Alex Rodriguez TRT: A Clinical Interpretation of His Testosterone History

What Alex Rodriguez Has Publicly Said About Testosterone Use

Alex Rodriguez has given several on-record statements about testosterone across different media appearances. The most widely cited came in a February 2009 ESPN interview with Peter Gammons, where Rodriguez said he used a substance he called "boli", a colloquial reference to Primobolan (methenolone), an anabolic steroid, along with testosterone, between 2001 and 2003 while playing for the Texas Rangers. He described these years as a period when he felt "naive" and wanted to prove himself after signing a then-record $252 million contract.

Rodriguez did not frame this as medically supervised TRT. He described it as self-directed use of substances obtained without a physician's oversight, a distinction with major clinical and regulatory consequences.

The 2009 ESPN Admission in Context

The 2009 admission came only after Sports Illustrated reported that Rodriguez had tested positive in 2003 MLB survey testing. That survey was anonymous and was not supposed to trigger discipline; it was used to determine whether the player base exceeded the 5% threshold that would trigger mandatory testing. The positive result was leaked years later, making it one of the more unusual public disclosures in sports doping history.

From a clinical standpoint, "testosterone" and "Primobolan" used together without medical supervision, in a professional athlete context, is not TRT. TRT is a physician-prescribed protocol targeting a deficient serum testosterone level toward mid-normal range, typically 400 to 700 ng/dL, using a calibrated dose.

The Biogenesis Scandal and the 2014 Suspension

The second major episode began when the Miami New Times reported in January 2013 that records from the Biogenesis of America clinic listed Rodriguez as a client. MLB investigators obtained clinic documents and witness testimony implicating Rodriguez in receipt of testosterone, human growth hormone, and insulin-like growth factor 1 (IGF-1).

Rodriguez was suspended 211 games initially, later reduced to 162 on arbitration, covering the entire 2014 season. He denied the allegations publicly for months before eventually accepting the suspension without further appeal after losing arbitration in January 2014.

The compounds attributed to Rodriguez through Biogenesis are not part of any standard TRT protocol. IGF-1 peptides and HGH are not indicated for testosterone deficiency; they are used in doping to promote muscle hypertrophy and accelerate recovery.

What Legitimate TRT Actually Looks Like

Understanding where Rodriguez's documented use falls requires a clear baseline for what medically supervised TRT involves. The Endocrine Society's 2018 clinical practice guideline defines male hypogonadism as a serum total testosterone consistently below 300 ng/dL on two morning measurements, combined with symptoms such as reduced libido, fatigue, and loss of muscle mass [1].

Diagnostic Criteria Before Prescribing

A physician evaluating a patient for TRT will order:

• Two fasting, morning total testosterone levels (8 to 10 AM draws)
• Free testosterone if total T is borderline
• LH and FSH to distinguish primary from secondary hypogonadism
• Hematocrit, PSA (in men over 40), and lipid panel

The American Urological Association's 2018 guideline recommends initiating therapy when total testosterone is below 300 ng/dL and symptoms are present [2]. Prescribing testosterone to a eugonadal athlete, one whose baseline levels are already normal, falls outside these guidelines entirely and would represent off-label, ethically problematic use.

Standard Therapeutic Doses

The Endocrine Society guideline supports the following representative doses for adult males [1]:

• Testosterone cypionate or enanthate: 75 to 100 mg intramuscular injection weekly, or 150 to 200 mg every two weeks
• Testosterone gel (1%): 50 to 100 mg applied daily
• Testosterone pellets (Testopel): 150 to 450 mg subcutaneously every 3 to 6 months

These doses are calibrated to restore serum testosterone to the mid-normal range (400 to 700 ng/dL), not to push it above the upper reference limit. Doses that drive serum T above 1,000 to 1,200 ng/dL, the levels associated with performance-enhancing use, carry well-documented risks including erythrocytosis, dyslipidemia, and suppression of endogenous LH and FSH [3].

Monitoring During Therapy

The AUA guideline recommends monitoring hematocrit at 3 and 6 months after starting therapy, then annually. If hematocrit exceeds 54%, therapy should be paused [2]. Rodriguez's reported use lacked any of this structured oversight, which further separates it from legitimate clinical TRT.

