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Abstract
Androgens are potent drugs requiring prescription for valid medical indications but are misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit nonmedical application for performance or image enhancement. Following discovery and first clinical application of testosterone in the 1930s, commercialization of testosterone and synthetic androgens proliferated in the decades after World War II. It remains among the oldest marketed drugs in therapeutic use, yet after 8 decades of clinical use, the sole unequivocal indication for testosterone remains in replacement therapy for pathological hypogonadism, organic disorders of the male reproductive system. Nevertheless, wider claims assert unproven, unsafe, or implausible benefits for testosterone, mostly representing wishful thinking about rejuvenation. Over recent decades, this created an epidemic of testosterone misuse involving prescription as a revitalizing tonic for anti-aging, sexual dysfunction and/or obesity, where efficacy and safety remains unproven and doubtful. Androgen abuse originated during the Cold War as an epidemic of androgen doping among elite athletes for performance enhancement before the 1980s when it crossed over into the general community to become an endemic variant of drug abuse in sufficiently affluent communities that support an illicit drug industry geared to bodybuilding and aiming to create a hypermasculine body physique and image. This review focuses on the misuse of testosterone, defined as prescribing without valid clinical indications, and abuse of testosterone or synthetic androgens (androgen abuse), defined as the illicit use of androgens without prescription or valid indications, typically by athletes, bodybuilders and others for image-oriented, cosmetic, or occupational reasons.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, Australia.,Andrology Department, Concord Hospital, Sydney, Australia
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2
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Cannaert A, Vandeputte M, Wille SMR, Stove CP. Activity-based reporter assays for the screening of abused substances in biological matrices. Crit Rev Toxicol 2019; 49:95-109. [DOI: 10.1080/10408444.2019.1576588] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Toxicology, National Institute of Criminalistics and Criminology, Federal Public Service Justice, Brussels, Belgium
| | - Marthe Vandeputte
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Sarah M. R. Wille
- Department of Toxicology, National Institute of Criminalistics and Criminology, Federal Public Service Justice, Brussels, Belgium
| | - Christophe P. Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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3
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Xing Y, Liu X, Yan M, Chen T, Lu F, Xu B, Gong Y, Chu F, Lei H. Impact of nonsteroidal aromatase inhibitors on steroid profile in a Chinese population. Medicine (Baltimore) 2017; 96:e7411. [PMID: 28700478 PMCID: PMC5515750 DOI: 10.1097/md.0000000000007411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Steroid profiling was introduced to determine the endogenous steroid misuse in sports. Thus, screening for the exogenous use of these prohibited substances can be established by monitoring a range of endogenous steroids, which constitute the steroid profile and evaluate their concentrations and ratios against reference values. The steroid profiling is currently based on population statistics. As large interindividual variations exist, athlete biological passport (ABP) analysis is ongoing. This study aimed to identify new biomarker(s) for aromatase inhibitor detection in sports using statistical analysis and adapt the model into ABP analysis.Forty-one Chinese nonathlete volunteers (21 males and 20 females) were administered 3 nonsteroidal aromatase inhibitors (aminoglutethimide, letrozole, and anastrozole) independently. Statistical analysis was performed on 16 steroid profile parameters.After administration, the concentrations of endogenous androgen biomarkers including testosterone (T), epitestosterone, androsterone (AN), etiocholanolone (ETIO), 5α-diol, 5β-diol, and dehydroepiandrosterone were increased, while the level of estrogen was decreased. These biomarkers returned to the baselines levels within 1 month. In females, the concentrations of endogenous biomarkers were affected by nonsteroidal aromatase inhibitors, without a common trend. Three new endogenous biomarkers (AN/estrone, ETIO/estrone, and T/estrone) elevated significantly after treatment. The 3 new models were more sensitive than the World Anti-Doping Agency ratio biomarkers. They were also effective in exponentially weighted moving average chart analysis.Verification experiment demonstrated that the biomarker T/estrone was valid in judging the steroidal aromatase inhibitor abuse. The screening of these new endogenous biomarkers can provide additional parameters to support ABP monitoring and specific information regarding the administered steroids.
