Anabolic steroids purchased on the Internet as a cause of prolonged hypogonadotropic hypogonadism

Abstract

Objective: To report a case of hypogonadotropic hypogonadism due to the chronic abuse of anabolic steroids purchased over the Internet. Design: Case report. Setting: Endocrinology unit of the University of Brescia. Patient(s):A 34-year-old man. Intervention(s): A single dose (100 mg) of triptorelin (triptorelin test). Main Outcome Measure(s): Clinical symptoms, androgen normalization, levels of serum testosterone, folliclestimulating hormone, and luteinizing hormone. Result(s): Within 1 month, the patient's serum testosterone was in the normal range, and he reported a return to normal energy and libido. Conclusion(s):The World Anti-Doping Code has proved to be a very powerful and effective tool in the harmonization of antidoping efforts worldwide, but it is insufficient to combat this illegal phenomenon. To tackle the serious side effects caused by doping we believe that it is necessary to increase monitoring and adopt severe sanctions, particularly with regard to Internet sites. (Fertil Steril Ò 2010;94:2331.e1-e3. Ó2010 by American Society for Reproductive Medicine.)Key Words: Anabolic steroids, doping, hypogonadotropic hypogonadism, triptorelin Doping involves the use of artificial means or substances with the specific aim of improving performance, despite well-known adverse effects on health (1). This practice has spread to the general population, in particular to young adults, along with the exaggerated ideals of body image portrayed by the mass media (2-4). Over the last few years, Internet marketing may have played an important role in increasing consumption of anabolic drugs such as anabolic androgen steroids (AAS) and clomiphene citrate (5). We describe the case of a young male with prolonged hypogonadotropic hypogonadism due to ongoing consumption of various doping drugs purchased over the Internet, where they are readily available. CASE REPORTA 34-year-old man presented to our department in September 2008 for loss of libido and energy and for mild depression. He was a computer programmer and a nonprofessional bodybuilder with an unremarkable personal medical history. He admitted to having used doping drugs since he was 21 years old. More specifically, he would perform cycles of intramuscular injections of nandrolone (25 mg) and stanazol (25 mg) daily for 8 weeks, followed by mesterolone (50 mg/day) for 15 days. Then he would then take clomiphene citrate (50 mg/day) for 1 week, followed by an injection of human chorionic gonadotropin (2,000 IU) three times in 1 week. He had repeated these cycles from 1995 to 2005. From 2005 to August 2008, to his nandrolone and stanazol cycle he added an intramuscular injection of boldenone (50 mg) daily for 3 weeks. He said he had bought all the drugs on the Internet.The patient was 175 cm tall and 80 kg, and he appeared very muscular and toned. His blood pressure and pulse rate were normal. Examination of his heart, lungs, and abdomen were likewise unremarkable. The physical examination showed normal secondary sexual characteristics, but the genital examination revea...

Quality of Online Pharmacies and Websites Selling Prescription Drugs: A Systematic Review

“…All the cases reported so far occurred in the US, although other evidence shows that the phenomenon exists in Europe as well. A case of prolonged hypogonadotropic hypogonadism caused by anabolic steroids purchased on the Internet by a 34-year-old Italian man was reported by Pirola et al [126]. In the United Kingdom, orlistat-induced subacute liver failure was reported in a 57-year-old woman [127].…”

Persistent primary hypogonadism associated with anabolic steroid abuse

“…Previous case reports describe reversible hypogonadism, infertility, and testicular atrophy associated with prolonged use of anabolic steroids (2,(5)(6)(7)(8). Rarely, reports of persistent hypogonadism associated with anabolic steroid abuse have been described, and of interest, these cases are typically associated with endocrine abnormalities consistent with secondary hypogonadism (4,9). We report a 40-year-old man with persistent primary hypogonadism and infertility associated with previous anabolic steroids abuse.…”

“…Treatment with these agents in supraphysiological doses is associated with increased muscle size and strength (1), and as a result this has led to abuse by competitive athletes and bodybuilders to improve physical appearance and performance (2,3). Anabolic steroids are now readily available through Internet sites (4). Previous case reports describe reversible hypogonadism, infertility, and testicular atrophy associated with prolonged use of anabolic steroids (2,(5)(6)(7)(8).…”

MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions

“…In addition, various therapeutic attempts have been undertaken to overcome ASIH and to hasten recovery. Human chorionic gonadotropin (hCG) has been given in individual cases (42), and has also been combined with tamoxifen or clomiphene to counteract the increased oestrogen levels under hCG, inducing or worsening gynecomastia (43,44). However, hCG administration simultaneously with AASs in order to maintain fertility in power athletes showed an increase in morphologically abnormal sperm in comparison with a control group receiving only AASs.…”