Substance of interest: Testosterone

TrueHoop has been investigating PEDs and the NBA all season. The next in a series:

Thanks to Lance Armstrong, Bill Simmons and others, NBA fans are thinking about performance-enhancing drugs in new ways.

And if the comments on ESPN.com or Twitter are any judge, the drug they're most concerned with is human growth hormone. When superhuman athletic performance is the topic, this seemingly magical new substance that they don't even test for in the NBA generally stars in the conversation.

But talk to people with deep first-hand knowledge of doping and HGH takes a back seat to testosterone.

It's a widely available substance that dopers from other sports put at the forefront of their regimens. It's all over baseball's Mitchell Report, the thoughts of Victor Conte (mastermind of the BALCO scandal that engulfed baseball and track) and cycling's various scandals.

And testosterone has several built-in advantages to the would-be NBA drug cheat.

  1. It works. Anecdotes from users and respected research generally agree that testosterone is effective as a performance enhancer -- something you can't say about deer antler spray and the like.

  2. Little fear of testing positive. Used carefully, athletes have very little risk of being caught -- many busted dopers from other sports admit to having used testosterone but very few were caught because of failing a test for this.

  3. No injections. Testosterone comes in every form imaginable. Pills, cream, gel, patches ... it even comes in roll-on underarm form, like Old Spice.

  4. Not a street drug. Testosterone need not come in an unlabeled canister of powder sold out of somebody's trunk outside your gym. It's manufactured by major pharmaceutical companies. You don’t even have to go to some anti-aging clinic in Hollywood to get it. By complaining about low energy levels and sex drive, it’s something available from your local doctor -- and quite possibly even covered by your insurance plan.

  5. It's legal. Don't get me wrong, it's banned in the NBA. But a lot of drug busts come from the police or customs officials finding the stuff on your person. Traveling with amphetamines or anabolic steroids from the FDA's controlled substances list comes with real legal risk. But prescribed by a doctor, testosterone is of no concern to the government.

Testosterone is a compound with such profound and varied effects on the human body that the implications for athletes are almost limitless. For starters, it is the original steroid; the definition of "anabolic steroid" is something that mimics or is derived from testosterone. It comes with all the implications for muscle density and size known to anabolics.

It's also associated with the kind of decisiveness and killer mentality that athletes so prize -- if you have an hour, listen to this decade-old-but-still-relevant radio show all about testosterone. Enlightening to no end. This hormone is no small part of what it means to be a man; despite what you may have heard about X and Y chromosomes telling the story, levels of hormones like testosterone are at the core of determining who is male and who is female. Meanwhile, people who have lived with incredibly low levels of testosterone report an almost total lack of passion. People who take lots of testosterone report finding themselves doing aggressive things their normal selves could never imagine.

The implications are big, and yet it's so easy to use.

“It is sort of the lollipop of drug cheating,” says Daniel Coyle, who co-wrote “The Secret Race” with cyclist Tyler Hamilton. That's the book that blew the doors open on the Lance Armstrong doping scandal, because not only did Hamilton cheat right along with his teammate Armstrong, but he also reformed himself and resolved to tell every little detail of how it happened.

To recover better between contests

"The Secret Race" has an important story about the first time Hamilton, who did not want to cheat, took banned drugs. At that stage of his career, Hamilton was fast enough to be a good pro cyclist on many days. But he simply couldn't recover fast enough between races.

This is exactly what dogs NBA players. In the long-haul of an 82-game season, with several contests a week for months upon months, there is precious little time to recover. Under those conditions, it's very hard to end a season in tip-top shape. Recovery is the key.

Hamilton tells a story of the team doctor, Pedro Celaya, stopping by his room in the fall of 1997, when Hamilton had been through a grueling stretch of races:

Just after the Tour of Valencia, Pedro came to visit me in my hotel room. My roommate, Peter Meinert Nielsen, was at dinner, so we could talk in private. Pedro was wearing what he usually wore at races: a vest with lots of pockets, like a fly fisherman might use. He sat down and asked me the question he always asked: How are you, Tyler? He was always so good at asking that question; he made you feel how much he cared. So I told him the truth. I was wiped out. I could barely make it to the shower. I didn't have anything left.

Pedro didn't say anything at first. He just looked at me -- or, to be more honest, looked into me with those soft, sad brown eyes. Then his hand started rooting around in the fly-fishing vest, and pulled out a brown glass bottle. Slowly, casually, he showed it to me, unscrewed the top, gave an expert tap with his fingertips. A single capsule. A tiny red egg.

Hamilton swallowed it, and felt the difference in a race called the Luis Puig a couple of days later:

As we neared the top of the climb, I noticed I was moving up; I was passing one rider, then three, then ten. ...

