The Los Angeles Times has the complete breakdown of the Manny Ramirez suspension. Ramirez was ultimately suspended for a Human Chorionic Gonadotropin (HCG) prescription found after a spring training drug test revealed elevated levels of testosterone.
Elevated testosterone levels are discovered through a testosterone-epitestosterone (T:E) ratio test. A normal T:E ratio is 1:1. According to the Times, Ramirez’s was at least 4:1.
Ramirez had intended to appeal a potential suspension for elevated testosterone by arguing that the spike in his T:E ratio was caused by Dehydroepiandrosterone (DHEA). DHEA is an over-the-counter testosterone booster banned by the Olympics and other professional sports leagues, but still legal in the United States and not banned by Major League Baseball.
According to the Times the following sequence of events led to Ramirez’s suspension.
- During a routine spring training drug test, Ramirez’s sample was "flagged for having an unusually elevated synthetic testosterone level."
- Ramirez’s representatives were "expected" to appeal any suspension on the basis of an inflated T:E ratio by arguing that Ramirez had used DHEA.
- During the ensuing investigation, MLB found evidence that Ramirez had been prescribed HCG without a "therapeutic use" exemption.
- MLB moved to suspend Ramirez on the basis of the HCG prescription and Ramirez withdrew his appeal.
According to Professor Christiane Ayotte, director of the World Anti-Doping Agency (WADA) accredited lab responsible for Ramirez’s test, DHEA can be distinguished from other sources of testosterone.
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.
So not only can the lab determine if DHEA is present, but MLB would have known all along if Ramirez’s had used DHEA even though it is not banned.
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."