Clinical Difference Between TRT and Testosterone Doping

The distinction matters both medically and legally. TRT and testosterone doping use the same molecule. The differences lie in dose, intent, baseline hormone status, and medical supervision.

Serum Level Targets

Therapeutic TRT targets mid-normal physiologic range. Doping protocols drive serum testosterone well above the normal ceiling of 1,000 ng/dL, sometimes to 2,000 to 3,000 ng/dL or higher, to exploit the dose-response relationship between testosterone and muscle protein synthesis [4]. A 2001 randomized trial by Bhasin et al. In the New England Journal of Medicine demonstrated that supraphysiologic testosterone doses (600 mg/week of testosterone enanthate for 10 weeks) increased fat-free mass by 6.1 kg in men without exercise, compared with 2.0 kg in placebo controls [4]. This study is frequently cited in doping physiology literature because it quantified the muscle-building advantage of doses well above therapeutic range.

Anti-Doping Detection and the Testosterone/Epitestosterone Ratio

The World Anti-Doping Agency (WADA) and MLB's Joint Drug Program both use the urinary testosterone-to-epitestosterone (T/E) ratio. A ratio above 4:1 triggers a carbon isotope ratio (CIR) test to confirm exogenous testosterone use. In a clinical TRT patient whose dose is properly calibrated, T/E can still be elevated, which is one reason sports governing bodies have historically required therapeutic use exemptions (TUEs) for athletes on legitimate TRT, though MLB's policy on TUEs for testosterone has been restrictive since 2008.

Peptides and IGF-1: Not Part of TRT

The Biogenesis records attributed both IGF-1 and HGH to Rodriguez. Neither compound is part of TRT. IGF-1 (mecasermin, brand name Increlex) is FDA-approved only for growth failure in children with primary IGF-1 deficiency [5]. Off-label use in adult athletes exploits IGF-1's anabolic effects on skeletal muscle. Similarly, HGH (somatropin) is FDA-approved for adult growth hormone deficiency, short bowel syndrome, and HIV-related wasting, not athletic recovery [6]. Using these compounds alongside testosterone signals a multi-agent performance-enhancement regimen, not a medical correction of hypogonadism.

Health Risks Rodriguez's Documented Use Pattern Carries

Any physician reviewing the pattern attributed to Rodriguez would identify several areas of concern, independent of the legal and professional consequences.

Cardiovascular Risk

Supraphysiologic testosterone increases red blood cell mass and hematocrit, raising blood viscosity and the risk of thromboembolic events. A 2023 FDA drug safety communication updated labeling for all testosterone products to emphasize the risk of major adverse cardiovascular events (MACE) [7]. The TRAVERSE trial (N=5,246), published in the New England Journal of Medicine in 2023, found that testosterone therapy in men with hypogonadism and pre-existing cardiovascular risk did not increase MACE compared with placebo over a median 33-month follow-up, but the study population was hypogonadal men on therapeutic doses, not eugonadal athletes on supraphysiologic doses [8].

Endocrine Suppression

Exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis via negative feedback on GnRH and LH secretion. In men who were previously eugonadal, meaning their own testosterone production was normal before use, prolonged exogenous testosterone can cause testicular atrophy and azoospermia. Recovery of endogenous production after stopping high-dose exogenous testosterone may take 6 to 24 months and is not guaranteed in all cases [3].

Psychological Effects

High-dose androgen use is associated with mood instability, increased aggression, and, paradoxically, depressive episodes during and after cessation. A 2019 cohort study in JAMA Psychiatry (N=3,647 anabolic steroid users versus matched controls) found that former users had a significantly higher rate of mood disorder diagnoses and suicide attempts in the years following cessation [9].

How Physicians Evaluate a Patient Who Reports Past Performance-Enhancing Use

A patient presenting with a history similar to Rodriguez's, high-dose, non-medically supervised testosterone use spanning multiple years, possibly combined with IGF-1 or HGH, requires a specific clinical approach distinct from a standard new-patient TRT workup.

