1
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Goodrum JM, Peek K, Moore C, Eichner D, Miller GD. Is blood blood? Comparing quantitation of endogenous steroids and luteinizing hormone in concurrently collected venous serum and Tasso+ SST capillary serum samples. Drug Test Anal 2024. [PMID: 38794805 DOI: 10.1002/dta.3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
The monitoring of endogenous steroids in urine has been an important component of the Athlete Biological Passport (ABP) for the last decade. Recently, the quantitation of endogenous steroids in blood has been incorporated into the ABP to increase sensitivity in circumstances where the excretion of urinary ABP biomarkers is low. Current ABP guidelines mandate the use of venous blood draws for blood steroid sample collections, however, recent efforts have focused on investigating the use of less invasive sample collection methods, such as capillary blood collected from the upper arm. The focus of this study was to compare the analytical results of venous and capillary blood collected weekly from 20 individuals, 10 males and 10 females, over six weeks. The two primary biomarkers of the blood steroid ABP module, testosterone (T) and the testosterone/androstenedione (T/A4) ratio, were compared, as well as luteinizing hormone (LH) and the T/LH ratio in male participants, two biomarkers known to be responsive to T use. All biomarkers showed excellent agreement between venous and capillary blood. Longitudinal stability between sample types within individuals was also comparable for all biomarkers. Finally, storage of simultaneously collected capillary samples at room temperature and frozen conditions was compared with evaluate the potential impact of non-cold chain shipping conditions. Most biomarkers showed excellent agreement between frozen and room temperature storage conditions. These results indicate capillary blood collections represent a promising alternative to venous blood collections for the blood steroid module of the ABP.
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Affiliation(s)
- Jenna M Goodrum
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, USA
| | - Katy Peek
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, USA
| | - Chad Moore
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, USA
| | - Geoffrey D Miller
- Sports Medicine Research and Testing Laboratory, Salt Lake City, UT, USA
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2
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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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3
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Mulawkar PM, Maheshwari PN, Gauhar V, Agrawal SG, Mohammed TO, Singh AG, Tak GR, Shah US, Shukla DP, Mamankar D. Use of Anabolic-Androgenic Steroids and Male Fertility: A Systematic Review and Meta-analysis. J Hum Reprod Sci 2023; 16:268-285. [PMID: 38322636 PMCID: PMC10841926 DOI: 10.4103/jhrs.jhrs_90_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 02/08/2024] Open
Abstract
Background Anabolic-androgenic steroids (AASs) are often used by men for bodybuilding and to improve sports performance. The use is not limited to professional competitive athletes, but many amateur men. Objective The objective of this study was to assess and systematically review the effects of AAS on male fertility parameters, spermiogram, testosterone, follicle-stimulating hormone (FSH) and luteinising hormone (LH) and to review reversibility and other morbidity impacting fertility. Methods Eligibility criteria - We included studies mentioning data about adult males using supraphysiologic doses of AAS for sports performance or appearance enhancement, with comparison data from general population or matched controls if available reporting fertility parameters and sexual performance. Information sources - A systematic literature search was performed using PubMed, MEDLINE, EMBASE, Google Scholar and World of Science. Controlled clinical trials randomised or nonrandomised (if available), case series with or without matched controls, case reports, cross-sectional surveys, reports on follow-up of subjects caught in doping test and their fertility parameters when reported. Risk of bias/quality assessment - The quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. Results Included studies - Thirty-two studies were included. There were 12 cohort studies, 5 case-control studies, 9 cross-sectional surveys and 6 case reports. The study population comprised 9371 individuals, of which 2671 were AAS users. Synthesis of results - AAS users had reduced levels of FSH and LH than the naïve population. These levels remained low for 3-6 months after stopping AAS. One year after stopping AAS, the users and naïve population had insignificant differences in FSH and LH values. The total testosterone (TT) levels were comparable in users and naïve populations at baseline, 3 months and 6 months after stopping, but at 1 year, TT values were lower in AAS users. Sperm concentration in AAS users and naïve population was similar, but sperm motility was lower in AAS users. The testicular size was lower in AAS users. The erectile function improved with AAS use, but on withdrawal, there was decreased libido and erectile dysfunction. Most AAS users need additional medications to mitigate detrimental effects on fertility. Description of the effect - AAS use negatively impacted the gonadotrophin levels and had lower sperm motility and testicular size. Strength - Comprehensive review of 32 publications, study population of 9371 individuals, of which 2671 were AAS users, meta-analysis of reproductive hormones, semen parameters and testis size. Limitations The limitations are small sample size of most of the studies, polypharmacy, lack of information on dosing and high heterogeneity. Interpretation AAS use is detrimental for sperm motility and has a partially reversible negative impact on male fertility. Users must be cautioned about its negative impact on libido and erectile function.Registration: PROSPERO Registration No. CRD42023411294.
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Affiliation(s)
- Prashant Motiram Mulawkar
- Urology, Tirthankar Superspeciality Hospital, Mumbai, India
- Department of Urology, GMC and SSH, Mumbai, India
- Urology, University of Edinburgh, Edinburgh, UK
| | | | - Vineet Gauhar
- Urology, Ng Teng Fong General Hospital, NUHS, Singapore
| | | | | | | | - Gopal Ramdas Tak
- Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
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4
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Esposito M, Salerno M, Calvano G, Agliozzo R, Ficarra V, Sessa F, Favilla V, Cimino S, Pomara C. Impact of anabolic androgenic steroids on male sexual and reproductive function: a systematic review. Panminerva Med 2023; 65:43-50. [PMID: 35146992 DOI: 10.23736/s0031-0808.22.04677-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Anabolic-androgenic steroids (AASs) are a complex cluster of synthetic derivatives of testosterone. AAS abuse is considered a major public health issue since it has increased among young/adolescent males. The use of steroids has a prevalence rate of 14% in young athletes and 30-75% in professional athletes or bodybuilders. AASs simulate the testosterone mechanism, binding the intracellular androgen receptor, and dysregulating the normal hypothalamic-pituitary-gonadal axis in the same way as exogenous testosterone. Abuse can produce several side effects on organs, such as the genital system. The physio-pathological mechanisms that cause AAS abuse-related, genital system disorders in humans are still not completely known. EVIDENCE ACQUISITION This study focuses on the effect of AASs on the male reproductive organs in humans and animals. EVIDENCE SYNTHESIS A systematic review was performed using SCOPUS, PubMed, Google Scholar, and Web of Sciences database up to 31 December 2021 using the keywords: "anabolic-androgenic steroids," "erectile dysfunction," "spermatogenesis" and "infertility;" (anabolic agents) "erectile dysfunction," "spermatogenesis" and "infertility." The review of the literature identified 66 articles published until 2021. Sixty-two articles were included. The use of AASs induces testicular atrophy and azoospermia known as "anabolic steroid-induced hypogonadism." Anabolic steroid induced infertility is characterized by oligo or azoospermia and abnormalities in sperm motility and morphology. Although sperm quality recovers in most cases within 4 months of stopping anabolic steroid abuse, the negative consequences on spermatogenesis can take up to 3 years to disappear. Human studies reported a positive correlation between AAS abuse in athletes and an increase in morphologically abnormal spermatozoa. Animal studies showed the destruction of Leydig cells and testicular atrophy in animals treated with cycles of AASs. CONCLUSIONS The present review of the literature highlights how little is known about the action of AASs on the male genital system. However, although their use is prohibited in many countries, the black market for these substances is still very frequent. The scientific landscape still has a lot to invest in the research of AAS on the male genital system to make young people even more aware of the negative aspects of these substances, contributing to the reduction of these products in an inappropriate way.
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Affiliation(s)
- Massimiliano Esposito
- Unit of Legal Medicine, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia, " University of Catania, Catania, Italy
| | - Monica Salerno
- Unit of Legal Medicine, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia, " University of Catania, Catania, Italy
| | - Gianluca Calvano
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Roberta Agliozzo
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Vincenzo Ficarra
- Section of Urology, Department of Human and Pediatric Pathology Gaetano Barresi, University of Messina, Messina, Italy
| | - Francesco Sessa
- Unit of Legal Medicine, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia, " University of Catania, Catania, Italy
| | - Vincenzo Favilla
- Section of Urology, Department of Human and Pediatric Pathology Gaetano Barresi, University of Messina, Messina, Italy
| | - Sebastiano Cimino
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Cristoforo Pomara
- Unit of Legal Medicine, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia, " University of Catania, Catania, Italy -
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5
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Thirumalai A, Anawalt BD. Androgenic Steroids Use and Abuse. Urol Clin North Am 2022; 49:645-663. [DOI: 10.1016/j.ucl.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Fyksen TS, Vanberg P, Gjesdal K, von Lueder TG, Bjørnerheim R, Steine K, Atar D, Halvorsen S. Cardiovascular phenotype of long-term anabolic-androgenic steroid abusers compared with strength-trained athletes. Scand J Med Sci Sports 2022; 32:1170-1181. [PMID: 35460300 PMCID: PMC9540672 DOI: 10.1111/sms.14172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022]
Abstract
Introduction Abuse of anabolic‐androgenic steroids (AAS) has been linked to a variety of different cardiovascular (CV) side effects, but still the clinical effects of AAS abuse on CV risk are not clear. The aim of this study was to assess the CV phenotype of a large cohort of men with long‐term AAS use compared with strength‐trained athletes without AAS use. Methods Fifty one strength‐trained men with ≥3 years of AAS use was compared with twenty one strength‐trained competing athletes. We verified substance abuse and non‐abuse by blood and urine analyses. The participants underwent comprehensive CV evaluation including laboratory analyses, 12‐lead ECG with measurement of QT dispersion, exercise ECG, 24 h ECG with analyses of heart rate variability, signal averaged ECG, basic transthoracic echocardiography, and coronary computed tomography angiography (CCTA). Results Hemoglobin levels and hematocrit were higher among the AAS users compared with non‐users (16.8 vs. 15.0 g/dl, and 0.50% vs. 0.44%, respectively, both p < 0.01) and HDL cholesterol significantly lower (0.69 vs. 1.25 mmol/L, p < 0.01). Maximal exercise capacity was 270 and 280 W in the AAS and the non‐user group, respectively (p = 0.04). Echocardiography showed thicker intraventricular septum and left ventricular (LV) posterior wall among AAS users (p < 0.01 for both), while LV ejection fraction was lower (50 vs. 54%, p = 0.02). Seven AAS users (17%) had evidence of coronary artery disease on CCTA. There were no differences in ECG measures between the groups. Conclusions A divergent CV phenotype dominated by increased CV risk, accelerated coronary artery disease, and concentric myocardial hypertrophy was revealed among the AAS users.
