Rhinestones, the contraceptive pill and performance...

It was a tough choice deciding what to write about this week. Having just paid a visit to Alex Davey the official costume designer for the WBFF show I'm competing in, I could write about how distraught I was at the realisation of how much "rhinestoning" I'm going to have to do and the COST of these things. A bikini will set you back £350 and with themewear can be up to £800. My dad loves a bit of DIY so perhaps I shall turn this into a family project with the glue gun. In my head, I have grand images of embellished designs and Mardi Gras; then....the reality where I look like the Tin man out of the wizard of Oz.
Believe you me there will be a rant coming on this. Interpret the selfie how you will, but in this particular case there was no one else around to document my DIY experiment. Thank goodness I don't rely on this for a living!

Sainsbury's push up bra and tin foil: £8.50

Proper WBFF themewear: £ a lot more!!

But for now....something a little more academic but useful.

The Oral contraceptive pill and performance

I've just spent the last few weeks sweating over my MSc project proposal. I'm very interested in the endocrine system and effects of training on hormone levels and vice versa, so I'm curious about the effects of the oral contraceptive pill on performance. Does it have an "enhancing" effect or a "negating" effect? Women choose to take the pill for a variety of reasons, so it isn't just for contraceptive purposes. My experience of taking the combined pill Dianette, was rather a lot of weight gain! Unfortunately that's not an uncommon problem, which is meant to be because it increases appetite. I'm not so sure it's that simple....Cyproterone one of the active ingredients is an anti-androgen. It prevents testosterone binding, which we know is implicated in decreasing production of adipocytes (fat cells) and promoting lean muscle mass. Had I have been better informed, I may have chosen a better variety, of which there are many.
My hormones are the bane of my life! My mood and physiology change much more than I would like; whether this is perceived or not, it feels very real and makes life and training sometimes a bit tricky! I also feel it's one of those unspoken miseries that many women silently deal with. This is part of the reason for my curiosity and why I want to do this study. I'm lucky I have some good people at Imperial College helping me; so I shall be standing on the shoulders of giants and all that!


My research questions

• Do women using the oral contraceptive pill (OCP)and non users (non-OCP) athlete groups differ in their testosterone profiles (baseline levels, dynamic changes within a training session and across the menstrual cycle)?

• Is testosterone related to functional performance and/or behaviour in the OCP and non-OCP groups, therefore providing a marker of readiness in athletes? 

From scouring the published literature, it would seem fair to conclude that the oral contraceptive pill reduces absolute levels of estradiol (the predominant form of oestrogen during reproductive years), progesterone and testosterone. (I haven't looked at the effects on other hormones such as Cortisol). It also minimises fluctuations of these hormones. Testosterone especially is known to modify protein synthesis in skeletal muscle and connective tissue, enhance muscle contraction signalling, and shift stem cell differentiation pathways away from forming adipocytes (fat cells); so it's effects on building lean muscle mass is important. Current opinion also favours testosterone being implicated in "motivation" and readiness to train, allowing one to push harder. This last point is increasingly being given weight and viewed as an indirect cause of increased muscle mass. If one can train harder, positive muscle growth adaptations are more likely to occur.  

Mean endogenous concentrations of estradiol and progesterone in non-users and users of OCP during follicular, peri-ovulatory and luteal phases of the menstrual cycle, units pmol/ml (Casey et al, 2014). 

The figure above shows the hormone profiles of estradiol and progesterone in women that use the pill and those that don't. There are few consistencies in data when it comes to endocrine research but this change in magnitude of hormone levels does seem to be one of few things that is repeatable amongst the research. In terms of testosterone, baseline levels in women are very variable but ranges of 0.42-2.94nmol/L are not uncommon to find cited in the literature. Most hormones will be bound to another protein. Testosterone is no exception, so there are different fractions you can measure: free testosterone (0.5-3%), albumin-bound (30-35%) and sex hormone binding globulin (SHBG)-bound (65-70%). It is hypothesised (and now argued) that only the "free" or bioavailable fraction are useable by the body. 

In women that use the OCP, there is often a documented decrease in circulating levels of total testosterone and free testosterone and an increase in the main binding protein SHBG. Contraceptive pills with second generation progestins and/or lower oestrogen doses have less impact on SHBG levels. 

The link below is a reference to a meta-analysis of 42 studies of 1495 healthy young women aged 18-40. 

The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis.

I've always wondered at the magnitude of effect endogenous hormones can have on performance and mood. The data would certainly suggest that it could have a knock on effect to psychology and physiology.

Reading between the lines with the studies

However, there is no strong evidence to suggest that the OCP does affect strength levels and other performance indicators. You can search the literature over and over again but results are not conclusive. This is where the scientific method may not always hit the mark. Looking at the differences in methodology is vast and you can see:

•  There are many ways of quantifying performance and fitness; aerobic and anaerobic fitness, muscle strength and power, flexibility, body composition.

• There are many ways of quantifying strength and many different types of strength; maximum strength, speed strength (power), strength endurance, etc. Not all of these "lab" based tests are relevant to a sport.

There is also the issue of a "motivational" bias that goes along with doing a test. The very nature of being watched or doing a "test" for a study, means motivation is going to be slightly higher compared to a standard training environment. 

In addition how you measure hormones has big implications for how you interpret these studies. 

There are many ways to measure hormone levels using a variety of methods and sample types (mainly blood and saliva). The use of saliva sampling is peaking in popularity for measuring hormone levels because it is easy to use and saliva is thought to contain the "free" useable fraction of testosterone. 

However with all things scientific, nothing is ever simple!!! The "free" testosterone hypothesis is now being challenged, as it is thought there are definite but unclear roles for the SHBG-bound testosterone. 

Another good review, if interested:

Circulating androgens in women: exercise-induced changes.

All the studies I looked at had fairly variable methodologies and protocols so of course it makes comparisons very difficult. But it is worth noting, if you do pubmed this topic, to look closely at the methodology and what and how they looked at hormone levels and performance indicators. 

Common sense

My challenge with science is always trying to understand what papers can and can not say, what the common themes are and where there is no commonality. 

In fact because of inconsistencies in methodology, subject group, age, level of sport played, performance measure taken, fatigue, overtraining etc etc, it's really quite hard. This is where perhaps common sense has to be factored in.

I find most women that are into Sport or Fitness are relatively in tune with their bodies. They know when something is not quite right. Most understand their unique pattern of mood and physiology over the month... and er probably men understand this "coding"; PMS = xbox time. 

There are many different varieties of pill with different doses of oestrogen and progestin type and they may all work a little differently in an individual. Quality unbiased information is good, it allows you to make an informed decision, but then it's just trial and error. 

I lose the battle of control against my hormones, but there is something rather nice knowing they are mine; they are part of my slightly batty, eccentric personality. It also reminds me of a very important lesson; for every action there is an equal and opposite reaction. Manipulation of these things, will ultimately have a less good component that goes with it. Mother nature always wins in the end. 

Reference: CASEY, E., HAMEED, F. & DHAHER, Y. Y. 2014. The Muscle Stretch Reflex throughout the Menstrual Cycle. Med Sci Sports Exerc, 46, 600-9.