Performance-Enhancing Drugs Used by Elite Athletes That Are Surprisingly Legal

The World Anti-Doping Agency (WADA) always seems to take the fun out of doping for elite competitive athletes. All of the best performance-enhancing drugs (PEDs) – such as anabolic steroids and erythropoietin (EPO) – have long since been banned. WADA conducts extensive drug testing to enforce its ban on prohibited substances. But there are some PEDs that WADA explicitly permits athletes to use.

Three of these drugs – meldonium (Mildronate), telmisartan (Micardis) and T3 liothyronine (Cytomel) – are currently being used by numerous elite athletes particularly in endurance sports. Athletes tend to be secretive about their use of PEDs. However, they could openly reveal their use of these three drugs without fear of penalty or other repercussions from WADA, national drug testing organizations or any other signatories to the WADA Code.

For all intents and purposes, WADA has given the thumbs up for athletes interesting in experimenting with these three drugs. Granted, the drugs are no longer a secret. WADA is fully aware of their use by athletes. Meldonium and telmisartan were added to WADA’s Monitoring Program in 2015. Last month, WADA decided to move meldonium from its monitoring list to its prohibited substance list beginning on January 1, 2016.

This means it is may be a little too late for athletes interested in experimenting with meldonium. They only have 10 more weeks before it becomes as banned as anabolic steroids.

Telmisartan and Cynomel are still good to go. WADA refused to add T3 liothyronine and telmisartan to the banned list. Telmisartan remains a drug that WADA will continue to monitor in 2016.

Meldonium has generally been used by athletes in various sports for its mild stimulant-like properties. It is a relatively safe and non-toxic drug. Athletes have used it in performance-enhancing dosages of 1000-2000mg/day in divided dosages preferably prior to training in order to take advantage of its stimulant properties.

Meldonium was first developed and marketed by the Latvia-based pharmaceutical company Grindeks. It has been used clinically as an anti-ischemic drug to treat patients with angina and myocardial infarction. Of interest to athletes is the finding that it consistently and significantly improves exercise tolerance. Some pharmaceutical companies have recently marketed it explicitly as a performance-enhancing drug. It’s also used as a “smart drug” by non-athletes. Athletes have been using it for over 5 years.

Telmisartan has been used by endurance athletes as an alternative to the banned substances AICAR and GW1516. It is also a relatively safe and non-toxic drug used by athletes in dosages of 80-160 mg/day in divided dosages. The latter two drugs have been banned. Telmisartan has been shown to act by a similar mechanism. Specifically, telmisartan promises to enhance running ability, increase fat burning ability, reduce lactic acid formation and enhance recovery from exercise. However, its actual performance-enhancing effects remain the subject of debate.

Telmisartan is used clinically to treat individuals with borderline hypertension and high blood pressure. It belongs to the category of drugs known as angiotensin II receptor antagonists (angiotensin receptor blockers, ARBs). Since it reduces blood pressure, athletes who use it must be careful of reducing blood pressure too low which could cause fainting episodes.

Cytomel (T3) has been popular among bodybuilders for decades for its ability to promote rapid fat loss and weight loss. It has not generally been used by elite athletes to enhance performance but rather to help competitors, in sports like wrestling or boxing, to come in under the cut-off for weight classes in their sport.

Some track athletes have also used thyroid hormones for perceived performance-enhancing effects beyond those associated with weight loss. The Cytomel dosage used for performance-enhancing purposes ranged from 25mcg to 50mcg per day. The drug is typically used 30-60 minutes prior to training or competition.

Victor Conte, the architect of the infamous BALCO steroid program, included T3 as an important drug in his recipe for success in his athletes back in the early 200s. The media headlines focused on THG (“The Clear”) and testosterone gel (“The Cream”). But there was another drug called “The Lightness” that his athletes used. “Lightness” was the code name for T3 liothyronine aka Cytomel.

More recently, Alberto Salazar, the coach of the Nike-sponsored Oregon Project, has been accused of referring his athletes to a doctor known for diagnosing endurance athletes with hypothyroidism and prescribing them Cytomel as a treatment. Salazar’s critics accused him of bending the rules so that his athletes could use Cytomel for performance-enhancing purposes.

The United States Anti-Doping Agency (USADA) and United Kingdom Anti-Doping (UKAD) both aggressively lobbied WADA to include thyroid hormones on its 2016 Prohibited Substances List. WADA refused.

As of today, October 17, 2015, WADA allows athletes to use meldonium, telmisartan and liothyroinine (T3) without penalty.

As of January 1, 2016, WADA will continue to permit the use of telmisartan and liothyronine but will ban any athlete who tests positive for meldonium for a period of 4 years (if it is a first-time anti-doping violation).

WADA claims that neither telmisartan or liothyronine enhances athletic performance. It is unlikely that this will stop athletes from continuing to experiment with these drugs.