FDA: Testosterone and Other Anabolic Androgenic Steroids (AAS): Risks Assoc. With Abuse and Dependence

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AUDIENCE: Patient, Endocrinology, Internal Medicine

ISSUE: FDA approved class-wide labeling changes for all prescription testosterone products, adding a new Warning and updating the Abuse and Dependence section to include new safety information from published literature and case reports regarding the risks associated with abuse and dependence of testosterone and other AAS. 

The Anabolic Steroids Control Act of 1990 placed AAS, including testosterone, in Schedule III of the Controlled Substances Act. Testosterone and other AAS are abused by adults and adolescents, including athletes and body builders. Abuse of testosterone, usually at doses higher than those typically prescribed and usually in conjunction with other AAS, is associated with serious safety risks affecting the heart, brain, liver, mental health, and endocrine system. Reported serious adverse outcomes include heart attack, heart failure, stroke, depression, hostility, aggression, liver toxicity, and male infertility. Individuals abusing high doses of testosterone have also reported withdrawal symptoms, such as depression, fatigue, irritability, loss of appetite, decreased libido, and insomnia. 

The new Warning will alert prescribers to the abuse potential of testosterone and the serious adverse outcomes, especially those related to heart and mental health that have been reported in association with testosterone/AAS abuse. In addition to the new Warning, all testosterone labeling has been revised to include information in the Abuse and Dependence section about adverse outcomes reported in association with abuse and dependence of testosterone/AAS, and information in the Warning and Precautions section advising prescribers of the importance of measuring serum testosterone concentration if abuse is suspected.     
BACKGROUND: Prescription testosterone products are FDA-approved as hormone replacement therapy for men who have low testosterone due to certain medical conditions. Examples of these conditions include failure of the testicles to produce testosterone because of genetic problems, or damage to the testicles from chemotherapy or infection.

RECOMMENDATION: Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

  • Complete and submit the report Online: www.fda.gov/MedWatch/report
  • Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

Indiana asst. football coach arrested for smuggling steroids

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Ryan Grace – High School Football Coach

Ryan Grace gained respect as an assistant coach for Charlestown High in Indiana. All the goodwill he built came crashing down Wednesday when he was arrested for possession of steroids which he allegedly smuggled in from across the globe.

As reported by Louisville Fox affiliate WDRB, Grace was arrested as part of an illegal drug roundup campaign in Floyd and Clark counties in Indiana called “Operation Icebreaker.” After he was seen picking up an illegal package at the post office in Jeffersonville, Ind., authorities gained a search warrant for his house.

That search turned up a disturbing amount of steroids, which Grace said were part of an elaborate personal routine which he had been taking.

Here was the full set of drugs repossessed by officials, per WDRB:

… police said they found 40 pills, 85 syringes, 4 glass vials, 30 individual vials, and 23 individual blister packs of steroids listed as Schedule III drugs.

To his credit, Grace was quick to apologize for his use of steroids and insisted he, “never gave any steroids to any kids.”

“I don’t promote any drugs or steroids,” Grace told WDRB. “I’m sorry to the community, and to the kids that I coached, for letting everybody down.”

Charlestown wasted no time after Grace was charged in relieving him of his duties. Whether another program might eventually offer Grace another opportunity to contribute remains to be seen.

Ind. assistant football coach arrested for smuggling steroids

Expert cites urgent need to reconsider steroid use as a public health issue

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The use of image and performance enhancing drugs – in particular steroids – is a growing area of concern globally

The use of these drugs has traditionally been limited to elite athletes and professional bodybuilders. But now their use is becoming normalised as part of a fitness and beauty regime for people who want to gain muscle, become leaner, and improve their appearance.

Several population studies have shown the use of image and in Australia is relatively low. However, the dramatic increase of steroids detected at the country’s borders, and the number of users accessing needle and syringe programs, seem to indicate otherwise.

If Australia is to respond to image and performance enhancing drug use effectively, we need to improve our prevention and harm-reduction strategies – and not merely further criminalise users.

Potential health harms

The most-researched (and targeted) image and performance enhancing drugs are steroids. But other examples include clenbuterol (to lose weight) and melanotan II (a tanning agent).

The inappropriate and excessive use of these drugs has been associated with a range of negative physical and psychological health consequences. Steroid use, for example, has been linked to high blood pressure, heart attack, stroke, acne and skin infections, liver damage, tendon rupture, premature baldness and stunted bone growth in adolescents. There are also psychological implications such as addiction, mood syndromes, and body image disorders.

