Bethanie Mattek-Sands and DHEA – A Love Story

by Savannah

TUE-Gate is still going on. So far three top African American females and one lesbian WNBA player’s record releases have gooten the most coverage from the media. That said media obviously doesn’t understand what “out of competition” means or that an opiate (think heroin, morphine, oxy) would give no in competition advantage to anyone their mewlings can be dismissed out of hand.
What is interesting is that the press, with one exception, has ignored a much bigger story. It involves the US tennis player Bethanie Mattek-Sands and her attempts to get a TUE for her use of male synthetic hormone (testosterone) due to the imminent collapse of her adrenal system (kidneys).

Yesterday on a fan site someone calling themselves “Marlene” released a heavily redacted CAS hearing result on an athlete. We know it was a woman due to the conclusions drawn. We know it was an United States citizen because the doctor involved resides in Arizona. It soon became obvious who the athlete was since the TUE she requested had been made public.

The CAS report is a sobering read on how an athlete can try and game the system and how in the end, the system of checks and balances did work. The report is seventeen pages long so I will excerpt from the conclusions only.

6.15 In her submissions as part of the TUE application process and this proceeding, both Dr.
Serrano and Dr. Larrimer attributed the Appellant’s symptoms to hypopituitarism. Dr.
Serrano, in his August 17, 2014 letter to the 1TF TUEC wrote “{mjy initial opinion was
and still is that of hypopituitarism,” while Dr. Larrimer concluded in his July 25, 2014
letter, “Ida believe she has Hypopituitarism, “1

6.16 The Respondent challenged the accuracy of that diagnosis in its Answer and at the hearing, on a number of grounds, including submitting evidence that:
• Hypopituitarism is a malfunction between the hypothalamus and the pituitary gland. The
relationship between the hypothalamus and the pituitary gland plays a critical role in the
secretion of several hormones in the body, including the production of Cortisol through the
adrenal gland. If this relationship was malfunctioning, one would expect that secretion of
all, or at least several, of these hormones would be inhibited. The inhibited productions
would be demonstrable in blood tests. However, in the blood tests collected closest in time
to the Appellant’s doctors’ diagnosis of hypopituitarism, nothing indicates that any of the
hormones that rely on the pituitary gland, other than Cortisol, which as discussed appeared
depleted beginning in 2013, were at all deficient This is inconsistent with hypopituitarism,
• The effect of hypopituitarism would be that the adrenal gland could not function without
lifetime treatment. This is paradoxical to the Appellant’s doctors’ assertions that, under
the proper supervision and circumstances, the Athlete could been weaned off of
hydrocortisone or other Cortisol supplementation.
6.17 At the heaving, Dr. Serrano acknowledged that he was not an expert in endocrinology, but
conceded a number of the criticisms levied by the Respondent. He also seemingly
attempted to backtrack from his own diagnosis of hypopituitarism by suggesting that his diagnosis was based on Dr. Larrimer’s diagnosis of the same. Two troubling aspects of this position are that (i) it is at odds with his contemporaneous submission in which he
stated that his initial opinion, presumably dating back to 2012, was that the Appellant
suffered from hypopituitarism, and (ii) despite apparent rehance Dr. Larrimer’s diagnosis, he was Unable to offer any insight into how Dr. Larrimer came to his conclusion.3
6.18 Accordingly, there is serious doubt that hypopituitarism could be the proper diagnosis of the Appellant’s adrenal insufficiency, regardless of when said deficiency manifested itself, meaning that the Appellant has likely still not yet been properly diagnosed.4

C. DHEA and Symptoms

6.19 Finally, one matter that raises doubts about the appropriateness of DHEA specifically as a treatment for the Appellant, that has yet to be adequately explained by the Appellant or her expert, is the juxtaposition of the timing of the manifestation of her symptoms, her DHEA use, and her objective blood and salivary tests.

6.20 By her own account,^ B symptoms began in 2010 and continued on and
off for 2 years before she saw Dr. Serrano and before she was a granted the HC TUE in December 2012.

