The Transhuman Olympics

As I write, nearly every country on Earth has sent its greatest champions to compete at the highest level of athletics. From weightlifting, to sprinting and track, we come together to exceed all previously known limits. To lift more, jump higher, run faster. To break records, and do the unprecedented.

The Olympics should represent the paragon of human accomplishment. Instead, they’ve been reduced to endless scandal. An embarrassment on the civilizational scale.

The problems are too numerous to enumerate [1], but can be clustered into principal categories:

  1. The International Olympics Committee is a breeding group for corruption.
  2. The World Anti-Doping Agency is ineffective, and unbalanced in its enforcement.
  3. The regulatory environment necessitates a culture of stagnation, preventing advances in drug development, equipment, and athletic accomplishment.

Throughout repeated attempts at reform, one thing has become clear: the IOC will not save us. It is an institution rotten to its core, and incapable of serious change. Rather than more protests and petitions. It’s now time to exit.

Among other changes, the most radical I recommend is a new kind of Olympics without the World Anti-Doping Agency. In short, I propose an Olympics with no drug testing.

As I’ll go on to demonstrate in Appendix B, incremental improvements to the current state of drug testing are simply not an attainable solution. As such, the notion of anti-doping as a path to fairness must be abandoned entirely. Instead, we should celebrate a drug-enabled Olympics that would outcompete the original in terms of viewership, athletic accomplishment, and cultural legitimacy.

That might sound crazy, but it shouldn’t. The Paralympics have only existed since 1960. The Special Olympics since 1968, and the World Anti-Doping Agency since 1999. Even the IOC has only existed since 1894. These are not immortal institutions, except by the logic of self-perpetuating authority.

The Transhuman Olympics would do more than improve the playing field for international athletics. It would sublimate geopolitical rivalries into a competition that is not merely harmless, but actually productive. In essence, leveraging the popularity and notoriety of the Olympics as a way to fund development into improved pharmaceuticals, alongside improved equipment, prosthetics, and medicine with general prosocial uses.

The true aim however, is even more basic and foundational. We need to remind humanity that progress is still possible. Not by mere milliseconds and millimeters, but by literal leaps and bounds.

We need to demonstrate decisively over and over again that human civilization is improving on undeniable axes.

And we need to do it in a public arena.

How Drug Testing Fails

Athletes face a genuine dilemma in the world of drug testing. They can either compete without drug-enhancement, and ruin their chances of victory, or they can take drugs, and spend the rest of their career in fear of getting caught, losing their reputation, their awards, and everything else they’ve worked for.

The Anti-Doping community urges them to do the first, but I reject the dichotomy outright. These can’t be the only options we provide to athletes.

At the moment, the situation is grim, almost humorously so. From Track Stats:

And from The Economist on doping in bicycling:

One solution is to simply improve the quality of anti-doping. Require more testing, more rigorous examinations, more scrutiny and so forth. Unfortunately, this plan is unrealistic, with no viable endgame in view. No matter how many new tests we develop, new drugs can be synthesized that won’t be detected. It’s an asymmetric war with no real hope for anti-doping. As the head of one lab explains:

although more than a dozen sarms [Selective androgen receptor modulators] are in development, tests exist for only a few of them, and only at the most advanced laboratories.

The pipeline of new drugs is unlikely to run dry, says Dr Cooper, for the human body contains hundreds of processes and chemical targets that might be tweaked to boost sporting performance. There is often more than one biochemical way to achieve the desired effect.

It’s worth understanding as well, just how badly existing tests fail, even on known chemicals. Since there’s natural underlying variation in testosterone levels, we attempt to test the Testosterone:Epitestosterone ratio, assumed to be held at around 1:1. A ratio of over 4:1 results in a positive test.

That sounds clever, except that the assumption doesn’t actually hold. A 2006 study of Korean and Swedish men found immense underlying variation not just in T levels, but in the T/EpiT ratio:

So just given natural genetic variation, an athlete of korean heritage will be able to take far more testosterone than an athlete of swedish heritage without triggering a positive test.

These are just a couple examples of the numerous ways athletes can use performance-enhancing drugs while testing clean. More details in Appendix B, and in the follow on video from Clarence Kennedy.

But the scientific failures alone don’t even scratch the surface. As WADA’s own working group admits: “To date, testing has not proven to be particularly effective in detecting dopers/cheats.” They continue:

The real problems are the human and political factors. There is no general appetite to undertake the effort and expense of a successful effort to deliver doping-free sport.