Another issue is that the widespread use of illicitly manufactured products sourced through the black market puts drug users at risk of adverse reactions to tainted products.

In addition, as many of these substances are injected, there are potential harms from unsafe injecting practices. For example, research has found that 41% of Australian men who injected steroids reported an injection-related health problem such as such as fevers, scarring and abscesses.
Expert cites urgent need to reconsider steroid use as a public health issue

Number of national steroid arrests, 2005-06 to 2014-15

Beefing up steroid laws

In Australia, increases in the detection of these drugs at the border, coupled with contested concerns about links to organised crime, has led to greater levels of law enforcement.

Queensland, Australia’s steroid capital, reclassified steroids a schedule-one drug in 2014. This means they are now classed alongside heroin, cocaine and ice in the highest category of dangerous illicit drugs.

Under this legislation, the maximum penalty for possession or supply of steroids is 25 years’ imprisonment. Similar tough penalties apply in New South Wales and Victoria.

However, there is little evidence that tougher penalties have resulted in reductions in steroid availability. The total number of seizures at the border fell in 2013-14. But there is evidence of increases in recent years.

The Australian Crime Commission suggested in 2015 that any decrease in border interceptions could be the result of an increase in domestic production, coupled with increasingly easy access to drugs over the internet.

Despite having the toughest legislation, Queensland accounts for the greatest proportion of national steroid arrests (58% in 2014-15). But the greatest proportion of those arrested are steroid consumers – not suppliers. This suggests the current criminal justice approach may have limited capacity to limit distribution.

That growth in steroid use is most apparent in jurisdictions where recent legal changes have increased penalties suggests enhancing measures may be an ineffective response to steroid use. Other research on the impact of drug policies on other illicit substances have reached similar conclusions.

Consequences of a tough law enforcement approach

As is the case with drug use broadly, users of enhancement drugs can be considered rational consumers who make a deliberate choice to use steroids to achieve a desired outcome.

But social and cultural factors are also very influential in the decision to use drugs. Research suggests people considering drug use rarely take the illegality of a particular substance into consideration.

Increasing penalties associated with the use and possession of image and performance enhancing drugs are unlikely to prevent uptake or encourage users to stop. Instead, this may result in several unintended negative consequences. For one, it can hinder access to medical services and information by discouraging both users and healthcare practitioners from talking about drug use.

Tougher penalties can also distract from key harm-minimisation measures, such as safe injecting practices.

Other unintended negative consequences of criminal justice responses to such use include:

What about harm-reduction strategies?

Victoria’s existing harm-reduction initiative, the Steroid Education Project, lags far behind services for alcohol and other illicit drugs in its funding and resources. It provides face-to-face and over-the-phone counselling to steroid users, and delivers training to needle and syringe program staff.

Greater resourcing is required to extend this program to allow for training in needle and syringe programs across Australia, and to deliver training to GPs. Given the reluctance of users to engage with traditional drug services, GPs may be an important avenue for providing harm-minimisation messages to this group.

There is an urgent need to reconsider steroid use as a public health issue, as opposed to a  concern. Harsher penalties will do nothing to tackle misinformation about or underlying issues of body image dissatisfaction, depression and mental health concerns among users.


16-year-old boy dies from caffeine overdose

In this undated family photo, Davis Cripe, 16, is shown with his dad Sean. According to a coroner, Cripe died April 26, 2017 from “caffeine-induced cardiac event, with probable arrhythmia.

A 16-year-old boy died from a caffeine overdose after drinking caffeine-laden soft drinks, coffee and an energy drink, a South Carolina coroner said Monday.

Davis Allen Cripe collapsed and died last month, Richland County coroner Gary Watts said, at a news conference.

“On this particular day within the two hours prior to his death, we know had consumed a large diet Mountain Dew, a cafe latte from McDonald’s and also some type of energy drink,” Watts said.

“It was so much caffeine at the time of his death that it caused his arrhythmia.”

Last month researchers reported that energy drinks can cause dangerous changes in heart function and blood pressure above and beyond caffeine alone. Another team found similar dangers in 2015.

“These drinks can be very dangerous,” Watts said. “I’m telling my friends and family don’t drink them.”

Watts, who is not a medical doctor, did not give details on how he came to the conclusion that the drinks killed Cripe. He said he did not know what type of energy drink Cripe drank.

