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...