text no. 15
16.Johannsson G, Grimby G, Sunnerhagen KS, Bengtsson BA. Two years of growth hormone (GH) treatment increase isometric and isokinetic muscle strength in GH-deficient adults. J Clin Endocrinol Metab 1997;82:2877-84.  Back to cited text no. 16
17. Cuneo RC, Salomon F, Wiles CM, Hesp R, Sonksen PH. Growth hormone treatment in growth hormone-deficient adults. II. Effects on exercise performance. J Appl Physiol 1991;70:695-700.  Back to cited text no. 17
18.Widdowson WM, Gibney J. The effect of growth hormone replacement on exercise capacity in patients with GH deficiency: A metaanalysis. J Clin Endocrinol Metab 2008;93:4413-7.  Back to cited text no. 18
19.Colao A, Baldelli R, Marzullo P, Ferretti E, Ferone D, Gargiulo P, et al. Systemic hypertension and impaired glucose tolerance are independently correlated to the severity of the acromegalic cardiomyopathy. J Clin Endocrinol Metab 2000;85:193-9.  Back to cited text no. 19
20.Ezzat S, Forster MJ, Berchtold P, Redelmeier DA, Boerlin V, Harris AG. Acromegaly. Clinical and biochemical features in 500 patients. Medicine (Baltimore) 1994;73:233-40.  Back to cited text no. 20
21.McNab TL, Khandwala HM. Acromegaly as an endocrine form of myopathy: Case report and review of literature. Endocr Pract 2005;11:18-22.  Back to cited text no. 21
22. Nagulesparen M, Trickey R, Davies MJ, Jenkins JS. Muscle changes in acromegaly. Br Med J 1976;2:914-5.  Back to cited text no. 22
23. Liu H, Bravata DM, Olkin I, Friedlander A, Liu V, Roberts B, et al. Systematic review: The effects of growth hormone on athletic performance. Ann Intern Med 2008;148:747-58.  Back to cited text no. 23
24. Graham MR, Baker JS, Evans P, Kicman A, Cowan D, Hullin D, et al. Physical effects of short-term recombinant human growth hormone administration in abstinent steroid dependency. Horm Res 2008;69:343-54.  Back to cited text no. 24
25. Meinhardt U, Nelson AE, Hansen JL, Birzniece V, Clifford D, Leung KC, et al. The effects of growth hormone on body composition and physical performance in recreational athletes: A randomized trial. Ann Intern Med 2010;152:568-77.  Back to cited text no. 25
26. Powrie J, Weissberger A, Sonksen P. Growth hormone replacement therapy for growth hormone-deficient adults. Drugs 1995;49:656-63.  Back to cited text no. 26
27. Jenkins PJ, Mukherjee A, Shalet SM. Does growth hormone cause cancer? Clin Endocrinol (Oxf) 2006;64:115-21.  Back to cited text no. 27
28. Brown P, Gajdusek DC, Gibbs CJ, Jr., Asher DM. Potential epidemic of Creutzfeldt-Jakob disease from human growth hormone therapy. N Engl J Med 1985;313:728-31.  Back to cited text no. 28
29. Prinz PN, Weitzman ED, Cunningham GR, Karacan I. Plasma growth hormone during sleep in young and aged men. J Gerontol 1983;38:519-24.  Back to cited text no. 29
30. Savine R, Sonksen P. Growth hormone-hormone replacement for the somatopause? Horm Res 2000;53 Suppl 3:37-41.  Back to cited text no. 30
31. Baumann G. Growth hormone heterogeneity in human pituitary and plasma. Horm Res 1999;51 Suppl 1:2-6.  Back to cited text no. 31
32. Wu Z, Bidlingmaier M, Dall R, Strasburger CJ. Detection of doping with human growth hormone. Lancet 1999;353:895.  Back to cited text no. 32
33. Irie M, Ueki M, Kishikawa Y, Nishii M, Kawahara T. 20K-GH and its use in detecting GH abuse. Growth Horm IGF Res 2009;19:352-6.  Back to cited text no. 33
34.Holt RI. Meeting reports: Beyond reasonable doubt: Catching the growth hormone cheats. Pediatr Endocrinol Rev 2007;4:228-32.  Back to cited text no. 34
35. Wallace JD, Cuneo RC, Bidlingmaier M, Lundberg PA, Carlsson L, Boguszewski CL, et al. Changes in non-22-kilodalton (kDa) isoforms of growth hormone (GH) after administration of 22-kDa recombinant human GH in trained adult males. J Clin Endocrinol Metab 2001;86:1731-7.  Back to cited text no. 35
