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Karila D, Kerlan V, Christin-Maitre S. Androgenic steroid excess in women. ANNALES D'ENDOCRINOLOGIE 2024; 85:142-149. [PMID: 38040089 DOI: 10.1016/j.ando.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
Excessive use of anabolic-androgenic steroids (AAS) in sport occurs among professional athletes but increasingly also in amateurs. Prevalence of steroid use has been on the rise for a number of years. While the practice involves mostly men, it also occurs in women with an estimated prevalence of 1.6%. Since 2014, a 'steroid passport' has operated for sports people in competition that is based on longitudinal urinary and blood steroid levels, measured by liquid chromatography and mass spectrometry. Androgen excess stimulates muscle growth and improves muscle performance. However, their consumption carries numerous side effects, including myocardial hypertrophy; altered lipid metabolism and pro-thrombotic effects. The excess of AAS is associated with increased risk of atherosclerosis and cardiovascular events. Data for their effects in women is lacking. Perturbations of the menstrual cycle are common in female athletes, with spaniomenorrhea and even amenorrhea. This can be a consequence of gonadotropin insufficiency due to negative caloric balance, but may also be due to endogenous or exogenous hyperandrogenism. The use of AAS is probably underestimated as a public health issue, particularly in women, and thus presents a prevention challenge for healthcare professionals.
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Affiliation(s)
- Daphné Karila
- Service d'endocrinologie, diabétologie et médecine de la reproduction, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 75012 Paris, France; Sorbonne université, 75006 Paris, France.
| | - Véronique Kerlan
- Service d'endocrinologie, hôpital de Brest, université de Bretagne-Occidentale, 29200 Brest, France
| | - Sophie Christin-Maitre
- Service d'endocrinologie, diabétologie et médecine de la reproduction, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 75012 Paris, France; Sorbonne université, 75006 Paris, France
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2
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Moreillon B, Salamin O, Krumm B, Iannella L, Molaioni F, Kuuranne T, Nicoli R, Saugy JJ, Botrè F, Faiss R. Variability of the urinary and blood steroid profiles in healthy and physically active women with and without oral contraception. Drug Test Anal 2023; 15:324-333. [PMID: 36414566 DOI: 10.1002/dta.3412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
The steroidal module of the athlete biological passport (ABP) targets the use of pseudo-endogenous androgenous anabolic steroids in elite sport by monitoring urinary steroid profiles. Urine and blood samples were collected weekly during two consecutive oral contraceptive pill (OCP) cycles in 15 physically active women to investigate the low urinary steroid concentrations and putative confounding effect of OCP. In urine, testosterone (T) and epitestosterone (E) were below the limit of quantification of 1 ng/ml in 62% of the samples. Biomarkers' variability ranged between 31% and 41%, with a significantly lesser variability for ratios (except for T/E [41%]): 20% for androsterone/etiocholanolone (p < 0.001) and 25% for 5α-androstane-3α,17β-diol/5ß-androstane-3α,17β-diol (p < 0.001). In serum, markers' variability (testosterone: 24%, androstenedione: 23%, dihydrotestosterone: 19%, and T/A4: 16%) was significantly lower than in urine (p < 0.001). Urinary A/Etio increased by >18% after the first 2 weeks (p < 0.05) following withdrawal blood loss. In contrast, serum T (0.98 nmol/l during the first week) and T/A4 (0.34 the first week) decreased significantly by more than 25% and 17% (p < 0.05), respectively, in the following weeks. Our results outline steroidal variations during the OCP cycle, highlighting exogenous hormonal preparations as confounder for steroid concentrations in blood. Low steroid levels in urine samples have a clear negative impact on the subsequent interpretation of steroid profile of the ABP. With a greater analytical sensitivity and lesser variability for steroids in healthy active women, serum represents a complementary matrix to urine in the ABP steroidal module.