So despite all of rabble-rousing and the joy of radical rhetoric, it turns out my position is not even contrarian. Anti-doping is not desired, even by the bodies intended to enforce it.

The question is, where do we go from here?

The Olympics as They Stand Today

Before we dive into the details of my proposal, it’s worth asking what we might risk by changing the existing system. Surely, the Olympics have some value, or they wouldn’t exist.

The IOC itself is hilariously vague stating self-referentially that “The mission of the IOC is to promote Olympism”. It does go on to detail several sub-mission statements, but they’re mostly preventative in nature (“to act against any form of discrimination affecting the Olympic Movement”, “to promote a positive legacy from the Olympic Games to the host cities, regions and countries;”). Those are worthy aims, but they only address problems that arise as a result of the Olympics. They don’t, on their own, justify the existence of the institution.

But we can be generous and suggest some purposes, even if they go unstated. Perhaps the aim of the Olympics is to celebrate the limits of human achievement? To reward effort? To promote health and wellbeing?

Though they sound reasonable on paper, none of these aims are really coherent, at least not with the actual practice of the IOC. If the Olympics were about peak human achievement, we wouldn’t have banned the LZR Swimsuit or the Nike Alphafly. If the Olympics were about effort, they wouldn’t allow competitors with genetic advantages, access to better facilities and coaching. If the Olympics were about health, they wouldn’t require pushing athletes to the limits of safety and injury.

At the moment, the Olympics are simply for nothing, and people are starting to notice.

The New Republic writes Abolish the Olympics. The New York Times headline: Let the Games … Be Gone?, followed by the subtitle “After bidding scandals, human rights outrages, overburdened host cities, rampant cheating, a pandemic… has the world had enough of the Olympics?” Back in 2020, The New Yorker wrote “The I.O.C. Is a Threat to the Olympic Project”. The Economist has done their own analysis, asking Are the Olympic games a bad deal for host cities? (yes) and pointing out that Sport is still rife with doping. Concerned about the 2022 games in Beijing, the National Review writes “Boycott the Olympics? China’s Games See Bipartisan Backlash”, featuring an extended quote from Mitt Romney’s NYT Op-Ed on “The Right Way to Boycott the Beijing Olympics”.

The point is not that these articles are necessarily right, nor is it to beat you over the head with the force of their authority. The point is that the Olympics, as they currently stand, are doomed. They derive their importance solely from sponsorship and tickets that depend on popularity, and from a symbolic importance derived from legitimacy. At the moment, they have neither, and with the already contentious Beijing Olympics coming up in 2022, it’s only downhill from here.

In just over 6 months, athletes will either risk sacrificing their careers in a boycott, or attend the Olympics in Beijing and risk legitimizing an authoritarian dictatorship in the midst of multiple mass human rights abuses. For athletes in highly age-dependent sports, sitting this one out and waiting 4 years is not an option. 2022 could be their last chance.

Again, these can’t be the only options we provide to athletes. We have to do better.

The Olympics don’t have to be for nothing. They don’t have to be senseless. They could be a genuine celebration of human achievement in both athletic, and scientific spheres. Moreover, by leveraging the popularity of the Olympics, we could use athletics as a platform to incentivize and fund the development of improved pharmaceuticals, improved prosthetics, and medicine with general prosocial uses.

That’s the daring vision, now it’s time to see how we get there.

A Proposal for the Transhuman Olympics

Freedom from unfair drug-testing is only the beginning. An improved Olympics would require radical overhaul, but could at least begin with the following principles:

  1. No drug-testing of any kind. Since it’s not feasible to conduct an anti-doping regime, the process should be abandoned entirely in favor of harm reduction. The billions of dollars we currently spend on an antiquated anti-doping regime could instead be spent on developing safer steroid alternatives, and investigating the safety of existing compounds.

    • As basic mitigation against really extreme abuses, medals would be awarded on the day of competition, but not officially confirmed until the next 4-year cycle, after verifying that the athlete remains alive and in generally good health.
  2. A permanent Olympic village and stadium. The process for selecting cities enables corruption, not to mention “high debt, wasteful infrastructure and onerous maintenance obligations”, as well as mass displacements, human rights violations, forced evictions, and the over-policing of vulnerable communities. Trying to host the cities in unsuitable environments also leads to athletes playing on “burning sand” and risk of heat stroke alongside “oppressive humidity”. Instead, a permanent Olympic village should be built to host athletes year round. Since performance enhancing drugs will remain illegal in many countries, the village could also serve as a safe-haven where crucial drug categories are decriminalized, ensuring equal treatment for athletes regardless of country of origin.

