Doping agent groups and methods

Substances and methods prohibited at all times (in- and out-of-competition, for example, during the training season and between competitions)


S0. Non-approved substances
S1. Anabolic agents
S2. Peptide hormones, growth factors, related substances and mimetics
S3. β2-agonists
S4. Hormone and metabolic modulators
S5. Diuretics and masking agents
M1. Manipulation of blood and blood components
M2. Chemical and physical manipulation
M3. Gene and cell doping

Substances and methods prohibited in-competition

In addition to substances and methods specified under items S0 to S5 and M1 to M3, the following substances and methods are prohibited in-competition:

S6. Stimulants
S7. Narcotics
S8. Cannabinoids
S9. Glucocorticoids

Substances prohibited in particular sports

P1. Beta-blockers

Substances and methods prohibited at all times (in- and out-of-competition, for example, during the training season and between competitions)

S0. Non-approved substances

The use of all pharmacological substances that have not been covered in this entire list and that have not been approved for medical use on humans by any national health authority (for example, substances that are in the pre-clinical or clinical stage of research, or that are no longer developed or manufactured, and substances whose structure has been modified or substances approved for veterinary use only) is prohibited at all times.

S1. Anabolic agents

Anabolic agents are divided into two categories: anabolic androgenic steroids (such as testosterone and nandrolone) and other anabolic agents.

1) Anabolic androgenic steroids
Anabolic androgenic substances increase muscle mass and strength. They also affect the body's hormonal balance and metabolism by making the body more tolerant to hard training while decreasing the probability of an overtraining condition. In women, the side effects include hirsutism, acne, lowering of the voice, diminishing breast size, baldness, clitoral hypertrophy and menstrual cycle problems. Some of these harmful effects are permanent and are not reversed when the use of the substance is discontinued. In men, the harmful effects of anabolic androgenic steroids can be seen in the reduction of the body's own hormone production. After-use effects may include infertility and reduced sexual function, lasting up to several months. In adolescents, their use can also result in stunted growth. Anabolic androgenic steroids are among the risk factors for cardiovascular diseases. Continued use may advance the development of coronary artery disease, cerebral infarction and paralysis, for example, and increase the risk of sudden cardiac death. Hormones increase the risk of diabetes.

The intravenous use of anabolic androgenic steroids increases the potential for various infections, such as hepatitis C and HIV. In large doses, anabolic androgenic steroids also affect mood and behaviour, causing aggressive behaviour and even psychotic episodes. The withdrawal syndrome that follows after the cessation of prolonged use includes mood swings, low mood and depression.

2) Other anabolic agents
Other anabolic agents on the list of doping agents include, among others, tibolone, zeranol and clenbuterol. Clenbuterol has a particularly intense anabolic effect and has been noted to increase the protein content in striated muscles while the body's glycogen and fat are burned. The size of muscle cells grows but their number does not change. Since the relative proportion of fast-contracting muscle fibres that enhance anaerobic performance increases in particular, it is probable that clenbuterol augments not only strength needed in athletic performance but also speed. Selective androgen receptor modulators (SARMs) are anabolic compounds in the experimental stage. They attach to androgen receptors in the tissue and alter their structure and functioning. Many of the effects of SARMs resemble those of testosterone and anabolic steroids, and they can be used to treat the same diseases, such as osteoporosis, hypogonadism and muscular diseases.

S2. Peptide hormones, growth factors, related substances and mimetics

Peptide hormones, growth factors and the related substances include, for example, erythropoietins (EPO, CERA, darbepoetin), human chorionic gonadotrophin (hCG), luteinising hormone (LH), growth hormone (hGH) and several experimental substances stimulating the secretion of growth hormone. Erythropoietins and other erythropoiesis-stimulating agents increase red blood cell production in the body. With them, athletes can enhance their oxygen uptake. Potential side effects of erythropoietins include hypertension, flu-like symptoms with ache in muscles and bones, convulsions, coagulation disorders (blood clots), swelling and headache. In men, human chorionic gonadotrophin increases testosterone secretion. In adolescents, growth hormone is one of the factors controlling growth in height. In addition, it influences carbohydrate, fat and protein metabolism, for example. Through growth factors, growth hormone promotes muscle growth and recovery from sports injuries. The use of growth hormone may cause severe cardiac diseases, cardiac dystrophy, diabetes and hypothyroidism.
 

