As for HCG, Dr. Glenn Braunstein, an expert in reproductive endocrinology at Cedars-Sinai Medical Center, said the drug slightly bumps up testosterone production but typically not to the level that would cause a T-E ratio such as 4:1. A typical dose leaves a person's system in 36 hours.
At the time of Ramirez's suspension, not much was known about HCG among the general pubic. The drug can be used to boost sex drive but can also assist steroid users to repair testosterone production at the end of a cycle, medical authorities say. According to sources in Ramirez's camp, the player's need to improve sexual performance was a factor in his use of the drug.
Gary Wadler, a New York sports medicine expert and WADA's chairman of the prohibited list and methods, said if HCG was not present, Ramirez's explanation would ring hollow.
"Maybe they hoped this would never surface, but in the name of transparency, you'd like to know who flunked a steroid test," he said.
The confidentiality of positive drug tests in MLB, crafted in collective-bargaining negotiations with baseball's strongly organized union, is "not good -- for the public, or the individual," WADA Director General David Howman said. "We don't get the blow by blow with MLB and we know why."
Under baseball's drug policy, if a player is suspended on a basis other than a positive test for a banned substance, "the only public comment from the club or the commissioner's office shall be that the player was suspended for a specified number of days for a violation of this program." Ramirez's suspension was not based on a positive test but on the evidence of the prescription without a therapeutic use exemption.
While the drug policy restricts the disclosure of the specific substance that triggered a positive test and resulted in suspension, the commissioner's office can disclose how the substance was classified -- as a performance-enhancing substance, drug of abuse or stimulant.
In January, for example, Selig's office announced that pitchers J.C. Romero of the Philadelphia Phillies and Sergio Mitre of the New York Yankees each had "received a 50-game suspension for testing positive for a performance-enhancing substance in violation of Major League Baseball's Joint Drug Prevention and Treatment Program."
The Ramirez announcement said only that he had "been suspended 50 games for a violation of Major League Baseball's Joint Drug Prevention and Treatment Program."
