Interestingly, despite Kenya’s reputation as an endurance-running powerhouse, erythropoietin (EPO) and CERA, both used to stimulate red blood cell production, do not appear to be the most frequently cited substances in its athletics doping cases.
If not a red blood cell booster, then what?
That distinction belongs to norandrosterone, a urinary metabolite associated with the anabolic steroid nandrolone and related prohormones.
Twenty-six Kenyan athletes have been suspended for EPO-related violations. That is a substantial number. However, the number of cases involving norandrosterone is considerably higher.
More than 80 Kenyan athletes have tested positive for the metabolite, according to the Anti-Doping Database. Kenya accounts for 32.5 per cent of all sanctions involving norandrosterone recorded in athletics. Globally, the database lists more than 700 cases involving the metabolite, including 271 in athletics, the sport with the highest number of recorded cases. Kenya accounts for approximately 12 per cent of all cases involving the substance across sports.
According to the database, “India is the country with the most doping cases involving norandrosterone. With 130 registered cases in the Anti-Doping Database, the country is involved in nearly 18 percent of all doping cases involving this steroid.”
Two prominent names associated with nandrolone-related cases in athletics are American middle-distance runner Shelby Houlihan and British sprinter Linford Christie.
On the surface, Christie’s case might seem consistent with the muscle-building properties associated with anabolic steroids. But the substance’s presence in doping cases involving endurance athletes, including Houlihan, raises a different question and that is why does a substance associated with anabolic effects appear so frequently in a sport where endurance is paramount?
Houlihan holds American records in the 1500m and 5000m. She received a four-year ban after testing positive for nandrolone-related substances in a case she attributed to contaminated pork purchased from a food truck. The explanation became widely known as “Burritogate.”
Christie tested positive for nandrolone-related substances in 1999. He was initially cleared by his national federation, but the case subsequently became controversial.
According to research published in PubMed, the National Library of Medicine, 19-norandrosterone is the primary urinary metabolite used to identify the presence of nandrolone and certain related prohormones. Its detection is central to anti-doping analysis, although the interpretation of a finding depends on the concentration measured and the applicable testing procedures. The presence of the metabolite can reflect the use of prohibited substances, but other sources and biological processes can complicate the analysis.
The important distinction is that a positive finding for norandrosterone does not, by itself, tell us precisely which compound was taken or how it entered the body.
The number of positive findings for one substance compared with another does not necessarily provide a complete picture of doping practices. Nevertheless, the available figures offer a starting point for examining the pattern. The next step is to understand what those figures can and cannot tell us.
It’s about the half-life
The differences between EPO, CERA, and nandrolone-related substances extend beyond their intended physiological effects. Their pharmacokinetics and the methods used to detect them also differ.
Conventional EPO has a relatively short elimination half-life, although the precise duration depends on the formulation and route of administration. CERA, a longer-acting erythropoiesis-stimulating agent, was modified by attaching a polyethylene glycol (PEG) chain to the molecule. Its elimination half-life is approximately 130 hours, substantially longer than that of conventional EPO.
The short half-life of conventional EPO has historically presented challenges for anti-doping authorities. Direct detection depends on the substance, the timing of the sample, and the analytical method used. Changes in blood parameters and other indirect indicators can also contribute to the detection of suspicious patterns.
How many athletes have used EPO or other prohibited substances without being detected is impossible to establish from positive-test figures alone.
Nandrolone-related substances present a different analytical challenge. Norandrosterone is a metabolite that can remain detectable in urine after the parent compound or a related prohormone has been administered. Depending on the compound, dose, formulation, and individual metabolism, detection periods can vary considerably. Research has documented the detection of nandrolone metabolites for extended periods following certain long-acting formulations.
This is an important distinction as a drug’s elimination half-life is not the same as its detection window. The latter depends on how the substance is metabolized, which metabolites are measured, and the sensitivity of the analytical methods.
Consequently, the relative numbers of EPO- and nandrolone-related cases cannot be explained by half-life alone. Testing frequency, detection methods, patterns of use, and the underlying prevalence of each substance may all contribute to the figures.
Recovery is important for all athletes
It cannot be ignored that middle- and long-distance runners also require muscle recovery, repair and adaptation. Running 100 to 250 kilometres per week places enormous repetitive loads on the legs, particularly the calf muscles, Achilles tendon and other structures of the lower leg. Muscle damage, connective-tissue stress and the need to recover between training sessions are part of the physiological demands of high-volume endurance training.
Anabolic steroids are generally associated with muscle growth and strength, but their potential appeal to an endurance athlete need not be about building larger muscles. The question is whether an athlete might seek an advantage in recovery, tissue repair, or adaptation to demanding training loads. That is a plausible line of inquiry, although it does not establish why nandrolone-related cases appear so frequently among Kenyan runners, nor does it demonstrate that nandrolone improves recovery from the repetitive impact of distance running.