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Affiliation(s)
- Yanyi Xing
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
- National Anti-Doping Laboratory, China Anti-Doping Agency
| | - Xin Liu
- National Anti-Doping Laboratory, China Anti-Doping Agency
| | - Mengmeng Yan
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Tianqi Chen
- College of Applied Statistics, Beijing University of Technology, Beijing, China
| | - Fei Lu
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Bing Xu
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Yan Gong
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Fuhao Chu
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
| | - Haimin Lei
- School of Chinese Pharmacy, Beijing University of Chinese Medicine
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Handelsman DJ, Idan A, Grainger J, Goebel C, Turner L, Conway AJ. Detection and effects on serum and urine steroid and LH of repeated GnRH analog (leuprolide) stimulation. J Steroid Biochem Mol Biol 2014; 141:113-20. [PMID: 24495617 DOI: 10.1016/j.jsbmb.2014.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/21/2014] [Accepted: 01/27/2014] [Indexed: 12/14/2022]
Abstract
Non-steroidal drugs that increase endogenous testosterone (T) may be used to exploit ergogenic effects of androgens in power sports. While superactive GnRH analog use is suspected, neither screening nor detection tests are developed. This study aimed to determine if (a) stimulation for 5 days by leuprolide (a superactive GnRH analog) of serum and urine steroids and urine LH is reproducible at a 2 week interval, (b) nandrolone decanoate (ND) co-administration masks responses to leuprolide administration, (c) performance of urine measurement of leuprolide and M1, its major metabolite, as a detection test. Healthy men were randomized into a 4 week parallel group, open label clinical study in which all men had daily sc injections of leuprolide (1mg) for 4 days in the 1st and 3rd weeks with hormone-free 2nd and 4th weeks. In the 3rd week, men were randomized to either ND injections or no extra treatment. Serum steroids were determined by liquid chromatography, tandem mass spectrometry (LC-MS), urine steroids by gas chromatography, mass spectrometry (GC-MS), urine leuprolide and M1 by high resolution LC-MS and urine LH by immunoassay. Leuprolide stimulated striking, reproducible increases in serum and urine LH and steroids (serum T, dihydroT (DHT), 3α diol; urine T, epitestosterone (E) and androsterone (A). ND suppressed basal serum T, E2, 3α diol, and urinary E but did not mask or change the magnitude of responses to leuprolide. Urine leuprolide and M1 measurement had 100% sensitivity and specificity in detecting leuprolide administration up to one day after cessation of injections with the detection window between 1 and 3 days after last dose. Screening using urine steroid and LH measurements, optimally by urinary log10(LHxT), correctly classified 82% of urine samples. It is concluded that leuprolide stimulation of endogenous testosterone is reproducible after a 10-day interval, is not masked by ND and is reliably detected by urine leuprolide or M1 measurement for at least 1 day after administration.
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Affiliation(s)
- David J Handelsman
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia.