“The purpose here today is not to slam Mountain Dew, not to slam cafe lattes, or energy drinks. But what we want to do is to make people understand that these drinks — this amount of caffeine, how it’s ingested, can have dire consequences. And that’s what happened in this case,” Watts said.

“It wasn’t a car crash that took his life. Instead, it was an energy drink,” the boy’s father Sean Cripe said at the news conference.

“Parents, please talk to your kids about these energy drinks.”

The Food and Drug Administration had said that caffeine in doses up to 400 mg (about five cups of coffee) is generally safe.

Caffeine prompts the release of natural compounds called catecholamines, including norepinephrine, a stress hormone that can speed the heart rate. People who have died from documented caffeine overdoses had irregular and rapid heart rates, seizures and sometimes choked on their own vomit.

A 12-ounce Mountain Dew contains 54 milligrams of caffeine. McDonald’s does not report the amount of caffeine in its coffee.


Retired Special Agent Jack Robertson Honored by THF for Career Achievement

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Dateline DEA, Washington, DC

Retired Special Agent Jack Robertson received the Taylor Hooton Foundation’s prestigious 2017 Legacy Award at an “All-Star Gala” event in Dallas on March 25. Several family members, friends and DEA colleagues attended the event.

“Each year we recognize individuals who have made a significant contribution to the fight against appearance and performance enhancing drug use,” said Don Hooton, who founded the organization following his 17-year-old son Taylor’s death in 2003 from depression caused by anabolic steroids.

Previous award winners are Jeff Idelson, president of the National Baseball Hall of Fame (2016) and Major League Baseball Commissioner Emeritus Bud Selig (2015).

Jack Robertson’s career at DEA is legendary, according to the many current Special Agents who worked with him over the years. Through much of his career with DEA, he was based in the San Diego area, where he and his family live now.  One of his many DEA successes was serving as lead investigator in Operation Raw Deal, the largest crackdown on illegal steroid labs and suppliers in U.S. history. Robertson was instrumental in orchestrating the takedown of more than 70 underground steroid labs in the U.S. and scores more globally. Operation Raw Deal received the DEA Administrator’s Award and many national awards.


In 2005’s Operation Gear Grinder, a team of agents under Robertson’s leadership successfully took down the world’s largest anabolic steroid maker and eight companies that manufactured the substances. The operation was part of an effort to curb the then-new problem of internet drug trafficking.

The following year, Robertson officially opened the DEA’s case targeting the infamous Arellano brothers.  The Arellano-Felix drug trafficking organization (AFO) was one of Mexico’s most powerful and violent criminal enterprises for over two decades. The Tijuana-based AFO cartel imported tons of cocaine, heroin, methamphetamine, and marijuana into the United States and was also responsible for numerous kidnappings and more than 100 drug-related murders in the United States and Mexico.

SA Robertson also worked on Operation TKO (Mexico: Ketamine & Steroids), Operation Counter Curse (USA, Canada & Global: Synthetic drugs) and Operation Motley Crew (Mexico: Tijuana Cartel).  In 2005, Robertson was selected as DEA Special Agent of the Year, the highest DEA award. In 2008, he was named Association of Former Federal Narcotics Agents (AFFNA) Special Agent of the Year (San Diego Division).

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Since retiring from DEA in August 2011, Robertson has channeled his love for sports and his law enforcement expertise to combat the spread of Performance Enhancing Drugs (PEDs).  As Chief Investigative Officer of the World Anti-Doping Agency (WADA) from 2011 to 2016, he collaborated with global law enforcement agencies to target and dismantle PED trafficking organizations.  He also served on a U.S. Olympic Committee panel discussing the fight against doping in sports.

Despite some significant health challenges in recent years, he’s just a real positive guy, said San Diego Division SAC Bill Sherman. “Jack was a tireless worker and completely selfless. He was able to build world-wide law enforcement coalitions which helped him successfully complete Operations Gear Grinder and Raw Deal, the largest steroid distribution and manufacturing cases in DEA history. Jack was one of the finest investigators I’ve worked with in my 30 years.”


Ex-Steelers team doctor convicted of steroids trafficking

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A federal jury in Pittsburgh convicted a former Steelers team doctor Tuesday on charges of trafficking in anabolic steroids, human growth hormones and painkillers.

