Ringworm? Tatis’s Explanations Stretch Common Sense, Experts Say

In the days since he was suspended for 80 games because a prohibited steroid was found in his system, the San Diego Padres star Fernando Tatis Jr. has insisted he wasn’t doping but has given shifting explanations about what condition he was trying to treat.

Tatis, one of the most talented young stars in baseball, first said that he had used a cream containing the steroid, clostebol, to treat a recent case of ringworm caused by a haircut. Then, at a news conference on Tuesday, he was less specific and mentioned dealing with a skin infection for years.

Only Tatis knows what he took and what it was for. But interviews with people working in baseball, some of whom spoke on condition of anonymity to discuss a confidential process, as well as with several doctors, pharmacists, pharmacologists, scientists, suggest that Tatis’s account of how he tested positive is plausible but clearly strained.

The suspension has raised several questions about how Tatis presented his explanation publicly and why he chose not to appeal.

The Steroid

On the evening of Aug. 12, Major League Baseball announced Tatis’s positive test for clostebol, an anabolic androgenous steroid. First used in athletics by the East German state-sponsored doping regime, clostebol helps build muscle and allows athletes to train harder and recover more quickly. Among anabolic steroids it is considered relatively weak, and has fewer visible side effects.

Clostebol was banned by the N.C.A.A. in the 1980s, by the International Olympic Committee in 1999 and by M.L.B. began punishing players who tested positive for it in 2005. But athletes continue to test positive for it, including at least six baseball players — three in the major leagues and three in the minors — since 2012.

The steroid is widely available in both topical creams and sprays in a number of countries, including the Dominican Republic, where Tatis was born and still spends time.

Like all anabolic steroids, clostebol is considered a controlled substance by the Food and Drug Administration and is difficult to obtain in the United States. Desi Kotis, the chief pharmacy executive at the University of California, San Francisco health system, said the U.C.S.F system does not carry any products containing clostebol.

Shortly after Tatis’s positive test was announced, he said in a statement that “it turns out that I inadvertently took a medication to treat ringworm that contained Clostebol.” Fernando Tatis Sr., his father and a former M.L.B. player, said that his son contracted ringworm after receiving a haircut, and that he used the product Trofobol to treat the ringworm.

Tatis’s mother, Maria Tatis, posted his statement on Instagram alongside a photo of a red rash on his neck. The post included a slide that said: “We continue adoring and glorifying the name of our God who is a just and powerful judge. Nothing escapes his sight and within his knowledge is the whole truth.”

Tatis was tested in mid-June, according to two people familiar with the details of baseball’s drug testing process, but it took nearly a month for the laboratory in Montreal to process the results. The people spoke on condition of anonymity because of the confidentiality rules of the process.

In mid-July, under the terms of the joint drug agreement between M.L.B. and the players union, Thomas Martin, the independent program administrator, was notified of the positive test. He told M.L.B. and the union about it, but not the Padres, under the rules of the agreement. Soon thereafter, Tatis’s backup sample was tested and also came up positive.

According to the drug agreement, after the results of the backup sample are confirmed, the rest of the process — M.L.B. meeting with the union, the player receiving notice of the discipline and the discipline taking effect — should take no more than a week if the player declines to appeal. That it took a couple of weeks to announce Tatis’s suspension suggests the two sides agreed to stay the process, perhaps while Tatis considered his options.

Tatis decided not to appeal, and his suspension was publicly announced on Aug. 12. The Padres learned of the suspension from a Tatis representative on that day.

It’s unclear whether Tatis raised the ringworm explanation with M.L.B. during the time the two sides were in discussions. But in offering it publicly when his punishment was announced, he may have breached the terms of the joint drug agreement.

Under a section titled “Public Statements Undermining Integrity of the Program,” the agreement says each suspended player is allowed a “general denial” that he violated the terms of the drug program. But he is not allowed to offer any specific defense. If he does, the agreement allows M.L.B. to publicly release confidential information “to respond to the public statements.”

