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Raj Persaud and Peter Bruggen


Mystery continues to surround the revelation that tennis champion Maria Sharapova has tested positive for a banned substance. One of the enigmas surrounds the drug implicated; meldonium is reportedly widely used for the treatment of heart problems, so why would an elite athlete take it?


Does the incident reveal deeper and more widespread problems in performance enhancement and elite sport, than the authorities and fans would like to admit to?


A study entitled ‘Self-Reported Attitudes of Elite Athletes Towards Doping: Differences Between Type of Sport’, published in the ‘International Journal of Sports Medicine’, of 446 athletes financially supported by the National Finnish Olympic Committee, found 30 % reported that they personally know an athlete who uses banned substances. The authors, from the University of Helsinki, argued that risk of doping appears to be highest in speed and power sports and lowest in motor skills demanding sports.


A study entitled ‘Effects of Meldonium on sexual performance, sperm motility, testes morphology and blood biochemical markers in boars’, found that meldonium improved sexual performance and sperm motility in boars. This finding may be linked to the fact that blood serum testosterone was higher in the meldonium treated group.


The authors of the study, published in the academic journal ‘Animal Reproduction Science’, conclude that meldonium increased testosterone in blood serum, and it may have potential use as a sperm motility and sperm quality-enhancing agent in livestock. However, the authors of the study, based at the Latvia University of Agriculture, and the company Grindeks, also point out that it is prolonged use of meldonium which might be necessary to achieve its positive effects on testosterone, as previous research had found that shorter term administration didn’t have these effects.


A recent study, from the Monaco Institute of Sports Medicine and Surgery-Exercise Physiology, examined androgen blood levels in female elite athletes – androgens are male sex hormones and are anabolic steroids – testosterone is probably the most famous example.


The study entitled, ‘Serum Androgen Levels in Elite Female Athletes’, points out that even today the best documentation of the effects of testosterone on physical performance in female athletes remains experiments by sports scientists in the former German Democratic Republic.


This study published in the ‘Journal of Clinical Endocrinology & Metabolism’, reports that these scientists, after the 1972 Olympic Games in Munich, concluded that “the effects of the treatment with androgenic hormones were so spectacular, particularly in female athletes in strength dependent events, that few competitors not using the drugs had a chance of winning.” Sports governing bodies, and the World Anti-Doping Agency (WADA), consequently banned them.

Testosterone stimulates muscle mass and reduces body fat, increasing aggression and competitive motivation, as well as enhancing visuospatial ability, possibly even assisting in perceiving critical targets and navigating your way around a sports environment.


In a paper entitled, ‘Testosterone and sport: Current perspectives’,  it is reported that in 2006, testosterone was the single most-common banned substance detected in urine tests at World Anti-Doping Agency accredited laboratories, representing 26% of all ‘adverse analytical findings’.


The same investigation, by Ruth Wood and Steven Stanton, points out that the effects of testosterone can also occur within minutes. In the 1980s, the authors report that East German scientists developed a male hormone nasal spray to enhance aggression and competitiveness, without it showing up in the body’s general systems.


The review, published in the journal ‘Hormones and Behaviour’, explains that these rapid actions of testosterone could have contributed to American cyclist Floyd Landis’ dramatic comeback in the steep 17th stage of the 2006 Tour de France. Although Landis was initially declared the winner of the 2006 Tour, his urine sample collected after the 17th stage revealed results consistent with use of externally taken testosterone. Such supplemental testosterone would not be expected to acutely enhance boost muscle function or exercise capacity, but could increase competitive drive.


In research published in the ‘International Journal of Sports Physiology & Performance’, twenty-two professional male rugby union players were studied. Entitled, ‘Relationship Between Pregame Concentrations of Free Testosterone and Outcome in Rugby Union’, the study found that pregame testosterone concentrations were significantly higher during winning games than losing contests.


Machar Reid and Rob Duffield document the physical effort of Novak Djokovic and Rafael Nadal through the Australian Open in 2012, in their paper entitled, ‘The development of fatigue during match-play tennis’. Both players contended over 12 hours of tennis across 13 days before competing in a final that lasted close to six hours.


The analysis published in ‘The British Journal of Sports Medicine’, in 2014, points out that in the final the two players competed in 369 points, and, according to Hawkeye data, each contestant traversed in-point distances greater than 6 km.


The authors of this investigation, based at Sports Science and Sports Medicine Unit, Tennis Australia, Melbourne, and the Sport and Exercise Discipline Group, UTS: Health, University of Technology Sydney, Australia, point out that the players covered approximately 10% more ground when losing points than when winning, and reached maximum speeds in excess of 20 km/h. Throughout the match, more than 40% of points involved more than eight shots, and the players hit over 1100 groundstrokes at average velocities of >95 km/h.

In a study entitled, ‘Elite Collegiate Tennis Athletes Have Lower 2D: 4D Ratios Than Those of Nonathlete Controls’, longer ring fingers, compared to the finger you use to point at things, were found in both male and female elite tennis athletes.


This finding, published in the’ Journal of Strength & Conditioning Research’, is important because the longer your ring finger is compared to the pointer finger, then the more masculine you supposedly are. The ratio between the lengths of your index finger versus your ring finger is referred to as the 2D:4D ratio. This ratio is a measure of how much you were exposed to hormones such as testosterone in your mother’s womb. In other words, this finger ratio indicates how masculinized your body is.


This study is suggesting that being exposed to more testosterone while a foetus may give you a significant advantage many years later, in elite tennis.


Ruth Wood and Steven Stanton point out that a variety of Disorders of Sexual Development may result in elevated testosterone production in women. Given the hormone’s performance-enhancing abilities, higher levels could become a competitive advantage in athletics.


Whatever has happened in the case of Maria Sharapova, the reality is women’s tennis, as in all female elite athletics, might, behind the scenes, have been becoming deeply problematic in terms of defining normal biology, for a woman.


Andy Murray is now reported as commenting that Maria Sharapova “must accept responsibility” for failing the drugs test, and serve her ban.


Amélie Mauresmo, Andy Murray’s current coach, first came to tennis fame when she was just 19 years old, ranked 29, and during a remarkable winning streak at the Australian Open, knocked out American Lindsay Davenport, the number-one seed, in the 1999 semi-finals.


Davenport, in a comment after the match for which she later apologised, complained that her opponent’s physique and power were overwhelming, and that playing Mauresmo was like ‘playing a guy’.


Follow Dr Raj Persaud on Twitter

Raj Persaud and Peter Bruggen are joint podcast editors for the Royal College of Psychiatrists and also now have a free app on iTunes and Google Play store entitled ‘Raj Persaud in conversation’, which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world.

Download it free from these links:

Dr Raj Persaud’s new novel, Can’t Get You Out Of My Head, is based on a unique UK police unit that really does protect Buckingham Palace from fixated obsessives. The psychological thriller poses the question: Is love the most dangerous emotion?

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