Detection of anabolic steroid administration: Ratio of urinary testosterone to epitestosterone vs the ratio of urinary testosterone to luteinizing hormone

Our goal in this study was to determine whether the urinary ratio of testosterone to luteinizing hormone (T/LH) as an indicator of exogenous anabolic steroid (AS) use is superior to the urinary ratio of testosterone to epitestosterone (T/E). After 2 weekly placebo injections, 19 subjects were given testosterone cypionate (TC) injections of 250 or 500 mg/week for 14 weeks followed by 14 weekly placebo injections. Patients were considered to have ceased taking TC if they tested negative 9 weeks after their last injection. For detection of illicit or supraphysiological TC (AS) use, the urinary T/E ratio of greater than or equal to 6 yielded a false-negative rate of 46% and a false-positive rate of 4%. However, a urinary T/LH ratio of greater than or equal to 30 produced a false-negative rate of only 24% and a false-positive rate of 13%. We conclude that the urinary T/LH ratio of greater than or equal to 30 is a more sensitive marker of AS use than the urinary T/E ratio of greater than or equal to 6 and remains sensitive for twice as long as urinary T/E.