    • Olympia would be suitable for historical reasons, though it reaches 89° in July. We could instead choose a country with existing efforts to decriminalize drugs (Portugal, Netherlands, Switzerland). Alternatively, we could just host the Olympics in Miami every year, but push it forward to April to avoid the heatwave.
  3. Liberalize Equipment Restrictions. Nike’s Vaporfly lead to a record sub 2-hour marathon time by Eliud Kipchoge in 2019, but has since been banned in Olympic competition. This has a chilling effect on innovation, and hampers the development of improved athletic technology. The LZR Racer was subject to similar regulation, resulting in 93 new world records, before being banned for providing an “unfair advantage” in a newly invented phenomenon dubbed “technological doping”. This goes beyond mere cultural stagnation, it is the active impairment of technological innovation

    • To ensure continuous improvement rather than monopoly, all designs should be made commercially available following the first event in which they see competitive use. Alternatively, designs could be released through public patents with reasonable licensing fees.
    • “Mechanical doping”, defined as equipment which provides its own energy source, should not be banned outright, but would have to exist in its own category, equivalent to a weight class. Unlike drug-testing, this is easily verified through thermal imaging and conventional x-rays.
    • Within the mechanized category, bionic legs, third thumbs and exoskeletons would all be permitted.
    • Para-athletes should be welcomed without additional scrutiny, and without concern that running blades or other prosthetics provide an “unfair advantage”. As it stands, this regulation is not only an impediment to progress, but deeply ableist (“You’re allowed to compete, you’re just not allowed to be better”.)

The remaining question is whether these changes should be made to the existing Olympics program through the IOC, or built into an entirely new system.

Let’s consider the entrenched incentives at play: None of the existing Olympic city contenders would agree to a permanent city. The officials who currently benefit from bribery would not want an end to the anti-doping regime that allows them to pad their pockets. Nor would the countries who currently benefit from doping actually want to create a level playing field.

As you can guess by now, I simply don’t believe that serious reform is possible given the entrenched incentives that currently exist. We need new institutions.

Appendix A: Positive Side-Effects

As stated at the onset of this article, Olympic reform isn’t just about fairness, it’s about actually doing good. At the moment, the Olympics are seen as entertainment, or perhaps as inspiration for amateur athletes. But they could be so much more. The benefits of a new Transhuman Olympics would be numerous:

Enable Trickle-down Technologies
Instead of banning and stringently regulating performance enhancing drugs, we should be incentivizing their development and seeking out pro-social uses. Consider the steroid Norethandrolone, which is legal in France, and used to treat burns and anemia, but remains banned in the US due to its potential for abuse.

As in startups, it’s possible that the best prosocial and lay-person accessible technologies will appear first as toys for the rich. Just as Tesla began manufacturing a high-end sports car before producing an affordable high volume car, many of the drugs, prosthetics and equipment developed will initially only be available to elite athletes, but in time, there will be paths to commercialization.

With sufficient investment, performance enhancing drugs could be made safe and legal for both elite athletes and ordinary humans. Not merely to run faster and jump higher, but also to live longer and healthier lives, without fear of disability or muscular dystrophy.

Sublimate Warfare
During the Cold War, we saw rapid advances in aerospace technology. Though there were some related military uses, the Moon Landing itself was a purely propagandistic act. As JFK privately told NASA administrator James Webb:

I’m not that interested in space. I think it’s good. I think we ought to know about it we’re ready to spend reasonable amounts of money. But we’re talking about fantastic expenditures which will wreck our budget… The only justification for it, in my opinion, is because we hope to beat them and demonstrate that starting behind as we did by a couple of years, by God, we passed them.

Today, the world’s superpowers remain in competition, but have not yet come to view scientific achievement as the battlegrounds for their proxy wars. Rather than bloated defense budgets, we could have well-funded research programs.

Or as William James once wrote: “would our gilded youths be drafted off, according to their choice, to get the childishness knocked out of them, and to come back into society with healthier sympathies and soberer ideas.”