| | - Amanda Idan
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
| | - Janelle Grainger
- Australian Sports Drug Testing Laboratory, National Measurement Institute, Sydney, NSW 2139, Australia
| | - Catrin Goebel
- Australian Sports Drug Testing Laboratory, National Measurement Institute, Sydney, NSW 2139, Australia
| | - Leo Turner
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia
| | - Ann J Conway
- Andrology Department, Concord Hospital, Sydney, NSW 2139, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia
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Lundmark J, Gårevik N, Thörngren JO, Garle M, Ekström L, Rane A, Schulze JJ. Non-steroidal anti-inflammatory drugs do not influence the urinary testosterone/epitestosterone glucuronide ratio. Front Endocrinol (Lausanne) 2013; 4:51. [PMID: 23720652 PMCID: PMC3655282 DOI: 10.3389/fendo.2013.00051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/18/2013] [Indexed: 11/19/2022] Open
Abstract
The UDP Glucuronosyl Transferase (UGT) enzymes are important in the pharmacokinetics, and conjugation, of a variety of drugs including non-steroidal anti-inflammatory drugs (NSAIDs) as well as anabolic androgenic steroids (AAS). Testosterone glucuronidation capacity is strongly associated with a deletion polymorphism in the UGT2B17 gene. As the use of high doses of NSAIDs has been observed in athletes there is a risk for a drug-drug interaction that may influence the doping tests for AAS. In vitro studies show inhibitory potential on UGT2B7, 2B15, and 2B17 enzymes by NSAIDs. The aim of this study was to investigate if concomitant use of NSAIDs and a single dose of testosterone enanthate would affect the excretion rate of testosterone and epitestosterone glucuronide (TG and EG) as well as the T/E ratio, thereby affecting the outcome of the testosterone doping test. The study was designed as an open, randomized, cross-over study with subjects being their own control. The 23 male healthy volunteers, with either two, one or no allele (ins/ins, ins/del, or del/del) of the UGT2B17 gene, received the maximum recommended dose of NSAID (Ibuprofen or Diclofenac) for 6 days. On day three, 500 mg of testosterone enanthate was administered. Spot urine samples were collected for 17 days. After a wash-out period of 4 months the volunteers received 500 mg testosterone enanthate only, with subsequent spot urine collection for 14 days. The glucuronides of testosterone and epitestosterone were quantified. NSAIDs did not affect the excretion of TG or EG before the administration of testosterone. The concomitant use of NSAIDs and testosterone slightly increased the TG excretion while the EG excretion was less suppressed compared to testosterone use only. The effects of the NSAIDs on the TG and EG excretion did not differ between the UGT2B17 genotype groups. In conclusion, the outcome of testosterone doping tests does not seem to be affected by the use of NSAIDs.
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Affiliation(s)
- Jonas Lundmark
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska InstitutetStockholm, Sweden
| | - Nina Gårevik
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska InstitutetStockholm, Sweden
| | - John-Olof Thörngren
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska InstitutetStockholm, Sweden
| | - Mats Garle
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska InstitutetStockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska InstitutetStockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska InstitutetStockholm, Sweden
| | - Jenny J. Schulze
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska InstitutetStockholm, Sweden
- *Correspondence: Jenny J. Schulze, Clinical Pharmacology C1:68, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden. e-mail:
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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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Cadwallader AB, Lim CS, Rollins DE, Botrè F. The androgen receptor and its use in biological assays: looking toward effect-based testing and its applications. J Anal Toxicol 2012; 35:594-607. [PMID: 22080898 DOI: 10.1093/anatox/35.9.594] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Steroid abuse is a growing problem among amateur and professional athletes. Because of an inundation of newly and illegally synthesized steroids with minor structural modifications and other designer steroid receptor modulators, there is a need to develop new methods of detection which do not require prior knowledge of the abused steroid structure. The number of designer steroids currently being abused is unknown because detection methods in general are only identifying substances with a known structure. The detection of doping is moving away from merely checking for exposure to prohibited substance toward detecting an effect of prohibited substances, as biological assays can do. Cell-based biological assays are the next generation of assays which should be utilized by antidoping laboratories; they can detect androgenic anabolic steroid and other human androgen receptor (hAR) ligand presence without knowledge of their structure and assess the relative biological activity of these compounds. This review summarizes the hAR and its action and discusses its relevance to sports doping and its use in biological assays.
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Affiliation(s)
- Amy B Cadwallader
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti, Rome, Italy.