36. Wallace JD, Cuneo RC, Bidlingmaier M, Lundberg PA, Carlsson L, Boguszewski CL, et al. The response of molecular isoforms of growth hormone to acute exercise in trained adult males. J Clin Endocrinol Metab 2001;86:200-6.  Back to cited text no. 36
37. Bidlingmaier M, Suhr J, Ernst A, Wu Z, Keller A, Strasburger CJ, et al. High-sensitivity chemiluminescence immunoassays for detection of growth hormone doping in sports. Clin Chem 2009;55:445-53.  Back to cited text no. 37
38. Newton gets 2 years for world-first hGH finding. Available from: http://www.ukad.org.uk/news/article/newton-gets-two-years -for-world-first-hgh-finding. Accessed 26/07/2013  Back to cited text no. 38
39. CCES announces four anti-doping rule violations from University of Waterloo football team testing including the first for an adverse analytical finding of human growth hormone in North America. Available from: http://www.cces.ca/en/news-137-cces- announces-four-anti-doping-rule-violations. Accessed 26/07/2013  Back to cited text no. 39
40. Statement on positive hGH test in Minor League Baseball. Available from: http://www.wada-ama.org/en/Media-Center/Archives/Articles/Statement-on-positive-hGH-test-in-Minor-League-Baseball/. Accessed 26/07/2013  Back to cited text no. 40
41. CAS 2011/A/2566 Andrus Veerpalu v. International Ski Federation. Available from: http://www.tas-cas.org/d2wfiles/document/6633/5048/0/256620FINAL20Award20_internet_.pdf. Accessed 26/07/2013  Back to cited text no. 41
42. Keller A, Wu Z, Kratzsch J, Keller E, Blum WF, Kniess A, et al. Pharmacokinetics and pharmacodynamics of GH: Dependence on route and dosage of administration. Eur J Endocrinol 2007;156:647-53.  Back to cited text no. 42
43. Giannoulis MG, Boroujerdi MA, Powrie J, Dall R, Napoli R, Ehrnborg C, et al. Gender differences in growth hormone response to exercise before and after rhGH administration and the effect of rhGH on the hormone profile of fit normal adults. Clin Endocrinol (Oxf) 2005;62:315-22.  Back to cited text no. 43
44.Wu RH, St LY, Martino-Nardi J, Wesoly S, Sobel EH, Sherman B, et al. Preservation of physiological growth hormone (GH) secretion in idiopathic short stature after recombinant GH therapy. J Clin Endocrinol Metab 1990;70:1612-5.  Back to cited text no. 44
45. Wallace JD, Cuneo RC, Lundberg PA, Rosen T, Jorgensen JO, Longobardi S, et al. Responses of markers of bone and collagen turnover to exercise, growth hormone (GH) administration, and GH withdrawal in trained adult males. J Clin Endocrinol Metab 2000;85:124-33.  Back to cited text no. 45
46. Wallace JD, Cuneo RC, Baxter R, Orskov H, Keay N, Pentecost C, et al. Responses of the growth hormone (GH) and insulin-like growth factor axis to exercise, GH administration, and GH withdrawal in trained adult males: A potential test for GH abuse in sport. J Clin Endocrinol Metab 1999;84:3591-601.  Back to cited text no. 46
47. Powrie JK, Bassett EE, Rosen T, Jorgensen JO, Napoli R, Sacca L, et al. Detection of growth hormone abuse in sport. Growth Horm IGF Res 2007;17:220-6.  Back to cited text no. 47
48. Erotokritou-Mulligan I, Bassett EE, Cowan DA, Bartlett C, Milward P, Sartorio A, et al. The use of growth hormone (GH)-dependent markers in the detection of GH abuse in sport: Physiological intra-individual variation of IGF-I, type 3 pro-collagen (P-III-P) and the GH-2000 detection score. Clin Endocrinol (Oxf) 2010;72:520-6.  Back to cited text no. 48
49. Healy ML, Dall R, Gibney J, Bassett E, Ehrnborg C, Pentecost C, et al. Toward the development of a test for growth hormone (GH) abuse: A study of extreme physiological ranges of GH-dependent markers in 813 elite athletes in the postcompetition setting. J Clin Endocrinol Metab 2005;90:641-9.  Back to cited text no. 49
50. Sonksen P. The International Olympic Committee (IOC) and GH-2000. Growth Horm IGF Res 2009;19:341-5.  Back to cited text no. 50