Cultivate a Culture of Progress
Anti-doping is not a phenomenon in isolation, but part of a larger system of traditionalism and stagnation. Although they cite health concerns in the realm of drug use, the IOC consistently bans innovation across a variety of domains. Novel effective techniques are banned (see Tuariki Delamere’s somersault long jump). And innovation in equipment is banned, including the LZR Racer swimsuit, the Nike Vaporfly shoes, and spaghetti stringing in Tennis.

It’s seriously difficult to understand all of this from within the dogma of the IOC. So let me state it as clearly as possible: We are actively hampering innovation in the field of athletes through needless regulation. This is occurring systematically, and hailed as a commitment to fairness.

That appeal fairness is especially ironic, given that anti-doping creates the worst abuses of all. Athletes who get caught have their careers and reputations ruined, with athletes who sneak through or benefit from state-sponsored systems win medal after medal. Where’s the fairness in that?

Meanwhile, it’s worth at least sanity checking the fairness claim. Critics suggest that Vaporfly shoes might not be accessible or affordable to all athletes. This is a shoe that  costs $250, being banned from a competition that costs $20 billion.

Appendix B: Failures of the ​​World Anti-Doping Agency

Sha’Carri Richardson’s suspension was appalling, but not surprising. From the moment the International Olympic Committee began drug testing in 1967, it’s first ever ban was on Hans-Gunnar Liljenwall, a Swedish pentathlete disqualified for his use of… ethanol. Since the start, “anti-doping” has been a ridiculous concept. Flawed in theory, and botched in execution.

Still, the obvious objection to my proposal is that drugs are bad. Anabolic steroids are known for their aesthetic side effects, but also pose serious health risks. As just one example, a 1999 paper found that “mortality during the 12-year follow-up was 12.9% for the powerlifters compared to 3.1% in the control population”. [2]

Taking the health of athletes seriously, it would seem that we have no choice but to insist on rigorous and stringent anti-doping policies, with the aim of ensuring that no athlete loses years of life in the pursuit of glory. How can we then justify a non-tested Olympics?

The problem is that under the current regime, athletes are still abusing drugs, they’re just doing it in more dangerous and exotic ways.

A 2017 report surveyed elite athletes, and found 30% admitting to taking banned substances, with up to 45% of athletes at the 2011 Pan-Arab Games admitting to drug use. That’s all just self-reported, so we can expect the actual numbers to be even higher. Russian whistleblower Grigory Rodchenkov reports in Icarus that of the 2012 London Olympics athletes, “50% for sure” were on a state-sponsored doping program.

In the world of Olympic weightlifting, the crisis seems especially severe. At the 2016 Rio Olympics, Ruslan Nurudinov was awarded the gold medal, but was later disqualified for doping. 2012 was even worse. In the heavyweight category

  • Khadzhimurat Akkaev, previous PR 430kg Total, disqualified,
  • Dmitry Klokov, previous PR 428kg Total, disqualified
  • Oleksiy Torokhtiy, lifted 412kg Total, awarded gold, but later disqualified

So the two top athelees, capable of living over 420kg, didn’t even make it. The third best athlete did win, until testing positive later. This might initially sound like a tale of justice correctly served. After all, with those athletes disqualified, the clean athletes could now be upgraded in rank, and awarded the medals they truly deserved.

The problem with this narrative is that even the athletes who pass drug tests are most likely doping, just doing so more discreetly. The eventual gold medalist, Navab Nassirshalal, is from Iran, a country with over 10 confirmed doping cases from 2008 to 2018. Prior to 2008, things were even worse. In 2006, an Iranian weightlifting official was forced to resign following a ban on nine Iranian weightlifters for confirmed doping cases. To put things in perspective, only 11 athletes were tested, for a failure rate of 82%.

As a result of the disqualifications, Uzbekistan weightlifter Ivan Efremov was moved up several places, ultimately earning a bronze medal. Again, this might initially sound like proof that the system is working and cheaters are caught, but we have decent reason to believe that this is all only the tip of the iceberg. Consider that of the 6 weightlifters Uzbekistan sent to the 2012 Olympics, 3 of them (Ruslan Nurudinov, Marina Sisoeva, Bakhram Mendibaev) were later confirmed to be doping. [3]

Or consider the results from 2012’s Middle heavyweight event. Of the 21 athletes who competed, 8 were disqualified retroactively, leading to Polish weightlifter Tomasz Zieliński getting bumped from 9th place all the way up to 3rd, and getting awarded a bronze medal. That would sound like a success story… except that just a few years later, Zieliński was also tested positive leading up to the 2016 Olympics. So don’t mistake the absence of proof for proof of absence. [4]