6.21 But as discussed above, the blood and salivary tests from September and November 2012, the period of time before the Appellant began taking HC, unequivocally show that the Appellant’s Cortisol and DHEA levels were within, or above, the reference range for her demographic. In other words, during one of the periods when the Appellant’s impairments were at their worst, her Cortisol and DHEA levels were not depleted, Without questioning the Appellant’s veracity in stating that she felt better while talcing DHEA, it is difficult then to reconcile the objective evidence with her doctors’ recommendations that simply increasing her DHEA levels back to normal level today should cure her symptoms (notwithstanding any other potentially beneficial medical reasons to do so).
6.22 Considering all of these points, the Sole Arbitrator must conclude that the lack of a clear diagnosis of an existing medical condition is fatal to the Appellant’s appeal.

6.23 Because the failure to adequately identify a medical condition in itself precludes the granting of a TUE, there is no need to address the remaining standards at this time. But nothing in this opinion should be interpreted to suggest that, should the Appellant undergo further examination and receive a verifiable diagnosis – which the Sole Arbitrator strongly
advises her to do – any treatment options are precluded, as the Appellant’s health is obviously of Critical importance.
6.24 In this connection, the Parties agreed that an abrupt termination of the Appellant’s HC treatment could adversely affect her health. As a result, she must be given some time to reduce her current intake of HC and replace it by a treatment that addresses her properly diagnosed indication, subject to the cumulative conditions for granting a TUE set forth in Article 4.1(a)-(d) of the International Standard. The Sole Arbitrator considers that the
Appellant would have sufficient time to achieve this by April 30.2015.
6.25 The Appellant must therefore be authorized to continue to take HC, at levels no higher than permitted in the Appealed Decision until the Appellant is granted a new TUE by the ITF TUEC, based on a proper medical diagnosis but in any event no later than April 30. 2015. For the avoidance of doubt, the Appealed Decision’s revocation of the DHEA TUE is confirmed.

If that is too much for you here’s my summary:

The unnamed athlete went to her governing body, the ITF, and presented documentation that showed she had serious adrenal issues and that she needed hydrocortisone to stop the deterioration of her physical condition. The athlete and her doctor then said that the HC was not sufficient and he recommended adding DHEA to her course of treatment. The ITF approved the diagnosis and proposed treatment and routinely sent the information to WADA where cooler heads prevailed and the addition of DHEA was denied. Further investigation showed that the original doctors statements were contradictory and the conclusion was reached that the athlete had still not received a proper diagnosis of what the root cause of her stated symptoms were. The CAS also asked for the athlete to pay for all costs associated with her appeal.

There were whispers about who the athlete was (don’t forget this report is from 2015) but no one seemed interested in pursuing the publicly available, non-redacted report until now.

You can like or dislike a journalist but when he/she is doing a public service you have to give him or her credit for what they’ve done.

In his report for the New York Times Ben Rothenberg not only named the athlete, <strong> Bethanie Mattek-Sands </strong> but revealed some information about her doctor. No one has challenged his report. Instead there’s been deafening silence from the ITF, the USTA and the WTA. Despite her TUE being denied Mattek-Sands played for over a year using DHEA, “an endogenous steroid hormone.” WebMD says the following “it functions as a precursor to male and female sex hormones, including testosterone and estrogen.”

Meanwhile the campaign to try and discredit the four women who were first outted by the hack continues unabated.

Tennis fans need answers. How could the ITF grant exemptions in this situation when the medical reports didn’t jibe with any known medical results. It’s very clear. If “A” is happening then so should “B, C or D”. If B, C or D isn’t happening then how can “A” be happening? It’s not rocket science.

Secondly how the hell wasn’t this made public and Mattek-Sands not receive some kind of discipline from her Federation (The USTA) or the WTA tour where she remains a top doubles player. If she was penalized in any way by either organization they’ve been very quiet about it. It’s situations like this that allow internet trolls to push meme’s saying the entire system is rotten in order to make one player’s situation appear normal and not out of the ordinary.

So what about it USTA? What about it ITF? What about it WTA? Are you all running around a room screaming and pulling your hair out by the roots? This report is over a year old and to this fan nothing whatsoever has been done to Ms Mattek-Sands. I wonder if the same “hands off let’s pretend it didn’t happen “attitude would have prevailed if some other athletes had done the same thing.

So far this is the only report that shows how an athlete tried to game the system. That the system worked in the end is small consolation.

©2016 Savannahs World Tennis all rights reserved

 

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