51. Erotokritou-Mulligan I, Bassett EE, Cowan DA, Bartlett C, McHugh C, Sonksen PH, et al. Influence of ethnicity on IGF-I and procollagen III peptide (P-III-P) in elite athletes and its effect on the ability to detect GH abuse. Clin Endocrinol (Oxf) 2009;70:161-8.  Back to cited text no. 51
52. Holt RI, Erotokritou-Mulligan I, McHugh C, Bassett EE, Bartlett C, Fityan A, et al. The GH-2004 project: The response of IGF1 and type III pro-collagen to the administration of exogenous GH in non-Caucasian amateur athletes. Eur J Endocrinol 2010;163:45-54.  Back to cited text no. 52
53. Erotokritou-Mulligan I, Bassett EE, Bartlett C, Cowan D, McHugh C, Seah R, et al. The effect of sports injury on insulin like growth factor-I and procollagen III peptide: Implications for detection of growth hormone abuse in athletes. J Clin Endocrinol Metab 2008;93:2760-63.  Back to cited text no. 53
54. Nelson AE, Howe CJ, Nguyen TV, Leung KC, Trout GJ, Seibel MJ, et al. Influence of demographic factors and sport type on growth hormone-responsive markers in elite athletes. J Clin Endocrinol Metab 2006;91:4424-32.  Back to cited text no. 54
55. Velloso CP, Aperghis M, Godfrey R, Blazevich AJ, Bartlett C, Cowan D, et al. The effects of two weeks of recombinant growth hormone administration on the response of IGF-I and N-terminal pro-peptide of collagen type III (P-III-NP) during a single bout of high resistance exercise in resistance trained young men. Growth Horm IGF Res 2013;23:76-80.  Back to cited text no. 55
56. Kniess A, Ziegler E, Kratzsch J, Thieme D, Muller RK. Potential parameters for the detection of hGH doping. Anal Bioanal Chem 2003;376:696-700.  Back to cited text no. 56
57. Nelson AE, Meinhardt U, Hansen JL, Walker IH, Stone G, Howe CJ, et al. Pharmacodynamics of growth hormone abuse biomarkers and the influence of gender and testosterone: A randomized double-blind placebo-controlled study in young recreational athletes. J Clin Endocrinol Metab 2008;93:2213-22.  Back to cited text no. 57
58. Latest Testing Methods Result in Suspension of Two Russian Powerlifters for Anti-Doping. Available from: http://www.paralympic.org/press-release/latest-testing-methods-result-suspension- two-russian-powerlifters-anti-doping. Accessed 26/07/2013.  Back to cited text no. 58


  [Table 1]

This article has been cited by
1 The Use and Abuse of Growth Hormone in Sports
Richard I G Holt,Ken K Y Ho
Endocrine Reviews. 2019; 40(4): 1163
[Pubmed] | [DOI]
2 Growth hormone, growth hormone secretagogues, and insulin-like growth factor-1 in sports: prohibited status, therapeutic use exemptions, and analytical detectability
Alan D. Rogol,Geoffrey D. Miller,Daniel Eichner
Current Opinion in Endocrine and Metabolic Research. 2019; 9: 8
[Pubmed] | [DOI]
3 Obese adolescents exhibit a constant ratio of GH isoforms after whole body vibration and maximal voluntary contractions
A. E. Rigamonti,M. Haenelt,M. Bidlingmaier,A. De Col,S. Tamini,G. Tringali,R. De Micheli,L. Abbruzzese,C. R. Goncalves da Cruz,M. Bernardo-Filho,S. G. Cella,A. Sartorio
BMC Endocrine Disorders. 2018; 18(1)
[Pubmed] | [DOI]
4 The Use and Abuse of Human Growth Hormone in Sports
David M. Siebert,Ashwin L. Rao
Sports Health: A Multidisciplinary Approach. 2018; 10(5): 419
[Pubmed] | [DOI]
5 LC-MS-Based Metabolomics Discovers Purine Endogenous Associations with Low-Dose Salbutamol in Urine Collected for Antidoping Tests
Yaoyao Wang,Richard Caldwell,David A. Cowan,Cristina Legido-Quigley
Analytical Chemistry. 2016; 88(4): 2243
[Pubmed] | [DOI]
6 Annual banned-substance review: analytical approaches in human sports drug testing
Mario Thevis,Tiia Kuuranne,Hans Geyer,Wilhelm Schänzer
Drug Testing and Analysis. 2014; : n/a
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Why Athletes Mis...
    Potential Advers...
    Challenges in th...
    Development of A...
   The Isoform Method
    The GH-2000 Mark...
    Article Tables

 Article Access Statistics
    PDF Downloaded409    
    Comments [Add]    
    Cited by others 6    

Recommend this journal