Starling Marte, nandrolone, and a few thoughts on PED suspensions

According to Dan Szymborski’s ZiPS, Starling Marte projected (3.8 zWAR) to be the second most valuable member of the Pittsburgh Pirates in 2017 — behind only Andrew McCutchen (4.1 zWAR). Thirteen games into the season, due to below average offensive numbers (through only 59 plate appearances, I know), Marte had put up exactly 0.0 fWAR. Thus, if Marte, 28, plans on reaching his projection this season, he will have to go on an absolute tear upon returning from his lengthy suspension.

On Tuesday, the league announced that Marte had tested positive for nandrolone — an anabolic steroid — warranting an 80-game suspension per the terms of the current Joint Drug Prevention and Treatment program. Honestly, fans of the game of baseball should never get “excited” about drug suspensions, but as a pharmacist, I’ll be the first to admit that I find great interest in drug-related reports, especially when they involve such a big name player and such an easily-detectable performance-enhancing drug (PED).

As you may recall, I wrote about Ervin Santana and his reported PED, stanozolol, back in April 2015. Today, let’s take a closer look at nandrolone, starting with a section of my class notes on the drug:

The very definition of anabolic steroid is a “synthetic variation of male sex hormone testosterone.” And just as I wrote about in my article on stanozolol, testosterone has both androgenic — male sexual characteristics — and anabolic — muscle-building — effects. Male athletes, while they wouldn’t necessarily be against androgenic effects, are primarily interested in anabolic effects. Hence the creation of drug products like nandrolone decanoate — which, as you can see in the box above, possesses equal anabolic activity to testosterone, but only one-tenth of the androgenic activity.

The above drug product is an intramuscular injection. The section of the structure marked “long-acting ester” allows for such a route of administration. One of the benefits of this type of administration is that it is much longer acting than an oral formulation. One of the benefits is also one of its drawbacks as well when you are talking about a league that regularly drug tests its players. Remember, nandrolone is by no means a new drug, is readily detectable, and has been banned for a very long time — across all sports.

Well, according to a decades old study (published in Acta Endocrinologica), the mean half-life for nandrolone decanoate was determined to be 6 days. In general, it takes five half-lives for a drug to be cleared from the body. Thus, in a very simple sense, Marte could’ve tested positive for nandrolone (but likely its metabolites) up to one month after receiving it. It’s obviously much more complex than that, as each body reacts differently to drugs, but this a general truth — one in which you’d hope Marte was aware of at the time of the offense.

Bottom line, I am pleased with the progress the league and players’ union have made regarding PED suspensions. I believe the game has successfully moved past the “steroid era,” but incidents like the ones we’ve now seen with All-Stars Santana and Marte show that it is still an active issue. The “three strikes, you’re out” policy serves as a decent deterrent, but it clearly isn’t enough. I understand that the system will never be perfect, but I would still like to see even stricter punishments — particularly for anabolic steroids, of which have been proven to be legitimate performance enhancers. Frankly, in a league that hands out Therapeutic Use Exemptions (mainly for amphetamines) rather liberally, it really is the least the two groups can agree upon for the betterment of the sport. That’s a roundabout way in saying that I’d support the institution of a “second-chance” policy, meaning one year for the first offense and a lifetime ban for the second offense.