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Affiliation(s)
- Tea Saetereng Fyksen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Paul Vanberg
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Knut Gjesdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Reidar Bjørnerheim
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjetil Steine
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Sigrun Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
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7
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Linhares BL, Miranda EP, Cintra AR, Reges R, Torres LO. Use, Misuse and Abuse of Testosterone and Other Androgens. Sex Med Rev 2021; 10:583-595. [PMID: 37051948 DOI: 10.1016/j.sxmr.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION For several decades, testosterone and its synthetic derivatives have been used for anabolic and androgenic purposes. Initially restricted to professional bodybuilders, these substances gradually became more popular with recreational weightlifters. Considering its increasing prevalence, the consumption of anabolic androgenic steroids (AAS) has become a matter of great concern. Although most side effects are mild and reversible, some of them can cause permanent damage or can be potentially life threatening. OBJECTIVES To review and summarize medical literature regarding misuse and abuse of testosterone and other androgens, in order to provide evidence-based information on the main topics related to this subject, such as how to identify and how to deal with these patients, and to elucidate the multiple possible adverse effects secondary to this practice. METHODS Key studies were retrieved from PubMed (1989-2021) with reference searches from relevant articles. Search terms included "hypogonadism", "anabolic androgenic steroids", "androgens", "misuse AND testosterone", "abuse AND testosterone", and "side effects AND testosterone". RESULTS There is a significant lack of information in the peer-reviewed literature describing demographic data, implications for different organ systems and the management of current or former AAS users; however, androgen abuse has been already linked to a wide variety of cardiovascular diseases, metabolic, endocrine, neurological, psychiatric and liver disorders. Despite all this, most physicians still feel uncomfortable and hesitate to discuss the issue with patients. CONCLUSIONS The chronic use of high doses of AAS is associated with adverse effects in several organ systems; however, there are still many gaps in our knowledge about the long-term consequences of this practice and how to deal with these patients. Healthcare professionals have a crucial role in combating this public health problem, recognizing and preventing the spread of androgen abuse. Linhares BL, Miranda EP, Cintra AR, et al. Use, Misuse and Abuse of Testosterone and Other Androgens. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Bruno L Linhares
- Division of Urology, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Eduardo P Miranda
- Division of Urology, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Anna R Cintra
- Division of Urology, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Ricardo Reges
- Division of Urology, Universidade Federal do Ceara, Fortaleza, Brazil
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8
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Börjesson A, Ekebergh M, Dahl ML, Ekström L, Lehtihet M, Vicente V. Women's Experiences of Using Anabolic Androgenic Steroids. Front Sports Act Living 2021; 3:656413. [PMID: 34859201 PMCID: PMC8632252 DOI: 10.3389/fspor.2021.656413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Anabolic androgenic steroids are used by women to increase their muscle mass and because of their performance-enhancing effects. Despite permanent/high risk of side effects, knowledge is inadequate. Our aim has been to deepen understanding about women's use of anabolic androgenic steroids. This phenomenological study is based on the reflective lifeworld research (RLR) approach. Lifeworld interviews were conducted with 12 women, aged 21-56 years, about their experiences of using anabolic steroids. The results show that women experience a sense of pride when they successfully achieve their goals. This is the driving force, triggering tension between suffering and success. Our research adds important knowledge from a reflective lifeworld perspective and shows that women's use of anabolic androgenic steroids is a complex phenomenon. Understanding and knowledge are important in order to be able to meet and support women in their fears and difficulties.
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Affiliation(s)
- Annica Börjesson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Margaretha Ekebergh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Marja-Liisa Dahl
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Lehtihet
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Vicente
- Department of Clinical Science and Education, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
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9
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Lood Y, Aardal E, Gustavsson S, Prasolov I, Josefsson M, Ahlner J. False negative results in testosterone doping in forensic cases: Sensitivity of the urinary detection criteria T/E and T/LH. Drug Test Anal 2021; 13:1735-1742. [PMID: 34228890 DOI: 10.1002/dta.3125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
At the Swedish national forensic toxicology laboratory, a measured testosterone/epitestosterone (T/E) ratio ≥ 12 together with testosterone/luteinizing hormone (T/LH) in urine > 400 nmol/IU is considered as a proof of exogenous testosterone administration. However, according to the rules of the World Anti-Doping Agency (WADA), samples with T/E ratio > 4 are considered suspicious and shall be further analysed by gas chromatography-combustion-isotope ratio mass spectrometry (GC-C-IRMS) to confirm the origin of testosterone and its metabolites. The aim of this study was to investigate the possibility of false negative results and to estimate the frequency of negative results using the current criteria for detection of abuse of testosterone in forensic investigations. Urine and serum samples were collected by the police at suspected infringement of the doping law in Sweden. Fifty-eight male subjects were included in the study. Urinary testosterone was determined by gas chromatography-mass spectrometry (GC-MS), serum testosterone and LH-by immunoassay. The origin of testosterone and its metabolites was confirmed by means of GC-C-IRMS. Twenty-six of the 57 analysed subjects tested positive for exogenous testosterone using the criteria T/E ≥ 12 combined with T/LH > 400 nmol/IU. The IRMS analyses confirmed 47 positives; thus, 21 were considered false negatives. Negative predictive value was 32% (95% confidence interval [CI]: 16%-50%) and sensitivity 55%. No false positive subjects were found. The number of false negative cases using the current criteria for the detection of testosterone abuse and hence the low sensitivity indicates a need to discuss introduction of new strategies in forensic doping investigations.
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Affiliation(s)
- Yvonne Lood
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elisabeth Aardal
- Division of Clinical Chemistry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sara Gustavsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping University, Linköping, Sweden
| | - Ilya Prasolov
- Swedish Doping Control Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Josefsson
- Drug Unit Department, National Forensic Centre, Linköping, Sweden.,Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Johan Ahlner
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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10
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Corona G, Rastrelli G, Marchiani S, Filippi S, Morelli A, Sarchielli E, Sforza A, Vignozzi L, Maggi M. Consequences of Anabolic-Androgenic Steroid Abuse in Males; Sexual and Reproductive Perspective. World J Mens Health 2021; 40:165-178. [PMID: 34169679 PMCID: PMC8987149 DOI: 10.5534/wjmh.210021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022] Open
Abstract
The real epidemiology and the possible consequences of anabolic-androgenic steroids (AAS) use still represent a very tricky task due to the difficulties in the quantification and detection of these drugs. Chronic use of AAS, frequently combined with other illicit substances, can induce tremendous negative effects on the reproductive system, but it is also associated with an increased overall and cardiovascular mortality risk. In the present review we summarize and discuss the available evidence regarding the negative impact of AAS on the male reproductive system, providing practical suggestions to manage these problems. For this purpose a meta-analysis evaluating the effects of AAS abusers vs. controls on several hormonal, reproductive and metabolic parameters was performed. In addition, in order to overcome possible limitations related to the combined use of different AAS preparations, we also retrospectively re-analyzed data on animal models treated with supraphysiological dosage of testosterone (T), performed in our laboratory. Available data clearly indicated that AAS negatively affect endogenous T production. In addition, increased T and estradiol circulating levels were also observed according to the type of preparations used. The latter leads to an impairment of sperm production and to the development of side effects such as acne, hair loss and gynecomastia. Furthermore, a worse metabolic profile, characterized by reduced high density lipoprotein and increased low density lipoprotein cholesterol levels along with an increased risk of hypertension has been also detected. Finally sexual dysfunctions, often observed upon doping, represent one the most probable unfavorable effects of AAS abuse.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda-Usl Bologna, Maggiore-Bellaria Hospital, Bologna, Italy.
| | - Giulia Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Sara Marchiani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Sandra Filippi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Annamaria Morelli
- Section of Human Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Erica Sarchielli
- Section of Human Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandra Sforza
- Endocrinology Unit, Medical Department, Azienda-Usl Bologna, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Linda Vignozzi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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11
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Börjesson A, Ekebergh M, Dahl ML, Ekström L, Lehtihet M, Vicente V. Men´s experiences of using anabolic androgenic steroids. Int J Qual Stud Health Well-being 2021; 16:1927490. [PMID: 34006211 PMCID: PMC8274439 DOI: 10.1080/17482631.2021.1927490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: Anabolic androgenic steroids (AAS) are used by men for their aesthetic and performance-enhancing effects and are associated with risk for side effects. Our research aims to deepen knowledge and understanding of men´s experiences of using AAS. Method: This phenomenological study is based on the reflective lifeworld research approach. Lifeworld interviews were conducted with twelve men about their experiences of using AAS. Results: By using AAS, men strive towards a muscular, strong and athletic ideal. Self-imposed demands, self-discipline and performance accelerate male physical development. The perfect male body ideal thus attained is fragile from both an existential and a biological perspective. The perfect self-image can easily be shattered by adversity. A man’s very existence may be jeopardized if the use of AAS is revealed to others or if the body is let down by illness. Conclusions: Men´s use of AAS is a complex phenomenon. It partly concerns a traditional view of masculinity that is reflected in the community. It requires both broad and deep knowledge and understanding to be able to meet men using AAS in their problems and vulnerability; a meeting that is hampered by their low trust in healthcare, and by the fact that AAS are illegal.
