Should injured baseball players be allowed to take HGH?

After a promising start to his career, Los Angeles Angels reliever Ryan Madson missed all of last season while recovering from Tommy John surgery.

Madson went under the knife last April, yet 14 months later, he's still not healthy enough to pitch. Frustrated by numerous setbacks, he suggested this week that human growth hormone could aid his recovery — and that Major League Baseball, which currently bans its use, should allow rehabbing players to take it in limited cases.

"If HGH were legal, just in the process of healing, under a doctor's recommendation, in the right dosage, while you're on the [disabled list], I don't think that's such a bad idea — as long as it doesn't have any lasting side effects, negative side effects," he told MLB.com.

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More from Madson:

Madson's comments broached the delicate subject of performance enhancing drugs in baseball, a topic that has once again risen to the forefront of the game this year.

The Hall of Fame shut out everyone for the first time in years over mere suspicion that some players had taken PEDs. The league is reportedly considering unprecedented 100-game suspensions for star players linked to a PED-peddling Miami clinic. And though the league had already listed HGH as a banned substance, MLB and the players' union agreed over the winter to begin in-season testing for HGH for the first time.

MLB policy aside, the Food and Drug Administration has only approved HGH for limited uses, including hormonal imbalances and muscle-wasting diseases related to HIV. None of them have anything to do with expediting recovery times.

Yankees' pitcher Andy Pettite and others have admitted to using HGH, claiming it helped them recover from injuries faster than they otherwise would have. Yet there is no medical consensus on whether HGH actually has that effect.

"There are no studies — zero studies — showing any benefit from using growth hormone by itself to aid in recovery or post-surgical or post-injury type thing," the league's medical director, Gary Green, told MLB.com.

While the benefits of HGH are unproven, the side effects can be quite serious. Synthetic HGH can weaken heart muscles, cause muscle and joint pain, and lead to higher cholesterol levels. It has also been linked to an increased risk of diabetes and cancer.

Steroids, the more-maligned PED, have been around for much longer and are a far more accepted treatment for serious injuries. Madson said he was not suggesting players be allowed to take steroids, though the underlying point about their effectiveness gets at another problem, from MLB's perspective, regarding HGH use.

The league, acutely concerned about the stain PEDs have left on the sport, has drawn a firm line against all doping that could conceivably be said to give players an edge over the competition. HGH, by promoting muscle growth, would fall into that category. And allowing even limited HGH use would blur that hard line, raising questions about acceptable dosage limits, what sorts of injuries qualify for HGH treatment in the first place, and how league officials, who have struggled to enforce their existing policy, could regulate it.

Still, as Deadspin's Barry Petchesky pointed out, the league already does allow players to use one steroid: Cortisone. And as many others have noted, the league's strong stand against any and all "performance-enhancing" treatments would be untenable when extrapolated to other medical procedures.

"Imagine a world where baseball banned LASIK, arthroscopic surgery, antibiotics or other medical procedures that help players get better," Hardball Talk's Craig Calcaterra wrote. "Crazy, right?"