Still, it’s critical to understand exactly how some athletes manage to avoid drug-testing while others fail, and just how easy it is to slip through. In an extended video essay, world-class weightlifter Clarence Kennedy details the science behind drug-testing. We can break it down into three main categories:

1. Corruption and Country-specific Enforcement
The World Anti-Doping Agency is not an omnipotent body, it largely relies on each country to enforce guidelines internally. Obviously, this creates a massive conflict of interest. As WADA’s own documents make clear, National Anti-Doping Organizations “operate in the national realm, carry a mission of public interest and are often subject to stringent national regulations. They can experience external pressure from their main interest groups, in particular their governments and national sports bodies.” Though WADA does attempt to undertake independent investigation, this too is hampered by country-specific demands. Per Kennedy: “In order for WADA to enter some countries, they have to obtain visas. Those countries can get notified when they apply for visas, so athletes can simply go off their drugs, get tested and be clean”.

As an additional report from a WADA working group admits: “To date, testing has not proven to be particularly effective in detecting dopers/cheats.” They blame this not on failures of science, but on failures of political factors, and go on to write:

The real problems are the human and political factors. There is no general appetite to undertake the effort and expense of a successful effort to deliver doping-free sport. This applies (with varying degrees) at the level of athletes, international sport organizations, national Olympic committees, NADOs and governments. It is reflected in low standards of compliance measurement (often postponed), unwillingness to undertake critical analysis of the necessary requirements, unwillingness to follow-up on suspicions and information, unwillingness to share available information and unwillingness to commit the necessary informed intelligence, effective actions and other resources to the fight against doping in sport.

But the problem isn’t just “low standards of compliance” in National Anti-Doping Organizations, it’s corruption within WADA itself.

As a New York Times report details, Russia athlete Darya Pishchalnikova decided to come clean, and privately contacted WADA with “information on systematic doping in her country”. But instead of investigating, WADA “did not begin an inquiry”, instead forwarding Pishchalnikova’s plea to “Russian sports officials — the very people who she said were running the doping program.”

Even after the release of Icarus, confirmation of it’s claims, and admissions from Rodchenkov of Russia’s state-sponsored doping program, Russian athletes continue to compete in the Olympics. An initial 4 year ban was shortened to 2 years, then ignored altogether, as Russian athletes can simply compete “independently”, opting to attend under the name “Russian Olympic Committee”.

2. Testosterone
This one hormone deserves a category of its own. Athletes vary tremendously in their natural levels of testosterone, with “1st to 99th centile ranges of 5.6–27.6 nmol/L at age 35” [5]. As a result, it’s difficult to test purely for testosterone levels, and WADA ends up relying on various ratios, including testosterone to epitestosterone (T/EpiT). Since our bodies produce Epi-T as a byproduct, it’s thought that the T/EpiT ratio will be constant around 1, regardless of the underlying absolute levels. [6]

As noted earlier, this assumption doesn’t actually hold. A 2006 study of Korean and Swedish men found immense underlying variation not just in T levels, but in the T/EpiT ratio. Given natural variation, some athletes will be able to take far more testosterone than others without triggering a positive test.

Different testosterone variants also have wildly different half lives. Testosterone buciclate has a half-life of 29.5 days, putting athletes at high risk of getting caught by random drug tests, or by doping too close to the competition. In contrast, testosterone propionate has a half-life of just 0.8 days, making it a far safer bet, and extremely difficult to detect.

Finally, if all else fails, you can just take Epitestosterone in equal amounts, ensuring a “clean” ratio. This isn’t just speculative. Classified documents released on East Germany’s state-sponsored doping program reveal that “The injection of epitestosterone, alone or together with testosterone, was then frequently incorporated into the program”.

3. Drug Testing as an Asymmetric Arms Race
On one hand, WADA tries to develop and deploy an increasingly large and sensitive set of tests. Simultaneously, national programs attempt to develop increasingly obscure and undetectable drugs, hoping to evade capture.

Note that there’s a fundamental asymmetry here. WADA has to test for every possible drug that could be used, whereas athletes just have to find a single compound that won’t be detected. So it’s an arms race, but from the start there’s no question that WADA will fail to keep up.

