Major League Baseball suspended Manny Ramirez of the Los Angeles Dodgers on Thursday, after investigators turned up documents suggesting that the slugger was using human chorionic gonadotropin. Typically a fertility drug for women, HCG is also used to complement steroid cycles. Ramirez, however, claims he was using the medication to treat a "personal health issue." What issue might that be?
Infertility. The hormone HCG is released naturally in women during pregnancy, when it serves to maintain the appropriate levels of progesterone. It's commonly prescribed to women undergoing IVF treatment to trigger ovulation. If taken by men, HCG stimulates the testicles' leydig cells to synthesize testosterone. Doctors prescribe the drug to boys as a treatment for delayed puberty (no secondary sex characteristics at 14, for example) and undescended testes. But a man of Manny's age—he's 36—would take HCG if he's suffering from oligospermia, or a low sperm count. The hormone is generally administered via intramuscular injection.
HCG has also been used as a weight-loss drug. It first came into vogue as a miracle diet aid in 1957, when Harper's Bazaar ran an article called "Slimming: A Roman Doctor's Treatment." In the article, British endocrinologist ATW Simeons claimed his patients felt less hungry if they took shots of HCG. But in 1962, the Journal of the American Medical Association warned against the so-called "Simeons diet," noting that it was ineffective and potentially dangerous. Although some still take HCG for this purpose, the medical establishment—including the Mayo Clinic—holds that the hormone injections are no more effective than placebos.
HCG is on the MLB's list of banned substances because it artificially increases testosterone levels. An athlete would never take HCG as a performance-enhancing drug per se—he'd be better off taking straight testosterone (which is more efficient). Rather, athletes take it to counter the effects of anabolic steroid use, which, over time, switches off the body's natural production of testosterone and shrinks the testes. After a steroid cycle, which lasts between seven and 14 weeks, HCG can return the testes to their normal size and reboot natural hormone synthesis.
Professed HCG users say the hormone makes them feel more energetic, as if they're still on a steroid cycle rather than tapering off one. Former Mets clubhouse member Kirk Radomski, for example, told ESPN that he'd used HCG numerous times and that "[y]ou feel great. After you come off a [steroid] cycle, your body doesn't crash." But since testosterone is naturally converted into estrogen, continued use of HCG can result in a few nasty side effects—most notably gynecomastia, or breast enlargement in men. Other potential side effects include acne, irritability, and, in women, excessive ovulation and multiple pregnancy.
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Explainer thanks Gary Wadler of the World Anti-Doping Agency and Stephanie Older of the National Institute on Drug Abuse.