1
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Naughton M, Salmon PM, Kerhervé HA, McLean S. Applying a systems thinking lens to anti-doping: A systematic review identifying the contributory factors to doping in sport. J Sports Sci 2024:1-15. [PMID: 38284139 DOI: 10.1080/02640414.2024.2306056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 01/06/2024] [Indexed: 01/30/2024]
Abstract
The use of performance enhancing substances and methods (known as "doping") in sport is an intractable issue, with current anti-doping strategies predominantly focused on the personal responsibility and strict liability of individual athletes. This is despite an emerging understanding that athletes exist as part of a broader complex sports system that includes governance, policymakers, media, sponsors, clubs, team members, and athlete support staff, to name a few. As such, there is a need to examine the broader systemic factors that influence doping in sport. The aim of this systematic review was to identify and synthesise the factors contributing to doping and doping behaviours, attitudes, and beliefs and the extent to which this knowledge extends beyond the athlete to consider broader sports systems. The review followed PRISMA guidelines with risk of bias and study quality assessed by the Mixed Methods Appraisal Tool, and identified contributory factors synthesised and mapped onto a systems thinking-based framework. Overall, the included studies were determined to be of high quality. Support personnel, the coach, and the coach-athlete relationship represent key influences on the athletes' decisions to dope. From the evidence presented, doping is an emergent property of sport systems and represents a complex systemic problem that will require whole-of-system interventions. The implications for this and the focus of future research are discussed.
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Affiliation(s)
- Mitchell Naughton
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Maroochydore, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
- Applied Sports Science and Exercise Testing Laboratory, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Maroochydore, Australia
| | - Hugo A Kerhervé
- Movement, Sport and Health Sciences Laboratory, University of Rennes, Rennes, France
| | - Scott McLean
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Maroochydore, Australia
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2
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McLean S, Naughton M, Kerhervé H, Salmon PM. From Anti-doping-I to Anti-doping-II: Toward a paradigm shift for doping prevention in sport. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104019. [PMID: 37028132 DOI: 10.1016/j.drugpo.2023.104019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
Doping remains an intractable issue in sport and occurs in a complex and dynamic environment comprising interactions between individual, situational, and environmental factors. Anti-doping efforts have previously predominantly focused on athlete behaviours and sophisticated detection methods, however, doping issues remain. As such, there is merit in exploring an alternative approach. The aim of this study was to apply a systems thinking approach to model the current anti-doping system for four football codes in Australia, using the Systems Theoretic Accident Model and Processes (STAMP). The STAMP control structure was developed and validated by eighteen subject matter experts across a five-phase validation process. Within the developed model, education was identified as a prominent approach anti-doping authorities use to combat doping. Further, the model suggests that a majority of existing controls are reactive, and hence that there is potential to employ leading indicators to proactively prevent doping and that new incident reporting systems could be developed to capture such information. It is our contention that anti-doping research and practice should consider a shift away from the current reactive and reductionist approach of detection and enforcement to a proactive and systemic approach focused on leading indicators. This will provide anti-doping agencies a new lens to look at doping in sport.
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3
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Doping and sports endocrinology: anabolic-androgenic steroids. Rev Clin Esp 2022; 222:612-620. [PMID: 36400345 DOI: 10.1016/j.rceng.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
The use of anabolic steroids affects not only professional athletes but also the general population (bodybuilders, gym clients, and adolescents). In the first case, its use is prohibited and sanctioned by the World Anti-Doping Agency and Olympic committees. For the other users, it is difficult to establish its prevalence since many obtain the products via the internet. The reasons for its use are varied and different forms of use and other types of users have been described. Among the side effects of steroid use, hypogonadism is the most frequent cause for endocrinological consultation. After a general introduction to doping, this review describes the historical background of anabolic-androgenic steroids, their classification, forms of use, physiological effects, adverse effects on different organs and systems, treatment of hypogonadism, as well as detection methods.
