Italy’s Jannik Sinner trains last week ahead of the 2024 US Open in New York City. The world’s top-ranked player tested positive for low levels of a banned steroid after his physical therapist used a topical spray to treat a minor cut before giving Sinner a massage.

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The final Grand Slam tournament of the year begins on Monday, shortly after a revelation that has sent the tennis world into turmoil: the world’s best player, Jannik Sinner, had tested positive for a banned substance twice earlier this year, but was still allowed to participate.

Now, less than a week after Sinner’s case was made public, the 23-year-old Italian will compete as the top-seeded player in the men’s singles event at the US Open in New York.

Speaking publicly for the first time since the news broke on Friday, Sinner told reporters he was “relieved” by the International Tennis Integrity Agency’s decision to clear him of wrongdoing, even though the timing of the announcement, just days before a major event, had sparked a storm of media attention and criticism from competitors.

“It’s not ideal for a Grand Slam. But in my mind I know I didn’t do anything wrong,” Sinner said. “I always respect these rules, and I will always respect these rules of anti-doping.”

What happened to Jannik Sinner’s failed tests?

The controversy revolves around two urine tests that Sinner failed for eight days in March, both times testing positive for “low levels” of a banned substance called clostebol. according to the ITIA.

Clostebol is an anabolic steroid that has long been used in sports as a performance-enhancing drug. (In 2022, San Diego Padres star Fernando Tatis, Jr. won was suspended for 80 MLB games (after testing positive for the drug.) In the US, it is classified as a Schedule III controlled substance.

The drug is also used in topical skin treatments. In Italy, where Sinner and his fitness team come from, clostebol treatments are available over the counter.

In his appeal to the ITIA, which oversees doping in tennis, Sinner said he was unknowingly exposed to the drug through two members of his staff at the BNP Paribas Open tournament in California in March.

According to to arbitration reports released by the ITIASinner’s physical therapist accidentally cut his finger and treated the wound every day with a medical spray called Trofodermin, which contains clostebol. This spray had been purchased in Italy and taken to California by a second member of Sinner’s entourage, a fitness coach.

The physical therapist then massaged Sinner’s body and helped him with foot exercises, without washing his hands or wearing gloves, the reports said.

Ultimately, Sinner was cleared of blame, although the arbitrator annulled his results at Indian Wells, requiring him to repay $325,000 in prize money.

Is such an explanation plausible?

In Sinner’s case, a panel of three independent experts, convened by arbitrators (two of whom were unaware of the player’s identity), found the explanation plausible.

Italy’s Jannik Sinner speaks to the media during a press conference ahead of the 2024 US Open. The world’s highest-ranked player tested positive for a banned substance twice earlier this year but was still allowed to compete.

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One of them, David Cowan, who once headed a World Anti-Doping Agency-accredited laboratory at King’s College London, added: “the small amounts likely to have been administered would not have had any (…) relevant doping or performance-enhancing effect.”

Clostebol has been repeatedly associated with Italian athletes, partly because it is widely available without a prescription in Italy.

“As an Italian athlete with an Italian medical staff, you would think they would be aware of this problem and take more care to prevent this type of contamination,” said John Gleaves, a kinesiologist at California State University, Fullerton, who tracks doping cases.

On Friday, Sinner said he had fired the two members of his team involved: both the physical therapist who had used the drug and the fitness coach who had purchased it and traveled to California with it.

“These mistakes don’t make me feel confident enough to continue,” Sinner said. “All I need now is some fresh air. I’ve been struggling a lot these last few months.”

Athletes have often been exonerated in doping cases by arguing that they were unknowingly exposed to the banned substance, Gleaves said. Ingestion of contaminated meat is a common explanation, or other environmental exposure, as seen in the case of the Chinese swimmers whose positive test results for a banned substance were announced earlier this year, ahead of the Summer Olympics in Paris.

“We’re seeing more and more of these types of cases that really indicate that an athlete didn’t intend to ingest something, but it’s still getting into their system at a level that’s below a threshold that would be performance enhancing, but at a threshold where it’s detectable,” Gleaves said.

What do Sinner’s competitors say?

Sinner was allowed to continue competing while referees considered his case. Between the tests in March and the revelation last week, he played in eight tournaments, including the French Open and Wimbledon. (It is notable that he withdrew from the Olympic Games due to a case of tonsillitis.)

That stood in contrast to other cases of doping in tennis. Two-time Grand Slam champion Simona Halep was provisionally suspended for more than a year while referees considered her case, ultimately concluding that she had acted with “no significant wrongdoing.”

The revelations about Sinner led to strong reactions in the tennis world last week.

“Different rules for different players”, wrote Denis Shapovalova Canadian player who will play in the first round of the US Open on Monday.

“Ridiculous – whether it was accidental or planned. You get tested twice with a banned (steroid) substance… you should be gone for 2 years,” wrote Nick Kyrgiosthe Australian who finished runner-up at Wimbledon in 2022.

On Friday, Sinner said he was allowed to continue playing because he was able to quickly identify the source of the banned substance and provide evidence to international authorities.

Still, he acknowledged his competitors’ frustration.

“It was obviously a very tough moment for me and my team. It still is. It’s all still fresh,” he said. “I also know now who my friends are and who aren’t, because my friends know I would never do that.”