S3. β2-agonists

β2-sympathomimetics, or β2-agonists, stimulate the β2-receptors in the sympathetic nervous system. Due to their bronchodilating effect, these substances are used as asthma medication, either inhaled or as tablets. In the treatment of asthma, the preferred method for administering these medicines is usually inhalation into the bronchial system, producing a local effect. For the most part, this enables one to avoid potentially harmful effects: trembling, palpitation, arrhythmia, muscle cramps and electrolytic disorders. The muscle-building, or anabolic, effects of β2-agonists are their most important doping effect. Inhaled formoterol, salbutamol and salmeterol are permitted, when used in limited doses, for instance, for the treatment of asthma.

S4. Hormone and metabolic modulators

Anti-estrogenic substances are used in treating breast cancer in order to decrease estrogen activity in the body. They shift the body's androgen/oestrogen balance towards the androgenic direction. Substances preventing the activation of the activin type IIB receptor are still only in experimental use. They use several different mechanisms to inhibit the activation of the receptor, which controls muscle growth, and thus increase the muscle growth rate. These compounds include, for example, receptor antibodies and myostatin inhibitors. Most metabolic modulators are still only in experimental use. They build muscle and burn fat and produce similar beneficial metabolic changes as physical exercise, but without the exercise. Insulins, which are used for treating diabetics, are considered to belong to this group as well. They have an anabolic effect due to their wide range of metabolic effects. In excessively large doses, they lead to hypoglycemia and sometimes even death.

S5. Diuretics and masking agents

Diuretics are used to eliminate swelling and as hypertension medication. These substances include hydrochlorothiazide and furosemide, for example. Diuretics remove salt and fluids from the body and increase urine secretion. In sports, diuretics are used to mask the use of other doping agents or to lose weight in order to reach a lower weight class, for example. Harmful effects of diuretics include electrolytic disorders, faintness and an excessive drop in blood pressure. In connection with abundant sweating during physical exertion or going to the sauna, for example, these effects can become dangerous. Excessive use of diuretics is known to have caused fatalities among athletes. Plasma expanders, such as hydroxyethyl starch, pull water out of tissues and into blood vessels, enabling blood to enter small capillaries more easily and increasing the oxidation of tissues. On the other hand, blood becomes diluted and the haemoglobin content of blood decreases.

M1. Manipulation of blood and blood components

The following methods are prohibited:

1. The administration or reintroduction of any quantity of autologous, allogenic (homologous) or heterologous blood or red blood cell products of any origin into the circulatory system is prohibited.

2. Use of any substances and products artificially enhancing the uptake, transport or delivery of oxygen is prohibited. Such substances and products include but are not limited to perfluorocompounds (such as perflubron and other fluorocarbons and perfluorochemicals), myo-inositol trispyrophosphate (ITPP, OXY111A), efaproxiral (RSR13) and substances derived from it as well as modified haemoglobin products (such as artificial haemoglobin compounds having a haemoglobin-like effect, blood substitutes based on the haemoglobin effect and microencapsulated haemoglobin). The inhalation of supplemental oxygen is not prohibited.

3. Any form of intravascular manipulation of the blood or blood components by physical or chemical means is prohibited.

M2. Chemical and physical manipulation

The following methods are prohibited:

1. Tampering, or attempting to tamper, to alter the integrity or validity of samples collected during doping control is prohibited. Such methods include, but are not limited to, urine substitution or adulteration (e.g. proteases).

