How They Got Away with It: Biogenesis and Testosterone Explained

Will Carroll@injuryexpertSports Injuries Lead WriterAugust 15, 2013

An ironic sponsor for Alex Rodriguez.
An ironic sponsor for Alex Rodriguez.Rich Schultz/Getty Images

Victor Conte went on Jim Rome on Showtime this week and dropped a bombshell, saying 50 percent of MLB players are on some form of performance-enhancing drug. While Conte has some credibility in this area, there's no proof here, much like the Jack Clark comments lobbed at Albert Pujols.

In baseball today, no player, from Pujols to Chris Davis, can do anything on the field without facing the question of PEDs. The "steroid era" has stained baseball as much as the Black Sox scandal, in that it has removed the public trust. 

If baseball's testing programthe strictest and best controlled in all sports, with an extensive list and blood testing for HGHis not good enough, what is? Is anything good enough, or is testing truly always behind?

I want to examine each of these with a particular focus on Biogenesis.

WARNING: I am going to discuss specific uses and varieties of PEDs. This is not intended to be an instruction manual in any way. Some of the links I use in this piece are to sites that operate in the "steroid underground." I do not intend any link to indicate approval of these sites.

The Clinic

Biogenesis was an anti-aging clinic. There's probably one in your town. Some are legitimate businesses while others are little more than fronts for soaking insurance companies or supplying substances like HGH and testosterone to men who have no real medical need, unless vanity is now a medical condition.

In the documents that were leaked back in February to the Miami New Times, the substances used by Tony Bosch were a bit surprising. There wasn't much there. Forget the idea of sophisticated new drugs or complex cycles that beat the testing. In fact, Conte's BALCO was using better drugs a decade ago. 

Instead, Bosch's regimen relied on testosterone. As a synthetic analog of the natural male sex hormone, it is exceptionally easy to detect using standard testing. The particular version that Bosch used is unknown, but due to the costs associated with the program, it is most likely a version of the hormone called Andriol.

As a very representative example of why MLB's testing could miss a lot of users, we'll explore how effective it would be in catching players who are using Andriol.

The Drug of Choice

Andriol has advantages and disadvantages over other versions, including wide variance in results, even on the same person from cycle to cycle and even dose to dose. Its most common use is not in sport, but in female-to-male transgender therapy.

Andriol's normal form is in a lozenge, called a "testocap" by the manufacturer and a "troche" in Biogenesis documents. No other form of testosterone is as regularly used in this format as Andriol, though others can be taken orally in various forms.  

The first advantage is Andriol has a relatively short detectable period of between five and 10 days. This means that a person taking the drug on Aug. 15 would be in danger until Aug. 25. MLB tests at least three times per year, with one of those tests coming during spring training. The other two have no advanced notice.

There is also the chance that there will be one other random test, which can come at any time. It could often be held for the playoffs. Ryan Braun's 2011 test came during the NLDS.

Most players in MLB will have three tests over a 200-day time frame. For a drug with a two-week detectable period, that leaves a lot of room where it is possible to "get away with it." If the test doesn't come until day 12, the player is unlikely to test positive. If the test comes on day nine, he's busted. There is, of course, some natural variation beyond the standard due to body chemistry and metabolism.

This random nature becomes a weakness of the system. The players are playing the odds, assuming that they won't be tested on a given day and especially immediately after a test. Testing officials in other sports have noted this behavior and often "doubled up" a few days later to try and discourage this. It doesn't take long for word to get around about someone having a quick second test.

2003 Called and Wants Its Drugs Back

This isn't advanced. This isn't some mad scientist who discovered a new drug. At least Victor Conte really did have a drug that wasn't so much undetectable as it was unknown.

Andriol is functionally no different than a testosterone cream like what BALCO used. While BALCO had a custom formulation that both increased the dosage and decreased the likelihood of being tested (a loophole that was closed tightly by 2006), it is no different than the commonly prescribed AndroGel. It is absorbed into the body at a higher rate since the digestive tract is a more efficient vector than skin. 

(You might note that AndroGel is a regular advertiser with MLB and in other sports. Its "Is It Low T?" ad now features former NFL player Daryl Johnston, who is an analyst with Fox Sports.)

What Biogenesis was counting on isn't some masking agent that rushes the drugs through the system. It didn't have a designer steroid that was undetectable. What Biogenesis did is nothing more than the sports equivalent of the rhythm method.

It works, until it doesn't.

But work, in a way, it does. While several Biogenesis clients were caught by normal MLB testing, more made it through. Is it possible for Alex Rodriguez to have taken as many as 12 drug tests over the three-year period he was alleged to have been involved with Bosch and gotten away with it?

Yes, it's possible. Absent an increase in testing that would be burdensome and costly—20 to 30 tests per year, regularly spaced within the normal detectable period—it is possible to get away with it for a longer period of time. The dice are rolled. 

But even increasing tests, which would be invasive and exceptionally expensive, wouldn't really solve the problem. While Andriol appears to have been the drug of choice, there are other drugs with shorter detectable periods. The suspension version of testosterone is one of the oldest versions available. It's cheap, effective and has a detectable period of as little as one day.