The players’ union and a spokesman for Tatis’s agent, Dan Lozano, declined to comment. Glen Caplin, a spokesman for Major League Baseball, declined to comment on the specifics of the case. In a statement, he said: “M.L.B. always strictly adheres to the collectively bargained confidentiality provisions of the Joint Drug Program, and therefore cannot comment on the veracity of the details in this story.”

Ringworm and Its Treatment

The ringworm explanation raises other questions.

If it was true, Tatis may have been able to get his suspension reduced upon appeal. An 80-game suspension for drugs like clostebol can be reduced to 30 games if a player “proves by clear and convincing evidence that he bears no significant fault or negligence for the presence of the Performance Enhancing Substance in his test result,” according to the joint drug agreement.

Tatis said he had consulted with a team of advisers about the drug test, though he declined to specify who they were.

“At the beginning, we felt like we had a very strong case moving forward,” Tatis told reporters on Tuesday.

But at some point, Tatis said, the advisers told him he would not likely win an appeal, and he chose not to take his case before an independent arbitration panel. Instead, he decided to begin serving his suspension immediately.

Perhaps the people advising Tatis thought his case was weak because the drug he took does not actually treat ringworm.

Ringworm is the common name for tinea corporis, a fungal infection on the body, and a product containing clostebol, or any other topical steroid, is not an appropriate treatment, according to several dermatologists and the Centers for Disease Control and Prevention.

“A topical steroid is going to be giving that fungal infection MiracleGro,” said Dr. Justin Ko, the chief of medical dermatology for Stanford Health Care. “It is going to make it go wild and replicate it and go worse.”

Dr. Anna Grossberg, an assistant professor of dermatology at Johns Hopkins University, said: “This would be a very bizarre treatment for ringworm.” Common treatments for ringworm include antifungal medications like Lotramin, Lamisil or Tinactin.

In the Dominican Republic, products containing clostebol are sold over the counter in some of the country’s biggest pharmacy chains. This week in Santo Domingo, the capital, a reporter found three separate products for sale under the Trofobol name: Trofobol, Trofobol V and Trofodelmax. They came in creams and sprays.

All of the Trofobol products sold clearly list clostebol as an ingredient on the box, container and in the instructions. The instructions, in Spanish, note that Trofobol contains an “anabolic agent” and is “testosterone derivative.” The wide variety of conditions that it treats include burns, skin lesions, infected wounds and other problems. Ringworm or other funguses are not mentioned.

But just because the medicine Tatis said he used does not treat the condition he said he had, it does not mean he is lying.

“It is common for patients to use the internet or other sources and try to figure out what they think the problem is,” said Dr. Jeffrey Cohen, an assistant professor of dermatology at Yale. “Sometimes they are correct, and other times incorrect.”

Recently, Tatis has been less insistent that he had ringworm. At the news conference on Tuesday he said he had a “skin infection” that he has dealt with “over the course of the years.” He said he obtained Trofobol in the Dominican Republic in June, and did not talk to the Padres medical staff about his condition or medication.

Clostebol Levels

Most athletes who test positive for clostebol test positive for very low levels of clostebol metabolites. According to a 2020 study on clostebol from researchers at the Federazione Medico Sportiva Italiana antidoping laboratory in Rome, in 77 percent of the cases where the laboratory detected clostebol in a drug test, the amount detected was less than 2 nanograms per milliliter.

In some other sports, athletes have successfully appealed suspensions for clostebol to the Court of Arbitration for Sport by arguing the low level in their system came from tainted meat or incidental contact with a cream. That Tatis neither appealed nor claimed contamination suggests that the level of clostebol detected in his system was not negligible.

Pharmacologists and scientists said knowing the level alone is not enough information to determine whether Tatis’s explanation is true. It also isn’t enough information to determine whether the method of entry was through the skin, as Tatis has claimed, or through the more common methods used to enhance performance, like orally or through injection.

Hogla Betiza contributed reporting from Santo Domingo, Dominican Republic, and Scott Miller contributed reporting from San Diego.