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Affiliation(s)
- Basile Moreillon
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Olivier Salamin
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bastien Krumm
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Loredana Iannella
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Molaioni
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raul Nicoli
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jonas J Saugy
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Francesco Botrè
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Raphael Faiss
- Research and Expertise in anti-Doping Sciences (REDs), Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Knutsson JE, Ekström L, Hirschberg AL. Disposition of serum steroids in response to combined oral contraceptives and menstrual cycle phases: A double-blind, randomized, placebo-controlled study. Drug Test Anal 2023; 15:134-138. [PMID: 36165603 DOI: 10.1002/dta.3373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 01/26/2023]
Abstract
To analyze doping control samples from female athletes demands understanding of non-doping factors that affect the steroid profile. These could be physiological factors such as exercise, alcohol consumption, hormonal changes during the menstrual cycle, or the effect of commonly used approved drugs like combined oral contraceptives. Urine samples have been the main way of doping testing, but serum samples are proposed as a complement. Testosterone, dihydrotestosterone, or the ratio of testosterone and androstenedione has been proposed as a biomarker for testosterone doping because it increases after transdermal testosterone administration. In this double-blind, randomized, placebo-controlled study of 340 healthy females, we analyzed the serum steroid levels, including glucuronide metabolites, before and after 3 months of combined oral contraceptives or placebo. At follow up, sample collection in the placebo group was randomly distributed between different menstrual cycle phases. This enabled to analyze changes in concentrations between the follicular, ovulation, and luteal phases. Combined oral contraceptives decreased all serum steroids including the glucuronide metabolites. As expected, serum testosterone levels increased during the ovulation phase, and also androstenedione and androstenediol, whereas the glucuronide metabolites remained unaffected. Neither combined oral contraceptives nor menstrual cycle phases did affect the ratio of testosterone and androstenedione in serum, and consequently this ratio seems promising as a marker of doping with endogenous anabolic androgenic steroids in women.
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Affiliation(s)
- Jona Elings Knutsson
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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4
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Song Z. SERUM-HORMONAL VARIATIONS IN JUNIOR BASKETBALL PLAYERS UNDER INTENSIVE TRAINING. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228062022_0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction Basketball is a long-duration, high-intensity ball game. High competition and athletic combat require athletes to perform at an excellent technical and tactical level. Therefore, studying physiological indicators related to serum-hormone levels of basketball players is an effective way to implement scientific physical monitoring of athletes. Objective This paper aims to understand the intense training effect on hormone-related physiological indicators in young basketball players. Objective This paper aims to understand the effect of intense training on physiological indicators related to serum-hormonal levels in young basketball players. Methods Serum hormone indices of 11 healthy young players without organic or genetic diseases were compared before, 2, 4, and 24 hours after an intense training protocol. Results Creatine and blood urea levels. After 24 hours, the levels were close to those found pre-workout. Conclusion Basketball training can improve the anaerobic capacity of young players. There is a high correlation between changes in serum hormones in young people and their physical fitness. Evidence Level II; Therapeutic Studies - Investigating the result.
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5
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Abstract
The rules of fair play in sport generally prohibit the use of performance-enhancing drugs (PEDs). The World Anti-Doping Agency (WADA) oversees global antidoping regulations and testing for elite athletes participating in Olympic sports. Efforts to enforce antidoping policies are complicated by the diverse and evolving compounds and strategies employed by athletes to gain a competitive edge. Now between the uniquely proximate 2021 Tokyo and 2022 Beijing Olympic Games, we discuss WADA's efforts to prevent PED use during the modern Olympic Games. Then, we review the major PED classes with a focus on pathophysiology, complexities of antidoping testing, and relevant toxicities. Providers from diverse practice environments are likely to care for patients using PEDs for a variety of reasons and levels of sport; these providers should be aware of common PED classes and their risks.