Welcome to the Machine

The second advantage is both easier and more difficult to address for MLB or any other sport. The best testing for exogenous (non-natural) testosterone is expensive and time-consuming, forcing testers to rely on an effective, but less sensitive, test based on a ratio of two substances. This testosterone-to-epitestosterone ratio is 4:1, lowered from 6:1 when testing first occurred to match the World Anti-Doping Agency standard.

The more accurate test is called Carbon Isotope Ratio testing, or CIR. (To confuse you more, it is also referred to in some areas as Isotope-Ratio Mass Spectrometry (IRMS). There's only a slight difference, but I'll use CIR here for simplicity.) In this test, it looks at the sample at an atomic level. It's not looking for an amount, but merely the presence of testosterone.

Remember, all samples will have some level of testosterone, or should. Yes, even females have detectable levels of testosterone, though males naturally have a higher amount. To CIR testing, natural testosterone will look different than exogenous testosterone. The isotopes will be slightly but notably different. This is due to the source. Most synthetic testosterone is made from soy

The simple answer—one that Conte has been touting for nearly two years now, both for baseball and other sports—is to perform CIR testing on each and every sample. It's simple but unfeasible for a couple of reasons. Currently, MLB is thought to perform random CIR tests on about 10 percent of samples. It is an "untriggered" test, and there are indications that one of these tests did catch one of the Biogenesis players, according to John Fauber of the Milwaukee Journal Sentinel.

The test is expensive, first off. It requires a very precise machine to do the testing and a highly trained technician to do the testing. It also requires time, about 30 minutes per test. That means one multimillion-dollar machine and one well-compensated scientist running it could do 16 tests in a normal shift.

Find a second scientist, and you could double it.

A Bigger Bucket

The problem is that MLB at this stage puts out 3,955 urine tests in a season. This is without the increase in testing discussed above! Ignoring maintenance, downtime and other complications of the real world, it would take 225 workdays of a two-technician, one-machine lab to process all those CIR tests. There's only 260 work days in a full year, so while it's possible, it would mean that the lab would be limited to only doing MLB tests for much of the year. 

If the Montreal lab used by MLB had a second machine, it would be unusual given the industry standards. The cost of these machines and the current level of usage do not require it. Even so, the addition of a second machine to the equation doesn't make the mechanics of it any easier, and this is before we even discuss the per-test cost. At about $400 per test in this kind of bulk, we're already talking about MLB paying out over $1,400,000 per season, and that's just for the CIR test. 

MLB could afford this, but that cost on top of the other costs of the program make it more difficult. More complex is the mechanics of the lab itself. Unless MLB were to essentially own the lab, becoming nearly the sole client, it would be nearly impossible to make this level of testing happen without significant complexities.

The Fix Is In

The system, as it is for MLB, is the best in world sports. That means that if its system is not working, then every other sport is even worse off. Of course, the pure statistics suggest that the system is in fact working, and working well.

While a group of 20 or so players might use a few banned substances and get lucky enough to make it through the testing for a while, something approaching Conte's suggested 50 percent would break down not to a need for more testing, but for dumping the whole failed system. Usage at that level would mean that almost 2,000 tests were a "false negative." 

Let's loop back for a moment and note that the Biogenesis positive tests of Melky Cabrera, Bartolo Colon and others were done under the normal MLB system. That means that in all likelihood, they were first detected by the T/E ratio and then confirmed by CIR. 

The numbers from Biogenesis indicate that, at best, the "false negative" rate is 50 percent, which means 50 percent usage would create nearly 1,000 positive tests. Let's also note that outside of Biogenesis, there were zero suspensions for testosterone in any form. That would mean that everyone else was perfect. Bad choice to go with Biogenesis, folks!

(Only one other player, Freddy Galvis, was caught for any form of steroid.)

The idea of drug testing is really not to catch everyone red-handed. It is, through a combination of uncertainty and fear, to make using at all less of an attractive option. The uncertainty comes from the random nature of the tests and the fear from the possible suspensions and public scorn.

MLB and the Players Association are assuredly going to address increasing those penalties this offseason, but should they toss more money into the pot and add in additional random tests? Probably not. As I showed above, increasing testing frequency would have to go to a ridiculously invasive level, increasing costs and driving those who do choose to use to other, less safe options. 

The quick fix would be to realize that slight, visible improvements to the system would overcome the asymmetric advantages of the drug users over the drug testers. A couple of additional tests, an increase in random untriggered CIR frequency, and there should be an increase in positive tests. An increase, that is, if there are users out there. That remains to be seen if it is even approaching the pre-testing levels which were established at 5.7 percent, or 104 users, during the 2004 survey.

If there is an easy target, it would be to increase the offseason testing. Conte believes that most of the use is from athletes doing an offseason cycle. There are complications to increasing these out-of-competition tests, mostly in tracking the athletes, but it could be done. 

Just Another Con

So how did Biogenesis get away with it? It gambled, hoping that time and money and luck were on its side, long enough to keep the cash moving from a handful of players into Tony Bosch's pockets.

Given Bosch's financial issues, it's not clear that he was doing that well at even that. The whole enterprise unraveled over a missed payment of a couple grand. Bosch was just a strip-mall conman, and his "clients" would be more accurately called "suckers."

Will Carroll has been writing about sports injuries for 12 years. His work has appeared at Sports Illustrated and ESPN. He is the author of The Juice, which won the SABR Research Award in 2005. All quotes were obtained firsthand unless otherwise noted.


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