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Affiliation(s)
- Annica Börjesson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Margaretha Ekebergh
- Faculty of Caring Science, Worklife and Social Welfare, University of Borås, Borås, Sweden
| | - Marja-Liisa Dahl
- 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
| | - Mikael Lehtihet
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Karolinska Institutet and are working at S: t Görans hospital
| | - Veronica Vicente
- The Ambulance Medical Service in Stockholm (AISAB), Academic EMS Stockholm and Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet, Stockholm, Sweden
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12
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Nair VS, Sharpe K, Husk J, Miller GD, Van Eenoo P, Crouch A, Eichner D. Evaluation of blood parameters by linear discriminant models for the detection of testosterone administration. Drug Test Anal 2021; 13:1270-1281. [PMID: 33629499 DOI: 10.1002/dta.3017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/09/2022]
Abstract
The steroidal module of the Athlete Biological Passport (ABP) has been used since 2014 for the longitudinal monitoring of urinary testosterone and its metabolites to identify samples suspicious for the use of synthetic forms of Endogenous Anabolic Androgenic Steroids (EAAS). Multiple recent studies have suggested that monitoring of blood parameters may provide enhanced detectability of exogenous testosterone administration. Transdermal and intramuscular testosterone administration studies were carried out in 15 subjects, and the effect on blood steroidal levels, hematological parameters, and gonadotropins was evaluated. Serum testosterone and dihydrotestosterone levels increased while gonadotropin levels were suppressed after administration. A modest increase in reticulocytes was also observed. The blood parameters that were responsive to the administrations were combined into several linear discriminant models targeting both administration (on) and washout (off) phases. The models were effective in detecting the large dose intramuscular administration but were less successful in the detection of the lower dose transdermal application. The blood profiling models may provide complementary value but do not appear to be substantially more advantageous than longitudinal urinary profiling.
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Affiliation(s)
- Vinod S Nair
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA.,DoCoLab, Department of Diagnostic Science, Ghent University, Ghent, Belgium
| | - Ken Sharpe
- Statistical Consulting Centre, School of Mathematics and Statistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jacob Husk
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
| | - Geoffrey D Miller
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
| | - Peter Van Eenoo
- DoCoLab, Department of Diagnostic Science, Ghent University, Ghent, Belgium
| | - Andre Crouch
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, South Jordan, Utah, USA
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13
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Börjesson A, Möller C, Hagelin A, Vicente V, Rane A, Lehtihet M, Dahl ML, Gårevik N, Ekström L. Male Anabolic Androgenic Steroid Users with Personality Disorders Report More Aggressive Feelings, Suicidal Thoughts, and Criminality. ACTA ACUST UNITED AC 2020; 56:medicina56060265. [PMID: 32481676 PMCID: PMC7353874 DOI: 10.3390/medicina56060265] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: Anabolic androgenic steroids (AAS) are mainly used for aesthetic and performance-enhancing reasons. Their use is a growing public health problem and concern for society because of their adverse effects. The primary aim of this study was to identify psychiatric and personality disorders and to measure anxiety and depression in AAS users. Materials and Methods: Fifty-six males who actively contacted the Anti-Doping Hot-Line and wished to stop using AAS were included. Structured Clinical Interviews Diagnosis-I and -II were used to diagnose psychiatric and personality disorders. The Brief Scale for Anxiety and Montgomery Asberg Depression Rating Scale (subscales from the Comprehensive Psychopathological Rating Scale) were used to measure changes in anxiety and depression. Structured Clinical Interviews Diagnosis-I and -II were performed at one time point. Anxiety and depression were measured at inclusion and after six months. Urine samples were collected for an analysis of AAS and drugs of abuse. Results: All participants reported some adverse effects that they associated with AAS use. In total, 56% and 52% of the cohort fulfilled the criteria for Structured Clinical Interviews Diagnosis-I and -II diagnoses, respectively. A significantly increased risk of reporting aggressive feelings/behaviors (Odds Ratio (OR) = 4.9; Confidence Interval (CI) 0.99-25, p = 0.04), suicidal thoughts/attempts (OR = 4.6, CI 95; 0.99-21, p = 0.04) and criminality (OR = 6.5, CI 1-39, p = 0.03) was found among individuals with AAS use fulfilling the criteria for personality disorders compared with those without such AAS use. The Brief Scale for Anxiety score decreased from the median of 15 at inclusion to 10 at the follow-up visit six months later (p = 0.01, n = 19). Conclusions: Our findings indicate that among individuals with AAS use, those with a personality disorder report more aggressive behaviors, suicidal thoughts/suicidal attempts, and criminality than those without a personality disorder.
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Affiliation(s)
- Annica Börjesson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
- Correspondence: ; Tel.: +46-8-585-811-92
| | - Christian Möller
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Psychiatric Clinic, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, 422 49 Gothenburg, Sweden
| | - Anders Hagelin
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
| | - Veronica Vicente
- The Ambulance Medical Service in Stockholm (AISAB), Academic EMS, 121 63 Stockholm, Sweden;
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
| | - Mikael Lehtihet
- Department of Medicine, Karolinska Institutet, S:t Görans Hospital, 122 19 Stockholm, Sweden;
| | - Marja-Liisa Dahl
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
| | - Nina Gårevik
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
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14
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Börjesson A, Lehtihet M, Andersson A, Dahl M, Vicente V, Ericsson M, Ekström L. Studies of athlete biological passport biomarkers and clinical parameters in male and female users of anabolic androgenic steroids and other doping agents. Drug Test Anal 2020; 12:514-523. [DOI: 10.1002/dta.2763] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/30/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Annica Börjesson
- Division of Clinical Pharmacology, Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Mikael Lehtihet
- Department of MedicineKarolinska Institutet and St Görans Hospital Stockholm Sweden
| | - Alexander Andersson
- Anti‐Doping Laboratory, Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
- Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Marja‐Liisa Dahl
- Division of Clinical Pharmacology, Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Veronica Vicente
- Ambulance Medical Service in Stockholm [Ambulanssjukvården i Storstockholm AB]Academic EMS Stockholm Sweden
- Department of Clinical Science and Education, Karolinska Institutet, StockholmSödersjukhuset Stockholm Sweden
| | - Magnus Ericsson
- Division of Clinical Pharmacology, Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Anti‐Doping Laboratory, Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
- Clinical Pharmacology, Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
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15
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Balgoma D, Zelleroth S, Grönbladh A, Hallberg M, Pettersson C, Hedeland M. Anabolic androgenic steroids exert a selective remodeling of the plasma lipidome that mirrors the decrease of the de novo lipogenesis in the liver. Metabolomics 2020; 16:12. [PMID: 31925559 PMCID: PMC6954146 DOI: 10.1007/s11306-019-1632-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/31/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The abuse of anabolic androgenic steroids (AASs) is a source of public concern because of their adverse effects. Supratherapeutic doses of AASs are known to be hepatotoxic and regulate the lipoproteins in plasma by modifying the metabolism of lipids in the liver, which is associated with metabolic diseases. However, the effect of AASs on the profile of lipids in plasma is unknown. OBJECTIVES To describe the changes in the plasma lipidome exerted by AASs and to discuss these changes in the light of previous research about AASs and de novo lipogenesis in the liver. METHODS We treated male Wistar rats with supratherapeutic doses of nandrolone decanoate and testosterone undecanoate. Subsequently, we isolated the blood plasma and performed lipidomics analysis by liquid chromatography-high resolution mass spectrometry. RESULTS Lipid profiling revealed a decrease of sphingolipids and glycerolipids with palmitic, palmitoleic, stearic, and oleic acids. In addition, lipid profiling revealed an increase in free fatty acids and glycerophospholipids with odd-numbered chain fatty acids and/or arachidonic acid. CONCLUSION The lipid profile presented herein reports the imprint of AASs on the plasma lipidome, which mirrors the downregulation of de novo lipogenesis in the liver. In a broader perspective, this profile will help to understand the influence of androgens on the lipid metabolism in future studies of diseases with dysregulated lipogenesis (e.g. type 2 diabetes, fatty liver disease, and hepatocellular carcinoma).
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Affiliation(s)
- David Balgoma
- Analytical Pharmaceutical Chemistry, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden.
