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Behind Bethanie Mattek-Sands’s Drug-Use Exemption, Questions About Her Doctor

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By BEN ROTHENBERG SEPT. 15, 2016

United States sports officials have been quick to defend the athletes whose medical information was publicly released by computer hackers this week. The documents showed that some top American athletes have exemptions to use drugs that are otherwise banned — exemptions that they requested and that were granted by antidoping officials.

While the hacked documents lay bare urine-test results, specific substances and the period of time they were taken, they do not reveal which doctors originally prescribed the drugs in question.

In at least one case — perhaps the most complicated exemption of those made public this week, that of tennis player Bethanie Mattek-Sands — the person behind the prescription is a former bodybuilder who does not shy away from discussing the use of prohibited substances.

That person, Dr. Eric Serrano, who has said that he has worked with “thousands of steroid-using athletes,” prescribed drugs for Ms. Mattek-Sands, who won the women’s doubles title at the United States Open on Sunday and a gold medal in mixed doubles at the Rio Olympics.

Ms. Mattek-Sands has not been accused of violating antidoping rules, and sports officials have said this week that the athletes whose medical information was compromised had properly followed all protocols.

“To those athletes that have been impacted, we regret that criminals have attempted to smear your reputations in this way,” the World Anti-Doping Agency said Wednesday, hours after Ms. Mattek-Sands’s records were published.

Dr. Serrano did not respond to several interview requests this week. Ms. Mattek-Sands has declined to talk about her case in requests dating to last year.

The special permission she was given to take banned substances has not been without controversy, nor was it unequivocally approved, resulting in a legal dispute.

Ms. Mattek-Sands, a 31-year-old from Rochester, Minn., made her first recorded applications for a therapeutic use exemption in 2012, asking for hydrocortisone, a mild steroid, to treat adrenal insufficiency. In 2013, she added a request for DHEA, which converts to steroids, including testosterone, in the bloodstream.

Dr. Alan Rogol, an endocrinologist who works with the United States Anti-Doping Agency on its review of exemption requests, criticized the premise of Dr. Serrano’s diagnosis, emphasizing that an accurate diagnosis was a precondition for any exemption to be granted.

Ms. Mattek-Sands’s application was approved by the International Tennis Federation but revoked in July 2014 by the World Anti-Doping Agency, which said it believed that DHEA would enhance her performance.

“DHEA supplementation cannot be justified as necessary to protect this athlete from significant health impairment,” WADA wrote in its decision. “The potential for testosterone production in a female athlete through the use of an androgenic pre-cursor such as DHEA carries a significant ergogenic potential with performance enhancement consequences across virtually every sport.”

In August 2014, Ms. Mattek-Sands reapplied for an exemption for DHEA, which was again approved by the I.T.F. before again being rejected by WADA.

Stuart Miller, director of the International Tennis Federation’s antidoping program, approved Ms. Mattek-Sands’s applications for exemptions. He said that of the hundreds of applications he had approved in his 10-year tenure at the federation, hers were the only ones overruled by WADA.

Dr. Rogol said DHEA, a precursor of testosterone, should never be approved for use by a female athlete.

“It’s going to be turned, likely, into relatively small doses of testosterone, which of course for a woman, even small doses are performance enhancing,” Dr. Rogol said. “Women’s testosterone levels are normally perhaps a tenth of men’s, so if you boost them up to a fifth or a fourth of men’s, there likely will be an advantage.”

Ms. Mattek-Sands filed an appeal to the Court of Arbitration for Sport, the final authority on international sports disputes. The court said she was most likely “suffering from some legitimate medical affliction” and “in good faith, sought to identify the medical condition afflicting her and receive appropriate treatment,” but it ruled against her despite a lack of “nefarious intent.”

Dr. Rogol called the Court of Arbitration’s expert “spot on” in his reasons for ultimately ruling against Ms. Mattek-Sands.

“I think it tells you that tennis is a little bit more insular,” he said of the federation’s initial approval.

In an interview this week, WADA’s director general, Olivier Niggli, said it was challenging to adjudicate athletes’ requests to use banned substances and to differentiate medical necessities from attempts to enhance performance. He said the antidoping system relied on checks and balances, including WADA’s veto power — such as that exercised in Ms. Mattek-Sands’s case — and the athlete’s right to appeal to the sports court.

According to the documents published by the computer hackers this week, Ms. Mattek-Sands’s subsequent applications for a therapeutic-use exemption for hydrocortisone have been approved, most recently in April.

The court’s decision against Ms. Mattek-Sands included footnotes expressing its surprise at what it called an apparent lack of expertise on her doctor’s part regarding her medical concerns.

“He stated, rather surprisingly, that he was open to ideas as to how to diagnose and treat the Appellant,” the court wrote.

Dr. Serrano was introduced in the court’s decision as a family-practice physician in Pickerington, Ohio — far from Ms. Mattek-Sands’s training base in Arizona — but he is better known for his work with athletes and bodybuilders, as well as for being the founding medical director for the supplement maker MusclePharm. (His profile has been removed from the company’s website, however, and MusclePharm has not responded to a request for comment on his status.)

Dr. Serrano has expounded on his theories and practices in interviews with bodybuilding-focused publications throughout his career.

In interviews with the website T-Nation, Dr. Serrano said that “testosterone is actually the most under-prescribed medication for females.” He also discussed his instruction to athletes not to “tell the newspapers I work with you — just tell the next athlete.”

“I also have a few athletes who I keep secret,” Dr. Serrano said in the interview. “I don’t prescribe steroids, but I want to make sure athletes stay healthy if they’re taking them. These athletes trust me, and I won’t put anything on the chart, and anything we talk about is between him and me.”

Dr. Serrano has also boasted of his work with athletes from Major League Baseball, the National Football League and the National Hockey League.

“I got some famous patients,” patients whom “no one is supposed to know because they in the Olympic Games,” he told the website Anabolic Extreme, adding a suggestive comment regarding “what the Olympic Games are about.”

Despite this pattern of apparent dog whistles to potential clients looking for a doctor who will abide rule-breaking, Dr. Serrano does not appear on WADA’s list of prohibited association for banned personnel.

Mr. Miller said that the tennis federation’s review committee checks WADA’s list when going over applications and tries to ensure that the doctor who signed off on the forms is a “legitimate medical professional” and an appropriate choice to be offering medical support regarding the condition for which an exemption is sought. He would not comment on any additional research that might be done into the doctors signing off on the forms.

“I think there’s always a need to be vigilant; that’s the starting point,” Mr. Miller said. “Is it possible that someone could try to game the system to get an advantage? Well, yes. It probably means that you have to have a doctor who is colluding with you in breaking the rules.”

Mr. Miller cited the example of a Ukrainian doctor, Elena Dorofeyeva, who was given a four-year ban this year for administering a banned substance, called Red Rum, to a tennis player.

“Thankfully, those people are few and far between, as far as I’m aware,” he said.

http://www.nytimes.com/2016/09/16/sports/tennis/mattek-sands-eric-serrano-doping-russian-hacking.html?_r=1

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