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Rationale: Anabolic steroids, also known as anabolic–androgenic steroids (AAS), encompass steroidal androgens such as testosterone, as well as synthetic counterparts with similar structures and effects. The misuse of AAS has increased over the years, leading to ethical and welfare concerns in sports. The World Anti‐Doping Agency (WADA) and the International Federation for Equestrian Sports (FEI) have banned AAS in relevant sports. Methandienone is one of the most identified anabolic androgenic steroids in sports drug testing, Therefore, reliable detection methods are crucial for effective doping control and maintaining the integrity of the sports. Methods: This study explores the use of homogenized camel liver for detecting methandienone metabolites in camels. The biotransformation pathways of methandienone in homogenized camel liver tissues are analyzed using Liquid Chromatography‐High Resolution Mass Spectrometry (LC‐HRMS) to identify and characterize the phase I and phase II metabolites. Chromatographic separation was achieved using a Thermo‐Hypersil C18 column. Results: The study has identified 11 methandienone metabolites (M1–M11), this includes 10 phase I and one phase II metabolite. A glucuronic acid conjugate of methandienone was observed in this study, but no sulfonic acid conjugations were found. The metabolites and their possible chemical structures, along with their fragmentation patterns are confirmed using MSMS (MS2) experiments in data‐independent acquisition (DIA) mode. Conclusions: These findings serve as a vital tool for the rapid detection of methandienone, combating its illicit use in camel racing. Comprehensive screenings covering both the parent drug and its metabolites are recommended to improve detection accuracy and ensure regulatory compliance in sports doping. Future research should explore methandienone's metabolite profile in administered camel samples. [ABSTRACT FROM AUTHOR]

Introduction: Women who use drugs, particularly those using anabolic‐androgenic steroids (AAS), encounter heightened social risks influenced by the legal status of AAS, varying regionally. In jurisdictions where AAS are legal, medical guidance and prescription are common, while in illegal regions, there are challenges associated with acquisition and safer usage. Therefore, we aimed to explore the experiences of women who use AAS in Australia, where these substances are criminalised, with a focus on the challenges they encounter in acquiring and using these drugs. Methods: We focused on data from six women in a broader study interviewing 15 AAS users. The data were subjected to iterative inductive analysis, resulting in two theme‐categories. Results: Women who use AAS face distinct challenges in accessing reliable suppliers, with men seemingly having 'easier' access. Women experience this disparity as increasing their vulnerability to unsafe products, further compounded by their lack of knowledge regarding these substances. Moreover, mislabelling and counterfeiting of female‐specific AAS substances is described to further compound these risks, reflecting the participants' expressed need for enhanced intervention and quality control in the AAS market. Discussion and Conclusions: Ensuring product reliability, transparency and accountability are perceived as essential for the health and safety of women who use AAS. To address these issues, interventions should provide women with comprehensive drug checking services tailored to their health needs. 'Steroid literacy' must be an integral component, equipping women with knowledge to make informed decisions in the gendered AAS market. [ABSTRACT FROM AUTHOR]

Osteoporosis is a metabolic bone disorder for which treatment options include antiresorptive therapies (e.g., bisphosphonates, denosumab); anabolics (e.g., teriparatide, abaloparatide); and dual mechanisms (e.g., romosozumab). Management of osteoporosis with concurrent antiresorptive and anabolic agents may be superior to monotherapy, as demonstrated in the DATA trial with the combination of denosumab and teriparatide. However, there is limited experience with the combination of denosumab and romosozumab, which may be an alternative antiresorptive/anabolic regimen for individuals who are not candidates for PTH receptor agonists. In this case, we present a young man with glucocorticoid-induced osteoporosis who could not tolerate a daily injectable anabolic and who experienced improvement in bone mineral density with concurrent denosumab and off-label romosozumab administration. [ABSTRACT FROM AUTHOR]

Hepatocellular adenomas (HCA) are acquired focal liver lesions, that occur mainly in young-to-middle-aged women who are on long-term estrogen-containing contraceptives or young men after prolonged use of anabolic steroids. Furthermore, distinct underlying diseases, such as obesity, metabolic dysfunction-associated steatotic liver disease, glycogen storage disease, etc. are considered risk factors. The 2017 Bordeaux classification, in particular Nault et al, divided HCAs into eight subtypes according to their pheno- and genotypic characteristics. This includes HCAs with hepatocyte-nuclear-factor (HNF1-alpha mutation), HCAs with β-catenin mutation, and HCAs without either of these genetic mutations, which are further subdivided into HCAs with and without inflammatory cells. HCAs should no longer be classified as purely benign without histologic workup since three of the eight subtypes are considered high-risk lesions, requiring adequate management: malignant transformation of the pure (ßex3-HCA) and mixed inflammatory/β-catenin exon 3 (ßex3-IHCA) adenomas, as well as potential bleeding of the sonic hedgehog HCA and pure (ßex7/8-HCA) and mixed inflammatory/β-catenin exon 7/8 (ßex7/8-IHCA). Elective surgery is recommended for any HCA in a male, or for any HCA exceeding 5 cm. Although MRI can classify up to 80% of adenomas, if findings are equivocal, biopsy remains the reference standard for adenoma subtype. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions YouTube personalities (YP) have amassed significant followings by distributing health information. There is concern that YP involved in anabolic androgenic steroid (AAS) communities are sharing information on how people should approach initiating AAS use. This research sought to explore how YP are using their platform to distribute information on AAS initiation, what information is being presented and how people are responding.This mixed methods research utilised a netnographic approach, a method adapted from traditional ethnographic techniques for the study of online sociocultural phenomena. The research included a selection of YouTube videos (n = 37) and user comments replying to the videos (n = 584).YP addressed the positives and negatives of AAS initiation (76%; n = 28 and 76%; n = 28 respectively), provided harm reduction strategies (76%; n = 28), and advice on which AAS people should use (97%; n = 36). A qualitative thematic analysis of the comments found two overarching themes: ‘Authenticity, capital and the influence of the YP on their audiences’ and ‘The evolving landscape of enhancement and health’. Viewers engaged with the videos due to the YPs lived experience using AAS, and YP influenced the health behaviours of viewers. Many believed that the videos were useful for health and lifestyle enhancement purposes.YP are disseminating diverse information on AAS initiation which is derived from their lived experience using AAS. Harm reduction is a key component of the YPs' message and viewers responded positively to a balanced and honest assessment of AAS initiation which is perceived to respect their personal autonomy. [ABSTRACT FROM AUTHOR]

