The controversy surrounding the apparent client list of a Miami clinic that includes Alex Rodriguez, Melky Cabrera, and others continues to be a major story after more than a week after the Miami New Times released it. While the specifics are still under investigation and names leak out from various outlets, the heart of the matter is still poorly understood. What are these drugs that are listed near the names (or code names) of professional athletes?
This article will provide some answers. (Many of which I also provided in a Thursday appearance on MLB Network's Hot Stove). Please note that I am going to try and keep this as simple and non-technical as I possibly can.
A couple key things to note here are the terms banned and illegal. A sports organization or governing body, such as MLB or USADA, can ban any substance they wish, even if the drug is legal. An example of this is marijuana. MLB and other bodies have made it clear that it remains a banned substance, even for those who reside in Colorado and Washington, where the use is now legal. Testosterone is also legal, when prescribed, but is banned in all sports.
Prescription drugs, even when banned, can be used if there is a demonstrated medical need. MLB has granted therapeutic use exemptions (TUEs) for prescription drugs and has an extensive procedure necessary to gain one of these waivers. The vast majority have been for ADHD drugs, which are usually stimulants like Adderall, but there have been waivers in the past for testosterone. Players who have survived testicular cancer, such as Mike Lowell, are known to have had waivers.
So let's look at the terms we've seen in the Biogenesis documentation:
HGH (Human Growth Hormone): This naturally occurring substance helps the human body grow. It is known to decrease over time. Some people have a growth hormone deficiency and supplementation allows them to grow to a more normal height. The hormone has been replicated in the lab under various trade names and can be detected by a blood test. There is a very short detectable period, perhaps shorter than 24 hours. MLB began testing for HGH in 2012 and will expand it in 2013 with additional tests during the season.
HGH's effects are controversial, with the best results coming when "stacked" (used in combination) with anabolic steroids. There are some studies which indicate HGH has some efficacy in decreasing healing time. HGH must be injected into the abdomen, is expensive, and requires careful handling
IGF-1 (Insulin Growth Factor-1): This hormone occurs naturally in the body and is believed to have an insulin-like effect on the body. It is also a growth factor and failure to have sufficient amounts of the hormone leads to a specific form of growth failure. It has been replicated in the lab and could theoretically be tested for, but that test currently does not exist. (Anti-doping officials have hinted in the past that they could use a simple blood count or a biological passport to determine usage.)
Studies have not been done to sufficiently determine the efficacy of IGF-1. Current scientific theory is that IGF-1 triggers HGH and systemic growth. There are no studies that indicate specific growth or increased healing. IGF-1, like HGH, must be injected and carefully handled.
Testosterone: Testosterone is the male sex hormone and a strong anabolic-androgenic agent. In fact, all anabolic steroids are compared to testosterone for efficacy. Most anabolic steroids are converted to testosterone in the body. Testosterone is generated in the testes and when exogenous (outside) testosterone is supplemented, the testes are often directed to stop producing testosterone by the body. This causes the unwanted side effect of "shrinkage."
Testosterone is very effective when used and can lead to increased muscle mass. It is easily detectable by urine tests and can have a very long detectable period. Testosterone can be injected, taken orally, or rubbed on as a cream or gel. Androgel is the prescription form and is sold at a concentration of 1.62%. The "pink cream" from Biogenesis was stated to be at 3%, while BALCO's cream was compounded at 10%.
GHRP (growth hormone releasing peptides): a newer substance on the PED landscape, these peptides are more formally known as secretagogues. They are signals to the body to release hormones, in this case growth hormones. There are other such peptides for various hormones. There is currently a major doping scandal going on in Australian Rules Football regarding this type of substance.
The class of GHRPs are banned and can be tested for in both urine and blood. However, it is unclear whether this test (originally developed in 2008) has been utilized. WADA has banned peptides and steroid precursors explicitly. MLB has not specifically banned the substances, but could claim to have done so under the "non-exhaustive clause" of the joint drug agreement. In this, substances that are not known or listed could be considered banned if they are substantially similar to other banned substances.
The major side effect of GHRP is hunger, but as it does cause more growth hormone to be released, the effects (if any) of that hormone's increase can be seen. There are significant clinical studies regarding the use of this peptide in HIV-positive patients, increasing muscle mass and decreasing the storage of abdominal fat. All known peptides must be injected and require careful handling, though some cite creams as a possible usage vector. However, these peptides are relatively low-cost (I found it at $30 per milligram online, without a prescription. I am not linking to this as I do not want to make it easier to find a banned substance.)
DHEA (Dehydroepiandrosterone): DHEA is a steroid precursor, similar to the well-known androstenedione. Most steroid precursors are banned in MLB, but DHEA could not be banned due to a special status it was granted by the U.S. government. DHEA has been specifically championed by Senator Orrin Hatch. It is naturally occurring, but can be easily synthesized from non-human natural sources. There are many studies but few show any effects on non-elderly men.
DHEA is readily available without a prescription in various forms. It is relatively inexpensive and requires no special handling. While not banned, NSF-certified supplements cannot contain DHEA. DHEA can be tested for easily in blood and urine.
Amino Acids: There were several amino acids listed in the Biogenesis notebooks. These legal substances are the building blocks of protein in the body and could assist with muscle building. Amino acids and branched-chain amino acids are widely used and legal. Taurine, one of the substances listed, is what gives Red Bull its name. These amino acids can be found in energy drinks, supplements and many other places. They are not commonly used in stacks but it is not unusual for bodybuilders or athletes to get them from other legal sources.
These descriptions are clearly not exhaustive, but I hope you have a clearer picture of what these substances do and don't do. The Biogenesis story is clearly not at an end. If you would like more information, please consult the WADA website or even read my book on this subject.
Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and won a SABR Award for his book, "The Juice: The Real Story of Baseball's Drug Problems" in 2005.