Manny Ramirez was suspended for 50 games by Major League Baseball on Thursday, becoming the latest high-profile Major League Baseball player busted by the league's performance enhancing drug policy. Ramirez denies it (naturally) said he took an agent given by a doctor that was believed to not be banned. The Dodgers dread-locked slugger says: "Recently, I saw a physician for a personal health issue. He gave me a medication, not a steroid, which he thought was OK to give me," he said in a statement issued by the players' union.
Ramirez went to a doctor for "...a personal health issue..."? What, he wanted to simulate pregnancy -- grow breasts -- throw-up every morning? Two sources told ESPN that Ramirez used a women's fertility drug — HCG, human chorionic gonadotropin. HCG is what is tested for in the blood or urine from a women when pregnancy is suspected. The hormone is released by a the trophoblast (early fertilized egg) and rises to maintain the pregnancy during the first trimester until adequate amounts are secreted by the placenta.
Human chorionic gonadotropin (hCG) and a recombinant formulation, called choriogonadotropin alfa (r-hCG), is a gonad-stimulating polypeptide hormone normally secreted by the placenta during pregnancy. The non-recombinant products are obtained from the urine of pregnant women. Recombinant-hCG is produced via recombinant DNA techniques in Chinese Hamster Ovary (CHO) cells. The pharmacological actions of hCG and of r-hCG are similar and resemble those of luteinizing hormone (LH); hCG is generally used as a substitute for LH. HCG has been used to treat cryptorchidism (undescended testicle) or hypogonadotropic hypogonadism in males, sometimes in combination with menotropins or follitropin. Interestingly, hCG was introduced for the treatment of cryptorchidism in 1931, and remained the only hormonal agent available to treat the condition until the 1970's, when gonadotropin-releasing hormone (GnRH) analogs also became a treatment option. Human chorionic gonadotropin (hCG) is used in controlled ovarian hyperstimulation protocols for infertility in females. Intralesional hCG has been utilized for the treatment of Kaposi's sarcoma, but further clinical trials are required to prove efficacy. Human chorionic gonadotropin is banned from use in competitive sport; some male athletes have used hCG to stimulate testosterone production or to prevent testicular atrophy resulting from the abuse of anabolic steroids and androgens. Urine-derived hCG was first approved by the FDA in 1939, and received subsequent approval for additional indications in 1973. Ovidrel®, the first recombinant hCG (r-hCG), received FDA approval for female infertility to induce final follicular maturation on September 20, 2000. Ovidrel® pre-filled syringes received FDA approval in October 2003; manufacturing of Ovidrel® vials has ceased.
The mechanism of action of human chorionic gonadotropin (hCG) depends upon the purpose for which it is being used, the sex of the patient, and the level of maturity of the patient to whom it is administered.
In select females with infertility , human chorionic gonadotropin has actions essentially identical to those of luteinizing hormone (LH). Human chorionic gonadotropin (hCG) also appears to have additional, though minimal, follicle-stimulating hormone (FSH) activity. By administering hCG after follitropin, menotropins, or clomiphene, the normal LH surge that precedes ovulation can be mimicked. Human chorionic gonadotropin (hCG) promotes the development and maintenance of the corpus lutetium and the production of progesterone. Following hCG administration, final luteinization or maturation of the oocytes occurs and either ovulation can ensue for timed insemination techniques, or oocyte retrieval can take place for assisted reproductive technology (ART) procedures such as in vitro fertilization (IVF). Once pregnancy takes place, endogenous hCG is normally secreted by the placenta to support the continued secretion of female hormones and the corpus luteum.
In adult and adolescent men with hypogonadotropic hypogonadism, hCG acts like LH and stimulates testosterone production in the Leydig cells and spermatogenesis in the seminiferous tubules. Stimulation of androgen production by hCG causes development of secondary sex characteristics in males (e.g., deepening of voice, facial hair, etc.). Human chorionic gonadotropin (hCG) also stimulates the Leydig cells to produce estrogens; increased estrogen levels may produce gynecomastia in some males. Once hCG is initiated, it takes at least 70—80 days for germ cells to reach the spermatozoal stage. Response to treatment is also noted by the development of masculine features and the normalization of serum testosterone levels. Induction of testicular growth and increased sperm volumes may help to restore fertility in these men after many months to years of treatment, which is then sometimes combined with the use of either menotropins or follitropin.
Human chorionic gonadotropin has no known effects on appetite, or on mobilization or distribution of body fat. It is not an effective treatment for obesity. In sport, athletes use HCG as an 'undetectable' anabolic steroid; hCG increases the body's production of testosterone and epitestosterone without increasing the ratio of the two hormones in the urine above normal values. Urinary testing is being developed which should allow for discriminate testing of hCG doping in sport.
It is difficult to imagine what "condition" Manny Ramirez was being treated for that required this peculiar hormonal agent that is going to cost him a reported $7.5M in salary benefits from the Dodgers (likely to eventually be made up by the doctor's malpractice insurance carrier). It is also impossible to imagine that this was not a malicious attempt to circumvent MLB's banned drug policy. The only source of this agent being found in a male's urine is a hormone producing germ cell tumor (e.g., testicular cancer). Manny: you better get an alfa-fetoprotein serum level and see a real doctor for a complete genital exam and testicular ultrasound.