Former Steelers doctor embraced HGH

Dr. Richard Rydze's long tenure on the Steelers' medical staff ended abruptly in 2007. Mike Fish/ESPN.com

PITTSBURGH -- At 6:45 on a Friday morning in October, Dr. Richard Rydze is perched behind the cluttered desk in his second-floor corner office, surrounded by autographed Pittsburgh Steelers footballs and photos. Just over his shoulder, a window provides a view of the Monongahela River and, just beyond it, Heinz Field, home to the Steelers.

Rydze wears a thick Super Bowl XL ring on his right hand, a reward for his work during the Steelers' 2006 championship season. A nurse scurries about the expansive, awakening office in a white scrub top dotted with Steelers logos. A receptionist shows up wearing a black-and-gold Steelers jacket.

Clearly, this is a Steelers town, and Rydze is a Steelers guy. For 22 seasons, longer than the tenure of Franco Harris, Terry Bradshaw or any of the other Steelers icons, Rydze, 58, paced the Pittsburgh sideline as part of the medical team. Then suddenly, in the summer of 2007, like a free-agent rookie signed as training camp fodder, the bespectacled internal medicine specialist quietly parted ways with the Steelers.

The details are sketchy, but his split with the team came approximately four months after news reports identified him as the buyer of a substantial quantity of human growth hormone (HGH) from a Florida pharmacy during several months in 2006. HGH, a performance enhancer banned by the NFL and other major sports leagues, is the supplement of choice for some athletes because it can't be detected by current testing.

Rydze has not been charged with violating any laws. But in February 2007, two law enforcement officials dropped by his former downtown practice in the Heinz 57 Center office building to question him about the use of a credit card to buy about $150,000 worth of HGH and testosterone -- with a retail value approaching $1 million -- from Signature Pharmacy. That Orlando, Fla., compounding facility had been raided days earlier as part of a multiagency investigation into the online sale of steroids and other performance-enhancing drugs.

The doctor didn't turn over his records, but the investigators said he told them he was dispensing the HGH to elderly patients referred to him for help in healing tendon and ligament injuries. According to the two officials who questioned him that day, Rydze said he treated the patients early in the morning before his normal office hours at a University of Pittsburgh Medical Center (UPMC) facility.

"Because I was associated with the Steelers, the assumption was that I was giving everyone on the Steelers growth hormone or steroids," Rydze told ESPN.com in his first in-depth interview on the subject. "You say a team doctor for the Pittsburgh Steelers, and you are saying he is buying growth hormone from a pharmacy in Florida -- what the hell else are you going to think?

"That whole thing got way overblown. I was doing some kind of little bit of research back then and using growth hormone to help heal people with tendon injuries. That seems to be, in my estimation in looking at that hormone, the only role it really plays in helping people. It does seem to make you heal better, quicker. So we were using it with various orthopedic patients.

"It was never done in athletes. It was never with any Steelers."

But when news of Rydze's connection to the Signature Pharmacy story spread, it surprised many of his former colleagues and friends. Some assumed his involvement with HGH led to his split with the Steelers.

An NFL official said that although the league was concerned by the doctor's link to HGH, it allowed the Steelers to deal in-house with the issue. No one will say whether Rydze was forced out, but he is gone.

"I didn't know about any of [Rydze's patients being treated with HGH], and I was surprised to learn of it," said Dr. Julian Bailes, a neurosurgical consultant to the Steelers from 1988 to 1997 who is now chair of the department of neurosurgery at West Virginia University's School of Medicine. "And sorry that it happened, of course.

"I never saw it. I never would have suspected it when I was there. He is kind of a quiet, somewhat introverted person that we respected for his medical skills."

UPMC's marketing deal with the Steelers calls for its doctors to serve on the team's medical staff -- the team also trains at a complex built by UPMC -- but four months after the investigators showed up in his office waiting room, he resigned from UPMC with little fanfare, Rydze said. A UPMC news release dated June 18, 2007 said, "Dr. Rydze has submitted his resignation from UPMC, effective Sept. 1, 2007."

