He's a man. Why shouldn't he test positive for testosterone?
It is the amount that matters. If you have many times normal levels it is a red flag.
Testosterone possesses both anabolic and androgenic properties [1]. The synthetic derivates of testosterone are modifications of the hormone designed to enhance the anabolic action while reducing the androgenic effects. However, a derivate performing only the anabolic effects has not yet been synthesized – all anabolic steroids also possess some androgenic activity. Thus the term ‘side effects’ for the unwanted androgenic action is misleading – the effect on primary and secondary sexual characteristics is clearly one of the dominant effects of testosterone, and is performed by all known derivates. Testosterone acts on the development of external genitalia, induces sex-related peripubertal changes, and affects the distribution of hairs and muscles. Later in life, the inherent androgenic effects of anabolic steroids lead to virilization in females, and to acne and suppression of testicular function in males. Athletes try to benefit from the anabolic effects – an increase in protein synthesis, muscle growth, and erythropoiesis. Although large, validated scientific studies on the performance-enhancing effects of anabolic steroids are scarce, athletes do not doubt their efficacy. Furthermore, the doses used by cheating athletes are much higher than those used in the few published studies. For example, the daily dose of testosterone used by an athlete from the former German Democratic Republic was about 400 times (2,720 mg) the dose normally produced in healthy men (7 mg). For obvious ethical reasons, controlled studies in healthy subjects cannot test such high amounts of anabolic steroids.
The list of dangerous long-term effects caused by steroid hormone abuse is long: hypertension, changes in the lipid profile, atherosclerosis, and an increase in tendon damage are the most frequently observed. The main endocrine effect is the development of hypogonadotropic hypogonadism, characterized by low levels of gonadotrophins, suppression of testosterone production, and azoospermia in men. As prostate development and many prostate diseases are androgen dependent, the finding of prostate cancer after long-term abuse is not surprising. Chronic application of high doses of anabolic steroids in healthy young men has been shown to increase central prostate volume. In addition, through the physiological conversion of androgens to estradiol, gynecomastia (development of breasts) in males is not uncommon. Originally, injectable forms of anabolic steroids were used. Today, anabolic steroids can be administered orally, offering several advantages to the cheating athlete, especially the shorter clearance time from the body. However, the orally active 17-alpha-methyl derivates of testosterone seem to be even more dangerous because they are first metabolized in the liver, increasing the risk of liver diseases such as hepatitis and hepatic carcinoma. Despite their awareness of most of these serious consequences of anabolic steroid abuse, athletes persist in taking these substances. Using performance-enhancing drugs to be competitive in sports seems to be accepted as an inevitable necessity, and the consequences, which might not appear for several years, are ignored.
Evaluation of Testosterone/Epitestosterone Ratio Influential Factors as Determined in Doping Analysis
The ratio of the concentration of testosterone glucuronide to the concentration of epitestosterone glucuronide (T/E ratio) as determined in urine is the most frequently used method to prove testosterone abuse by athletes. A T/E ratio higher than 6 has been considered as proof of abuse in the past; however, cases of naturally occurring higher T/E ratios have been described. Since the introduction of the T/E ratio in doping analysis, the parameters that may or may not influence the T/E ratio, possibly leading to false-positive results, have been debated. To achieve more insight on the influencing circumstances, an overview is given to obtain an objective view on the merits of the urinary T/E ratio. Relevant analytical aspects of the T/E ratio, potential parameters of endogenous and exogenous origins, as well as some alternative methods to determine testosterone abuse, such as the urinary testosterone/luteinizing hormone ratio, gas chromatography– combustion–isotope-ratio mass spectrometry, hair analysis, and high-performance liquid chromatography–mass spectrometry, are discussed.