In an extraordinary article published recently (see end of this story), the claim is made that Lance Armstrong's extraordinary performance feats are directly due to his battle with testicular cancer.

According to the authors, having your testicles cut off (well one, anyway) is performance enhancing. But perhaps in their over-zealousness to ‘unmuddy the waters’ of persistent doping allegations surrounding Armstrong, the authors have probably raised more questions than they have attempted to answer.

The article outlines that surgical removal of testicles (even one) re-positions the body's hormonal system, playing with the feedback system of normal testosterone production. Consequently, a cascade of events which allegedly favour or enhance endurance performance is proposed by the authors. They suggest that the increase in LH to testosterone ratio and the increase in free fatty acid (FFA) to glycogen utilisation ratio which resulted in an increase in power-to-weight ratio (a favourable characteristic for mountain climbing) and a remodelling of type I and type II muscle fibres in Armstrong's physiology all contributed to him becoming the super-athlete that he is or was.

Another mechanism by which the authors propose that Armstrong obtained and maintained his super physiology was that the altered hormonal state induced an increase in the production of red blood cells (RBCs). While the key to enhanced endurance is oxygen availability supplied by blood cells, to suggest that in the case of Armstrong this could have been provided by the extra blood produced as a consequence of the hormone imbalance is drawing a long bow, particularly in view of the evidence provided by the authors. The three studies reported in the article by the authors to support their argument provide very flimsy evidence that such a state results in increased red blood cell production.

One study performed on female rats which had their ovaries removed and were then placed on oestrogen therapy found a statistically significant increase in RBCs. But statistical significance is a long way from physiological significance, notwithstanding that the experiment was done on rats, and females no less. How could this result be applied to human male athletes, then?

The second study found an increase in haematocrits (hcts) of post-menopausal women while the third study revealed that post-menopausal women living at an altitude of 4,300 metres had higher hcts than pre-menopausal women. Again, how can these results be extrapolated to infer that it would be the same in males who are in an equivalent state physiologically (ie. in andropause) as caused by removal of the testicles.

These references are obscure, to say the least, although studies in the area are scarce. There are studies which refute the authors' position, although showing that blood volume is decreased rather than increased in post-menopausal women (eg. Jones PP et al 1997).

It appears then that evidence for increased RBCs at menopause (or andropause) is not clear-cut by any stretch of the imagination.

The authors also state that because Lance never tested positive for EPO (officially or legally), then he could not have taken blood boosters. Also the fact that EPO was capable of stimulating tumour growth surely would have perturbed someone like Armstrong enough to steer clear of such a drug because of his recent brush with cancer.

Legally, the results of Armstrong's EPO doping tests, whether official or not, remain unchallenged. Scientifically, though, there are still lingering doubts about the use of synthetic EPO or not by Armstrong. This stems from the ‘unofficial’ testing of his urine samples from the 99 tour in 2005, in which six of his samples were shown to contain synthetic EPO.

Armstrong resolutely defended his innocence, proclaiming that because of the age of the samples the scientific results were invalid (indeed, legally they were invalid). Well, the most fragile of human substances, DNA, contained in sperm cells stored and frozen regularly for many years can be brought out to produce off-spring. It is not beyond the realms of possibility, then, that a hardy protein/hormone such as synthetic EPO could also be stored, brought out years later and be validly detected.

The accusation by Armstrong that his frozen urine samples were void simply because they were old has no scientific basis. Indeed, six other riders were found to be positive for EPO during the same tests - and one of them, Bo Hamburger, was the first elite athlete ever to test positive (officially) for EPO in the world in 2001. A ‘smoking gun’, as they say!

I am to be convinced that the authors of this current article have proven one way or another that Lance's phenomenal performances are due to natural athleticism enhanced by his testicular cancer. Remarkably, the authors also go on to make a startling conclusion that they  “...do not recommend orchiectomy as a performance-enhancing modality”.

This is an extraordinary statement; one that infers that their results prove that having one's testicles removed improves performance. It’s almost reckless.

You can just see it now; some sick-minded male athletes now thinking that with only one testicle they can up their performance and female athletes thinking that they should do the same with their ovaries. Oh well, at least the doping test for males would be relatively easy. If a ‘cough test’ was done and something was missing down there, it would be pretty obvious!

Sorry, but I believe that two balls are still better than one.

Article reference: Med Hypotheses. 2006 Nov 7; Metabolic clues regarding the enhanced performance of elite endurance athletes from orchiectomy-induced hormonal changes. Authors: Atwood CS, Bowen RL.

Robin Parisotto is a former Australian Institute of Sport researcher and author of 'Blood Sports – the inside dope on drugs in sport'.