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4
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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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5
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García-Arnés J, García-Casares N. Endocrinología del dopaje y los deportes: andrógenos anabolizantes. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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6
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Amaral JMX, Deslandes AC, Padilha MC, Vieira Neto L, Osorio LE, Aquino Neto FR, Cruz MS. No association between psychiatric symptoms and doses of anabolic steroids in a cohort of male and female bodybuilders. Drug Test Anal 2022; 14:1079-1088. [PMID: 35092181 PMCID: PMC9303351 DOI: 10.1002/dta.3230] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022]
Abstract
The use of androgenic‐anabolic steroids (AAS) can be associated with psychiatric symptoms such as insomnia, anxiety and increased aggressiveness. Although dose‐dependent effects have been observed in some controlled studies, this association is not always seen in the ecological use of AAS. This study utilized WADA's steroid profile of suspicious use of AAS, urinary detection of AAS metabolites and measurement of sexual hormones to confirm recent use of AAS in a cohort of 103 bodybuilders (75 males, 28 females). The majority of participants (61.2%) presented symptoms of agitation, insomnia, increased aggressiveness or depression in the last 3 months. About one‐third of participants presented scores on the HAM‐A anxiety scale equivalent to moderate to severe symptoms of anxiety. A minority of participants (12.6%) presented high to moderate scores on the BPQ aggressiveness scale. The majority of participants (73.8%) presented hyperthymic temperament in the BRIEF‐TEMPS scale. There was no significant difference in the presence of psychiatric symptoms between males and females and no association between psychiatric symptoms and estimated weekly doses of AAS. A negative association was observed between scores on the BPQ scale (verbal aggression, anger and total score) and the time of AAS use. We discuss differences of AAS use between male and female bodybuilders and the screening of AAS use in the general population. Our findings highlight the importance of mental health awareness among people using AAS.
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Affiliation(s)
- JMX Amaral
- King’s College London. Institute of Psychiatry, Psychology and Neurosciences (IoPPN) London UK
- Federal University of Rio de Janeiro (UFRJ) ‐ Institute of Psychiatry Rio de Janeiro Brazil
| | - A. C. Deslandes
- Federal University of Rio de Janeiro (UFRJ) ‐ Institute of Psychiatry Rio de Janeiro Brazil
| | - M. C. Padilha
- Federal University of Rio de Janeiro – Chemistry Institute ‐ Brazilian Laboratory of Doping Control (LBCD – LADETEC, IQ ‐ UFRJ) Rio de Janeiro Brazil
| | - L. Vieira Neto
- Federal University of Rio de Janeiro (UFRJ) ‐ Department of Internal Medicine Rio de Janeiro Brazil
| | - L. E. Osorio
- Federal University of Rio de Janeiro (UFRJ) ‐ Department of Internal Medicine Rio de Janeiro Brazil
| | - F. R. Aquino Neto
- Federal University of Rio de Janeiro – Chemistry Institute ‐ Brazilian Laboratory of Doping Control (LBCD – LADETEC, IQ ‐ UFRJ) Rio de Janeiro Brazil
| | - M. S. Cruz
- Federal University of Rio de Janeiro (UFRJ) ‐ Institute of Psychiatry Rio de Janeiro Brazil
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7
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Huml L, Tauchen J, Rimpelová S, Holubová B, Lapčík O, Jurášek M. Advances in the Determination of Anabolic-Androgenic Steroids: From Standard Practices to Tailor-Designed Multidisciplinary Approaches. SENSORS (BASEL, SWITZERLAND) 2021; 22:4. [PMID: 35009549 PMCID: PMC8747103 DOI: 10.3390/s22010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022]
Abstract
Anabolic-androgenic steroids (AASs), a group of compounds frequently misused by athletes and, unfortunately, also by the general population, have lately attracted global attention; thus, significant demands for more precise, facile, and rapid AAS detection have arisen. The standard methods ordinarily used for AAS determination include liquid and gas chromatography coupled with mass spectrometry. However, good knowledge of steroid metabolism, pretreatment of samples (such as derivatization), and well-trained operators of the instruments are required, making this procedure expensive, complicated, and not routinely applicable. In the drive to meet current AAS detection demands, the scientific focus has shifted to developing novel, tailor-made approaches leading to time- and cost-effective, routine, and field-portable methods for AAS determination in various matrices, such as biological fluids, food supplements, meat, water, or other environmental components. Therefore, herein, we present a comprehensive review article covering recent advances in AAS determination, with a strong emphasis on the increasingly important role of chemically designed artificial sensors, biosensors, and antibody- and fluorescence-based methods.