“While a physician, (Dr. Richard A.) Rydze used his prescribing pad in place of his ATM card, doling out steroids to enrich himself and flooding the community with dangerous painkillers,” said David A. Sierleja, acting U.S. attorney for the Northern District of Ohio, which prosecuted the case because Rydze previously provided medical exams for the FBI’s Pittsburgh field office.

Downtown attorney Adrian Roe, who represented Rydze, did not return a message.

A sentencing date had not been set for Rydze, 67, of the Strip District.

Rydze served on the Steelers medical staff for 22 years until 2007, when he became the target of a federal investigation.

Five years later, authorities charged Rydze with trafficking in painkillers since 2005 and in steroids and human growth hormones since 2007. Authorities did not accuse Rydze of providing illegal performance-enhancing drugs or painkillers to Steelers players or other professional athletes.

The jury convicted Rydze, a former Olympic medalist in platform diving, on all 180 counts against him.

A related case accusing Rydze of health care fraud is pending.


Doping more prevalent among nonathletes vs. elite competitors

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AUSTIN, Texas — Contrary to public perception, most androgen abusers are not elite athletes seeking to enhance performance, but instead are nonathletes pursuing a leaner and more muscular appearance, according to a speaker at the American Association of Clinical Endocrinologists Annual Scientific and Clinical Congress.

Sandeep Dhinsda
Sandeep Dhinsda

The typical anabolic steroid abuser is a nonathlete weightlifter who began using these agents in his early 20s, according to Dhindsa.

“Most of them are not using testosterone. They’re using a steroid that is approved for veterinary use — boldenone [Equipoise] — and some of the others,” Dhindsa said.

It is estimated that approximately 6% of U.S. men have abused anabolic steroids at some point during their lifetime, Dhindsa said. About 30% of these men become long-term users, who may have developed a steroid dependency. In perhaps half of those, dependency is due to muscle dysmorphia, a psychiatric disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, as “an insatiable desire for continuous body shaping towards, but never reaching, a desired goal.”

“Then, there are a large number of people who are not really trying to take anabolic steroids, but are turning to supplements to get their muscles and, unknown to them, many of these supplements contain anabolic steroids,” Dhindsa said.

These men may seek medical care for side effects of steroid misuse, such as erectile dysfunction or infertility, or because they’ve been found to have a high hemoglobin level. History and physical exam may reveal anabolic steroid abuse among patients who do not disclose this information.

“You’re [likely] to have someone who has symptoms of both androgen excess and androgen deficiency,” Dhindsa said. Indicators of androgen excess may include a muscular appearance, high hemoglobin level, low HDL, male-pattern baldness and truncal acne. Signs of androgen deficiency may include testicular atrophy, infertility, low sperm count and perhaps gynecomastia depending on the agent used.

“One thing that we worry about [in these patients] is sudden deaths,” Dhindsa said. Although there are few long-term studies, some anabolic steroid users have been found to have cardiac hypertrophy on autopsy. In one study, compared with nonusers, steroid users had lower ejection fraction and systolic and diastolic dysfunction.

Less easily quantified, aggression has also been associated with steroid abuse, Dhindsa said.

Infertility appears to be less of a risk with anabolic steroid use, at least in the short term.

“There seems to be quick reversal as long as they stop anabolic steroids around 3 or 4 months,” Dhindsa said. “Recovery may take sometimes up to 2 years, but there is no evidence that it causes permanent damage to spermatogenesis.” – by Jill Rollet


Texans Max Bullough suspended 4 games for violating PED policy

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Houston Texans inside linebacker Max Bullough has been suspended without pay for the first four games of next season for violating the league’s policy on performance enhancing substances.

Bullough has spent his three-year career in Houston after he was signed by the Texans as an undrafted free agent in 2014. The 25-year-old appeared in every game for the Texans last season with three starts. He had 25 tackles last season after finishing with a career-high 30 tackles in 2015.

Bullough is eligible to return to the active roster the Monday after Houston’s game against the Tennessee Titans on Oct. 1. He may participate in Houston’s offseason practices and preseason games before his suspension begins



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Pirates Closer Joins 39 Others in Helping to Educate Young People  About the Dangers of Appearance and Performance Enhancing Drugs


McKinney, Texas (Monday, May 8, 2017) – The Taylor Hooton Foundation announced today that Tony Watson of the Pittsburgh Pirates has joined its “Advisory Board” of active players from throughout Major League Baseball. The Taylor Hooton Foundation is widely acknowledged as the leader in the advocacy against appearance and performance enhancing drug use by the youth of America.

