Which of the following two statements would you find to be more outlandish? That I have on multiple occasions throughout my career as a pediatrician prescribed Viagra to children or that professional athletes are using it to try and gain an edge on the field of play? What if I were to tell you that both of those statements are true and neither of them is outlandish?
Earlier this week, Chicago Bears wide receiver Brandon Marshall made a claim that has been the subject of snickering and laughter throughout the world of sports. He had been asked by one of the local beat reporters about the the recent spate of football players being suspended for supposed Adderall use. To paraphrase, he said that he didn’t know much about Adderall use, but he had heard of NFL players using Viagra (aka sildenafil) for better performance on the field.
Since that moment, I have heard a string of jokes and innuendos implying that this is a ridiculous thought. Viagra is for erectile dysfunction, silly, stupid NFL player. What good would that do on the playing field. Maybe it would help with the groupies after the game, but how does it help you run faster, throw father or jump higher? Stick to catching footballs. Except that I would be willing to bet that he is right, for the same reason that I wrote all of those orders for sildenafil back in residency.
A brief primer on how Viagra (and its competitors Levitra and Cialis) works. Basically, it blocks an enzyme which allows a chemical to build up in the body which leads to the opening of small blood vessels called arterioles. Open blood vessels lead to increased blood flow, which in the case of the organ in question, leads to “being prepared, when the time is right”.
However, just as when you take ibuprofen for a headache or backache, when you take any of these medicines, it doesn’t just work in the intended area. Arterioles throughout the body are dilated and lead to increased blood flow in those areas. This is why there are the warnings in all of the commercials that you should not take Viagra if you also take nitrates for chest pain. Nitrates dilate blood vessels and combining that with another dilator can lead to dire consequences. This is also the reason I would write orders on occasion for pediatric patients. Whether it was a premature baby or a child with a complicated heart issue, sildenafil would help open up the blood vessels in their lungs and increase the amount of oxygen picked up by the blood. Anybody think that the possibility of increased oxygen uptake might help an athlete perform better between the white lines? Its the same reason athletes take erythropoeitin (EPO).
However, just because something works in theory does not mean that it is actually effective in practice. You may be surprised to hear that there are many scientists who have tried to see if this theoretical benefit exists in the real world. And unfortunately for many of those athletes who have tried to get an edge, the evidence would indicate that there is no benefit to using Viagra to improve oxygenation. Same thing with Cialis. And it is not just in humans. It doesn’t work in thoroughbred horses either. Then again it is not that surprising that athletes would use anything to try and gain an edge, even if there is no proven benefit, such as magnetic bracelets (with or without holograms) or possibly Kinesio tape
Then again, maybe Brandon Marshall was on to something. The one scenario where studies have shown Viagra to have some benefit to athletes is when they are at high-altitudes. Where did Brandon start his NFL career? In Denver, the Mile High City. The NFL might want to start investigating the men in orange and blue. And maybe Barrel Man too.