Steelers president Art Rooney II, through a team spokesperson, declined comment for this story.

A UPMC representative said a confidential internal review found no wrongdoing in relation to Rydze's patient care.

And Leslie Amoros, a spokesperson for the Pennsylvania Department of State, which oversees the State Board of Medicine, said Rydze remains a licensee in good standing. When asked whether Rydze's connection to the online pharmacy purchases was reviewed, Amoros said, "At this point, we cannot confirm or deny the existence of any investigation."

Still, the longtime Steelers physician might have been skirting the law by injecting growth hormone to treat tendon and ligament injuries. That is the opinion of multiple medical and legal experts contacted by ESPN.com, as well as the investigators who discovered Rydze's HGH purchases from Signature Pharmacy.

That belief is supported by the Food and Drug Administration.

After consulting with legal counsel, FDA spokesman Chris Kelly issued a statement to ESPN.com, saying, "FDA has not approved any New Drug Application for a drug containing HGH for use in treating ligament/tendon injuries. If an FDA-approved drug containing HGH is being used for this purpose, it would fall within the prohibition described at 21 U.S.C. 333[e]."

That federal statute spells out that the distribution of HGH is legal only for the following conditions: short bowel syndrome, muscle-wasting disease associated with AIDS, adult growth hormone deficiency due to rare pituitary tumors and short stature in children. An FDA alert dated Jan. 23, 2007 further describes uses for which HGH can be legally prescribed, including "long-term treatment of growth failure due to lack of exogenous GH secretion."

None of those appears to apply to the patients Rydze was treating with HGH.

"The short answer is HGH is the only drug that cannot be lawfully distributed or prescribed for off-label uses," said bioethicist Maxwell J. Mehlman, director of the Law-Medicine Center at Case Western Reserve University. "If the doctor's argument were correct, then it basically creates a loophole that eliminates this unique status. It just wipes out that peculiar provision in the law, because off-label use almost by definition is informal research in the sense you are giving it to a patient, and it has not been approved for that."

Rydze's explanation for his use of HGH -- to treat tendon and ligament injuries -- raises eyebrows with those policing drug usage in the sports world, too.

I know [HGH] has caused me a lot of grief, simply because I believe in it and I know what it does.

--Dr. Richard Rydze

"The off-label use is illegal," said Travis Tygart, chief executive of the U.S. Anti-Doping Agency. "It doesn't happen. Using [HGH] for tendon repair, he has admitted to a crime."

Indeed, experts make the point that pro athletes would be lined up outside league offices seeking therapeutic exemptions to use the banned drug after everything from Tommy John elbow surgery to an ACL knee operation if HGH could be injected legally to hasten recovery from tendon and ligament injuries.

But that isn't the case. NFL spokesman Greg Aiello said the league has never granted a therapeutic use exemption for HGH, including for healing purposes.

Nor has Major League Baseball been inclined to hand out exemptions.

"There are very limited purposes for which growth hormone can be legally prescribed," said Rob Manfred, MLB's executive vice president of labor relations and human resources. "I mean, you have got to be a dwarf or have wasting disease. … We don't have a lot of people with AIDS or who have dwarfism in our game."

Synthetic growth hormone originally came on the medical scene for the treatment of dwarfism in children. According to medical experts, excessive use of HGH is thought to cause the enlargement of organs, especially the heart, which can be dangerous and sometimes fatal. It also has been linked to diabetes, muscle and joint pain and hypertension, and some researchers believe it can accelerate cancer.

Rydze, though, said the danger of low-dosage growth hormone therapy is vastly overstated, and that HGH is wrongly associated with steroids. And although he acknowledged the sports community likely won't permit its use any time soon, he said athletes should be allowed access to HGH to heal injuries.

"I know it has caused me a lot of grief, simply because I believe in it and I know what it does," Rydze said. "And to deny people the effect to heal better -- that is the art of medicine, to make people heal. And using something off-label, which we use for many, many drugs … I don't see how someone can single out one thing and say you can't use it for off-label use. And you show me there is one side effect, and I'd be a believer. But I have never seen a side effect. And I just think it is just ignorance of people who don't know. They just hear about it, and they assume it is bad."

