Alex Rodriguez, David Ortiz, Manny Ramirez and Performance-Enhancing Drugs , Part 2

As previously reported, David Ortiz and Manny Ramirez had tested positive for performance-enhancing drugs (PED) in 2003. Although the most commonly used PEDs have been anabolic steroids, there are a number of other drugs that are considered performance enhancing, and it is possible that these players tested positive for any number of these drugs (published reports do not specifically name the drugs found).

Performance-enhancing drugs can be divided into a number of categories:

  • Lean mass enhancers– increase muscle and lean body mass. This group includes anabolic steroids, but also includes hormones, such as human growth hormone (HGH- see below)
  • Stimulants– such as amphetamines and caffeine, which stimulate alertness and increase aggressiveness
  • Painkillers– mask pain so that athlete can compete when injured
  • Diuretics– decrease weight by increasing urine output. Used by wrestlers and jockeys who need to meet weight restrictions
  • Masking drugs– usually have no performance enhancing effect on their own, but are used to mask the detection of banned substances. This is an ever-changing landscape as these drugs evolve in tandem with drug testing techniques. The most notable one of these drugs is epitestosterone. A common criterion for many testosterone tests is actually the ratio of testosterone to epitestosterone. If the level of epitestosterone is raised then a higher amount of testosterone will still give a normal ratio.

Human Growth Hormone (HGH) is a normally occurring hormone that is essential for growth and cell reproduction, and which can increase muscle mass. Originally used to treat children and adults with growth problems, the hormone was replaced by obtaining small amounts of the hormone from cadaver pituitary glands. Affected children were only able to receive enough to bring them closer to a “normal” adult height, but distribution of the hormone was tightly rationed. Later, HGH was synthesized in the lab and became plentiful. At that time people began to use the drug not only to increase muscle mass but as an “anti-aging” medication. This latter indication has never been proven. The International Olympic Committee banned HGH in 1989.


Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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