In general, this discussion will tend to sound speculative and conspiratorial. By definition, we don’t have real evidence of designer drugs that evade detection.

But there are historical cases we can point to. For nearly 20 years, the Bay Area Laboratory Co-operative (BALCO) operated ostensibly as a testing facility, while actually developing Tetrahydrogestrinone (THG, “The Clear”). Wikipedia describes how THG was developed “completely in secret by [Patrick] Arnold as a designer drug, on the basis that doping testers would be unlikely to detect a totally new compound”. Arnold was right, and THG was never detected in athletes until 2003 when an anonymous whistleblower leaked accusations to the United States Anti-Doping Agency. Without this tip off, it’s unclear if THG use would ever have been detected, since WADA and other regulatory bodies simply wouldn’t have known that it even existed.

Even now, by WADA’s own admission, “there may well be some drugs or combinations of drugs and methods of which the anti-doping community is unaware”. And of course, if we don’t even know they exist, there’s no way to test for them. As the earlier article from The Economist writes:

He points out that although more than a dozen sarms [Selective androgen receptor modulators] are in development, tests exist for only a few of them, and only at the most advanced laboratories.

The pipeline of new drugs is unlikely to run dry, says Dr Cooper, for the human body contains hundreds of processes and chemical targets that might be tweaked to boost sporting performance. There is often more than one biochemical way to achieve the desired effect.

Meanwhile, drug testing has also evolved to a non-trivial cost. One estimate from economics professor and former Olympic gold medalist Wolfgang Maennig finds that WADA performs around 270,000 drug tests per year, costing $228 million annually. As more drugs are discovered and added to WADA’s ban list, and as more tests have to be run on every athlete that competes, WADA’s costs will continue to inflate.

So unless we’re willing to increase spending to billions of dollars per year, just to catch some athletes, all while knowing that many will find ways to avoid testing positive anyway, the goal of a “Clean Olympics” will remain an unreachable dream.

Ultimately, there is simply no realistic plan for reform. The inherent flaws of the IOC/WADA system will not be fixed by minor amendments, new working groups or “independent” investigators. At their core, the Olympics are a deeply political event, which cannot be freed from conflicts of interest. Even with redoubled efforts at the political level, the scientific dynamics will frustrate attempts to create a 100% clean sport.

What’s worse, anti-doping efforts are actually the breeding ground that allow corruption to thrive. Since winners and losers depend so heavily on the selective enforcement of regulations, countries can simply bribe their way to victory.

But we don’t have to struggle in futility against drug-use. We don’t even have to lean back and begrudgingly accept it. Instead, we can lean in, fully embrace the reality of drug-enhanced sports, and in doing so, create the greatest Olympics the world has ever seen.

See Also

Clarence Kennedy — Why I’m Against Anti-Doping

[1] Just to list a few headlines from the last month alone: Tokyo is so hot that Olympic beach volleyball players had to stop practicing because the sand was burning their feet, Deaf-Blind Athlete Quits Team USA After She’s Told She Can’t Bring A Care Assistant, Tokyo man evicted twice, 50 years apart, for Olympic construction, Namibia teenagers barred from Olympic 400 over [naturally occurring] testosterone, Serena Williams joins growing list of tennis stars to skip Tokyo Olympics, ​​Olympics swimmer ‘disappointed’ by restrictions forcing athletes to leave nursing infants at home.

[2] There were only 8 powerlifter deaths, of which 3 were suicides, so we can debate the severity of this result, but it’s still likely not healthy.

[3] Of course, this is all just guilt by association. But it’s not just anti-nationalist stereotyping. The Uzbekistan national weightlifting team trains together, gets coached together, etc, as do many Olympic national teams. That doesn’t make any of this definitive, but in the obfuscated world of Olympic scandals, it’s the closest we’re likely to get.

[4] To be clear, it’s not just (ex-)communist countries, Eastern Europeans and Iran. One ranking from 2018 puts Russia at the top, but with Italy, France and India close behind. Another ranking from 2016 has Italy first, followed by France, the US, Australia and Belgium.

[5] That’s the 99th percentile, which sounds stringent, but that’s just 1-in-100. Remember that Olympic athletes are selected as the top competitors from across the entire world, so the true upper bound within their population is likely even higher.

[6] There is another test, known as Carbon Isotope Ratio which can specifically detect synthetic testosterone, but it’s expensive, and only used if an athlete fails the T/EpiT test.