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Affiliation(s)
- Lukáš Huml
- Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, 16628 Prague, Czech Republic; (O.L.); (M.J.)
| | - Jan Tauchen
- Department of Food Science, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, 16500 Prague, Czech Republic;
| | - Silvie Rimpelová
- Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, 16628 Prague, Czech Republic;
| | - Barbora Holubová
- Department of Biochemistry and Microbiology, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, 16628 Prague, Czech Republic;
| | - Oldřich Lapčík
- Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, 16628 Prague, Czech Republic; (O.L.); (M.J.)
| | - Michal Jurášek
- Department of Chemistry of Natural Compounds, Faculty of Food and Biochemical Technology, University of Chemistry and Technology Prague, 16628 Prague, Czech Republic; (O.L.); (M.J.)
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8
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Ekström L, Broström S, Dahl ML, Börjesson A. A Summary of Online Enquiries Submitted to Anti-doping Hotline 2005–2018. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:787954. [PMID: 36304044 PMCID: PMC9580816 DOI: 10.3389/frph.2021.787954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Anabolic Androgenic Steroid (AAS) abuse in the society is considered a health problem and has been associated with cardiovascular toxicity, endocrine disruption, as well as psychiatric symptoms such as aggression and cognitive dysfunction. Men and women abusing AAS, as well as persons in close relationship to AAS abusers, may encounter concerns. Subsequently, the Anti-Doping Hotline was formed 1993 to answers questions about doping in the society. Here we have reviewed 7,123 enquiries posted on the Anti-Doping Hotline website between 2005 and 2018 to see what type of questions were raised. Most questions (n = 2,924) involved AAS, 60% from abusers themselves, and 17% from a person close to an AAS abusers. Only 2.3% of the questions concerned AAS abusing women. Of the AAS specific questions most were from persons who sought personal advice regarding risks and side effects. Notably, the AAS abusers themselves were concerned about somatic side effects (e.g., gynecomastia) and problems related to the AAS injection. The persons in close relationship to an AAS abusers on the other hand, expressed concerns about psychiatric changes including mood swings and aggressivity. In addition to AAS, 26 and 13% of the questions involved dietary supplements and other doping substances, respectively. A gradual decrease of questions regarding ephedrine was noted, whereas the numbers of SARMs related questions increased during this time. Our results show that there is a continuous need to provide medical, nursing, and social support and counseling to AAS abusers and their next of kin.
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Affiliation(s)
- Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Broström
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Marja-Liisa Dahl
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Annica Börjesson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
- *Correspondence: Annica Börjesson
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9
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Lima G, Muniz-Pardos B, Kolliari-Turner A, Hamilton B, Guppy FM, Grivas G, Bosch A, Borrione P, DI Gianfrancesco A, Fossati C, Pigozzi F, Pitsiladis Y. Anti-doping and other sport integrity challenges during the COVID-19 pandemic. J Sports Med Phys Fitness 2021; 61:1173-1183. [PMID: 34256541 DOI: 10.23736/s0022-4707.21.12777-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The coronavirus disease (COVID-19) pandemic has had an unprecedent impact on the world of sport and society at large. Many of the challenges with respect to integrity previously facing competitive sport have been accentuated further during the pandemic. Threats to the integrity of sporting competition include traditional doping, issues of technological fairness, and integration of transgender and intersex athletes in elite sport. The enforced lull in competitive sport provides an unprecedented opportunity for stakeholders in sport to focus on unresolved integrity issues and develop and implement long-lasting solutions. There needs to be a concerted effort to focus on the many technological innovations accelerated by and perfected during COVID-19 that have enabled us to work from home, such as teaching students on-line, applications for medical advice, prescriptions and referrals, and treating patients in hospitals/care homes via video links and use these developments and innovations to enhance sport integrity and anti-doping procedures. Positive sports integrity actions will require a considered application of all such technology, as well as the inclusion of "omics" technology, big data, bioinformatics and machine learning/artificial intelligence approaches to modernize sport. Applications include protecting the health of athletes, considered non-discriminative integration of athletes into elite sport, intelligent remote testing to improve the frequency of anti-doping tests, detection windows, and the potential combination with omics technology to improve the tests' sensitivity and specificity in order to protect clean athletes and deter doping practices.
