
The problem here keys on the use of normal, because when you get into the elite ranks of swimming normal starts to become less and less relevant. There are some who have natural testosterone ratios of 4:1 or even higher – it’s one of the reasons they’re as competitive as they are. Throw in the fact there are several known ways to naturally boost testosterone levels, ranging from alcohol consumption to the use of birth control pills and recent sex, then add in the inherent variability of the tests themselves, and determining just who is doping and who isn’t becomes considerably more blurry. For these reasons when testing was first instituted the ratio was established at 10:1. After studies showed the methods were sufficiently rigorous it was dropped to 6:1, and then in 2005 it was reduced still further to the current 4:1. Contrary to popular belief, while this ratio is considered in determining a positive result, it is used more as a screen for more complex and conclusive tests. Experience has shown a sample with a T/E ratio of 20:1 or ‘better’ will reveal doping more than 95% of the time¹ but the confirmation rate drops as the ratio declines. A 10:1 T/E ratio sees only 31% confirmed positive and the recent reduction in the threshold ratio from 6:1 to 4:1 has resulted in only an additional 0.3% increase in adverse findings (3 out of 1,000). Having the first sample fail doesn’t mean a positive test but it does, however, prompt the testing of the athlete’s “B” sample to verify the initial finding. Only if the second test confirms a higher than allowable amount of T does a positive test officially result. Still no reason to panic, especially if the test results from the two samples are only a little over the allowable 4:1 ratio because you’ll remember we can expect many in this particular population will have naturally high T/E ratios and there are a lot of ways the level can be boosted naturally. A confirmatory second test should therefore be carried out which examines the carbon isotope ratios of the byproducts of testosterone metabolism, known as metabolites, to determine whether the testosterone was made by the body ('endogenous T') or came from a man-made source ('exogenous T'). Four different metabolites are tested and an abnormal result in just one of them will confirm the positive result (i.e. the sample contains manufactured testosterone). It’s the finding of man-made testosterone in the sample which provides the actual evidence of doping. If there’s no evidence of exogenous testosterone then regardless of how high the T/E ratio the athlete will have an excellent chance to be cleared on review – despite a confirmed positive result of testosterone in excess of allowable limits.
So you see while Gary Hall Jr.’s hypothesis of how RNG could have been cheating has merit it is also quite possible to have a positive result and see it reversed by the responsible authority. In fact, rather than saying the ratio is too lax, many are arguing it is far too narrow knowing what we do about the natural variability in human testosterone levels. Dissenters believe, beyond just being a waste of money, that the constant stream of false positives resulting from the current 4:1 T/E ratio will eventually cause the general public to lose confidence in the testing system. Perhaps the way to go is to jump directly to carbon isotope testing in certain random situations to prevent ‘doping to limit’, but practically speaking the present standard is already pretty close to that. RNG didn’t need his medical team to screw up and not adjust his doping program to the new standards (a very doubtful hypothesis); at his hypothetical elevated levels a slight unforeseen fluctuation in his testosterone, maybe too much beef for dinner, could have been enough to get him flagged for carbon isotope testing. Nowadays the margin for error is much too tight for somebody to hope get away with boosting testosterone levels over a long period of time without eventually raising some flags. But if RNG was cheating and caught as Junior suggests his medical ‘advisors’ may still be responsible for the mess: more knowledgeable cheats are now believed to be using animal based testosterone preparations because of the similarities their carbon isotope ratios have to endogenous T. Oy vey.
¹I have to point out this means upwards of five percent of those tested actually had naturally occurring T/E ratios of 20:1 or more – an amazing ratio which prompts the obvious question – just how do we get invited to their parties? On a more serious note the T/E ratio is known to be also affected by ethnicity; age; circadian rhythm; training and competition; diet; nutritional supplementation; environmental factors; enzyme deficiencies; decreased epitestosterone excretion; menstruation; pregnancy; other hormonal therapy; consumption of meat from animals supplemented with anabolic steroids; polycystic ovary syndrome (a common endocrine disorder); and other pathologic medical conditions (source: Inferences About Testosterone Abuse Among Athletes).
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Good for people to know.
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