The Pirates left-handed reliever joins 39 other members of the Hooton Foundation’s “Advisory Board,” which now includes at least one player from all 30 major-league teams. Watson replaces Jared Hughes as the Pirates’ “Advisory Board” representative.

“It is so important that our young people have positive role models to look up to, especially when it comes to the topic of competing in sports and in life by doing things the right way,” said Taylor Hooton Foundation Founder and Executive Chair Don Hooton. “These major league athletes reached the pinnacle of their sport and, combined with our education campaign, are the most effective weapons we have in this national struggle. We are honored to have such a terrific group of major league players working with us.”

As members of the “Advisory Board” – formed in 2014 and fully endorsed by Major League Baseball – the players will participate in the THF’s 2017 public-service campaign, All Me. For the campaign, a print and video PSA featuring each of the Foundation’s “Advisory Board” members will be created – with images provided by THF national partner, Getty Images – and will be made available to each player’s respective team for its program/magazine and video boards for the ‘17 season. In addition, All-Me-themed print PSAs will run in Major League Baseball’s All-Star-Game, League-Championship-Series and World-Series programs.

In addition to their participation in the public-service-ad campaigns since 2015, members of the “Advisory Board” also take part in the THF’s educational activities in their local communities. Board members have also provided their input on the most-effective ways to educate North America’s young people about the dangers of anabolic steroids and other appearance and performance enhancing drugs.

To date, the Taylor Hooton Foundation has spoken to and educated more than one-million people. It has a Latin American outreach and travels throughout the Caribbean, speaking to thousands of RBI (Reviving Baseball in Inner Cities) athletes, coaches and parents in partnership with Major League Baseball. Additionally, the THF introduced a new eLearning program in 2014 – narrated by Bob Costas – to Little League Baseball that is offered to its one-million adult coaches and other volunteers.

Members of the Taylor Hooton Foundation’s “Advisory Board” – to date – include:

Elvis Andrus (Texas Rangers)

Jake Arrieta (Chicago Cubs)

Jose Bautista (Toronto Blue Jays)

Charlie Blackmon (Colorado Rockies)

Michael Blazek (Milwaukee Brewers)

Jay Bruce (New York Mets)

Matt Carpenter (St. Louis Cardinals)

Brian Dozier (Minnesota Twins)

Matt Duffy (Tampa Bay Rays)

Adam Duvall (Cincinnati Reds)

Logan Forsythe (Los Angeles Dodgers)

Brett Gardner (New York Yankees)

Dillon Gee (Texas Rangers)

Ken Giles (Houston Astros)

Alex Gordon (Kansas City Royals)

  1. J. Hardy (Baltimore Orioles)

Derek Holland (Chicago White Sox)

Jared Hughes (Milwaukee Brewers)

Clayton Kershaw (Los Angeles Dodgers)

Dallas Keuchel (Houston Astros)

Jason Kipnis (Cleveland Indians)

Nick Markakis (Atlanta Braves)

James McCann (Detroit Tigers)

Mark Melancon (San Francisco Giants)

Aaron Nola (Philadelphia Phillies)

Chris Owings (Arizona Diamondbacks)

Joe Panik (San Francisco Giants)

Dustin Pedroia (Boston Red Sox)

Josh Reddick (Houston Astros)

Anthony Rendon (Washington Nationals)

Clayton Richard (San Diego Padres)

Tyson Ross (Texas Rangers)

Chris Sale (Boston Red Sox)

Marcus Semien (Oakland Athletics)

Matt Shoemaker (Los Angeles Angels)

Neil Walker (New York Mets)

Tony Watson (Pittsburgh Pirates)

Christian Yelich (Miami Marlins)

Brad Ziegler (Miami Marlins)

Mike Zunino (Seattle Mariners)


CONTACT:    Rick Cerrone / Rick Cerrone Communications

(914) 715-5491 / rick@rickcerrone.com

 About The Taylor Hooton Foundation: The Taylor Hooton Foundation is a 501c3 non-profit organization that is dedicated to educating North America’s young people about the dangers of anabolic steroids and other appearance and performance enhancing drugs.   The friends and family of Taylor Hooton formed the Foundation in 2004 after his untimely death at 17 years old following his use of anabolic steroids.