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Affiliation(s)
- Giscard Lima
- Foro Italico University of Rome, Rome, Italy.,Centre for Stress and Age Related Disease, University of Brighton, Brighton, UK.,School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
| | - Borja Muniz-Pardos
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Blair Hamilton
- Centre for Stress and Age Related Disease, University of Brighton, Brighton, UK.,School of Sport and Health Sciences, University of Brighton, Eastbourne, UK.,School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Fergus M Guppy
- Centre for Stress and Age Related Disease, University of Brighton, Brighton, UK.,School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Gerasimos Grivas
- Division of Humanities and Political Sciences, Department of Physical Education and Sports, Hellenic Naval Academy, Piraeus, Greece
| | - Andrew Bosch
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Borrione
- Foro Italico University of Rome, Rome, Italy.,NADO Italia, National Antidoping Organization, Rome, Italy
| | - Alessia DI Gianfrancesco
- Foro Italico University of Rome, Rome, Italy.,NADO Italia, National Antidoping Organization, Rome, Italy
| | - Chiara Fossati
- Foro Italico University of Rome, Rome, Italy.,NADO Italia, National Antidoping Organization, Rome, Italy
| | - Fabio Pigozzi
- Foro Italico University of Rome, Rome, Italy - .,Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Yannis Pitsiladis
- Foro Italico University of Rome, Rome, Italy.,Centre for Stress and Age Related Disease, University of Brighton, Brighton, UK.,International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
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10
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El Deib MM, El-Sharkawy NI, Beheiry RR, Abd-Elhakim YM, Ismail SA, Fahmy EM, Saber T, Saber TM. Boldenone undecylenate disrupts the immune system and induces autoimmune clinical hypothyroidism in rats: Vitamin C ameliorative effects. Int Immunopharmacol 2021; 99:107939. [PMID: 34224995 DOI: 10.1016/j.intimp.2021.107939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 12/20/2022]
Abstract
The present study was designed to evaluate the effects of boldenone undecylenate (BL) abuse alone and in combination with vitamin C (VC) on the immune responses and thyroid structure and function in rats. Thirty adult male Wistar rats were randomly divided into five equal groups and were subjected to various treatment regimens for eight weeks as follows: control group, vehicle control group, VC group orally received VC (120 mg/Kg BW/day), BL-treated group intramuscularly injected with BL (5 mg/kg BW, once/week), and BL+VC group received BL and VC. At the end of this experiment, blood and tissue samples (thyroid, thymus, and spleen) were subjected to hematological evaluation, biochemical analysis, histopathological, and immunohistochemical examinations. In comparison to controls, BL significantly increased the levels of serum proinflammatory interleukins (IL-1 β and IL-6), immunoglobulins (IgG and IgM), and complement 3 but reduced anti-inflammatory interleukin-10, lysosome, and nitric oxide. Besides, altered platelet count and leukogram were evident in BL-injected rats. BL notably disturbed thyroid profile as revealed by a significant increase of thyroid-stimulating hormone and thyroid peroxidase antibody. In contrast, both total and free forms of thyroid hormones (tri-iodothyronine and thyroxine), thyroglobulin, and thyroid peroxidase, were significantly decreased. Moreover, BL caused histopathological changes in the thyroid, thymus, and spleen tissues.CD4+ immuno-expression was reduced, but CD8+ immunolabelling was increased in both spleen and thymus. The daily dosing of VC to BL-exposed rats significantly corrected most of the deviations in immune parameters. It restored most of the thyroid architecture and function, revealing a significant protective effect of this vitamin. This experimental study demonstrates that BL abusing disrupts the immune system by different mechanisms and addresses BL, for the first time, as an autoimmune clinical hypothyroidism inducer drug. Additionally, VC is helpful in the management of BL abuse.
