The Usefulness of Metabolic Ratios in the Interpretation of Steroid Misuse

Abstract

This chapter discusses the approaches used to determine testosterone (T) administration, with a particular focus on the use of metabolic ratios to facilitate the distinction between cases of T administration and naturally derived steroid profiles. Given the association of T misuse with elite sports, a brief history of this area is provided, and the approaches used to detect T administration are mainly discussed in this context. The key areas included are the use of the steroid ratios (T/epitestosterone), steroid/glycoprotein ratios (T/luteinising hormone), the athlete biological passport (longitudinal profiling of a specific athlete’s steroid profile) and the use of the carbon isotope ratio to distinguish exogenous and endogenous T. While the desire to detect T administration is sport has driven much of the research in this area, it should be remembered that T misuse and, more widely, steroid abuse is an increasing problem in society.