2. Intravenous infusions and/or injections of a total of 100 mL per 12-hour period are prohibited except for those legitimately received in the course of hospital treatments, surgical procedures or clinical diagnostic investigations.

M3. Gene and cell doping

The following, with the potential to enhance sport performance, are prohibited:

1. The transfer of polymers of nucleic acids or nucleic acid analogues.

2. The use of gene editing agents designed to alter genome sequences and/or the transcriptional post-transcriptional or epigenetic regulation of gene expression.

3. The use of normal or genetically modified cells.

Substances and methods prohibited in-competition

In addition to substances and methods specified under items S0 to S5 and M1 to M3, the following substances and methods are prohibited in-competition:

S6. Stimulants

Stimulants (such as amfetamine, dexamfetamine, ecstasy, lisdexamfetamine, methylphenidate, modafinil, pseudoephedrine and ephedrine) increase vigour and reduce feelings of fatigue through the central nervous system. Trembling, palpitation and increase in blood pressure are among the most common harmful effects of stimulants. For sensitive persons or in high doses, stimulants may cause incoherence and paranoia, heat stroke and severe arrhythmia. A threshold has been defined for pseudoephedrine concentration in a doping sample; concentrations below the threshold are not considered doping. The threshold concentration has been set in such a way that regular therapeutic doses of pseudoephedrine will not exceed the threshold concentration if the last use of the drug took place at least 24 hours ago.

S7. Narcotics

Narcotics is a general term for strong morphine-like medication. The pain-relieving effect of narcotics is transferred by the central nervous system. Narcotics improve athletic performance in sports that involve a strong momentary pain. Due to their tranquillising effect, they can also be used as doping in sports that require accuracy. The most common side effects are nausea and constipation. Narcotics produce euphoria, which is why they can be used as intoxicating drugs. They cause addiction.

S8. Cannabinoids

Cannabinoids are the active ingredients (such as tetrahydrocannabinol) in plant-based cannabis (marihuana and hashish) and their synthetic derivatives. Some of the latest synthetic cannabinoids intended for abuse (such as JWH-018 or Jehova, JWH-081, HU-210) are structurally different from traditional cannabinoids, but have the same effect. Cannabinoids interfere with the perception of time, place, speed and distance. Combined with the impairment of coordination, reaction time and memory resulting from CNS suppression, this usually results in impaired athletic performance. One of the reasons why cannabinoids are prohibited is that they are considered to be contrary to athletic ideals. Cannabidiol is not prohibited; it does not produce the typical intoxicating effects of cannabinoids.

S9. Glucocorticoids

In large doses, glucocorticoids may increase the body's ability to endure exertion. However, there is no clear evidence that glucocorticoids improve athletic performance. All glucocorticoids are prohibited when administered by the oral, rectal, intravenous or intramuscular routes. Their use requires a valid TUE.
 
Glucocorticoids are permitted without a TUE when they are inhaled or administered by a subcutaneous and intradermal, oral, intra-articular, periarticular or peritendonal route, locally as ointments, drops or sprays to treat illnesses in the eyes, ears, sinuses, the mucous membranes in the mouth, nasal and anal areas and skin diseases.
 

Substances prohibited in particular sports

P1. Beta-blockers

Beta-blockers are used for treating hypertension and to prevent a relapse of myocardial infarction, among other purposes. Their effect, which tranquillises the CNS and reduces the heart rate and tremors, can improve performance in sports that require concentration, calm nerves and steady hands. Beta-blockers are prohibited only in certain sports that require precision. Such sports are listed on the FINCIS website, among other places. Beta-blockers impair performance in sports that require endurance and speed.

Pekka Rauhala

Pekka Rauhala

Medical expert

phone: +358 400 801 411

e-mail: pekka.rauhala@suek.fi

Anna Simula

Anna Simula

Pharmacist, TUEs

phone: +358 400 338 510

e-mail: anna.simula@suek.fi