First Gibbons and Bell, now Manny

Manny Ramirez isn't the first baseball player linked to the drug hCG -- human chorionic gonadotropin.

Former All-Star and Oakland A's bash brother Jose Canseco was detained by immigration officials at the San Diego border last year as he tried to bring the fertility drug in from Mexico. Two other former big leaguers, Jay Gibbons and David Bell, reportedly attempted to purchase it online from pharmacies that came under investigation.

And Kirk Radomski, the former New York Mets clubhouse attendant and later a major steroid supplier to pro ballplayers, acknowledges he used hCG in his steroid-cycling days.

The drug was added to Major League Baseball's banned list last year. In late 2007, when Gibbons' name surfaced in connection with purchases made from Signature Pharmacy in Florida between October 2003 and July 2005, hCG wasn't outlawed by MLB. (Gibbons, then with the Orioles, also reportedly ordered synthetic HGH and testosterone, along with hCG.) Nor was hCG banned when Bell reportedly purchased six packages of it from Applied Pharmacy in Alabama while he was playing for the Phillies in April 2005.

According to the Mitchell report on performance-enhancing drugs in baseball, Bell said he had received a prescription for hCG to treat "a medical condition" that he refused to identify. In a statement issued Thursday, Ramirez, too, said he had been given hCG by a physician "for a personal health issue" that he did not identify.

It is not an anabolic steroid but rather a fertility drug that is widely considered to be part of the chemical enhancement game played by athletes. The hormone is produced naturally by women during pregnancy and often is used by steroid users to reboot their body's natural testosterone production coming off a steroid cycle. It is also associated in the sports and the bodybuilding communities with serious and prolonged steroid use.

"I have used hCG numerous times," Radomski told ESPN.com. "It works great. You feel great. After you come off a [steroid] cycle, your body doesn't crash. It turns your [testosterone] production back on. It gives you more energy. It makes you feel like you're still on a cycle.

"Typically, people who use hCG have abused drugs. Their bodies have shut down. A perfect example is Canseco. He went across the border to get it. He admitted that he abused his body. People who stay on long [steroid] cycles would have to take it. People who go on short cycles or don't use [steroids] that much can get away without having to use hCG."

While investigating recent cases of online pharmacies that sell steroids, authorities have found that individuals, particularly athletes and bodybuilders, are ordering hCG along with steroids. hCG normally is injected and is thought to be detectable in drug testing.

"You order X cycles of anabolic steroids, and you're going to order your hCG for when you take time off [from using steroids]," said Travis Tygart, chief executive officer of the U.S. Anti-Doping Agency. "From a layman's perspective, it jump-starts your own body's testosterone production. That begs the question: Why do you jump-start it? Well, you need to jump-start it if you are coming off a steroid cycle. Because when you use synthetic steroids, that shuts your body's own natural production of testosterone off. So when you stop using the synthetic steroids, you need something to help restart your own body's production, which is when hCG is typically used."

In a statement issued Thursday, Ramirez said the substance he tested positive for was prescribed by his physician, although it is generally thought that there are few legitimate medical uses for hCG by an otherwise healthy male pro athlete.

"We don't know anything about the case other than what is in the press," Tygart acknowledged. "But I think it is highly unlikely an otherwise healthy athlete would need hCG for a legitimate medical purpose. If this is true, and I don't know that it is, it is frankly a failure on his agent [Scott Boras] and his union's part in not better educating him that there is a process where you can obtain permission to use legitimate medications. And that is flabbergasting to me.

"To my knowledge, there are only a couple rare disorders, [one being] pituitary gland disorder, that are legitimate reasons to be using hCG for an otherwise healthy male.''

ESPN.com reported later Thursday that baseball's drug testing revealed that Ramirez had an elevated level of testosterone from an artificial source in his body, although that is not the reason for the 50-game suspension announced Thursday. The suspension was hooked to baseball's documentation of Ramirez's use of hCG.

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