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Mazzarino M, Braganò MC, de la Torre X, Molaioni F, Botrè F. Relevance of the selective oestrogen receptor modulators tamoxifen, toremifene and clomiphene in doping field: endogenous steroids urinary profile after multiple oral doses. Steroids 2011; 76:1400-6. [PMID: 21745489 DOI: 10.1016/j.steroids.2011.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 06/13/2011] [Accepted: 06/15/2011] [Indexed: 11/17/2022]
Abstract
The present study was performed to investigate the influence of the intake of selective oestrogen receptor modulators on the urinary endogenous steroids profile. For this purpose the circadian variability of luteinizing hormone, follicle-stimulating hormone, testosterone, 5α-androstan-3α,17β-diol, 5β-androstan-3α,17β-diol, epitestosterone, 4-androstenedione, androsterone and etiocholanolone were measured on eight subjects (four males and four females) by gas chromatography-mass spectrometry and chemiluminescent immunometric assay techniques before and after oral administration of multiple doses of either tamoxifen (80 mg for 2 days) or toremifene (120 mg for 2 days) or clomiphene (100 mg for 2 days). The individual baseline variability of the steroids studied was set up by collecting the urine samples every 3 h, for 3 days prior to the treatment; whereas the evaluation of the effects of the oral administration of multiple doses of selective oestrogen receptor modulators on the steroid urinary profile was assessed by collecting urine samples every three hours for at least five days from the first administration. The results of our measurements showed that, only in male subjects, the relative urinary concentrations of testosterone, epitestosterone and 4-androstenedione were significantly altered generally after the second day of drug administration. While no significant effects were recorded in both sexes on the luteinizing hormone, follicle-stimulating hormone, androsterone, etiocholanolone, 5α-androstan-3α,17β-diol and 5β-androstan-3α,17β-diol urinary levels and on testosterone/epitestosterone, 5α-androstan-3α,17β-diol/5β-androstan-3α,17β-diol and androsterone/etiocholanolone ratios.
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Affiliation(s)
- Monica Mazzarino
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Largo Giulio Onesti, 1, 00197 Rome, Italy
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Gooren L. The significance of testosterone for fair participation of the female sex in competitive sports. Asian J Androl 2011; 13:653-4. [PMID: 21725329 DOI: 10.1038/aja.2011.91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Louis Gooren
- VU University Medical Center, Amsterdam, The Netherlands.
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Schulze JJ, Rane A, Ekström L. Genetic variation in androgen disposition: implications in clinical medicine including testosterone abuse. Expert Opin Drug Metab Toxicol 2010; 5:731-44. [PMID: 19442030 DOI: 10.1517/17425250902976862] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Testosterone replacement therapy in hypogonadal men has been used for > 60 years. The use of testosterone substitution is continuously growing and is given to aging men to improve the quality of life. Because testosterone use is associated with muscle strength enhancing effects, it has become a popular drug to abuse. Doping with anabolic steroids, such as testosterone, is a severe challenge to the vision, moral and ethics in sports and has also become a significant and increasing problem in society. OBJECTIVE The primary aim of this review is to summarize and discuss the contribution of genetic components to inter-individual variation in androgen disposition. CONCLUSION Genetic variation has a large impact on androgen disposition. This variation is of the utmost importance for the interpretation of doping test results and may modulate the effects of testosterone replacement therapy and testosterone doping.
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Affiliation(s)
- Jenny J Schulze
- Karolinska Institutet, Division of Clinical Pharmacology, Stockholm, Sweden
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MacLean HE, Handelsman DJ. Unraveling androgen action in muscle: genetic tools probing cellular mechanisms. Endocrinology 2009; 150:3437-9. [PMID: 19622777 DOI: 10.1210/en.2009-0438] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Helen E MacLean
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg 3084, Victoria, Australia
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12
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:260-77. [PMID: 19390324 DOI: 10.1097/med.0b013e32832c937e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Handelsman DJ, Gooren LJ. Hormones and Sport: physiology, pharmacology & forensic science. Asian J Androl 2008; 10:348-50. [DOI: 10.1111/j.1745-7262.2008.00412.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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