- Uppsala Biomedicinska Centrum BMC, Husargatan 3, Box 574, 751 23, Uppsala, Sweden.
| | - Sofia Zelleroth
- The Beijer Laboratory, Biological Research on Drug Dependence, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Alfhild Grönbladh
- The Beijer Laboratory, Biological Research on Drug Dependence, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Mathias Hallberg
- The Beijer Laboratory, Biological Research on Drug Dependence, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Curt Pettersson
- Analytical Pharmaceutical Chemistry, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Mikael Hedeland
- Analytical Pharmaceutical Chemistry, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
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16
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Petrov PD, Fernández-Murga L, Conde I, Martínez-Sena T, Guzmán C, Castell JV, Jover R. Epistane, an anabolic steroid used for recreational purposes, causes cholestasis with elevated levels of cholic acid conjugates, by upregulating bile acid synthesis (CYP8B1) and cross-talking with nuclear receptors in human hepatocytes. Arch Toxicol 2020; 94:589-607. [PMID: 31894354 DOI: 10.1007/s00204-019-02643-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
Anabolic-androgenic steroids are testosterone derivatives, used by body-builders to increase muscle mass. Epistane (EPI) is an orally administered 17α-alkylated testosterone derivative with 2a-3a epithio ring. We identified four individuals who, after EPI consumption, developed long-lasting cholestasis. The bile acid (BA) profile of three patients was characterized, as well the molecular mechanisms involved in this pathology. The serum BA pool was increased from 14 to 61-fold, basically on account of primary conjugated BA (cholic acid (CA) conjugates), whereas secondary BA were very low. In in vitro experiments with cultured human hepatocytes, EPI caused the accumulation of glycoCA in the medium. Moreover, as low as 0.01 μM EPI upregulated the expression of key BA synthesis genes (CYP7A1, by 65% and CYP8B1, by 67%) and BA transporters (NTCP, OSTA and BSEP), and downregulated FGF19. EPI increased the uptake/accumulation of a fluorescent BA analogue in hepatocytes by 50-70%. Results also evidenced, that 40 μM EPI trans-activated the nuclear receptors LXR and PXR. More importantly, 0.01 μM EPI activated AR in hepatocytes, leading to an increase in the expression of CYP8B1. In samples from a human liver bank, we proved that the expression of AR was positively correlated with that of CYP8B1 in men. Taken together, we conclude that EPI could cause cholestasis by inducing BA synthesis and favouring BA accumulation in hepatocytes, at least in part by AR activation. We anticipate that the large phenotypic variability of BA synthesis enzymes and transport genes in man provide a putative explanation for the idiosyncratic nature of EPI-induced cholestasis.
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Affiliation(s)
- Petar D Petrov
- Unidad Mixta de Hepatología Experimental, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Av. Fernando Abril Martorell 106, 46026, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Leonor Fernández-Murga
- Unidad Mixta de Hepatología Experimental, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Av. Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Isabel Conde
- Unidad Mixta de Hepatología Experimental, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Av. Fernando Abril Martorell 106, 46026, Valencia, Spain.,Unidad de Hepatotoxicidad Clínica, Servicio de Medicina Digestiva, Sección Hepatología, Hospital La Fe, Valencia, Spain
| | - Teresa Martínez-Sena
- Unidad Mixta de Hepatología Experimental, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Av. Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Carla Guzmán
- Unidad Mixta de Hepatología Experimental, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Av. Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - José Vicente Castell
- Unidad Mixta de Hepatología Experimental, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Av. Fernando Abril Martorell 106, 46026, Valencia, Spain. .,Departamento de Bioquímica Y Biología Molecular, Facultad de Medicina, Universidad de Valencia, Valencia, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Ramiro Jover
- Unidad Mixta de Hepatología Experimental, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Av. Fernando Abril Martorell 106, 46026, Valencia, Spain. .,Departamento de Bioquímica Y Biología Molecular, Facultad de Medicina, Universidad de Valencia, Valencia, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
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17
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Marocolo M, Katayama PL, Meireles A, Barbosa Neto O. Combined effects of exercise training and high doses of anabolic steroids on cardiac autonomic modulation and ventricular repolarization properties in rats. Can J Physiol Pharmacol 2019; 97:1185-1192. [PMID: 31505126 DOI: 10.1139/cjpp-2019-0286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Several studies have reported that high doses of synthetic anabolic androgenic steroids (AAS) can have serious negative effects on health, including the cardiovascular system. The aim of this study was to evaluate the combined effects of AAS and exercise training on ventricular repolarization and cardiac autonomic modulation in rats. Male Wistar rats were allocated into 4 groups: sedentary rats treated with vehicle, sedentary rats treated with nandrolone decanoate, swimming-trained rats treated with vehicle, and swimming-trained rats treated with nandrolone decanoate. Ventricular repolarization was evaluated by electrocardiographic analysis of QT interval and QT dispersion. Cardiac autonomic modulation was assessed by heart rate variability. Our results show that AAS increased QT interval and QT dispersion in sedentary rats treated with nandrolone decanoate as compared to sedentary rats treated with vehicle, indicating AAS-induced ventricular repolarization abnormalities. When rats treated with nandrolone decanoate were subjected to concomitant exercise training, ventricular repolarization was normalized. On the other hand, AAS-induced reduction in cardiac parasympathetic modulation was not prevented by exercise training. In conclusion, AAS produced cardiac autonomic dysfunction and ventricular repolarization disturbances in rats. Combining an exercise training protocol during the AAS treatment attenuated the ventricular repolarization abnormalities and did not prevent cardiac autonomic dysfunction.
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Affiliation(s)
- Moacir Marocolo
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Pedro L Katayama
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, SP, Brazil
| | - Anderson Meireles
- Physiology and Human Performance Research Group, Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Octávio Barbosa Neto
- Sport Sciences Department, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
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18
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Duca Y, Aversa A, Condorelli RA, Calogero AE, La Vignera S. Substance Abuse and Male Hypogonadism. J Clin Med 2019; 8:E732. [PMID: 31121993 PMCID: PMC6571549 DOI: 10.3390/jcm8050732] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/18/2019] [Accepted: 05/18/2019] [Indexed: 12/27/2022] Open
Abstract
Progressive deterioration of male reproductive function is occurring in Western countries. Environmental factors and unhealthy lifestyles have been implicated in the decline of testosterone levels and sperm production observed in the last fifty years. Among unhealthy lifestyles, substance and drug abuse is a recognized cause of possible alterations of steroidogenesis and spermatogenesis. Alcohol, opioids and anabolic-androgenic steroids are capable to reduce testosterone production in male interfering with testicular and/or hypothalamic-pituitary function. Other substances such as nicotine, cannabis, and amphetamines alter spermatogenesis inducing oxidative stress and subsequent apoptosis in testicular tissue. Substance and drug abuse is a potentially reversible cause of hypogonadism, defined as the failure of the testis to produce physiological concentrations of testosterone and/or a normal number of spermatozoa. The identification of the abuse is important because the withdrawal of substance intake can reverse the clinical syndrome. This review summarizes the most important clinical and experimental evidence on the effect of substance abuse on testosterone and sperm production.
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Affiliation(s)
- Ylenia Duca
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy.
| | | | - Aldo Eugenio Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
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19
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Andrade TU, Haguihara SCGC, Falsoni RMP, Silva CL, Dubois Filho DG, Souza Andrade Moraes F, Nascimento AM, Brasil GA, Lima EM. Stanozolol promotes lipid deposition in the aorta through an imbalance in inflammatory cytokines and oxidative status inLDLrknockoutmice fed a normal diet. Basic Clin Pharmacol Toxicol 2018; 124:360-369. [DOI: 10.1111/bcpt.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 10/01/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Tadeu Uggere Andrade
- Department of Pharmaceutical Sciences University of Vila Velha Vila Velha Espírito Santo Brazil
| | | | | | - Cristiane Lyrio Silva
- Department of Pharmaceutical Sciences University of Vila Velha Vila Velha Espírito Santo Brazil
| | | | | | | | | | - Ewelyne Miranda Lima
- Department of Pharmaceutical Sciences University of Vila Velha Vila Velha Espírito Santo Brazil
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20
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Goldman A, Basaria S. Adverse health effects of androgen use. Mol Cell Endocrinol 2018; 464:46-55. [PMID: 28606866 DOI: 10.1016/j.mce.2017.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 01/21/2023]
Abstract
Anabolic androgenic steroids (AAS) are performance enhancing drugs commonly used by athletes and bodybuilders to improve appearance and athletic capability. Unfortunately, these testosterone derivatives can be associated with serious and potentially irreversible side effects, and can impact multiple organ systems. It is important that physicians be familiar with these adverse consequences so that they can appropriately counsel patients whom they suspect of AAS-abuse. In this chapter, we will review the negative effects of these compounds on various organ systems in men using AAS.
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Affiliation(s)
- Anna Goldman
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shehzad Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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21
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Björkhem-Bergman L, Lehtihet M, Rane A, Ekström L. Vitamin D receptor rs2228570 polymorphism is associated with LH levels in men exposed to anabolic androgenic steroids. BMC Res Notes 2018; 11:51. [PMID: 29351807 PMCID: PMC5775552 DOI: 10.1186/s13104-018-3173-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/12/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The primary aim of this study was to investigate the association between the vitamin D receptor polymorphisms rs2228570 (Fok1) and rs731236 (TaqI) and LH and FSH levels in relation to anabolic androgenic steroid (AAS) use. RESULTS Two cohorts were analyzed. Cohort 1 comprised healthy volunteers given single supra-physiological doses of 500 mg testosterone (n = 25). Cohort 2 comprised 45 self-reporting AAS users. Healthy volunteers homozygous for the C-allele of the Fok1 polymorphism exhibited 30% higher LH levels than T-carriers at baseline (p = 0.04) and twice the levels 14 days after testosterone administration (p = 0.01). AAS users homozygous for the C-allele had four times higher LH levels than TT-individuals (p < 0.05). FSH levels were not associated with Fok1 polymorphism, nor were LH and FSH levels associated with the TaqI polymorphism. In conclusion, there is an association between LH levels and the Fok1 VDR polymorphism and this difference is even more pronounced in AAS users and subjects with suppressed LH levels.
