Br J Sports Med 47:109-114 doi:10.1136/bjsports-2012-090988
  • Original articles

Traditional Chinese medicine and sports drug testing: identification of natural steroid administration in doping control urine samples resulting from musk (pod) extracts

  1. Jiri Dvorak4,5
  1. 1Institute of Biochemistry – Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
  2. 2Institute of Doping Analysis, Kreischa, Germany
  3. 3Zoo Leipzig GmbH, Leipzig, Germany
  4. 4Schulthess Klinik, Zurich, Switzerland
  5. 5Fédération Internationale de Football Association (FIFA), Zurich, Switzerland
  1. Correspondence to Mario Thevis, Institute of Biochemistry – Center for Preventive Doping Research, German Sport University, Am Sportpark Muengersdorf 6, Cologne 50933; thevis{at}
  1. Contributors WS, HG and UF conducted the steroid profile analyses of musk pod preparations including data interpretation; DT, JG and CR performed doping control analyses with steroid profiling and IRMS measurements, RH provided authentic musk pod material and expertise in species identification, SB, AT and MT conducted the synthesis of reference steroids and LC-MS/MS analyses, and JD coordinated the doping control procedures and the overall case management.

  • Received 25 January 2012
  • Accepted 25 March 2012
  • Published Online First 3 May 2012


The administration of musk extract, that is, ingredients obtained by extraction of the liquid secreted from the preputial gland or resulting grains of the male musk deer (eg, Moschus moschiferus), has been recommended in Traditional Chinese Medicine (TCM) applications and was listed in the Japanese pharmacopoeia for various indications requiring cardiovascular stimulation, anti-inflammatory medication or androgenic hormone therapy. Numerous steroidal components including cholesterol, 5α-androstane-3,17-dione, 5β-androstane-3,17-dione, androsterone, etiocholanolone, epiandrosterone, 3β-hydroxy-androst-5-en-17-one, androst-4-ene-3,17-dione and the corresponding urea adduct 3α-ureido-androst-4-en-17-one were characterised as natural ingredients of musk over several decades, implicating an issue concerning doping controls if used for the treatment of elite athletes. In the present study, the impact of musk extract administration on sports drug testing results of five females competing in an international sporting event is reported. In the course of routine doping controls, adverse analytical findings concerning the athletes' steroid profile, corroborated by isotope-ratio mass spectrometry (IRMS) data, were obtained. The athletes' medical advisors admitted the prescription of TCM-based musk pod preparations and provided musk pod samples for comparison purposes to clarify the antidoping rule violation. Steroid profiles, IRMS results, literature data and a musk sample obtained from a living musk deer of a local zoo conclusively demonstrated the use of musk pod extracts in all cases which, however, represented a doping offence as prohibited anabolic–androgenic steroids were administered.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • ▸ References to this paper are available online at