Rydze isn't alone among doctors in his liberal off-label approach to HGH, which has become increasingly controversial because of growing usage by practitioners of anti-aging medicine. Other advocates note its value as a healing agent. Even a medical consultant to pro sports leagues who asked not to be identified said he believes that in time, after emotions settle and adequate research is done, HGH could play a larger role in mainstream medicine because of its apparent ability to accelerate healing.

Off-label use for many drugs -- in other words, prescribing a drug for a purpose that differs from the one for which the product is approved -- is a widely accepted practice. Under current law, though, the FDA spells out the unique status of human growth hormone. In an e-mail to ESPN.com, another FDA spokeswoman, Susan Cruzan, wrote, "Human growth hormone is the only drug for which Congress has expressly prohibited the off-label distribution or possession with intent to distribute, making such distribution a crime under 21 USC 333."

Rydze described his research as "kind of a project of mine" to determine the healing effects of HGH, acknowledging he did not seek an FDA exemption. Nor, he said, has he compiled any research data yet.

Rydze told ESPN.com that during a five-year period, he injected about 200 patients with growth hormone. A significant number were referrals, mostly from orthopedists, he said.

Among the details Rydze provided to ESPN.com about his practice is the fact that four highly respected physicians currently serving on medical staffs of professional franchises in multiple leagues -- including the NFL, where the drug is banned -- wrote referrals to him for HGH therapy. Two of those doctors are also on staff at well-known sports orthopedic clinics recognized for treating millionaire athletes and celebrities.

Rydze indicated that none of the patients receiving HGH was a Steeler, or a professional team athlete.

But ESPN.com found that in an apparent conflict with NCAA doping rules, an orthopedist referred an injured soccer player at a top collegiate program to Rydze for separate rounds of growth hormone therapy -- including during the weeks just prior to the start of a season.

Rydze initially said the athlete didn't compete after receiving the treatment, but later said he couldn't recall details.

According to Mary Wilfert, staff liaison to the NCAA's Committee on Competitive Safeguards and Medical Aspects of Sports, the governing body issues "about five or seven or maybe even 10" medical exceptions each year for athletes to use growth hormone or testosterone. Wilfert declined to say whether the use of HGH has ever been allowed to aid in healing injuries, adding, "We don't have published lists of what would qualify for an exception."

Rydze indicated one NFL team orthopedist referred at least 25 patients -- none of whom was an active professional athlete -- to him for growth hormone therapy. In one instance, Rydze wrote a note that a patient was referred "to begin him on growth hormone therapy in order to expedite the healing and strengthening of his shoulder girdle prior to his return to work as a police officer."

One patient is the father of a current NFL player.

If information came forward about a team doctor prescribing to his other non-NFL patients those types of substances, it would raise concerns and questions.

-- NFL spokesman Greg Aiello

Several others, according to Rydze, had lesser ties to the sports world: a marathoner suffering chronic hamstring injuries and another with Achilles tendinitis, a personal trainer with chronic hamstring woes, a former karate champion with bum elbows and knees and a Frisbee golf player coming off surgery.

An attorney received injections to relieve knee pain and, according to Rydze, wrote a letter to him before another round of treatments in March in which he said he hoped the "stupid publicity" wouldn't stop the doctor from prescribing HGH.

Rydze also indicated at least five other doctors, as well as the wife of a sixth, received growth hormone therapy from him.

"The orthopedic people sending people to me obviously believe it works, 'cause they see it work," Rydze said. "And if I can help people, then I am going to help them."

Aiello, the NFL spokesman, said clubs have been "advised" that team doctors should not use illegal steroids or growth hormone, particularly with an active player or his family.

"If information came forward about a team doctor prescribing to his other non-NFL patients those types of substances, it would raise concerns and questions," Aiello said. "And we would deal with it on a case-by-case basis, in this case as the Steelers did."