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Affiliation(s)
- Linda Björkhem-Bergman
- Division of Clinical Microbiology F68, Department of Laboratory Medicine, Karolinska University Hospital, Karolinska Institutet, Huddinge, 141 86, Stockholm, Sweden.
| | - Mikael Lehtihet
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetesm Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden
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22
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Baggish AL, Weiner RB, Kanayama G, Hudson JI, Lu MT, Hoffmann U, Pope HG. Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use. Circulation 2017; 135:1991-2002. [PMID: 28533317 DOI: 10.1161/circulationaha.116.026945] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Millions of individuals have used illicit anabolic-androgenic steroids (AAS), but the long-term cardiovascular associations of these drugs remain incompletely understood. METHODS Using a cross-sectional cohort design, we recruited 140 experienced male weightlifters 34 to 54 years of age, comprising 86 men reporting ≥2 years of cumulative lifetime AAS use and 54 nonusing men. Using transthoracic echocardiography and coronary computed tomography angiography, we assessed 3 primary outcome measures: left ventricular (LV) systolic function (left ventricular ejection fraction), LV diastolic function (early relaxation velocity), and coronary atherosclerosis (coronary artery plaque volume). RESULTS Compared with nonusers, AAS users demonstrated relatively reduced LV systolic function (mean±SD left ventricular ejection fraction = 52±11% versus 63±8%; P<0.001) and diastolic function (early relaxation velocity = 9.3±2.4 cm/second versus 11.1±2.0 cm/second; P<0.001). Users currently taking AAS at the time of evaluation (N=58) showed significantly reduced LV systolic (left ventricular ejection fraction = 49±10% versus 58±10%; P<0.001) and diastolic function (early relaxation velocity = 8.9±2.4 cm/second versus 10.1±2.4 cm/second; P=0.035) compared with users currently off-drug (N=28). In addition, AAS users demonstrated higher coronary artery plaque volume than nonusers (median [interquartile range] 3 [0, 174] mL3 versus 0 [0, 69] mL3; P=0.012). Lifetime AAS dose was strongly associated with coronary atherosclerotic burden (increase [95% confidence interval] in rank of plaque volume for each 10-year increase in cumulative duration of AAS use: 0.60 SD units [0.16-1.03 SD units]; P=0.008). CONCLUSIONS Long-term AAS use appears to be associated with myocardial dysfunction and accelerated coronary atherosclerosis. These forms of AAS-associated adverse cardiovascular phenotypes may represent a previously underrecognized public-health problem.
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Affiliation(s)
- Aaron L Baggish
- From Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston (A.L.B., R.B.W.); Department of Medicine, Harvard Medical School, Boston, MA (A.L.B., R.B.W.); Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, MA (G.K., J.I.H., H.G.P.); Department of Psychiatry, Harvard Medical School, Boston, MA (G.K., J.I.H., H.G.P.); Cardiac MR PET CT Program, Massachusetts General Hospital and Department of Radiology, Harvard Medical School, Boston (M.T.L., U.H.).
| | - Rory B Weiner
- From Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston (A.L.B., R.B.W.); Department of Medicine, Harvard Medical School, Boston, MA (A.L.B., R.B.W.); Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, MA (G.K., J.I.H., H.G.P.); Department of Psychiatry, Harvard Medical School, Boston, MA (G.K., J.I.H., H.G.P.); Cardiac MR PET CT Program, Massachusetts General Hospital and Department of Radiology, Harvard Medical School, Boston (M.T.L., U.H.)
| | - Gen Kanayama
- From Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston (A.L.B., R.B.W.); Department of Medicine, Harvard Medical School, Boston, MA (A.L.B., R.B.W.); Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, MA (G.K., J.I.H., H.G.P.); Department of Psychiatry, Harvard Medical School, Boston, MA (G.K., J.I.H., H.G.P.); Cardiac MR PET CT Program, Massachusetts General Hospital and Department of Radiology, Harvard Medical School, Boston (M.T.L., U.H.)
| | - James I Hudson
- From Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston (A.L.B., R.B.W.); Department of Medicine, Harvard Medical School, Boston, MA (A.L.B., R.B.W.); Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, MA (G.K., J.I.H., H.G.P.); Department of Psychiatry, Harvard Medical School, Boston, MA (G.K., J.I.H., H.G.P.); Cardiac MR PET CT Program, Massachusetts General Hospital and Department of Radiology, Harvard Medical School, Boston (M.T.L., U.H.)
| | - Michael T Lu
- From Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston (A.L.B., R.B.W.); Department of Medicine, Harvard Medical School, Boston, MA (A.L.B., R.B.W.); Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, MA (G.K., J.I.H., H.G.P.); Department of Psychiatry, Harvard Medical School, Boston, MA (G.K., J.I.H., H.G.P.); Cardiac MR PET CT Program, Massachusetts General Hospital and Department of Radiology, Harvard Medical School, Boston (M.T.L., U.H.)
| | - Udo Hoffmann
- From Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston (A.L.B., R.B.W.); Department of Medicine, Harvard Medical School, Boston, MA (A.L.B., R.B.W.); Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, MA (G.K., J.I.H., H.G.P.); Department of Psychiatry, Harvard Medical School, Boston, MA (G.K., J.I.H., H.G.P.); Cardiac MR PET CT Program, Massachusetts General Hospital and Department of Radiology, Harvard Medical School, Boston (M.T.L., U.H.)
| | - Harrison G Pope
- From Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston (A.L.B., R.B.W.); Department of Medicine, Harvard Medical School, Boston, MA (A.L.B., R.B.W.); Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, MA (G.K., J.I.H., H.G.P.); Department of Psychiatry, Harvard Medical School, Boston, MA (G.K., J.I.H., H.G.P.); Cardiac MR PET CT Program, Massachusetts General Hospital and Department of Radiology, Harvard Medical School, Boston (M.T.L., U.H.).
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Christou MA, Christou PA, Markozannes G, Tsatsoulis A, Mastorakos G, Tigas S. Effects of Anabolic Androgenic Steroids on the Reproductive System of Athletes and Recreational Users: A Systematic Review and Meta-Analysis. Sports Med 2017; 47:1869-1883. [DOI: 10.1007/s40279-017-0709-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Simão VA, de Almeida Chuffa LG, Cherici Camargo IC. Ovarian sex steroid receptors and sex hormones in androgenized rats. Reproduction 2016; 152:545-559. [DOI: 10.1530/rep-16-0233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/24/2016] [Indexed: 12/16/2022]
Abstract
This study evaluated for the first time the effects of different doses of the anabolic steroid nandrolone decanoate (ND) on the expression of ovarian steroid receptors (AR, ER-α (ESR1) and ER-β (ESR2)) and related sex hormones after treatment and recovery periods in adult rats. The animals were injected subcutaneously with doses of ND (1.87, 3.75, 7.5 or 15 mg/kg b.w.) or mineral oil (control group) for 15 days, and the experimental groups were divided into three periods of evaluation: (a) ND treatment for 15 days, (b) ND treatment and recovery for a period of 30 days and (c) ND treatment and recovery for a period of 60 days. Estrous cycle was monitored daily. At the end of each period, rats were killed for collection of blood and ovaries. Persistent diestrus occurred in all rats during ND treatment and after 30-day recovery. The highest dose of ND was able to maintain all rats arrested at diestrus until 60-day recovery. The expression of steroid receptors varied in a dose- and period-dependent manner, having a more pronounced response with the dose of 15 mg ND/kg. ND treatment increased serum levels of testosterone, 17β-estradiol and dihydrotestosterone, especially at the highest doses of 7.5 and 15 mg ND/kg. No change was observed in the levels of follicle-stimulating hormone (FSH), whereas levels of the luteinizing hormone (LH) varied according to the dose and period. In conclusion, the ovarian sex steroid receptors and sex hormones were restored only at lower doses of ND and after a longer period of recovery.
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Palonek E, Ericsson M, Gårevik N, Rane A, Lehtihet M, Ekström L. Atypical excretion profile and GC/C/IRMS findings may last for nine months after a single dose of nandrolone decanoate. Steroids 2016; 108:105-11. [PMID: 26853157 DOI: 10.1016/j.steroids.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 11/28/2022]
Abstract
The use of the anabolic androgenic steroid nandrolone and its prohormones is prohibited in sport. A common route of nandrolone administration is intramuscular injections of a nandrolone ester. Here we have investigated the detection time of nandrolone and 19-norandrosterone and 19-noretiocholanolone metabolites in eleven healthy men after the administration of a 150 mg dose of nandrolone decanoate. The urinary concentrations of nandrolone and the metabolites were monitored by GC-MS/MS for nine months and in some samples the presence of 19-norandrosterone was confirmed by GC/C/IRMS analysis. The participants were genotyped for polymorphisms in PDE7B1 and UGT2B15 genes previously shown to influence the activation and inactivation of nandrolone decanoate. There were large inter-individual variations in the excretion rate of nandrolone and the metabolites, although not related to genetic variations in the UGT2B15 (rs1902023) and PDE7B1 (rs7774640) genes. After the administration, 19-norandrosterone was found at 2-8-fold higher concentrations than 19-noretiocholanolone. We showed that nandrolone doping can be identified 4 and 9 months after the injection of only one single dose in six and three individuals, respectively. We also noted that GC/C/IRMS confirms the presence of exogenous 19-norandrosterone in the urine samples, showing δ13 values around -32 ‰. This was true even in a sample that was not identified as an atypical finding after the GC-MS/MS analysis further showing the power of using GC/C/IRMS in routine anti-doping settings.
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Affiliation(s)
- Elzbieta Palonek
- Doping Control Laboratory, Division of Clinical Pharmacology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden
| | - Magnus Ericsson
- Doping Control Laboratory, Division of Clinical Pharmacology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden
| | - Nina Gårevik
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden
| | - Anders Rane
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden
| | - Mikael Lehtihet
- Department of Medicine/Huddinge, Karolinska Institutet and Centre for Andrology and Sexual Medicine, Karolinska University Hospital C2:84, SE 141 86 Stockholm, Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, SE-14186 Stockholm, Sweden.
