January 4th, 2012

How Does Herpes Treatment Trigger a Positive Test for Performance-Enhancing Drugs?

Here’s my guess on how many of this blog’s readers know the following “facts”:

  • Acyclovir and related drugs are used to treat herpes: nearly 100%
  • Ryan Braun, superstar left fielder for the Milwaukee Brewers, is facing a 50 game suspension for testing positive for elevated levels of a “banned substance”, most likely testosterone: 10%
  • Braun has disputed the results, stating that it’s a false-positive caused by treatment he’s receiving for a “private medical issue”: 1%
  • That medical issue is widely rumored to be herpes: 0.01%

Now I should mention that I am a huge Ryan Braun fan, not only because of his stellar play, and his nickname (“The Hebrew Hammer”, one Braun shares with Hammerin’ Hank Greenberg), but also because he bears an uncanny resemblance to my nephew.

But it’s that last bullet point I can’t quite figure out — treatment of herpes is incredibly safe. How in the world would it lead to an elevated level of testosterone?

Turns out, it doesn’t.

But a quick search of “acyclovir” and “testosterone”, plus a perusal of an actual book — the irreplacable The Use of Antibiotics — finds that there are some obscure animal studies suggesting that anti-herpes drugs could do the reverse, i.e., lower testosterone levels.

From the book:

Dose-related testicular atrophy and abnormalities of spermatogenesis were noted in mice, rats and dogs treated on repeated occasions with either famciclovir or penciclovir …

All of which leads me to the very speculative conclusion that some doctors could be providing testosterone supplementation to their patients receiving anti-herpes therapy.

Which is, frankly, a completely bogus indication, way more “out there” as a practice than the typical off-label use of approved medications.

But that’s the only way I can connect the dots here.

In other words, something’s not right — the test result, the diagnosis, the prescribing practice — we just don’t know what that is yet.

5 Responses to “How Does Herpes Treatment Trigger a Positive Test for Performance-Enhancing Drugs?”

  1. […] that end, I direct you to a blog post by long, long long-time reader Paul Sax — who is a doctor and who is the Director of the Division of Infectious Diseases at Brigham […]

  2. JayT says:

    Interesting. What kinds of medical conditions would have treatments that would greatly increase testosterone?

    • Paul Sax says:

      What kinds of medical conditions would have treatments that would greatly increase testosterone?

      Not sure, perhaps some endocrine disorder? But none of them is an Infectious Disease, at least as far as I know!


  3. Kevin says:

    Because we only know rumors, nothing can really be determined as concrete. We will have to wait till Braun and his lawyers speak, but that won’t happen until the appeal. Personally believe it was herpes and test was not right in some way, and can’t wait to see my guy Ryan Braun when I see the Brewers on Easter Sunday against the Cardinals.

    Tell me what you think and Go Brewers,

  4. Kev says:

    Hi Paul, great story!
    Is Acyclovir ever prescribed for mouth herpes/ cold sores? If yes, is it common?

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.