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The NFL uses urine testing. Blood testing is much more sensitive. Typically (where quantitative, see below) blood testing shows higher hcg levels than urine testing.
There are many false negatives in urine testing. The NFLPA insisted on urine testing.
The normal serum level (blood testing) for males and non-pregnant wome are 0-5 miu/cc.
The NFL urine test is a qualitative test - it only gives a yes or no like a dip stick pregnancy test. The designed break over point is 20 miu/cc or four times the upper end of normal. Historically this test has had very few false positives and lots of false negatives.
Isotope ratio mass spectrometry can distinguish natural hcg from exogenous synthetic hcg.
Any residual semen hcg from ejaculation would be minuscule diluted into a urine test.
As has been stated before, any health related issue such as testicular cancer which would cause a positive should continue to cause positive results or at least extremely elevated levels until the health issue is a resolve.
Repeating this because it seemed like important background info to me.
CnD has been in contact with some people intimately involved in the develop and setting of the testing for the NFL and around the world in other sports. Some of the salient information:
I'd like to thank CnD for digging this information out. Always nice to have more information.
It is interesting to note that the information given to CnD conflicts with what Cushing's attorney is describing in the use of a quantitative test v. a qualitative test.
Follow up conversation with CnD.
Assuming Cushing has an enlarged pituitary, that can be either exactly what it says a pituitary which is simply larger than usual or is also often enlarged because of the presence of an adenoma. An Adenoma is a glandular tumor. They come in two varieties, functioning (they produce hormones along with the pituitary) or non-functioning (produce nothing). Most are non-functioning. There has been a study that says either adenoma will on average cause an increase in hcg. The non-functioning produces a minor increase which doesn't sound likely to trigger a positive under the NFL standard. The quantification of the increase of a functioning adenoma is being investigated.
As to cancerous tumors, the cut-off level becomes important for perspective. The NFL test cut-off is 20. Cancerous tumors will produce increasing hcg levels if untreated until plateauing so they will pass through 20 at some point but will continue on to levels in the hundreds.
On any of these issues it should be remembered that hormones work in conjunction with one another. Hcg is often termed a marker hormone which has smaller moves and would typically be accompanied by larger moves in some other hormone(s) depending on the cause of the change. So typically there would be abnormal levels of some other hormone(s). But those other hormones very well might not be tested by the NFL at all. One would think his Doctors would be looking at them though.
Getting tons of good information from CnD and his sources but in the end it just leads to more questions. Should remind us all that even with all this information which hasn't been reported by the media, we simply don't know the facts.
Oh and on the qualitative v. "very slightly positive" appeared to be quantitative comments by Steinberg. It appears those are just like the home pregnancy test. Sometimes the plus sign comes in real strong and sometimes it barely comes through. So there is still no quantitative result, just a judgment call on the qualitative test.
So basically, we just don't know. He could be a liar and cheater, or he could be a young man that does things the right way, but has a medical condition that putsw him in a bad light.
I would say we don't know. The best odds would be on steroid use but there are odd pieces to the story and other possibilities.. We are getting more information but still so much is missing.
For instance what is up with the warning? We have heard of that and Cushing said the test in September was only for hcg. Piece those two together and it sounds like there was a prior near miss negative which resulted in a discussion/warning and then a follow up specific test in September. If so, when was the prior test? Hcg as a steroid recovery drug (oh and CnD confirmed hcg is NOT a masking agent) is only taken for a limited time period and then would disappear after a couple weeks. So if that sequence is correct when was the prior test? - August, July, June. Elevated hcg over a 3-4 month time period would not be typical for recovery use as I understand it. So June would weigh against while August would be consistent. On the flip side, Cushing and Co. have had a lot of time to look into this. They should know by now if he has an adenoma pituitary tumor and whether it is active or not. This crap is complex and folks generally are playing monkey playing darts.
Yes, but at this point, the warnig is purely speculative. We have had no reinforecment of thet, other than that one statement by somebody?
Absolutely. Part of my point is folks are speculating on a lack of information about a lot of things. That one is out there. If we speculate on how it fits in with other things then what I was outlining fits together and leads to yet more inquiries.
On the flip side, Cushing and Co. have had a lot of time to look into this. They should know by now if he has an adenoma pituitary tumor and whether it is active or not. This crap is complex and folks generally are playing monkey playing darts.
Kinda like Watergate, people will never tire of the speculation as long as there continues to be discussion about it
In one of the all-time classic Seinfeld monologues, Kramer explains that, while driving a bus that had been hijacked, he kept making the stops because the passengers kept ringing the bell.
We're reminded of that one because when people want to know why keep writing about the Brian Cushing situation, a case that potentially has triggered a sea change regarding the public's attitude toward PEDs in pro football, the answer is simple -- Cushing's people keep talking about it.
One league source with knowledge of Cushing's situation hopes that the talking will now end.
"For the sake of his fellow players, Brian needs to direct his agent and lawyer to zip it," the source said. "He had a fair hearing. The NFLPA and the NFL know the full story. This little exercise is doing nothing other than casting a bad light over the claims of players either with legitimate appeals or legitimate disputes with the appeal process."
The source also points out that, while lawyer Harvey Steinberg generally introduced evidence as to the possibility that hCG may be naturally produced due to conditions other than the presence in the body of a tumor or a placenta, Steinberg failed to introduce evidence demonstrating that Cushing had any of the conditions that could naturally produce hCG.
Then there's the fact that the lingering Cushing apologists, most of whom reside in the 713, 832, or 281 area codes, fail to acknowledge the logical flaw inherent in the notion that Cushing had a condition that apparently caused him to "naturally produce" hCG for only a short period of time. The fact that Steinberg and Cushing have created the sense that this is a chronic problem for Cushing without directly stating that his urine continues to reveal the kind of hCG levels that would result in a violation of the NFL's steroids policy strongly suggests that this is an exercise in spin.
But if Cushing and/or Steinberg would like to have one more chance to set the record straight, we call on them to answer these questions:
1. What specific medical condition did (or does) Cushing have that is causing him to produce hCG naturally?
2. What are the specific dates on which Cushing has been tested, by the NFL or otherwise, for hCG?
3. What was the concentration of hCG measured in each sample?
We've yet to see the answers to these questions. And if the answers to these questions in any way help Cushing's position, we would have seen them at some point in the nine days since word of his suspension emerged.
Florio may be 100% correct in his conclusion Cushing did steroids but he is on an uninformed hatchet job in his writing. For instance demanding the concentrations on tests when the NFL uses a qualitative test rather than a quantitative test so he is demanding something neither Cushing nor the NFL could provide.
To me, it doesn't seem like a lot of stories.
Assuming that he didn't take hCG, and if you look at hCG and what it does and everything, it doesn't make a lot of sense for him to just take hCG. If he had been taking steroids prior to or while taking the hCG, then he would have failed the testosterone tests. But he didn't fail those, he just failed the hCG test.
So, in September he almost failed one test and then failed another. Both had slightly elevated hCG levels. He gets notified by the NFL that he failed in October. He goes to see a doctor who tells him that he either injected hCG or he's got a tumor. So, in November and December, he's going to doctors to see if they can find a tumor. So, he's playing most of the season wondering if he's got a tumor.
During this time, one of the doctors looks at his medical history and says, "Hey. You've had a history with your pituitary gland maybe that could be causing this."
The doctors figure this could be it. They put together some documentation. The lawyer takes the documentation to the NFL and presents it in the appeal. They think they've won the appeal. Blah blah blah.
As a story goes, it's not nonsensical.