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Börjesson A, Gårevik N, Dahl ML, Rane A, Ekström L. Recruitment to doping and help-seeking behavior of eight female AAS users. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:11. [PMID: 26945991 PMCID: PMC4779574 DOI: 10.1186/s13011-016-0056-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/02/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Doping with anabolic androgenic steroids in sports has now developed to a widespread use of these agents among young people outside the sport. This is of major concern to the society. The purpose of the use is mainly for aesthetic reasons and is seen as a male phenomenon. But use also occurs in women where the knowledge is scarce. Our aim was to identify the pattern of doping agents in eight female cases and compare them with similar data from men. METHODS Eight female users were recruited through Anti-Doping Hot-Line, a national telephone counseling service on doping issues during the years 1998-2004. The use was confirmed with urine doping analysis at the Doping Laboratory. The characteristic of use, co-use of narcotics/other doping agents, exercise pattern, adverse-side effects, family history and reason to begin was evaluated. RESULTS The women used on average 1.9 different anabolic androgenic steroids and clenbuterol preparations. Ephedrine and growth hormone were co-used in five and one of the women, respectively. Three women reported co-use of narcotics (cannabis and cocaine). The average duration of anabolic agent use before contacting health care was 58 weeks (range 7-104). Side effects for anabolic androgenic steroids (n = 5) included voice changes, clitoral enlargement, body hair growth, whereas women using clenbuterol (n = 2) reported tachycardia and depression. All women except one had a man in close relationship encouraging them to begin with the doping agents. CONCLUSIONS The use of doping agents in our eight women was different from that in male users. The women used less doping agents and were more prone to contact the health care, at an earlier stage, probably due to the adverse effects. The co-use with ephedrine, growth hormone and cannabis appeared to be in the same range as in men. This is the first study showing that a man in close relationship may motivate a woman to use anabolic agents.
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Affiliation(s)
- Annica Börjesson
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Nina Gårevik
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Marja-Liisa Dahl
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Anders Rane
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
| | - Lena Ekström
- Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
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27
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Gårevik N, Börjesson A, Choong E, Ekström L, Lehtihet M. Impact of single-dose nandrolone decanoate on gonadotropins, blood lipids and HMG CoA reductase in healthy men. Andrologia 2015; 48:595-600. [DOI: 10.1111/and.12488] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 01/17/2023] Open
Affiliation(s)
- N. Gårevik
- Division of Clinical Pharmacology; Department of Laboratory Medicine/Huddinge; Karolinska Institute; Karolinska University Hospital; Huddinge Sweden
| | - A. Börjesson
- Division of Clinical Pharmacology; Department of Laboratory Medicine/Huddinge; Karolinska Institute; Karolinska University Hospital; Huddinge Sweden
| | - E. Choong
- Division of Clinical Pharmacology; Department of Laboratory Medicine/Huddinge; Karolinska Institute; Karolinska University Hospital; Huddinge Sweden
| | - L. Ekström
- Division of Clinical Pharmacology; Department of Laboratory Medicine/Huddinge; Karolinska Institute; Karolinska University Hospital; Huddinge Sweden
| | - M. Lehtihet
- Department of Medicine/Huddinge; Karolinska Institute and Centre for Andrology and Sexual Medicine; Karolinska University Hospital; Huddinge Sweden
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Nieschlag E, Vorona E. Doping with anabolic androgenic steroids (AAS): Adverse effects on non-reproductive organs and functions. Rev Endocr Metab Disord 2015; 16:199-211. [PMID: 26373946 DOI: 10.1007/s11154-015-9320-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Since the 1970s anabolic androgenic steroids (AAS) have been abused at ever increasing rates in competitive athletics, in recreational sports and in bodybuilding. Exceedingly high doses are often consumed over long periods, in particular by bodybuilders, causing acute or chronic adverse side effects frequently complicated by additional polypharmacy. This review summarizes side effects on non-reproductive organs and functions; effects on male and female reproduction have been recently reviewed in a parallel paper. Among the most striking AAS side effects are increases in haematocrit and coagulation causing thromboembolism, intracardiac thrombosis and stroke as well as other cardiac disturbances including arrhythmias, cardiomyopathies and possibly sudden death. 17α-alkylated AAS are liver toxic leading to cholestasis, peliosis, adenomas and carcinomas. Hyperbilirubinaemia can cause cholemic nephrosis and kidney failure. AAS abuse may induce exaggerated self-confidence, reckless behavior, aggressiveness and psychotic symptoms. AAS withdrawal may be accompanied by depression and suicidal intentions. Since AAS abuse is not or only reluctantly admitted physicians should be aware of the multitude of serious side effects when confronted with unclear symptoms.
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Affiliation(s)
- Eberhard Nieschlag
- Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany.
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Elena Vorona
- Centre of Endocrinology, Diabetology and Rheumatology, Dortmund, Germany
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Nieschlag E, Vorona E. MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. Eur J Endocrinol 2015; 173:R47-58. [PMID: 25805894 DOI: 10.1530/eje-15-0080] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/24/2015] [Indexed: 01/30/2023]
Abstract
Anabolic androgenic steroids (AASs) are appearance and performance-enhancing drugs (APEDs) used in competitive athletics, in recreational sports, and by body-builders. The global lifetime prevalence of AASs abuse is 6.4% for males and 1.6% for women. Many AASs, often obtained from the internet and dubious sources, have not undergone proper testing and are consumed at extremely high doses and in irrational combinations, also along with other drugs. Controlled clinical trials investigating undesired side effects are lacking because ethical restrictions prevent exposing volunteers to potentially toxic regimens, obscuring a causal relationship between AASs abuse and possible sequelae. Because of the negative feedback in the regulation of the hypothalamic-pituitary-gonadal axis, in men AASs cause reversible suppression of spermatogenesis, testicular atrophy, infertility, and erectile dysfunction (anabolic steroid-induced hypogonadism). Should spermatogenesis not recover after AASs abuse, a pre-existing fertility disorder may have resurfaced. AASs frequently cause gynecomastia and acne. In women, AASs may disrupt ovarian function. Chronic strenuous physical activity leads to menstrual irregularities and, in severe cases, to the female athlete triad (low energy intake, menstrual disorders and low bone mass), making it difficult to disentangle the effects of sports and AASs. Acne, hirsutism and (irreversible) deepening of the voice are further consequences of AASs misuse. There is no evidence that AASs cause breast carcinoma. Detecting AASs misuse through the control network of the World Anti-Doping Agency (WADA) not only aims to guarantee fair conditions for athletes, but also to protect them from medical sequelae of AASs abuse.
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Affiliation(s)
- Eberhard Nieschlag
- Centre of Reproductive Medicine and AndrologyUniversity of Münster, 48129 Münster, GermanyCenter of Excellence in Genomic Medicine ResearchKing Abdulaziz University, Jeddah, Saudi ArabiaCentre of EndocrinologyDiabetology and Rheumatology, Dortmund, Germany Centre of Reproductive Medicine and AndrologyUniversity of Münster, 48129 Münster, GermanyCenter of Excellence in Genomic Medicine ResearchKing Abdulaziz University, Jeddah, Saudi ArabiaCentre of EndocrinologyDiabetology and Rheumatology, Dortmund, Germany
| | - Elena Vorona
- Centre of Reproductive Medicine and AndrologyUniversity of Münster, 48129 Münster, GermanyCenter of Excellence in Genomic Medicine ResearchKing Abdulaziz University, Jeddah, Saudi ArabiaCentre of EndocrinologyDiabetology and Rheumatology, Dortmund, Germany
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30
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Strahm E, Mullen JE, Gårevik N, Ericsson M, Schulze JJ, Rane A, Ekström L. Dose-dependent testosterone sensitivity of the steroidal passport and GC-C-IRMS analysis in relation to the UGT2B17 deletion polymorphism. Drug Test Anal 2015. [DOI: 10.1002/dta.1841] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Emmanuel Strahm
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; SE-141 86 Stockholm Sweden
| | - Jenny E. Mullen
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; SE-141 86 Stockholm Sweden
| | - Nina Gårevik
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; SE-141 86 Stockholm Sweden
| | - Magnus Ericsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; SE-141 86 Stockholm Sweden
| | - Jenny J. Schulze
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; SE-141 86 Stockholm Sweden
| | - Anders Rane
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; SE-141 86 Stockholm Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical Pharmacology; Karolinska Institutet; SE-141 86 Stockholm Sweden
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31
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Kanayama G, Hudson JI, DeLuca J, Isaacs S, Baggish A, Weiner R, Bhasin S, Pope HG. Prolonged hypogonadism in males following withdrawal from anabolic-androgenic steroids: an under-recognized problem. Addiction 2015; 110:823-31. [PMID: 25598171 PMCID: PMC4398624 DOI: 10.1111/add.12850] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/29/2014] [Accepted: 01/08/2015] [Indexed: 11/30/2022]
Abstract
AIMS To assess the frequency and severity of hypogonadal symptoms in male long-term anabolic-androgenic steroid (AAS) misusers who have discontinued AAS use. DESIGN Cross-sectional, naturalistic. SETTING Out-patient facility. PARTICIPANTS Twenty-four male former long-term AAS users and 36 non-AAS-using weightlifters, recruited by advertisement in Massachusetts, USA. Five of the former users were currently receiving treatment with physiological testosterone replacement, leaving 19 untreated users for the numerical comparisons below. MEASUREMENTS The Structured Clinical Interview for DSM-IV, questions regarding history of AAS use, physical examination, serum hormone determinations and the International Index of Erectile Function (IIEF). FINDINGS Compared with the 36 non-AAS-using weightlifters, the 19 untreated former AAS users displayed significantly smaller testicular volumes [estimated difference, 95% confidence interval (CI) = 2.3 (0.1, 4.5) ml; P = 0.042] and lower serum testosterone levels [estimated difference: 95% CI = 131 (25, 227) dl; P = 0.009], with five users showing testosterone levels below 200 ng/dl despite abstinence from AAS for 3-26 months. Untreated former users also displayed significantly lower scores on the IIEF sexual desire subscale [estimated difference: 95% CI = 2.4 (1.3, 3.4) points on a 10-point scale; P < 0.001]. In the overall group of 24 treated plus untreated former users, seven (29%) had experienced major depressive episodes during AAS withdrawal; four of these had not experienced major depressive episodes at any other time. Two men (8%) had failed to regain normal libidinal or erectile function despite adequate replacement testosterone treatment. CONCLUSIONS Among long-term anabolic-androgenic steroid misusers, anabolic-androgenic steroid-withdrawal hypogonadism appears to be common, frequently prolonged and associated with substantial morbidity.
