Lance Armstrong was involved in a sprawling, sophisticated doping program. He claims to have been tested 500-600 times over 14 years. USADA (United States Anti-Doping Agency) claims it tested Armstrong 60 times. And the International Cycling Union tested Armstrong about 200 times (many of the tests were for a health program rather than for testing for prohibited substances).

EPO (Erythropoietin) enlarges red blood cells, thus allowing the athlete to have access to more oxygen. There wasn’t an accurate test for EPO until the early 2000s, and even then it wasn’t sensitive. EPO doesn’t remain in the bloodstream very long, the 1/2 life (1/2 of it is gone) is 5 hours. If testing was suspected a liter of saline was given intravenously to dilute EPO to a normal level. Armstrong also would withdraw his EPO infused blood, then reinfuse his own EPO rich blood later. He also learned that when small doses of EPO were injected directly into his veins rather than under his skin – there was no fear of receiving a positive test.

Testosterone was originally tested using a test measuring the ratio between Testosterone and Epitestosterone. The original testing for Testosterone wasn’t highly sensitive and caught only those who consumed large amounts of Testosterone or used it at a time of day when testing was likely. The maximum ratio allowed was 4/1. Armstrong learned that if he took very small doses, he would test negative. Eventually in 2006 a better test with mass spectrometry confirmed that the carbon isotopes making up some of the Testosterone indicated non-human sources.

Professional cyclists are required to inform their national anti-doping agencies of their locations at all times. Armstrong had various methods to delude his whereabouts. He pretended not to be home when anti-doping testers arrived at his home. This was acceptable as long as the athlete was in the city they reported to be their location. His travel plans were submitted to Usada weeks late, sometimes the day of the trip to avoid testing. He stayed at a remote hotel in Spain where he was virtually certain not to be tested. Riders on the Armstrong team kept constant lookout for testers to avoid testing. Testers were diverted to other riders on the US team while Armstrong administered saline intraveneously to dilute banned substances. Armstrong also would drop out of a race to dodge testers.

A test for HGH (Human Growth Hormone) was only recently introduced in 2005. Armstrong did test positive for a corticosteroid during the 1999 tour but provided a prescription to show he was using cortisone cream to treat a saddle sore.