Will A-Rod’s Alleged HGH Use Make the Drug More Popular?

The stadium scene.
Jan. 30 2013 1:51 PM

A-Rod Hearts HGH

Will a crackdown on (supposedly) performance-enhancing growth hormone just make the drug more popular?

Alex Rodriguez #13 of the New York Yankees against the Detroit Tigers during game four of the American League Championship Series.
Alex Rodriguez of the New York Yankees has played under a cloud of performance enhancement.

Photo by Jonathan Daniel/Getty Images

"I was young, I was stupid, I was naive," explained Alex Rodriguez on Feb. 9, 2009, in an interview with Peter Gammons. "And I did take a banned substance. For that, I'm very sorry and deeply regretful." The slugger claimed that he had stopped using performance-enhancing drugs in 2003, but a report published this week by the Miami New Times suggests that A-Rod was doping even as he sought forgiveness.

Daniel Engber Daniel Engber

Daniel Engber is a columnist for Slate

The newspaper has uncovered handwritten records of drug sales to Rodriguez—testosterone creams, IGF-1, and human growth hormone—from a now-defunct drug dispensary in South Florida. One document related to these transactions lists the name "ALEX ROD" alongside that of his cousin and acknowledged drug mule, Yuri Sucart. It's from a book marked "2009," in an entry dated Feb. 7. That would place the deal just two days ahead of A-Rod's public mea culpa.

Rodriguez denies the allegations, as has the Washington Nationals’ Gio Gonzalez, who’s also listed in the notebooks. And there may be good reason to question the evidence: The file described above gives Feb. 7, 2009 as a Monday, when it was in fact a Saturday. Another entry implicating A-Rod shows up in the "2010" book below the date Monday, Nov. 21, though the 21st fell on a Sunday in 2010. If we trust the listed days, then the records would seem to have been misfiled—those dates would match the days of the week for 2011 or 2005, not 2009 or 2010.

But if the records prove legitimate, funny dates and all, then the New Times scoop casts doubt on the presumed tapering off of the steroids era in professional baseball. It also illuminates a shady world of "anti-aging clinics," where hormones are handed out to athletes and entertainers, and to anyone else who'd like to shed some weight or harden their physique. In December, the AP published a report on record sales of prescription growth hormone, apparently driven by a market for its illegal, off-label uses. "Years of raids, sports scandals and media attention haven't stopped major drugmakers from selling a whopping $1.4 billion worth of HGH in the U.S. last year," the article concluded.

What accounts for the continuation of this problem, in spite of all the anti-doping efforts that are arrayed against it? The most obvious explanation—and the one that will be cited most in coming weeks—has to do with testing. Though Major League Baseball banned HGH in 2005, it didn’t start screening its players for the drug until just prior to the 2012 season. A new testing program, first used for last summer's Olympic Games, will be in place for the upcoming season, with players getting tested for HGH in-season, too.

As in past years, however, the focus on enforcement may only make things worse. In fact, the unnecessary panic over HGH—a mild drug, with neither clear performance-enhancing benefits nor clearly dangerous side effects—has only served to boost its profile and promote its use.

The AP’s December investigation reveals that very link. From 2005 until 2011, inflation-adjusted sales of HGH were up by 69 percent, it says. Yet a closer look reveals that the majority of that increase had already occurred by the end of 2007. According to the AP's numbers, HGH prescriptions were up 41 percent that year, and have been stable ever since. Similarly, inflation-adjusted sales of HGH were up by 46 percent between 2005 and 2007, and then climbed by much smaller increments in the years that followed.

That spike in HGH prescriptions matches up with a major government crackdown on performance-enhancing drugs, which served to squeeze out illegal imports and fortify the domestic market. In 2006 and 2007, the feds completed two widespread criminal investigations designed to bring down a "global underground trade of anabolic steroids, human growth hormone and insulin growth factor." In December 2007, George Mitchell finished his 409-page review of anabolic-steroid and HGH use among MLB players.

In the midst of all this activity, no one bothered to distinguish HGH from its more potent (and more deadly) alternatives. Anabolic steroids made athletes stronger and more proficient. But while lab tests showed that HGH could help people lose weight and grow lean tissue, they hadn't linked those changes to improved athletic prowess. (The lean tissue seems to be mostly a byproduct of water retention.) The only thing we know for sure is that HGH can make you look better. Their side effects, too, appeared to differ: Where steroids are likely to increase the risk of cardiovascular disease, growth hormone tends to produce only nuisance symptoms like swollen joints and carpal tunnel syndrome, and these subside with discontinued use.

