The popular assumption is that David Jacobs’ testosterone levels were significantly elevated based on a reported testosterone/epitestosterone ratio (T:E ratio) value of 22:1 in his official autopsy report. Are we correct to make this assumption?
I have been corresponding with Jason Trahan of the Dallas Morning News to reach a better understanding of the T:E ratio and what it really means. I felt Trahan’s interpretation of the T:E ratio was misleading.
Mr. Jacobs had more than five times the amount of testosterone in his system than allowed by standard sports testing.
The T:E ratio was indeed over five times the 4:1 ratio permitted by the World Anti-Doping Agency. But Jacobs did NOT have five times the normal levels of testosterone in his body. And Jacobs did NOT have five times the normal level of testosterone glucuronide (TG) in his urine either.
Does the David Jacobs’ T:E ratio provide evidence of seriously elevated testosterone levels?
According to steroid and doping expert Dr. Michael Scally, of the biopharmaceutical company HPT/Axis, the answer is no.
It is not possible to accurately determine the testosterone dose or serum testosterone level from the testosterone/epitestosterone ratio or the urine testosterone level. The values cited within the autopsy report are the following: Testosterone (T) “ 270 ng/mL and Epitestosterone (E) “ 12.2 ng/mL. In addition, the urine tested positive for nandrolone.
At best, the T:E ratio can offer putative evidence of exogenous testosterone usage.
The levels within the autopsy report for T and E are significant for the ratio greater than 4. This clearly indicates that exogenous testosterone was administered. However, any attempt to extrapolate this ratio to an amount administered is futile.
But Scally points out that an individual can achieve comparable urinary testosterone levels without using exogenous testosterone.
A point of fact for this is that androstenedione administration will increase urinary testosterone to this level. In a published study, androstenedione intake increased (P < 0.05) urinary testosterone 35.1 ± 10.5 ng/ml vs. 251.6 ± 87.5 ng/ml and epitestosterone 35.3 ± 8.8 ng/ml vs. 99.7 ± 28.7 ng/ml. In this particular study the T/E ratio did not exceed 6, the level used by antidoping agencies [at the time]. The autopsy report results are clear for exogenous administration, but not for the amount taken or even when.
The T:E ratio is one of the most misunderstood tests used in medicine.
Talking point for the all journalists is that the T:E ratio does NOT tell us the amount of testosterone used or the serum testosterone levels used by an individual. This flies in the face of everything we have been led to believe by the media. But hopefully the truth will prevail.
About the author
Millard writes about anabolic steroids and performance enhancing drugs and their use and impact in sport and society. He discusses the medical and non-medical uses of anabolic-androgenic steroids while advocating a harm reduction approach to steroid education.
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