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Affiliation(s)
- Maha M El Deib
- Department of Biochemistry, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Nabela I El-Sharkawy
- Department of Forensic Medicine and Toxicology Faculty of Veterinary Medicine, Zagazig University, Egypt
| | - Rasha R Beheiry
- Department of Histology and Cytology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Yasmina M Abd-Elhakim
- Department of Forensic Medicine and Toxicology Faculty of Veterinary Medicine, Zagazig University, Egypt.
| | - Shimaa Aa Ismail
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Esraa M Fahmy
- Department of Pharmacology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Taisir Saber
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Taghred M Saber
- Department of Forensic Medicine and Toxicology Faculty of Veterinary Medicine, Zagazig University, Egypt
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11
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Haynes AZ, Levine M. Detection of anabolic steroids via cyclodextrin-promoted fluorescence modulation. RSC Adv 2020; 10:25108-25115. [PMID: 35517489 PMCID: PMC9055181 DOI: 10.1039/d0ra03485a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023] Open
Abstract
Reported herein is the detection of anabolic steroids through the use of cyclodextrin-promoted interactions between the analyte of interest and a high quantum yield fluorophore, which lead to measurable, analyte-specific changes in the fluorophore emission signal. By using a variety of β-cyclodextrin derivatives (unmodified β-cyclodextrin, methyl-β-cyclodextrin, and 2-hydroxypropyl-β-cyclodextrin) in combination with high quantum yield fluorophore rhodamine 6G, we detected five anabolic steroid analytes with 100% differentiation between structurally similar analytes and micromolar level limits of detection. Overall, these results show significant potential in the development of practical, fluorescence-based steroid detection devices.
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Affiliation(s)
- Anna Z Haynes
- University of Rhode Island, Department of Chemistry 140 Flagg Road Kingston RI 02881 USA
| | - Mindy Levine
- Ariel University, Department of Chemical Sciences 65 Ramat HaGolan Street Ariel Israel
- University of Rhode Island, Department of Chemistry 140 Flagg Road Kingston RI 02881 USA
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12
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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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13
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Anawalt BD. Diagnosis and Management of Anabolic Androgenic Steroid Use. J Clin Endocrinol Metab 2019; 104:2490-2500. [PMID: 30753550 PMCID: PMC6517163 DOI: 10.1210/jc.2018-01882] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/03/2019] [Indexed: 01/14/2023]
Abstract
CONTEXT The lifetime prevalence of anabolic androgenic steroid (AAS) use is estimated at 1% to 5% worldwide. AAS use occurs primarily male elite athletes and men who want a muscular appearance. The evidence for effective, safe management of AAS cessation and withdrawal is weak. DESIGN Key studies were extracted from PubMed (1990-2018) and Google Scholar with reference searches from relevant retrieved articles. RESULTS The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and defeminization in women, and erythrocytosis. Alkylated AASs that are taken orally may cause hepatopathy. There is an association between high-dosage AAS use and increased risk of cardiovascular disease. Clues for AAS use include very low serum high-density cholesterol and sex hormone-binding globulin concentrations and unexplained erythrocytosis. For elite athletes, the biological passport (monitoring of blood or urinary androgen and androgen precursor concentrations after determining the athlete's baseline) is useful for detecting AAS use. For nonelite athletes, the best method to confirm AAS use is to inquire in a nonjudgmental manner. Cessation of chronic AAS use is associated with a withdrawal syndrome of anxiety and depression. CONCLUSIONS Men who use AASs <1 year typically recover normal hypothalamic-pituitary-testicular axis function within 1 year after cessation. Men who have infertility due to high-dosage AAS use ≥1 year might benefit from short-term treatment with clomiphene or human chorionic gonadotropin.