The red egg -- which I found out later was testosterone -- had gone into my bloodstream and kicked off a cascade of beneficial changes: added fluid to my muscles, repaired tiny injuries, created a feeling of well-being. It wasn't just me going up that hill, it was an improved me.

One athlete after another has stories like that. Andrew Tilin, a freelance writer and a weekend bike racer, decided to give testosterone a try a few years ago. Tilin easily identified a local doctor who would prescribe a significant dosing regimen. He rubbed the cream on his thighs every night for a year … and his racing ability went through the roof. He wrote about it for Outside magazine.

I felt far more vital and virile than I had at the Wards Ferry race. Around the house, the T's presence had been palpable. The kids wondered why Daddy wanted to hug Mommy all the time. What I couldn't tell them was that testosterone fuels libido in the brain and facilitates the production of chemicals required for sexual arousal.

Other body parts were affected, too: I'd already seen new feats of strength from my jockey-slight, 145-pound frame. Over a span of six sets, I could do 210 partial squats with a 125-pound barbell. I pushed approximately 400 pounds during leg presses. I could see new muscle definition in my shoulders, triceps, calves, and quads. I was almost buff.

Meanwhile, on the bike, I recovered from hard workouts amazingly fast.

An easy test to beat

There is a common way to test for testosterone cheats -- and it’s a cinch to defeat. The body naturally produces about the same amount of testosterone and something called epitestosterone. The standard test is to check the ratio of one to the other. If they’re similar, in most leagues, that's the end of the story.

If, on the other hand, the testosterone is much higher than the epitestosterone -- four-to-one is a typical upper allowable limit -- then more expensive and accurate tests are called for.

For drug cheats taking testosterone, the trick is to keep the levels pretty close to the epitestosterone and avoid suspicion.

Which is easy.

Perhaps the most famous PEDs scandal in U.S. sports history centered around Victor Conte's California-based BALCO lab. BALCO’s notorious drugs of choice were "the clear" and "the cream." "The cream," it turns out, was testosterone mixed with a little bit of epitestosterone. Simple as that: As one went up, so did the other. Evidently it worked -- despite lots of testing of its athletes, BALCO didn’t fall because of failed testosterone tests. In fact, very few do. And from what we know publicly, that approach would still work today in a lot of leagues, including the NBA.

But even simpler is to take the testosterone in tiny doses, in the evening. This would work in the NBA because the league does not wake players up to test them for PEDs in the middle of the night. In fact, it seldom tests players at home at all. Eight or nine hours without a test is enough time for a "microdose" of testosterone to both do its work and clear the system sufficiently to have blood levels at legal limits by the time a player might see a tester at a shootaround or game.

This has been working for athletes for more than a decade. "Around 2001," writes Hamilton, "we got away from the red eggs and started using testosterone patches, which were more convenient. They were like big Band-Aids with a clear gel in the center; you could leave one on for a couple hours, get a boost of testosterone, and by morning be clean as a newborn baby."

A better test

Testosterone is widely seen as effective. Its ubiquity and source -- your local doctor -- suggest it is fairly safe. Failed tests are rare. I don't know if NBA players are using testosterone to cheat. But I'm not sure what would be stopping them.

Meanwhile, the league and Players Association could take important steps to catch testosterone cheats. They could implement the rigorous biological passport regimen, which tests athletes' blood and urine year-round, looking not for drugs but abnormal blood levels. High-performance blood would draw extra scrutiny. This is what's happening in many other sports, including cycling, to some degree baseball and the upcoming World Cup -- and Lance Armstrong, who scoffed at many drug testing efforts, calls this development effective.

In the NBA, such a testing regimen would have to be negotiated between the league and the union, however, which would not be easy.

In the interim, there's another important step that could be taken immediately if it isn't happening already. Instead of using the easily fooled testosterone/epitestosterone ratio tests, the NBA could instead direct its lab to use the more expensive but highly effective carbon isotope ratio (CIR) test. That test can actually tell the difference between natural and pharmaceutical testosterone, so athletes doping with testosterone, but with "normal" testosterone/epitestosterone ratios, could be detected. It would be cutting edge -- that test is not yet even standard practice for the aggressive World Anti-Doping Agency (WADA). But it would go a long way to catching those cheating with testosterone.

“We have a machine,” says WADA head David Bowman, “that can detect synthetic testosterone as easy as anything. The issue is how many tests do you run through the machine?"

In the NBA, the answer to that question is unknown -- the league did not want to comment on the record for this article. But the lab the WADA-approved lab league uses in Montreal can do the more advanced test, which would evidently be allowed under the current agreement with the union. If using the CIR test isn't already standard practice at the NBA, it evidently could be at any time ... which would go a long way to deterring those tempted to cheat with testosterone, a powerful but under-discussed performance-enhancer.