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Affiliation(s)
- Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, and the Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - James I. Hudson
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, and the Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - James DeLuca
- Division of Cardiology, Massachusetts General Hospital, Boston, MA and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Stephanie Isaacs
- Division of Cardiology, Massachusetts General Hospital, Boston, MA and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, MA and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Rory Weiner
- Division of Cardiology, Massachusetts General Hospital, Boston, MA and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Harrison G. Pope
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, and the Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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32
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Kuuranne T, Saugy M, Baume N. Confounding factors and genetic polymorphism in the evaluation of individual steroid profiling. Br J Sports Med 2015; 48:848-55. [PMID: 24764553 PMCID: PMC4033181 DOI: 10.1136/bjsports-2014-093510] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the fight against doping, steroid profiling is a powerful tool to detect drug misuse with endogenous anabolic androgenic steroids. To establish sensitive and reliable models, the factors influencing profiling should be recognised. We performed an extensive literature review of the multiple factors that could influence the quantitative levels and ratios of endogenous steroids in urine matrix. For a comprehensive and scientific evaluation of the urinary steroid profile, it is necessary to define the target analytes as well as testosterone metabolism. The two main confounding factors, that is, endogenous and exogenous factors, are detailed to show the complex process of quantifying the steroid profile within WADA-accredited laboratories. Technical aspects are also discussed as they could have a significant impact on the steroid profile, and thus the steroid module of the athlete biological passport (ABP). The different factors impacting the major components of the steroid profile must be understood to ensure scientifically sound interpretation through the Bayesian model of the ABP. Not only should the statistical data be considered but also the experts in the field must be consulted for successful implementation of the steroidal module.
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Affiliation(s)
- Tiia Kuuranne
- Doping Control Laboratory, United Medix Laboratories Ltd., , Helsinki, Finland
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33
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Donner DG, Beck BR, Bulmer AC, Lam AK, Du Toit EF. Improvements in body composition, cardiometabolic risk factors and insulin sensitivity with trenbolone in normogonadic rats. Steroids 2015; 94:60-9. [PMID: 25554582 DOI: 10.1016/j.steroids.2014.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/11/2014] [Accepted: 12/17/2014] [Indexed: 11/24/2022]
Abstract
Trenbolone (TREN) is used for anabolic growth-promotion in over 20 million cattle annually and continues to be misused for aesthetic purposes in humans. The current study investigated TREN's effects on body composition and cardiometabolic risk factors; and its tissue-selective effects on the cardiovascular system, liver and prostate. Male rats (n=12) were implanted with osmotic infusion pumps delivering either cyclodextrin vehicle (CTRL) or 2mg/kg/day TREN for 6 weeks. Dual-energy X-ray Absorptiometry assessment of body composition; organ wet weights and serum lipid profiles; and insulin sensitivity were assessed. Cardiac ultrasound examinations were performed before in vivo studies assessed myocardial susceptibility to ischemia-reperfusion (I/R) injury. Circulating sex hormones and liver enzyme activities; and prostate and liver histology were examined. In 6 weeks, fat mass increased by 34±7% in CTRLs (p<0.01). Fat mass decreased by 37±6% and lean mass increased by 11±4% with TREN (p<0.05). Serum triglycerides, HDL and LDL were reduced by 62%, 57% and 78% (p<0.05) respectively in TREN rats. Histological examination of the prostates from TREN-treated rats indicated benign hyperplasia associated with an increased prostate mass (149% compared to CTRLs, p<0.01). No evidence of adverse cardiac or hepatic effects was observed. In conclusion, improvements in body composition, lipid profile and insulin sensitivity (key risk factors for cardiometabolic disease) were achieved with six-week TREN treatment without evidence of adverse cardiovascular or hepatic effects that are commonly associated with traditional anabolic steroid misuse. Sex hormone suppression and benign prostate hyperplasia were confirmed as adverse effects of the treatment.
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Affiliation(s)
- Daniel G Donner
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia.
| | - Belinda R Beck
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Andrew C Bulmer
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Alfred K Lam
- Cancer Molecular Pathology, School of Medicine, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Eugene F Du Toit
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
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34
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Gårevik N, Rane A, Björkhem-Bergman L, Ekström L. Effects of different doses of testosterone on gonadotropins, 25-hydroxyvitamin D3, and blood lipids in healthy men. Subst Abuse Rehabil 2014; 5:121-7. [PMID: 25525405 PMCID: PMC4266340 DOI: 10.2147/sar.s71285] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS To study the effect and time profile of different doses of testosterone enanthate on the blood lipid profile and gonadotropins. EXPERIMENTAL DESIGN Twenty-five healthy male volunteers aged 27-43 years were given 500 mg, 250 mg, and 125 mg of testosterone enanthate as single intramuscular doses of Testoviron(®) Depot. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), blood lipid profile (total cholesterol, plasma [p-] low-density lipoprotein, p-high-density lipoprotein [HDL], p-apolipoprotein A1 [ApoA1], p-apolipoprotein B, p-triglycerides, p-lipoprotein(a), serum [s-] testosterone, and 25-hydroxyvitamin D3) were analyzed prior to, and 4 and 14 days after dosing. Testosterone and epitestosterone in urine (testosterone/epitestosterone ratio) were analyzed prior to each dose after a washout period of 6-8 weeks. RESULTS AND DISCUSSION All doses investigated suppressed the LH and FSH concentrations in serum. LH remained suppressed 6 weeks after the 500 mg dose. These results indicate that testosterone has a more profound endocrine effect on the hypothalamic-pituitary-gonadal axis than was previously thought. There was no alteration in 25-hydroxyvitamin D3 levels after testosterone administration compared to baseline levels. The 250 and 500 mg doses induced decreased concentrations of ApoA1 and HDL, whereas the lowest dose (125 mg) did not have any effect on the lipid profile. CONCLUSION The single doses of testosterone produced a dose-dependent increase in serum testosterone concentrations together with suppression of s-LH and s-FSH. Alterations in ApoA1 and HDL were observed after the two highest single doses. It is possible that long-time abuse of anabolic androgenic steroids will lead to alteration in vitamin D status. Knowledge and understanding of the side effects of anabolic androgenic steroids are important to the treatment and care of abusers of testosterone.
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Affiliation(s)
- Nina Gårevik
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Abstract
Objective. The aim of this study was to investigate the hematopoietic profile in AAS abusers, during or short after their last abuse and approximately six months later. Moreover, we studied if supraphysiological doses of testosterone influence the concentration of hemoglobin and erythropoietin in healthy volunteers. Design and Methods. Subjects (N=31) were recruited through an antidoping hotline. The hematological profile was measured when the subjects entered the study and approximately 6 months later. Testosterone enanthate (500 mg) was administered to healthy volunteers (N=24). Gene expression was studied in human hek293 cells exposed to 1 μM testosterone. Results. Decreased levels of hemoglobin, erythrocyte volume fraction, and erythrocyte counts were observed after 6 months without the use of AAS. Results in volunteers show that hemoglobin increased 3% four and 15 days after testosterone administration, whereas EPO was significantly increased by 38% four days after dose. Agreeingly, in vitro study shows that testosterone induces the mRNA level of EPO with 65% after 24-hour exposure. Conclusion. These results indicate that supraphysiological doses of testosterone may cause a perturbation in the hematopoietic profile. This is of interest in relation to the adverse cardiovascular effects observed in AAS abusers.
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Pope HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev 2014; 35:341-75. [PMID: 24423981 PMCID: PMC4026349 DOI: 10.1210/er.2013-1058] [Citation(s) in RCA: 332] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the high prevalence of performance-enhancing drug (PED) use, media attention has focused almost entirely on PED use by elite athletes to illicitly gain a competitive advantage in sports, and not on the health risks of PEDs. There is a widespread misperception that PED use is safe or that adverse effects are manageable. In reality, the vast majority of PED users are not athletes but rather nonathlete weightlifters, and the adverse health effects of PED use are greatly underappreciated. This scientific statement synthesizes available information on the medical consequences of PED use, identifies gaps in knowledge, and aims to focus the attention of the medical community and policymakers on PED use as an important public health problem. PED users frequently consume highly supraphysiologic doses of PEDs, combine them with other PEDs and/or other classical drugs of abuse, and display additional associated risk factors. PED use has been linked to an increased risk of death and a wide variety of cardiovascular, psychiatric, metabolic, endocrine, neurologic, infectious, hepatic, renal, and musculoskeletal disorders. Because randomized trials cannot ethically duplicate the large doses of PEDs and the many factors associated with PED use, we need observational studies to collect valid outcome data on the health risks associated with PEDs. In addition, we need studies regarding the prevalence of PED use, the mechanisms by which PEDs exert their adverse health effects, and the interactive effects of PEDs with sports injuries and other high-risk behaviors. We also need randomized trials to assess therapeutic interventions for treating the adverse effects of PEDs, such as the anabolic-androgen steroid withdrawal syndrome. Finally, we need to raise public awareness of the serious health consequences of PEDs.