As Rydze spoke to ESPN.com in his Pittsburgh office, wearing a black knit shirt and casual slacks, he didn't appear to be flustered by inquiries about his practice. In a soft, calm tone, he denied any impropriety in his prescribing of HGH, noting he used it with patients deficient in growth hormone, which he believes is linked to slow healing.

However, Dr. Thomas Perls, a specialist on aging who has written articles on the subject for the American Medical Association, said that measuring insulinlike growth factor-1 (IGF-1) levels, as Rydze does, is not an adequate test in the proper diagnosis of adult growth hormone deficiency. (Growth hormone stimulates the liver and other tissue to secrete the hormone IGF-1, which in turn leads to bone growth and plays a key role in muscle and organ growth.)

"That is separate from asking the question, 'Could giving growth hormone help repair injuries faster?'" Perls told ESPN.com "That is a totally different thing from adult growth hormone deficiency syndrome, which is very rare and a failure of the pituitary gland to produce growth hormone when it needs to. And it requires a pathological diagnosis. You have to come up with what is wrong with the patient, with their pituitary gland. Usually, it is a cancer or treatment of the cancer . . . It is complicated. So much so that an endocrinologist should be doing this."

"There is off-label for everything," Rydze said, defending his use of HGH. "I mean, everything. Ninety percent of medicine is off-label. … We use seizure drugs for treating migraines. We use drugs all the time [for other uses]. I think this drug gets way overtalked about, way overplayed."

When told the FDA specifically prohibits the use of HGH for any unapproved purpose, Rydze said: "I'm not aware of that. It can't be used off-label? For what reason?"

Although Kelly, the FDA spokesman, told ESPN.com "it is not a legal practice" for a doctor to treat tendon or ligament injuries with HGH, enforcement for violations is rarely pursued unless a complaint is filed with the Drug Enforcement Agency or a state licensing board.

Marc Mukasey, a former assistant U.S. attorney, suggested prosecutors allocate their resources to go after traffickers of what are considered more dangerous drugs such as cocaine, heroin and, to a lesser extent, crystal methamphetamine, or ecstasy. Steroids prosecutions, with exceptions such as the BALCO case, are unusual. And human growth hormone is viewed by most law enforcement agencies as something less than an egregious societal problem.

"Why is nobody prosecuting it?" said Mukasey, the stepson of outgoing U.S. Attorney General Michael Mukasey. "Because there are too many guns and drugs and violent crime on the streets. That is the short answer."

Don Catlin, a respected chemist who ran America's first anti-doping lab in Los Angeles, said, "Nobody clamps down, so they just go ahead and do it. If somebody got a book thrown at them and had to pay a fee or spend some time in court, they'd stop. But there is really not much incentive. That is this whole thing with growth hormone: There are so many gimmicks out there on how to use it. Its name is enough to bring in a lot of people that want to get their growth better or feel better or last longer or whatever. It has been tried on everything under the sun."

Rydze said he has injected HGH into ailing knees and hips. He has used it to treat rotator cuff tears and tennis elbow, torn biceps and hamstrings, torn Achilles tendons. He has used it to stimulate knee cartilage production. He has injected it to try to help a patient avoid surgery, he said, as well as after surgery.

Initially, Rydze's name surfaced in connection with the investigation into wholesale purchases of HGH from Signature Pharmacy in Orlando, but ESPN.com has learned he also bought the drug from College Pharmacy in Colorado Springs between 2004 and 2007. The owner of that compounding pharmacy and one of its sales representatives have been indicted and are scheduled for trial in the spring. As in the Florida case, Rydze and others who purchased the drugs from College Pharmacy were not targeted.

An official close to the federal investigation of College Pharmacy said of Rydze, "He was one of the customers. … [He] showed up on the pharmacy client list." The official declined to address the number of purchases or the quantity of HGH Rydze made from College Pharmacy.

Investigators working the Signature Pharmacy case thought they'd found a major mover in the world of sports when Rydze's name first popped up in billing records. Here was a highly credentialed doctor, a team physician for an NFL franchise, purchasing bulk orders of growth hormone and testosterone from an online pharmacy under investigation. They didn't know to whom Rydze was giving the drugs. They knew from records only that the FedEx shipments from the pharmacy went to Rydze at his UPMC office: 339 Sixth Avenue, fifth floor.