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Affiliation(s)
- Bradley D Anawalt
- Department of Medicine, University of Washington, Seattle, Washington
- Correspondence and Reprint Requests: Bradley D. Anawalt, MD, Department of Medicine, University of Washington Medical Center, Box 356420, 1959 NE Pacific Street, Seattle, Washington 98195. E-mail:
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14
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Stolz A, Navarro V, Hayashi PH, Fontana RJ, Barnhart HX, Gu J, Chalasani NP, Vega MM, Bonkovsky HL, Seeff LB, Serrano J, Avula B, Khan I, Cirulli ET, Kleiner DE, Hoofnagle JH. Severe and protracted cholestasis in 44 young men taking bodybuilding supplements: assessment of genetic, clinical and chemical risk factors. Aliment Pharmacol Ther 2019; 49:1195-1204. [PMID: 30934130 PMCID: PMC6682544 DOI: 10.1111/apt.15211] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 02/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bodybuilding supplements can cause a profound cholestatic syndrome. AIM To describe the drug-Induced liver injury network's experience with liver injury due to bodybuilding supplements. METHODS Liver injury pattern, severity and outcomes, potential genetic associations, and exposure to anabolic steroids by product analysis were analysed in prospectively enrolled subjects with bodybuilding supplement-induced liver injury with causality scores of probable or higher. RESULTS Forty-four males (mean age 33 years) developed liver injury with a median latency of 73 days. Forty-one per cent presented with hepatocellular pattern of liver injury as defined by the R > 5 ([Fold elevation of ALT] ÷ [Fold elevation of Alk Phos] (mean, range = 6.4, 0.5-31.4, n = 42) despite all presenting with clinical features of cholestatic liver injury (100% with jaundice and 84% with pruritus). Liver biopsy (59% of subjects) demonstrated a mild hepatitis and profound cholestasis in most without bile duct injury, loss or fibrosis. Seventy-one per cent were hospitalised, and none died or required liver transplantation. In some, chemical analysis revealed anabolic steroid controlled substances not listed on the label. No enrichment of genetic variants associated with cholestatic syndromes was found, although mutations in ABCB11 (present in up to 20%) were significantly different than in ethnically matched controls. CONCLUSIONS Patients with bodybuilding supplements liver injury uniformly presented with cholestatic injury, which slowly resolved. The ingested products often contained anabolic steroids not identified on the label, and no enrichment in genetic variants was found, indicating a need for additional studies.
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Affiliation(s)
- Andrew Stolz
- University of Southern California, Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | - Jose Serrano
- Liver Diseases Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Bharathi Avula
- National Center for Natural Product Research, School of Pharmacy, University of Mississippi, University, MS
| | - Ikhlas Khan
- National Center for Natural Product Research, School of Pharmacy, University of Mississippi, University, MS
| | | | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Jay H. Hoofnagle
- Liver Diseases Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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15
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Thevis M, Kuuranne T, Geyer H. Annual banned-substance review: Analytical approaches in human sports drug testing. Drug Test Anal 2019; 11:8-26. [DOI: 10.1002/dta.2549] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/18/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Cologne Germany
- European Monitoring Center for Emerging Doping Agents; Cologne Germany
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses; University Center of Legal Medicine, Genève and Lausanne, Centre Hospitalier Universitaire Vaudois and University of Lausanne; Epalinges Switzerland
| | - Hans Geyer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Cologne Germany
- European Monitoring Center for Emerging Doping Agents; Cologne Germany
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16
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Basaria S. Use of performance-enhancing (and image-enhancing) drugs: A growing problem in need of a solution. Mol Cell Endocrinol 2018; 464:1-3. [PMID: 29426019 DOI: 10.1016/j.mce.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Shehzad Basaria
- Section of Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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