Despite their glaring differences, HGH and steroids are often described as if they are interchangeable. (Athletes do tend to take the drugs together.) In a twisted way, the market for growth hormone may have benefited from all the negative attention. The more the anti-doping authorities went after it, the more effective the drug must have seemed to potential users. By early 2008, we'd learned that not just athletes but a bevy of celebrities—Mary J. Blige, 50 Cent, Tyler Perry, and Sylvester Stallone—had taken HGH. (The drug is big in Hollywood.) Magazine features in Outside and GQ touted its magical, rejuvenating effects for normal, aging men. And from what we now understand, baseball players (and perhaps their wives) continued to inject the stuff in the years the followed.

If the new testing regime in MLB, along with the New Times scoop, leads to a renewed interest in stamping out HGH abuse, this cycle may begin anew. Further research in the last five years has not brought much more clarity about the drug, in terms of its benefits or its risks.

The most dramatic recent study of how HGH affects athletic performance came out in 2010, and found that regular dosing could improve a sprinter's time by almost 4 percent. A senior author of the paper, Kenneth Ho, noted that a 4 percent improvement might cut four-tenths of a second from an Olympic athlete's 100-meter dash—enough to turn a last-place finisher into a gold medalist.

The last-to-first comparison was reported widely in the media, along with claims that researchers had at last produced "hard evidence" for the HGH effect. That fit in well with the message of the World Anti-Doping Agency, which provided funding for the study. But other scientists wondered at the paper's conclusions. Previous double-blinded, placebo-controlled studies had found no effect of HGH on muscle strength or bicycling performance, and the 4 percent effect from the Ho paper showed up not in a real 100-meter dash, but on something called a Wingate test, completed on a stationary bicycle. (No one in the field knows exactly how the Wingate test relates to actual sports performance.) The Ho paper also found that HGH had no detectable impact on its subjects' cardiovascular endurance, their ability to lift weights, or their capacity to jump straight up in the air. Finally, the drug did not appear to boost performance in female subjects.

A critique published in the same journal several months later warned that while the media attention to the study might be taken "as a victory in the highly publicized battle against sports doping, it is scientifically inaccurate, unethical and irresponsible." Then the author added: "Ironically, it could also encourage the abuse of doping agents by exaggerating their efficacy."

Evidence for the amazing healing powers of HGH remains obscure as well. (A few studies have found an effect on collagen protein synthesis and fracture repair, but they have not yet been corroborated.) Same goes for the drug's often-cited long-term health risks. The December AP report, for example, writes off some of the drug's purported benefits as having "scant scientific evidence," while listing diabetes, heart disease, and cancer growth among its "suspected side effects." But the research support for these dangers is scant as well. Children treated with growth hormone for legitimate medical conditions seem to have higher rates of certain kinds of cancer, but their overall mortality rates are unchanged. In August 2011, the FDA reviewed data from a large study of HGH that's underway in Europe and concluded that "the evidence regarding recombinant human growth hormone and increased risk of death is inconclusive," recommending that healthcare providers continue to prescribe it where appropriate. (N.B. the FDA considers "anti-aging" an inappropriate use.)

Six years ago, I wrote in Slate that "every star athlete who gets caught with a vial of HGH turns into a spokesperson for the drug." Indeed, these de facto advertisements are just like the ones that drive an underground market in deer-antler spray, holographic energy stickers, negatively charged water, and other mumbo jumbo for which pro athletes seem to have an endless hunger and credulity. HGH may not really improve your game, but that doesn’t matter much when it comes to its popularity. A-Rod just gave this product his endorsement, and that means the drug will sell.

What does this mean for all the nonathletes who are taking the drug for its "anti-aging"—i.e. cosmetic—benefits? They're left to fend for themselves amidst conflicting claims from sleazy clinicians and overzealous anti-dopers. They would be wise to ignore the marketing, wherever it comes from, and decide for themselves whether the potential for cosmetic gain is worth the as-yet-unknown risks.

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