No trace of the medicine HCG was found in Manny Ramirez's system at the time of his drug test, three sources with specific knowledge of the results have told The Times. It was a prescription for that drug, which is a non-steroid but banned by Major League Baseball, that led to the outfielder's 50-game suspension for violating the league's drug policy.
One of the sources with knowledge of the test results confirmed that the outfielder's sample was flagged for having an unusually elevated synthetic testosterone level, more than four times that of the average male. Sources also said that MLB's decision to move to suspend Ramirez would have happened only if the report showed a banned substance. Anti-doping experts said the absence of HCG (human chorionic gonadotropin), coupled with the league's action, indicated that the Dodgers' outfielder used steroids.
MLB officials had begun the process of disciplining Ramirez for a positive drug test when they obtained his medical records that contained a prescription for HCG. At that point he was suspended for "just cause" based on "non-analytical evidence" and for which a "therapeutic use" exemption was available but never requested. Once MLB had the prescription, Ramirez dropped the appeal and was suspended.
All the sources asked not to be identified because they were not authorized to speak publicly about the test results.
Attempts to reach Ramirez were unsuccessful. The Dodgers referred all questions to MLB.
At the time his suspension was announced, Ramirez said in a statement that his doctor, "gave me a medication, not a steroid, which he thought was OK to give me." Ramirez has not publicly commented since but is expected to meet with his teammates this weekend when the Dodgers are in Miami, where he has a home.
Before the prescription came to light, Ramirez's representatives had been expected to argue on appeal that the elevated testosterone level was caused by DHEA, said authorities familiar with MLB's testing procedure, who also asked not to be identified because they were not authorized to speak publicly. The World Anti-Doping Agency considers DHEA (dehydroepiandrosterone) a steroid and has banned it but baseball hasn't.
These authorities, however, said the league would not have considered a test a positive if it were known that DHEA caused the spike in a player's testosterone-epitestosterone (T-E) ratio, a key marker relied upon by international doping authorities to establish if an athlete is using steroids.
Speaking generally about the MLB testing procedures, Professor Christiane Ayotte, director of the WADA-accredited lab in Montreal where Ramirez's sample was tested, said her facility reports test results "as precisely as possible," knowing what substances are on a specific sport's banned list and detailing if exogenous testosterone (steroids or its precursors) or DHEA provoked the elevated T-E ratio.
The lab report would include whether the individual tested positive for DHEA even though Ayotte added, "We know DHEA is not on baseball's prohibited list of substances."
The authorities with knowledge of baseball's testing procedures stressed that MLB would not have declared a drug test a positive if the Montreal lab reported that DHEA had caused the elevated T-E ratio.
One of the three sources with information about the test results said baseball had three "powerful analytic foundations" to say the positive drug test was not caused by DHEA.
First, scientists have testified in other doping cases that DHEA does not raise an average person's T-E ratio (1:1) to more than 4:1, where Ramirez's was, the source said. Second, MLB could produce the player's urine sample showing how much manufactured DHEA was in his system. Finally, the WADA lab conducts a Carbon Isotope Ratio (CIR) test on DHEA that identifies the level of the substance and whether it was naturally occurring or manufactured.
"We can show the difference, with DHEA [and] testosterone . . . the CIR tells us if it's natural or doping," Ayotte said, again speaking generally about her lab's procedures. "There's no miracle in nature."
Even if previous DHEA use boosted natural testosterone production after the substance had left the system, Ayotte said the CIR can establish if synthetic testosterone caused a significant T-E ratio spike.
One of the sources familiar with the test result said baseball officials were confident in their case against Ramirez. Once they found a prescription of HCG, which Ramirez has said he was given, then the 50-game suspension was clinched -- the same penalty Ramirez would have received if it had been proved he used steroids.
Performance-enhancing drug experts said Ramirez's best legal argument in an appeal would have been to prove he has a naturally high level of testosterone -- for example, that his T-E ratio was naturally around the 3:1 range -- and to argue that any manufactured DHEA in his system caused the elevated result.
As for HCG, Dr. Glenn Braunstein, an expert in reproductive endocrinology at Cedars-Sinai Medical Center, said the drug slightly bumps up testosterone production but typically not to the level that would cause a T-E ratio such as 4:1. A typical dose leaves a person's system in 36 hours.
At the time of Ramirez's suspension, not much was known about HCG among the general pubic. The drug can be used to boost sex drive but can also assist steroid users to repair testosterone production at the end of a cycle, medical authorities say. According to sources in Ramirez's camp, the player's need to improve sexual performance was a factor in his use of the drug.
Gary Wadler, a New York sports medicine expert and WADA's chairman of the prohibited list and methods, said if HCG was not present, Ramirez's explanation would ring hollow.
"Maybe they hoped this would never surface, but in the name of transparency, you'd like to know who flunked a steroid test," he said.
The confidentiality of positive drug tests in MLB, crafted in collective-bargaining negotiations with baseball's strongly organized union, is "not good -- for the public, or the individual," WADA Director General David Howman said. "We don't get the blow by blow with MLB and we know why."
Under baseball's drug policy, if a player is suspended on a basis other than a positive test for a banned substance, "the only public comment from the club or the commissioner's office shall be that the player was suspended for a specified number of days for a violation of this program." Ramirez's suspension was not based on a positive test but on the evidence of the prescription without a therapeutic use exemption.
While the drug policy restricts the disclosure of the specific substance that triggered a positive test and resulted in suspension, the commissioner's office can disclose how the substance was classified -- as a performance-enhancing substance, drug of abuse or stimulant.
In January, for example, Selig's office announced that pitchers J.C. Romero of the Philadelphia Phillies and Sergio Mitre of the New York Yankees each had "received a 50-game suspension for testing positive for a performance-enhancing substance in violation of Major League Baseball's Joint Drug Prevention and Treatment Program."
The Ramirez announcement said only that he had "been suspended 50 games for a violation of Major League Baseball's Joint Drug Prevention and Treatment Program."
Times staff writer Bill Shaikin contributed to this report.
BEGIN TEXT OF INFOBOX
A look at the substances detailed in this story:
HCG (Human chorionic gonadotropin): is a hormone produced in pregnancy and is relied upon to detect a pregnancy. It can also be used as a fertility drug and for delayed puberty. HCG has been prescribed to assist in sex drive. The drug also has been used by bodybuilders and others to help restart testosterone production after a cycle of steroids. In 2008, after the drug had already been banned by the World Anti-Doping Agency, Major League Baseball declared it the sport's 55th banned performance-enhancing drug.
DHEA (Dehydroepiandrosterone): is a steroid produced in human's adrenal glands but is also sold in nutrition stores in pills and powders as an over-the-counter dietary supplement. WADA and the U.S. Anti-Doping Agency consider over-the-counter DHEA an anabolic steroid and there's a bill in the Senate Judiciary Committee to have the substance declared an anabolic steroid in the U.S. Major League Baseball, however, has yet to put DHEA on its prohibited list.
-- Lance Pugmire