So in February 2007, the lead investigators -- Mark Haskins of New York State's Bureau of Narcotic Enforcement and Alex Wright of the Florida Metropolitan Bureau of Investigations -- drove about seven hours from a suburb north of New York City to interview Rydze in Pittsburgh. They told ESPN.com they probably didn't have jurisdiction to bring charges, but they said they wanted to hear his story. And they wanted to know whether athletes were linked to his purchases.

What they heard during their informal hour-long questioning didn't ease their suspicions. Rydze, they said, told them he used the HGH to treat tendon injuries and joint repair in older patients, including an unnamed ex-NFL player. They also said he spoke about the drug's possible value in the treatment of post-concussion syndrome, although Rydze told ESPN.com he didn't use it that way.

Both Haskins and Wright described Rydze as short on specifics. They said they still aren't sure who ultimately was given the HGH.

"Dr. Rydze provided no legitimate explanation for his prescribing of these drugs," Haskins told ESPN.com. "He couldn't come up with any patients, never mind the significant number he'd have to have shown to order the quantity of drugs that he did. And there were some questions as to his story. He was an employee of the University of Pittsburgh Medical Center, where they had a pharmacy. If this was legitimate, why then not use your own pharmacy?

"That is one of the things I questioned him on. I said, 'Doc, this is one of the biggest university medical centers on the East Coast, correct?' I said, 'Never mind the ones that are in the Pittsburgh area, but I am sure there are other pharmacists trained to compound, correct? So why then would you use a pharmacy in Florida and purchase drugs that you can't even verify are legit when you are at one of the most prestigious places in your state that could provide these things for you? And use your own credit card?' He could not provide an answer."

Falk Pharmacy, billed as the "flagship pharmacy of UPMC" on the health care provider's Web site, is located less than three miles from Rydze's old office. The facility stocks pre-prepared HGH from major labels such as Genotropin, according to pharmacist Marie McCon, who noted that other area pharmacies compound human growth hormone.

We did not receive one outside inquiry from anybody. Here we spent an hour with this guy. Nobody was concerned. The hospital never contacted us. Nobody cared what he said to us.

-- Mark Haskins of New York State's Bureau of Narcotic Enforcement

Rydze told ESPN.com the price of the drugs was the reason he purchased from the Colorado and Florida compounding pharmacies rather than locally, saying, "I don't know how these pharmacies got their prices down so low."

Often, he said, HGH treatment is not covered by insurance, so his patients paid him directly.

Rydze said he learned about the online pharmaceutical vendors during conventions in Las Vegas of the American Academy of Anti-Aging Medicine (A4M). Rydze was an A4M member, as is Dr. Joseph Maroon, the Steelers' neurosurgeon and another UPMC physician. Maroon recently was appointed an A4M senior vice president. The Chicago-based A4M advocates the use of testosterone and human growth hormone as levels decline with age.

Steelers spokesman Dave Lockett indicated the team has no issue with its doctors' affiliations with A4M.

"Really, there are a lot of people who are members of that organization," Lockett said. "We do not have any concerns about Dr. Maroon."

When Rydze was asked whether he'd entertained concerns about the pharmacies from which he was ordering, he said, "No, I guess I was naive about it. They seemed like legit people. And they were advertising in the A4M magazine. I never heard anyone say a bad word about them until this all came down."

Haskins said neither New York nor Florida authorities are pursuing a further investigation of Rydze, but he acknowledged he spoke briefly about Rydze with NFL security chief Milt Aldrich after the Pittsburgh meeting. Aiello, the NFL spokesperson, confirmed Aldrich had spoken with investigators.

The two investigators said they are surprised that neither the Steelers nor UPMC followed up with them once Rydze's name was made public in connection with the investigation.

"We did not receive one outside inquiry from anybody," Haskins said. "Here we spent an hour with this guy. Nobody was concerned. The hospital never contacted us. Nobody cared what he said to us."

Rydze's new office is home to a private practice occupying the second floor of the Hartley-Rose Building, which is on the National Register of Historic Places. The entry on a narrow downtown cobblestone street leads to what once served as a factory and warehouse. The original red brick is exposed on the walls of the renovated office, and hardwood planks cover the high ceiling.

Rydze opened Optimal Health Center, LLC in September 2007. The scope of the practice ranges from corporate medicine/wellness and sports medicine to geriatrics and hormone therapy. Most days, he's in and at work by dawn, he said.

The waiting room is decorated with a pair of black-and-white photos of a young Rydze diving from a platform. In his youth, Rydze was an accomplished athlete. He won a silver medal in platform diving at the 1972 Munich Olympics, accomplishing the feat on the eve of the darkest day in Olympic history -- a Palestinian terrorist attack that left 11 members of the Israeli team dead.

He wears an Olympic ring on his left hand. He mentions he is one of only two people who have earned both an Olympic and Super Bowl ring, the other being the late Bob Hayes, who won Super Bowl VI as a wide receiver with the Dallas Cowboys and Olympic gold in the 100-meter dash and the 4x100-meter relay in 1964 in Tokyo.

Rydze's father was an international chairman for U.S. Diving. His brother, Bob, is the longtime diving coach at the University of Iowa and was the team leader for U.S. divers at this past summer's Olympic Games in Beijing.

Rydze said he wasn't running from his association with the pharmacy investigation when he left UPMC and the Steelers, despite the perception. He claimed neither the team nor the NFL forced him out. Instead, he said the situation emboldened him to follow his goal of branching into private practice.

"They knew I wasn't doing stuff with the Steelers," he said of the team's management. "No, they never came to me and said, 'OK, you got to leave because of this matter.' But I had been looking at doing this [private practice] for five or six years now.

"I have a huge practice, and I can make better money doing it this way."

Rydze said there is nothing further to investigate. NFL and UPMC officials already have been to his office, he said, and "looked through every record and chart." But the bad press put a crimp in the number of referrals he was getting for HGH therapy, and that also factored into his decision to venture out on his own.

"I think it scared the orthopedic people away," he said. "They didn't want to send people anymore. So it was a dying science then. It impacted on me wanting to leave UPMC, because I wasn't free to do what I wanted to do. And I thought it was important research."

Rydze said he wasn't forced to leave UPMC, either, although his practice of growth hormone therapy apparently stirred debate within the largest medical provider in western Pennsylvania.

Asked whether UPMC officials knew HGH was being used in his practice there, Rydze said, "They had an issue that I was doing it on their grounds. I mean, it was kind of a complicated situation since I was doing it off-hours. I mean, they knew and they didn't know.

"I knew people in the UPMC program, in the higher authorities, who knew I was doing it. It was OK. And then there were other people who thought maybe I should be doing it on another site."

One of Rydze's longtime patients, former Steelers running back Merril Hoge, said he knew about the doctor's interest in HGH therapy; in fact, Rydze and Hoge discussed it as a possibility for his treatment in the years since he retired from the NFL. Hoge refers to Rydze as a "world-class doctor."

"The HGH stuff was for elderly people, for joint reproduction, stuff like that," said Hoge, who is now a pro football analyst for ESPN. "He never prescribed to a player. He never did it around me. … I'm passionate about training. He educated me on HGH. Talked about the benefits later in life.

"He talked about the aging process, recovery process, helping with allergies. My allergies are atrocious. I wanted to educate myself. I asked medical people about it. I asked Dr. Rydze. I never took any steps to take anything."

Hoge remains supportive of Rydze, saying the doctor has been miscast in and hurt by the controversy around the pharmacy investigation. So why, Hoge was asked, did Rydze leave the Steelers so willingly? Why didn't he put up a fight to save his association with the team?

"I don't think there was anything to fight," Hoge said. "He bought it. He didn't deny it. It's just how he used it."

And that's the issue. People are still left to wonder.

Mike Fish is an investigative reporter for ESPN.com. He can be reached at michaeljfish@gmail.com.