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Affiliation(s)
- C James Watson
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Genevra L Stone
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel L Overbeek
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Takuyo Chiba
- Department of Emergency Medicine, International University of Health and Welfare, Ōtawara, Japan
| | - Michele M Burns
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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6
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Eklund E, Andersson A, Ekström L, Hirschberg AL. Urinary Steroid Profile in Elite Female Athletes in Relation to Serum Androgens and in Comparison With Untrained Controls. Front Physiol 2021; 12:702305. [PMID: 34526910 PMCID: PMC8435769 DOI: 10.3389/fphys.2021.702305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction In female athletes, the interpretation of doping tests is complex due to hormonal variations during the menstrual cycle and hormonal contraceptive use, both influencing the urinary steroid profile. Exercise is suggested to affect circulating steroid hormone levels, and in women, the urinary steroid profile differs between in competition testing and out of competition testing. No previous study has investigated the relationship between amount of exercise and the urinary steroid profile in female elite athletes. Purpose To compare the urinary steroid profile between female Olympic athletes and age- and BMI-matched untrained controls, and to study the urinary steroid profile in relation to serum hormones and amount of exercise. Methods In this cross-sectional study conducted at the Women’s Health Research Unit, Karolinska University Hospital, Stockholm, 94 female elite athletes and 86 untrained controls were included. Serum estrogens and testosterone and the urinary steroid profile were analyzed by liquid chromatography–tandem mass spectrometry and gas chromatography-tandem mass spectrometry, respectively. Exercise hours/week were evaluated by questionnaire. Results Although serum steroid hormones were comparable between groups, the athletes demonstrated approximately 30% lower urinary steroid metabolites of testosterone, epitestosterone, androsterone, etiocholanolone, 5α-androstan-3α, 17β-diol, and 5β-androstan-3α, 17β-diol compared to the controls. The urinary steroid metabolites correlated positively with serum steroid hormones. In the athletes, urinary steroid metabolites: androsterone (rs = −0.28, p = 0.007), epitestosterone (rs = −0.22, p = 0.034), 5αAdiol (rs = −0.31, p = 0.002) and testosterone (rs = −0.24, p = 0.026), were negatively correlated with amount of training (hours per week). Conclusion The urinary concentrations of steroid metabolites were lower in elite athletes than in sedentary controls, although serum steroids were comparable between groups. Moreover, exercise time was negatively associated with the urinary concentrations. Our findings suggest alternative excretion routes of androgens in the athletes related to training.
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Affiliation(s)
- Emma Eklund
- Department of Women's and Children's Health, Division of Neonatology, Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Andersson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Division of Neonatology, Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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7
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Piper T, Geyer H, Haenelt N, Huelsemann F, Schaenzer W, Thevis M. Current Insights into the Steroidal Module of the Athlete Biological Passport. Int J Sports Med 2021; 42:863-878. [PMID: 34049412 PMCID: PMC8445669 DOI: 10.1055/a-1481-8683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/07/2021] [Indexed: 12/25/2022]
Abstract
For decades, the class of anabolic androgenic steroids has represented the most frequently detected doping agents in athletes' urine samples. Roughly 50% of all adverse analytical findings per year can be attributed to anabolic androgenic steroids, of which about 2/3 are synthetic exogenous steroids, where a qualitative analytical approach is sufficient for routine doping controls. For the remaining 1/3 of findings, caused by endogenous steroid-derived analytical test results, a more sophisticated quantitative approach is required, as their sheer presence in urine cannot be directly linked to an illicit administration. Here, the determination of urinary concentrations and concentration ratios proved to be a suitable tool to identify abnormal steroid profiles. Due to the large inter-individual variability of both concentrations and ratios, population-based thresholds demonstrated to be of limited practicability, leading to the introduction of the steroidal module of the Athlete Biological Passport. The passport enabled the generation of athlete-specific individual reference ranges for steroid profile parameters. Besides an increase in sensitivity, several other aspects like sample substitution or numerous confounding factors affecting the steroid profile are addressed by the Athlete Biological Passport-based approach. This narrative review provides a comprehensive overview on current prospects, supporting professionals in sports drug testing and steroid physiology.
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Affiliation(s)
- Thomas Piper
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Hans Geyer
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Nadine Haenelt
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Frank Huelsemann
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Wilhelm Schaenzer
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Mario Thevis
- Center for Preventive Doping Research – Institute of
Biochemistry, German Sport University Cologne, Cologne, Germany
- European Monitoring Center for Emerging Doping Agents (EuMoCEDA)
Cologne/Bonn Germany
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8
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Castanier C, Bougault V, Teulier C, Jaffré C, Schiano-Lomoriello S, Vibarel-Rebot N, Villemain A, Rieth N, Le-Scanff C, Buisson C, Collomp K. The Specificities of Elite Female Athletes: A Multidisciplinary Approach. Life (Basel) 2021; 11:622. [PMID: 34206866 PMCID: PMC8303304 DOI: 10.3390/life11070622] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Abstract
Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18-40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.