The present study investigated the effect of the proviron, oral anabolic steroid on undifferentiated Nile tilapia (Oreochromis niloticus) larvae sex reversal and to compare its effect with that of 17 α-methyltestosterone. Thus, doses of 25 mg, 50 mg and 75 mg proviron versus 60 mg/kg for 17 α-methyltestosterone were incorporated in the diet of 10-days-post-fertilization old larvae for 28 days. At the end of the treatment and after pre-growth until 90 days post-fertilization, we carried out sexing. Results displayed male rates ranged from 65.7 ± 3.1% to 96.7 ± 1.1% for treatments with 25 mg and 75 mg proviron, respectively and was 99 ± 0.1% for that with 17 α-methyltestosterone. However, no significant difference (p > .05) was found between the average male rate of larvae fed the feed containing 75 mg of proviron and that of larvae fed the feed that containing 17 α-methyltestosterone. [ABSTRACT FROM AUTHOR]

Clostebol, the 4-chloro derivative of testosterone, available as Over The Counter product in pharmacies and drugstores in several countries, is mostly commercialized as a cream or spray in the form of acetate ester. As other anabolic steroids, clostebol is listed as a prohibited substance by the World Anti-Doping Agency (WADA). Controlled transdermal application of clostebol acetate has been reported to produce detectable amounts of its metabolites in urine, even after a single exposure. Indeed, a low urine concentration can be interpreted as the tail of a drug voluntarily used to enhance performance or a direct consequence of a contamination. The increased number of adverse analytical findings (AAFs) involving clostebol reported in the last years should lead to highlight the need for athletes to be warned against personal and /or accidental use/exposure of dermal preparation containing this doping agent. Further discussion on possible threshold limits and laboratory testing on different matrices (e.g. hair) to better clarify the origin of minimal amounts of clostebol in urines is advisable. [ABSTRACT FROM AUTHOR]

The gas chromatography-combustion isotope ratio mass spectrometry (GC/C/IRMS) confirmation procedure for prednisone (PS) and prednisolone (PSL) is still a great challenge for the doping control laboratory due to the many structurally similar steroids present in urinary matrices. This study aims to establish an innovative online two-dimensional high performance liquid chromatography (2D-HPLC) purification method for measuring the carbon isotope ratios (CIRs) and achieving the identification of the synthetic forms of these two endogenous anabolic androgenic steroids (EAASs). Initially, the one-dimensional chromatographic column was used to separate and purify endogenous reference compounds (ERCs), and the co-elution fluids containing PS and PSL were switched to a two-dimensional chromatographic column for further purification through an online transfer system. Then the purified compounds were analyzed using GC/C/IRMS after sample pretreatments. The results showed that the minimum detection concentration of PS and PSL reached 30 ng mL−1, and no isotope fractionation occurred during the entire collection and preparation process. This method has been validated with the WADA technical document and showed good sensitivity and selectivity, demonstrating its practical applicability for urine samples in doping control laboratories. [ABSTRACT FROM AUTHOR]

Introduction: Male contraception with exogenously administered hormones suppresses both luteinizing hormone and follicle stimulating hormone leading to low intratesticular testosterone concentration. This results in reversible suppression of spermatogenesis and marked decrease in sperm output in the ejaculate and preventing pregnancy in the female partner. Prior Studies: Studies of testosterone administered alone or in combination of another gonadotropin suppressive agent such as a progestin or gonadotropin releasing hormone (GnRH) analog showed decisively that the exogenous hormone administrations are effective in suppressing sperm output with few adverse events that are not anticipated. In contraceptive efficacy studies, testosterone alone or combined with a progestin are as effective in preventing pregnancies as female contraceptive methods. Conclusion: Hormone combinations for male contraception are in late‐phase clinical trials and hold the promise of being the new, reversible contraception method for men in over half a century. Lessons learned from the male hormonal contraceptive development pave the way for new targeted approached to regulate male fertility. [ABSTRACT FROM AUTHOR]

Background: Recent studies indicate that vitamin D impacts male reproductive function, with deficiency linked to infertility. This review evaluates the effect of vitamin D supplementation on male fertility, focusing on total testosterone, free testosterone, the free androgen index (FAI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex-hormone-binding globulin (SHBG), and estradiol. Methods: We systematically searched Medline, Web of Science, