Testosterone Boosters

Dietary supplements claiming to boost testosterone or enhance sexual performance are often explored and inquired about by athletes. However, these products come with concerns. Many of the ingredients are created in factories, making them unnatural, and lack scientific evidence regarding their safety and efficacy, even if the products are labeled as “herbal” or “all natural” (Campbell et al., 2013).

The Food and Drug Administration (FDA) holds dietary supplement manufacturers responsible for truth in labeling and safety of all dietary supplement products that enter the consumer market. Unfortunately, these companies may not list each product ingredient on the supplement facts panel, can make false or exaggerated claims, and/or add harmful ingredients. Due to the unregulated nature of supplements, there is little data regarding the products as a whole, including the ingredients, use of proprietary blends, and marketing claims (Willoughby, Spillane, & Schwarz, 2014).

Testosterone boosters and sexual enhancement products have a higher risk of containing harmful ingredients that are not listed on the label, compared to other supplement categories. For example, phosphodiesterase type 5 (PDE5) inhibitors are pharmaceutical medications used to treat erectile dysfunction. PDE5 inhibitors have been found in testosterone boosting and sexual enhancement supplements, but have not been listed on the product label. In 2013, researchers tested sexual performance supplements to determine if they were adulterated with PDE5 inhibitors or other undeclared ingredients. The marketing for all 54 tested supplements claimed they did not contain synthetic substances. However, 81% of the tested products contained one or more synthetic PDE5 inhibitor or similar ingredient, undisclosed to the consumer (Campbell et al., 2013).

Taking dietary supplements that “boost testosterone” have proven ineffective in reducing fat mass, as well as increasing total body or muscle mass. Instead, products making these claims come with a lot of unknowns and dangers (Willoughby et al., 2014).

Consumers are made to believe that testosterone levels and muscle mass will increase with the use of dietary supplements claiming to be testosterone boosters. Manufacturers even state that their product is scientifically proven to work. When in reality, they often contain dietary ingredients that have not been tested for efficacy or safety.

Tribulus terrestris (TT) is a popular herbal ingredient found in testosterone boosting supplements. TT is associated with claims of boosting testosterone and correcting erectile function. Physically-active men are the target market for products containing TT (Pokrywka, 2014). Similarly, TT allegedly improves plasma testosterone levels and increases skeletal muscle growth (Antonio, Uelmen, Rodriguez, & Earnest, 2000). The use of dietary supplements with TT has shown no substantiated benefits in human studies. As with most dietary ingredients, there is a lack of evidence-based information regarding the effectiveness and safety of TT use in sport (Pokrywka, 2014). The consumer should be aware that many herbal/all-natural ingredients claiming to boost testosterone levels or provide other anabolic effects have limited scientific support.

Drug Free Sport believes that food should be the first option for fueling when athletes are looking to reach performance goals. Dietary supplements are poorly regulated by the FDA, with manufacturers loosely following the FDA’s guidelines. Supplement companies market their products how they wish, often place unlabeled ingredients in the bottle, and make false claims. Appropriately-timed meals and snacks, on the other hand, have been proven to aid in weight reduction and achieving sports performance goals.

If you are thinking about taking any dietary supplement, please visit Drug Free Sport AXIS™ to learn more about your options to make an informed decision. 

References:

Antonio, J., Uelmen, J., Rodriguez, R., & Earnest, C. (2000). The effects of tribulus terrestris on body composition and exercise performance in resistance-trained males. International Journal of Sport Nutrition and Exercise Metabolism, 10, 208-215.

Campbell, N., Clark, J.P., Stecher, V.J., Thomas, J.W., Callanan, A.C., Donnelly, B.F.,… Kaminetsky, J.C. (2013). Adulteration of purported herbal and natural sexual performance enhancement dietary supplements with synthetic phosphodiesterase type 5 inhibitors. International Society for Sexual Medicine, 10, 1842-1849.

Pokrywka, A., Obminski, Z., Malczewska-Lenczowska, J., Fijatek, Z., Turek-Lepa, E., & Grucza, R. (2014). Insights into supplements with tribulus terrestris used by athletes. Journal of Human Kinetics, 41, 99-105.

Qureshi, A., Naughton, D.P., & Petroczi, A. (2014). A systematic review on the herbal extract tribulus terrestris and the roots of its putative aphrodisiac and performance enhancing effect. Journal of Dietary Supplements, 11(1), 64-79.

Willoughby, D.S., Spillane, M., & Schwarz, N. (2014). Heavy resistance training and supplementation with the alleged testosterone booster NMDA has on effect on body composition, muscle performance, and serum hormones associated with the hypothalamo-pituitary-gonadal axis in resistance-trained males. Journal of Sports Science and Medicine, 13, 192-199.

Medical Marijuana, Medical Exception?

State Marijuana Laws in 2016 (Post-Election)

Image Source: governing.com 

Here's what you should know as of the November 8 election:

• There are now eight states that have passed laws permitting recreational use of marijuana: Maine, California, Massachusetts, Nevada, Colorado, Washington, Oregon, and Alaska. 

• Medical marijuana is now legal in 28 states and Washington, D.C. after ballot measures passed in North Dakota, Arkansas, Florida, and Montana. 

• Federally, marijuana is still classified as a Schedule I drug by the Drug Enforcement Administration (DEA). 

• Because of the DEA's imposed status, doctors can only "recommend" marijuana to patients. Federal law prohibits medical professionals from prescribing the drug. 

• Rates of marijuana use in states that have legalized marijuana in some form have increased exponentially compared to those that have not. (Source, page 5)

• The average THC concentrations in cannabis have continued to increase, while the medicinal, non-psychoactive ingredient, cannabidiol (CBD), has not. (Source) 

What this means for athletes:

• Marijuana is still prohibited/banned in sport or considered a drug of abuse. 

• Drug-testing sanctions for marijuana-positive tests, as designated by each sport organization, still apply in states where marijuana has been legalized. 

• Marijuana's cannabinoids are stored in fat. The increasing potency of THC in marijuana means it can take longer for the drug to be metabolized and cleared from the body. (READ: Using marijuana over the holidays, and hoping for clean urine upon returning to practice is probably not the best idea.)

• There are NO medical exceptions (MEs) or therapeutic use exemptions (TUEs) for marijuana in sport. Athletes will not be granted a ME or TUE, even if a doctor has "prescribed" marijuana.

Other athlete-health implications to consider:

• Legalization of marijuana in Colorado has shown an increase in alcohol consumption—separately from the increase in marijuana-infused beers and wines on the market. (Source, page 26)

• Post-legalization of marijuana: DUI cases related to driving while high, and traffic fatalities where the driver tested positive for marijuana have increased in Washington State and Colorado, respectively. (Source, pages 17-18)

Share your thoughts with us on social media (#EducateDrugFreeSport) or request a speaker on marijuana to educate your athletes!

Risk Level Rating System: A Deeper Look

Contributed by Anna Filardo, MS
Education Program Manager, Drug Free Sport

Drug Free Sport AXIS™ staff review dietary supplements according to the ingredients listed on the product’s supplement facts panel, marketing claims, and related scam warnings or FDA recalls. After our research and evaluation process, a risk level is assigned as Level 1, 2, or 3. There is no Risk Level 0 because Drug Free Sport does not test dietary supplements.

Due to limitations on regulatory oversight of the dietary supplement industry, there can be no guarantees that a product does not contain banned ingredients without testing each individual item. Unfortunately, supplement companies may intentionally or unintentionally contaminate/adulterate products that end up on the market. For these reasons, the risk level rating system cannot guarantee that a product will not cause a positive drug test. For zero risk, athletes are advised to avoid dietary supplements altogether and focus on food as fuel.

Drug Free Sport AXIS serves as a helpful tool in determining supplement safety for athletes, and provides sports nutrition handouts and recipes as alternatives. For a detailed explanation of the different Risk Levels assigned through the Drug Free Sport AXIS Dietary Supplement Inquiry tool, please keep reading. 

Risk Level I:

•  The supplement facts panel does not list banned ingredients or ingredients related to a banned drug class. 
• Product webpage and/or the product label’s marketing is not related to a banned drug class. Example: testosterone is a banned substance; dietary supplements that claim to boost testosterone (and otherwise do not list banned substances) will not be assigned a Risk Level 1.
• Seen as the “safest” risk level. Remember—there is no guarantee that a dietary supplement company did not contaminate/adulterate the product, which in turn could cause a positive drug test.
• Specific to Collegiate Sports: A Risk level 1 does not indicate whether or not the product is permissible for direct distribution to athletes. Permissible items are typically determined by compliance officers on campus according to NCAA bylaws.
• Watch this webinar for more information on NCAA Permissibility of Dietary Supplements.

Risk Level II:

• Ingredients listed on the label have limited scientific evidence regarding the safety, purity, or effects on the body. The ingredient may not be specifically banned, but has a possibility to be detrimental to the athlete’s health.
• The marketing for the product makes claims related to a banned drug class. Example: a product that claims to boost testosterone (and otherwise  may not list banned substances) is a Risk Level 2.
• Specific to organizations that prohibit caffeine: Caffeine or sources of caffeine (green tea, guarana, white tea, etc.) are listed on the label. Caffeine is banned (for specific sport organizations) under the stimulants drug class when urinary concentrations exceed 15 mcg/mL.
• There is no way for us to know what amount of caffeine will cause a positive drug test due to many factors: metabolic rate, other food/drink consumed, age, gender, weight, height, etc.
• There are ingredients listed on the label related to a banned drug class. The ingredient is not strictly banned, but is similar to a banned substance. Example: raspberry ketones may share a similar chemical structure to synephrine, a strictly banned stimulant. Therefore, a product listing raspberry ketones (and no other banned substances) would be categorized as a Risk Level 2.

Risk Level III:

• Ingredients listed are strictly banned. 
• The product has been cited for contamination/adulteration issues with banned substances, or has been recalled by the FDA.

The Drug Free Sport AXIS risk level rating system is a tool to assist athletes and athletic staff to make informed decisions regarding the use of dietary supplements for sports performance. Ultimately, athletes consume dietary supplements at their own risk.

To have a dietary supplement reviewed by our team, login and submit an inquiry to Drug Free SportAXIS.