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Salazar, Hormones and Athlete Health

Dr Nicky Keay provides expertise to BBC Panorama.

4 mins read

Published on

March 6, 2020

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The subject of hormones and sports performance is a topical one. Recent media attention has been drawn to examples where illicit manipulation of athletes’ natural hormone levels may have been used to enhance competitive performance.


If you tuned in to Panorama on BBC One on the 24th of February, you’ll have seen the episode entitled ‘Mo Farah and the Salazar Scandal.’ The programme was an exceptional piece of investigative journalism by reporter Mark Daly into Alberto Salazar, a coach accused of doping athletes at the Nike Oregon Project, with hormone manipulation through thyroid and/or contraceptive medication one of the techniques allegedly used.

Dr Nicky Keay appeared as a clinical expert on the programme, as she has extensive practical and academic knowledge of endocrinology (the study of hormones) particularly in relation to sports performance.


Hormones are an essential element in the makeup of a healthy athlete, and access to Dr Keay’s expert medical knowledge is an important part of the service Forth Edge can provide.

For an athlete to perform at their best, they need good health first and foremost. Short-term performance gains that come at the cost of longer-term health can mean a drop in performance over time, so training and competing to a sustainable level while ensuring the body gets the rest, recovery and nutrition it needs to operate optimally is critical.

Hormones play a major part in this; they regulate everything from energy release to bone regrowth to blood-cell production. For example, thyroxine — produced in the thyroid — plays a major part in regulating the metabolism, muscle function and maintenance of bones.

The sex hormones oestrogen and testosterone aren’t just related to body morphology, muscle growth and the menstrual cycle. Oestrogen, in the form of oestradiol, is important for bone growth in men and women. Testosterone is well-known for its impact on muscle growth, but it also signals the body to produce red blood cells and can also affect bone density as well as affecting mood and focus.


So long as the body has enough of the right nutrition, plus sufficient rest and recovery, these hormones will remain at balanced levels ensuring the body works to its best — though of course there are some exceptions caused by certain conditions, such as PCS (polycystic ovary syndrome) in women.

But problems can arise when an athlete over trains, doesn’t give enough time to let their body recuperate after training and racing, or isn’t getting sufficient nutrition which can lead to a condition called RED-S, or Relative Energy Deficiency in Sport.

RED-S is caused by chronic under-fuelling, either intentionally (to gain what’s deemed to be an acceptable performance weight, for example) or unintentionally, by underestimating how much fuel the body needs to sustain the work it’s doing.

Over training and RED-S cause a lot of stress to the body, which will affect the hormone levels, which will in turn affect the athletes health. Essentially, the body realises it isn’t going to get the nutrients or rest it needs, so it starts to make decisions on which essential processes to maintain, and which to shut down.

The human body will always prioritise movement in such cases; it’s evolved to assume that the stress it’s under is either from lack of available food or the presence of predators, so being able to keep moving is essential for its survival — find food, or flee! This is why athletes might not immediately notice a downturn in their performance; they’re still able to run, lift, ride or swim and in fact the weight loss that sometimes comes with this means that initially their performance will improve.

But not only is this performance gain unsustainable, it will tail off and decrease as the detrimental effects of stress take their toll.


With all available energy going to movement, processes like red blood cell generation, bone regeneration and maintenance and reproductive systems will shut down.

In female athletes, this often manifests as amenorrhea, or an absence of periods. In severe cases, these hormonal changes can mean a lowering in bone density or even osteoporosis in extreme examples, fatigue, lowered metabolism, lowered mood and depression — none of which is conducive to athlete health and all of which can have long-term consequences.

This is why it’s important for each athlete to be aware of their own individual needs, and why ‘one-size-fits-all’ training programmes and target weights don’t work — every human body is unique.


The services that Edge offer allow athletes to have a greater insight into their own hormone and nutrient levels, and to measure how these change over time and in response to training, rest, racing and food intake.

The Edge sports medicine team provide oversight as well as expert advice on how to address any potential issues, such as recommending changes specific changes to diet or increased rest.

This allows athletes to work towards their best possible individual health, which will in turn ensure that they can perform their best, sustainably, and without compromising their own health.

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