Evaluating the Testosterone‐to‐Luteinizing Hormone Ratio in Male Anti‐Doping Serum Samples: Results From a Transdermal Testosterone Administration Trial and Field Collected Samples

The serum testosterone-to-luteinizing hormone (T/LH) ratio has previously been suggested as a sensitive marker of testosterone use in an anti-doping setting. When measured with an automated immunoassay platform, this ratio represents a quick and cost-effective screening biomarker to further direct isotope ratio mass spectrometry (IRMS) testing efforts in concurrently collected urine samples to confirm testosterone abuse. To evaluate the practicality of implementing the serum T/LH ratio for routine use, testosterone values in 356 serum samples were compared between a "gold-standard" LC-MS/MS method and an automated immunoassay method. Excellent correlation and minimal bias between the two methods were observed, highlighting the validity of the immunoassay method. Next, a testosterone administration study utilizing a transdermal delivery route was conducted to compare the effectiveness of the serum T/LH ratio to the currently used serum testosterone to androstenedione (T/A4) and urinary testosterone to epitestosterone (T/E) ratios. The serum T/LH ratio was more sensitive than the T/A4 ratio and showed similar sensitivity to the urinary T/E ratio with high interindividual variability. Finally, T/LH analysis was conducted on 626 capillary serum samples collected in the field from male Ultimate Fighting Championship athletes. Of the three samples that showed elevated T/LH ratios in this pool, two of the corresponding urine samples were IRMS positive, one of which showed an unremarkable urinary T/E ratio and relatively normal steroid profile. These results indicate serum T/LH ratio monitoring provides a beneficial addition to the anti-doping tool kit and can improve urinary IRMS testing recommendations.