Initial Laboratory Panel

The first step is establishing current endocrine status, since prior suppression may have left the HPG axis partially or fully impaired. Recommended tests include:

• Total and free testosterone (morning draw)
• LH and FSH (low levels suggest persistent HPG suppression)
• Estradiol (exogenous androgen excess can aromatize significantly)
• Prolactin (to rule out pituitary pathology)
• SHBG, CBC with hematocrit, comprehensive metabolic panel
• Lipid panel (AAS commonly depresses HDL)
• Testicular ultrasound if atrophy or pain is reported

If LH and FSH are suppressed with low-to-normal testosterone, the diagnosis is secondary hypogonadism, likely iatrogenic. In this case, the clinical question shifts from "does this patient need TRT" to "can we restore endogenous function first."

Considering Endogenous Recovery Before Starting TRT

For patients with iatrogenic secondary hypogonadism from prior AAS use, some endocrinologists attempt a recovery protocol before committing to lifelong TRT. Options include clomiphene citrate (50 mg every other day) or enclomiphene, both selective estrogen receptor modulators (SERMs) that block hypothalamic estrogen receptors and increase endogenous LH and FSH output. A 12-week trial of clomiphene can help determine whether the HPG axis can recover adequate function. If serum testosterone rises above 300 ng/dL with normalization of LH and FSH, the patient may not need exogenous TRT at all.

When TRT Is Appropriate After AAS History

If the HPG axis does not recover, typically defined as persistent total testosterone below 300 ng/dL with ongoing symptoms after 3 to 6 months off any anabolic agents, then TRT is medically appropriate. Dosing follows standard Endocrine Society guidelines, starting at the lower end of the therapeutic range and titrating based on symptom response and serum levels drawn at trough (just before the next injection).

The Regulatory History: MLB's Drug Policy and What Changed

Rodriguez's admitted 2001 to 2003 use occurred before MLB implemented its Joint Drug Prevention and Treatment Program. Mandatory random testing with consequences began in 2004, and amphetamine testing started in 2006. Prior to 2004, there were no suspensions for steroid use in MLB.

The Biogenesis episode unfolded under the post-2005 CBA rules, which established a 50-game suspension for a first violation, 100 games for a second, and a lifetime ban for a third. Rodriguez's 162-game suspension (reduced from 211) reflected penalties for what MLB characterized as non-analytical findings, meaning he was not caught by a urine test but by documentary and testimonial evidence of procurement.

This distinction matters clinically as well. Non-analytical findings cannot be based on a measured serum testosterone level; they are based on records of purchase and physician or clinic testimony. MLB's ability to suspend based on non-analytical findings was strengthened after the BALCO investigation in 2003 and codified in subsequent CBA updates.

What Rodriguez Has Said Post-Career About Health and Fitness

After retiring in 2016, Rodriguez has been more public about fitness and nutrition than about hormone therapy specifically. In interviews and on his podcast "The Corp," he has discussed training philosophy, diet, and entrepreneurship. He has not, to any documented public record as of this writing, claimed to be on a current medically supervised TRT protocol, nor has he denied it. These are inferences, and they should be labeled as such.

What he has said, on record, is that his 2001 to 2003 use was a mistake and that he believed, at the time, it was legal under MLB rules. That framing is factually accurate: it was not yet prohibited by the Joint Drug Program. Whether a physician would have sanctioned those substances and doses for medical reasons is a separate question, and the answer, given his age (he was 25 to 27 during those years), his likely eugonadal status, and the compounds involved, is almost certainly no.

Serum Testosterone Reference Ranges and Why Context Determines Everything

A serum testosterone of 900 ng/dL means something entirely different in a 28-year-old professional athlete who was baseline-normal versus in a 55-year-old man with symptomatic hypogonadism who was at 210 ng/dL before treatment. The Endocrine Society's reference interval for healthy adult men is 300 to 1,000 ng/dL [1]. A number within that range is not automatically "normal" or "therapeutic" if it was produced by exogenous administration rather than endogenous production.

Anti-doping programs exist precisely because a serum level cannot, by itself, distinguish therapeutic from performance-enhancing use. Carbon isotope ratio testing can distinguish synthetic from endogenous testosterone, and a suppressed LH suggests exogenous source, but serum level alone is insufficient. This is one reason the clinical and regulatory frameworks use different tools, and why a physician's role in documented, monitored TRT is not merely bureaucratic, it is the mechanism by which therapeutic intent is verified.