For more information about the Taylor Hooton Foundation and its efforts, please visit www.taylorhooton.org and www.allmeleague.com.

Rewarding cheaters to Hall of Fame hurts message Don Hooton and others trying to spread


Bill Madden, NY Daily News, May 5, 2017

Ever since 2003, when his own son, Taylor, committed suicide after suffering from depression as a result of using anabolic steroids, Don Hooton has embarked on a determined and often lonely mission to educate the youth of America about the dangers of PEDs.

A week ago, Hooton — whose Taylor Hooton Foundation has now affiliated with Major League Baseball and has “All Me” advisory board members on all 30 teams, including Brett Gardner with the Yankees and Neil Walker and Jay Bruce with the Mets — conducted a public forum at the National Press Club in Washington in which a special panel of physicians, foremost authorities on drugs and officials of the U.S. Doping Agency reached a consensus that the use of PEDs in America has reached epidemic levels. Among the findings: 20-25% of dietary supplements — the kind you can buy over the counter — are spiked with anabolic steroids while nearly four million people in the U.S. are using PEDs.

In a telephone conversation Thursday, Don Hooton, who really hopes he’s making a difference and helping to save lives, admitted to being alarmed. But even more ominously, he also admits to being somewhat discouraged his message to young kids is going to get lost if Barry Bonds and Roger Clemens are elected to the Hall of Fame.

“Let me first say, that Major League Baseball is so far ahead of all the other sports insofar as drug testing, education efforts and eliminating steroids and supplements from the game, it’s a no contest,” Hooton said. “At the same time, though, when you see these players, like (Starling) Marte and Dee Gordon getting busted by baseball right after getting those big contracts, what message are these kids going to take away from that? They listen to what we have to say, how steroids can kill you, and they say, ‘well even though the risk of getting caught is small, even if you do get caught, $31 million (Marte’s deal with the Pirates) doesn’t sound so bad.’”

That’s the monetary reward for cheating. The ultimate reward, Hooton said, is the Hall of Fame where, lately, he has taken dead aim on the candidacies of Bonds and Clemens, and his concern that, after the last election in which the two of them got over 50% for the time in five years on the ballot, the Baseball Writers may be softening in their stance on cheaters. It was bad enough when, after enlisting Alex Rodriguez to be his primary foundation spokesman on the evils of steroids, we all learned that A-Rod was still using and that everything he’d been telling Hooton’s kids was B.S. That, admitted Hooton, was a huge setback. But rewarding Bonds and Clemens with plaques in Cooperstown, well….

“That would be the ultimate message to kids that cheaters win,” Hooton declared. “After all the tough talk about PEDs and now we’re back to looking the other way again? It seems there’s a new crop of writers who are willing to let all that happened (in the steroids era) go under the bridge. It’s dulled our senses.”

When I told him the arguments voters for Bonds and Clemens bring up — “they were Hall-of-Famers before they started using steroids”… “they never failed a drug test”… “there’s no telling who was doing what in the ‘90’s” — Hooton laughed.

 “This is not a court of law,” he said. “It’s a court of public opinion. The jury of young people are not stupid. They’ve seen the before and after pictures of Bonds. They don’t need proof to know he was a cheater. I don’t understand why the writers do.”

In all probability the writers have already elected cheaters to the Hall of Fame. Pudge Rodriguez, most notably, has the same “before and after” pictures Bonds has. And I hated to tell Hooton that a decision the Baseball Writers made at their meeting last December — to make their ballots public next year “in the name of transparency” — could make it even easier for Bonds and Clemens to get elected.

I hope I’m wrong, but if the ballots were made public, the stigma of being castigated on social media might prompt a lot of voters to use all ten spots on the ballot, voting for candidates they would never have considered voting for, just to cover themselves. This, in turn, could result in a floodgate of people being elected. For that reason, I can see the Hall’s Board of Directors, rejecting the writers’ “transparency” decision in their meeting in Cooperstown next July. (It should be noted, secret ballots are the way of the land, are they not?)

For now Hooton can only do what he does, which is to call attention to the steroids epidemic in this country “which is hidden in plain sight” and for which there is no textbook a doctor can use to diagnose or treat. Bonds and Clemens and their like are a side issue that merely make his mission harder.

“I don’t talk to the writers,” he said, “but if I did, I would tell them: ‘If you believe these guys cheated, stand up as a responsible adult and do the right the thing.’”