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Affiliation(s)
- Carole Castanier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Caroline Teulier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Sandrine Schiano-Lomoriello
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nancy Vibarel-Rebot
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Aude Villemain
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nathalie Rieth
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Christine Le-Scanff
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Corinne Buisson
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
| | - Katia Collomp
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
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Wang J, Bao B, Meng F, Deng S, Feng J, Dai H, Xu H, Zhao Q, Li H, Wang B. In vitro and in vivo investigation of the therapeutic mechanism of Lycium Chinense and Cuscutae Semen on oligoasthenozoospermia. Andrologia 2021; 53:e14014. [PMID: 33666949 DOI: 10.1111/and.14014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/31/2021] [Indexed: 12/18/2022] Open
Abstract
Through network pharmacology research, we found that CYP19, CYP17, AR and SRD5A2 were potential targets for lycium chinense-cuscutae semen (LC-CS) treatment of oligoasthenozoospermia. Using in vitro and in vivo experiments, tripterygium glycosides were used to induce spermatogenic dysfunction models in GC-1spg cells and SD male rats, respectively, and LC-CS was used to intervene in a spermatogenic dysfunction model. In vitro, LC-CS could repair the ultrastructure of GC-1spg cells damaged by tripterygium glycosides (TG). Compared with TG group, LC-CS could upregulate protein and mRNA expression of CYP19, CYP17, AR and SRD5A2. In vivo, compared with TG, the body mass, testicular mass and epididymal weights of rats in TG + LC-CS increased. Progressive motility + nonprogressive motility spermatozoon (PR + NP) of TG + LC-CS were upregulate than TG. The levels of FSH, LH and testosterone in TG + LC-CS were upregulate than TG. LC-CS can repair the ultrastructure of spermatogonia damaged by TG (the above results are statistically significant, p <.05). Results of H&E staining and TEM showed that the morphology and ultrastructure of testicular tissue in TG + LC-CS were better than that in TG. Compared with TG, LC-CS could upregulate the expression of CYP19, CYP17, AR and SRD5A2 proteins and mRNA.
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Affiliation(s)
- Jisheng Wang
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China.,Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Binghao Bao
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China.,Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fanchao Meng
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China.,Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Sheng Deng
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China.,Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Junlong Feng
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China.,Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hengheng Dai
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China.,Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongsheng Xu
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China.,Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Zhao
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China.,Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Haisong Li
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bin Wang
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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10
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Schulze J, Suominen T, Bergström H, Ericsson M, Björkhem Bergman L, Ekström L. Urinary steroid profile in relation to the menstrual cycle. Drug Test Anal 2020; 13:550-557. [PMID: 33142032 PMCID: PMC7984021 DOI: 10.1002/dta.2960] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
The interpretation of the steroidal module of the Athlete Biological Passport (ABP) in female athletes is complex due to the large variation of the endogenous urinary steroids. The menstrual cycle seems to be one of the largest confounders of the steroid profile. The duration of the different phases in the menstrual cycle differs between women and is difficult to predict only by counting days after menstruation. Here, we have determined the follicle, ovulation, and luteal phases, by assessing the menstrual hormones in serum samples collected from 17 healthy women with regular menses. Urine samples were collected three times per week during two consecutive cycles to measure the urinary steroid concentrations used in the ABP. The metabolite that was mostly affected by the menstrual phases was epitestosterone (E), where the median concentration was 133% higher in the ovulation phase compared to the follicle phase (p < 0.0001). The women with a large coefficient of variation (CV) in their first cycle also had a large CV in their second cycle and vice versa. The inter-individual difference was extensive with a range of 11%-230% difference between the lowest and the highest T/E ratio during a cycle. In conclusion, E and ratios with E as denominator are problematic biomarkers for doping in female athletes. The timing of the sample collection in the menstrual cycle will have a large influence on the steroid profile. The results of this study highlight the need to find additional biomarkers for T doping in females.
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Affiliation(s)
- Jenny Schulze
- Karolinska Institute, Department of Laboratory Medicine, Division of Clinical Pharmacology C1:68Karolinska University HospitalStockholmSweden
| | - Tina Suominen
- Helsinki Doping Control Laboratory, Forensic Toxicology UnitFinnish Institute for Health and Welfare (THL)HelsinkiFinland
| | - Helena Bergström
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical GeriatricsKarolinska InstituteStockholmSweden
| | - Magnus Ericsson
- Karolinska Institute, Department of Laboratory Medicine, Division of Clinical Pharmacology C1:68Karolinska University HospitalStockholmSweden
- French Doping Control Laboratory, Agence Française de lutte contre le dopage (AFLD) Département des AnalysesFrance
| | - Linda Björkhem Bergman
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical GeriatricsKarolinska InstituteStockholmSweden
| | - Lena Ekström
- Karolinska Institute, Department of Laboratory Medicine, Division of Clinical Pharmacology C1:68Karolinska University HospitalStockholmSweden
- Department of Clinical Pharmacology C1:68Karolinska University Laboratory, Karolinska HospitalStockholmSweden
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