Awaiting Test Results, Landis Fears for Reputation

Testing For Testosterone

Scroll down to learn how athletes are tested, and how the test works.

The WADA View

Floyd Landis faces the loss of his Tour de France title if doping suspicions prove to be accurate. But as Landis awaits the results of a second test, he is worried that his reputation will still suffer, even if the results exonerate him.

"There's no evidence of any unnatural substance in my body," Landis said. "I can not explain it, because this is as equally new to me as it is to anyone else paying attention to this case right now."

The Phonak cycling team, which Landis leads, has threatened to fire him if the "B sample" tests confirm an elevated ratio of testosterone and epitestosterone.

Holding a news conference in Madrid for the second straight day, Landis went on the offensive, vigorously denying that he cheated to win. He maintains that any testosterone in his system is naturally produced by his body.

Landis started the week as cycling's new superstar, with an image as a rebellious rider who battled unimaginable pain — he raced with a degenerative hip condition that will require surgery.

But now his image, and his hopes of retaining his Tour title, let alone defend it, may be determined by the results of his second urine sample from the 17th stage.

NPR's Michele Norris talks with Landis, who is currently in Spain.

Q&A: Understanding the Doping Allegations

Testing For Testosterone

Scroll down to learn how doctors test for testosterone in athletes.

In the history of cycling, a Tour de France winner has never been disqualified because of doping. Now, that possibility exists for American Floyd Landis. After his remarkable comeback in the race's 17th stage, a test of Landis' testosterone ratio came back abnormally high. NPR's Tom Goldman puts the drug test into context:

Q: What is Landis accused of?

Last week, Floyd Landis underwent drug testing after his memorable comeback victory in Stage 17 of the Tour de France. According to Landis' team, Phonak, his urine sample showed "an unusual level of testosterone to epitestosterone." That's being interpreted and widely reported as a higher than legal level of testosterone, although people familiar with the so-called "T/E ratio" test say you can't assume that's the case.

For instance, Landis may have had a normal level of testosterone and a lower than normal level of epitestosterone — thereby throwing off the normal ratio.

Anti-doping rules allow for a 4-1 ratio of testosterone to epitestosterone. Anything higher than that is considered a positive test and is subject to further investigation, which can include a more sophisticated test to determine synthetic forms of testosterone. Landis has not revealed what the numbers were on his T/E ratio test.

Testosterone and epitestosterone are steroids that both occur naturally in the body and can be made synthetically. Testosterone can act as an athletic performance-enhancer by increasing strength and aiding in recovery from strenuous activity.

Q: What does Landis say about it?

Landis held a news conference in Spain Friday. It was his first public appearance since the news broke about his drug test. Landis said he has naturally high levels of testosterone, like many athletes, and that in his case, the level is higher still, for natural reasons. Landis also asked the media not to report the drug test as a case of doping, which hasn't been proved, he said. All that's out there, he said, is an abnormal finding on his T/E ratio test.

Q: What's the next step in the testing process?

When an athlete's urine is tested, it's divided into an A and B sample. If the result is positive from the A sample, the athlete can bypass analysis of the B sample and admit guilt, or ask for the B sample test. The B sample is tested to either confirm or negate the A test result. Landis' A sample showed the abnormal T/E ratio. Friday, he asked that his B sample be tested. He has the right to be present for the B sample test; he said he will have a representative at the test to make sure everything is above board.

Q: When are those results expected?

According to a spokesman for Landis, the test results from the cyclist's B sample should be known by the middle to end of next week.

Q: What happens if the results from the second test are also positive?

First, if the results from the second test are negative, Landis is cleared. According to veteran Tour de France reporter Andrew Hood on espn.com, Landis would retain his tour title, but there may be an asterisk placed next to his name.

If the results from the second test are positive, Landis will have officially failed the doping test. If that is the case, Phonak has said, it will fire Landis. Cycling has strict sanctions for doping violations. For a first offense, there's an automatic two- year ban. Landis would be facing that punishment. If he elects not to challenge the test results in court (see below), Landis would be stripped of his Tour de France title. Second-place finisher Oscar Pereiro would be named the winner. In the history of the Tour de France, no champion has ever been disqualified for doping.

Q: Would Landis have a right to appeal? Could he take it to court?

Absolutely. And it appears he's planning to fight a potential positive test and sanction by amassing an army of lawyers and medical experts. Landis has the right to appeal to the Court of Arbitration for Sport, kind of a Supreme Court for sports. It's located in Lausanne, Switzerland. Landis says he'll ultimately prove his innocence, for which there is precedent with the T/E ratio test. Other athletes have gone to the court and been successful in having their doping penalties overturned because the T/E ratio test historically has not been a consistently good indicator of synthetic testosterone use.

If Landis goes before the court and loses his case, he'll suffer the penalties listed above — a two-year ban and loss of his tour title.

Q: What is it about the Tour de France that it seems enmeshed in questions about steroid use?

The Tour de France is considered one of the most grueling sports events. It's three weeks in the summer over 2,000 miles of terrain, some of which can be incredibly difficult. The mountain stages in the Alps are legendary for their difficulty. The question is about steroid use, but actually, the drugs of choice in elite cycling are those that enhance endurance — banned substances such as EPO (which increases the amount of oxygen-carrying red blood cells in the body), stimulants and blood transfusions. Some people are connecting Floyd Landis' remarkable performance in Stage 17 and his abnormal test, which indicates possible testosterone doping. But the consensus is that if Landis wanted to get a quick and illegal boost before Stage 17, he would have used one of the aforementioned substances. There's been no word that his abnormal drug test had anything to do with EPO, stimulants or blood transfusions.

Recently, the World Anti-Doping Agency released a list of the sports with the highest percentage of doping infractions. Elite bicycle racing topped the list.

Testing For Testosterone

What does a test tell you? NPR's Joanne Silberner talked to endocrinologist Linn Goldberg of the Oregon Health and Science University in Portland. He's been a tester for the U.S. Anti-Doping Agency and for the U.S. Olympic Committee.

Goldberg explains it like this: What's measured are levels of testosterone and epitestosterone, and the ratio between the two. Epitestosterone is a breakdown product of testosterone. The T/E ratio reflects the presence of natural testosterone and any extra testosterone added by pill, cream, gel or injection.

A person's testosterone and epitestosterone levels don't normally vary much over time. Goldberg says he's never heard of whiskey altering the ratio — as Landis suggested might have occurred in his case.

So what can change it? A testosterone-producing tumor, pills, injections that contain testosterone or similar products. Tests have shown that some supplements promoted for building muscle or endurance contain testosterone or a related substance, although it's not marked on the packaging.

There's no one "normal" value. It's a bell-shaped curve. The most common ratio is 1. Some men are persistently lower. Some are persistently higher. In the Olympics, the top reading allowed used to be 6 to 1. Now it's 4 to 1, because of concern that some steroid users were slipping through.

Goldberg says the tests cost more than $100. The procedure in competitions is elaborate. With an observer watching, the subject selects an empty, sealed container from one of three on offer, opens it and urinates into it. Then he pours some urine into container "A" and some into container "B." A temperature reading and another test are immediately done on the remainder to make sure it's freshly voided urine.

After seeing that the two containers are properly labeled, the competitor seals them with tape that will break when they are opened, and hands them to the observer.

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