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Affiliation(s)
- Harrison G Pope
- McLean Hospital (H.G.P.), Harvard Medical School, Belmont, Massachusetts 02478; University of Southern California (R.I.W.), Los Angeles, California 90089; University of Virginia (A.R.), Charlottesville, Virginia 22904; Department of Pharmaceutical Biosciences, (F.N.), Upsala University, SE-751 24, Upsala, Sweden; United States Anti-Doping Agency (L.B.), Colorado Springs, Colorado 80919; and Brigham and Women's Hospital (S.B.), Harvard Medical School, Boston, Massachusetts 02115
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Rahnema CD, Lipshultz LI, Crosnoe LE, Kovac JR, Kim ED. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril 2014; 101:1271-9. [PMID: 24636400 DOI: 10.1016/j.fertnstert.2014.02.002] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/26/2014] [Accepted: 02/04/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management. DESIGN Review of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria. SETTING Not applicable. PATIENT(S) Men seeking treatment for symptomatic hypogonadism who have used nonprescribed AAS. INTERVENTION(S) History and physical examination followed by medical intervention if necessary. MAIN OUTCOME MEASURES(S) Serum testosterone and gonadotropin levels, symptoms, and fertility restoration. RESULT(S) Symptomatic hypogonadism is a potential consequence of AAS use and may depend on dose, duration, and type of AAS used. Complete endocrine and metabolic assessment should be conducted. Management strategies for anabolic steroid-associated hypogonadism (ASIH) include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators. CONCLUSION(S) Although complications of AAS use are variable and patient specific, they can be successfully managed. Treatment of ASIH depends on the type and duration of AAS use. Specific details regarding a patient's AAS cycle are important in medical management.
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Affiliation(s)
- Cyrus D Rahnema
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Lindsey E Crosnoe
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Jason R Kovac
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Edward D Kim
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee.
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Grönbladh A, Johansson J, Kushnir MM, Bergquist J, Hallberg M. The impact of nandrolone decanoate and growth hormone on biosynthesis of steroids in rats. Steroids 2013; 78:1192-9. [PMID: 24012727 DOI: 10.1016/j.steroids.2013.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/10/2013] [Accepted: 08/19/2013] [Indexed: 11/23/2022]
Abstract
Growth hormone (GH) and anabolic androgenic steroids (AAS) are commonly used in sports communities. Several studies have suggested an association between GH and AAS. We have investigated the impact of GH in rats treated with nandrolone decanoate (ND). Male Wistar rats received ND (15 mg/kg) every third day during three weeks and were subsequently treated with recombinant human GH (1.0I U/kg) for ten consecutive days. Plasma samples were collected and peripheral organs (i.e. heart, liver, testis and thymus) were dissected and weighed. Concentration of thirteen endogenous steroids was measured in the rat plasma samples using high specificity LC-MS/MS methods. Seven steroids were detected and quantified, and concentrations of estrone, testosterone, and androstenedione were significantly different among the groups, while concentrations of pregnenolone, DHEA, 17-hydroxyprogesterone and corticosterone were not altered. Administration of rhGH alone altered the plasma steroid distribution, and the results demonstrated significantly increased concentrations of plasma estrone as well as decreased concentrations of testosterone and androstenedione in the ND-treated rats. Administration of rhGH to ND-pretreated rats did not reverse the alteration of the steroid distribution induced by ND. Administration of ND decreased the weight of the thymus, and addition of rhGH did not reverse this reduction. However, rhGH administration induced an enlargement of thymus. Taken together, the plasma steroid profile differed in the four groups, i.e. control, AAS, rhGH and the combination of AAS and rhGH treatment.
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Affiliation(s)
- Alfhild Grönbladh
- Department of Pharmaceutical Biosciences, Division of Biological Research on Drug Dependence, Uppsala University, P.O. Box 591, SE-751 24 Uppsala, Sweden.
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Strahm E, Sjöberg U, Garle M, Rane A, Ekström L. Implication of Human UGT2B7, 2B15, and 2B17 in 19-Norandrosterone Metabolism. Front Endocrinol (Lausanne) 2013; 4:75. [PMID: 23805127 PMCID: PMC3693077 DOI: 10.3389/fendo.2013.00075] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/07/2013] [Indexed: 11/25/2022] Open
Abstract
Nandrolone (19-nortestosterone) is an anabolic androgenic steroid commonly abused for doping purposes. Nandrolone is mainly metabolized in the liver into 19-norandrosterone prior to glucuronidation and excretion through urine over an extended period of time. Several UGTs (i.e., UGT2B7, UGT2B15, and UGT2B17) are thought to be the major enzymes responsible for conjugation of androgens in human. An in vitro study using recombinant enzymes expressed in insect cells showed that UGT1A4 and UGT2B7 are the two main enzymes responsible of 19-norandrosterone glucuronidation. However, the identity of the enzyme involved in nandrolone metabolism in vivo together with their relative contribution and regulation remain unknown. Inhibition assays using human liver microsomes (HLM) incubated with 19-norandrosterone and selective inhibitors confirmed that UGT2B7 and UGT2B15 are involved in 19-norandrosterone glucuronidation, since the presence of the specific UGT2B7 and UGT2B15 inhibitors gemfibrozil and valproic acid inhibited the 19-norandrosterone glucuronidation by 35 and 45%, respectively. HLM were genotyped for UGT2B15 D85Y, UGT2B7 H268Y, and the UGT2B17 deletion polymorphism. The glucuronidation activity on 19-norandrosterone was significantly higher in UGT2B15 DD than in the other UGT2B15 genotypes (p < 0.05). Moreover, human liver cancer HepG2 cells were exposed to androgens to determine if the transcriptional activity of the genes of interest was affected. Only UGT2B7 mRNA expression was significantly increased (1.8-folds) after incubation with nandrolone decanoate. These results show that the UGT2B7 and UGT2B15 are involved in 19-norandrosterone glucuronidation and that the UGT2B15 polymorphism (D85Y) is the only UGT genetic variation that influences the glucuronidation activity. This could partly explain the inter-individual variation in 19-norandrosterone excretion.
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Affiliation(s)
- Emmanuel Strahm
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Emmanuel Strahm, Division of Clinical Pharmacology, Karolinska Institutet, 141 86 Stockholm, Sweden e-mail:
| | - Ulf Sjöberg
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Garle
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Thevis M, Kuuranne T, Geyer H, Schänzer W. Annual banned-substance review: analytical approaches in human sports drug testing. Drug Test Anal 2012; 5:1-19. [DOI: 10.1002/dta.1441] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/02/2012] [Indexed: 12/12/2022]
Affiliation(s)
| | - Tiia Kuuranne
- Doping Control Laboratory, United Medix Laboratories; Höyläämötie 14; 00380; Helsinki; Finland
| | - Hans Geyer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Am Sportpark Müngersdorf 6; 50933; Cologne; Germany
| | - Wilhelm Schänzer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Am Sportpark Müngersdorf 6; 50933; Cologne; Germany
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Abstract
The large variation in disposition known for most drugs is also true for anabolic androgenic steroids. Genetic factors are probably the single most important cause of this variation. Further, there are reasons to believe that there is a corresponding variation in efficacy of doping agents. Doped individuals employ a large variety of doping strategies in respect of choice of substance, dose, dose interval, duration of treatment and use of other drugs for enforcement of effects or correction of side effects. Metabolic steps up-stream and down-stream of testosterone are genetically variable and contribute substantially to the variation in disposition of testosterone, the most common doping agent in sports and in society. Large inter- and intra-ethnic variation in testosterone glucuronidation and excretion is described as well as the pit-falls in evaluation of testosterone doping test results. The hydrolysis and bioactivation of testosterone enanthate is also genetically variable yielding a 2-3 fold variation in excretion rate and serum concentration, thereby implicating a substantial variation in 'efficacy' of testosterone. Given this situation it is logical to adopt the new findings in the doping control programme. The population based cut-off level for the testosterone : epitestosterone ratio should be replaced by a Bayesian interpretation of consecutive tests in the same individual. When combined with the above genetic information the sensitivity of the test is considerably improved. The combination of the three approaches should reduce the rate of falsely negative or positive results and the number of expensive follow-up tests, stipulated by the World Anti-Doping Agency.
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Affiliation(s)
- Anders Rane
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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Abstract
PURPOSE OF REVIEW To summarize recent advances in studies of illicit use of androgens and other hormones. RECENT FINDINGS Androgens and other appearance-enhancing and performance-enhancing substances are widely abused worldwide. Three notable clusters of findings have emerged in this field in recent years. First, studies almost unanimously find that androgen users engage in polypharmacy, often ingesting other hormones (e.g., human growth hormone, thyroid hormones, and insulin), ergo/thermogenic drugs (e.g., caffeine, ephedrine, and clenbuterol), and classical drugs of abuse (e.g., cannabis, opiates, and cocaine). Second, reports of long-term psychiatric and medical adverse effects of androgens continue to accumulate. In cardiovascular research particularly, controlled studies have begun to supersede anecdotal evidence, strengthening the case that androgens (possibly acting synergistically with other abused drugs) may cause significant morbidity and even mortality. Third, it is increasingly recognized that androgen use may lead to a dependence syndrome with both psychological and physiological origins. Androgen dependence likely affects some millions of individuals worldwide, and arguably represents the least studied major class of illicit drug dependence. SUMMARY Given mounting evidence of the adverse effects of androgens and associated polypharmacy, this topic will likely represent an expanding area of research and an issue of growing public health concern.
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Affiliation(s)
- Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02478, USA
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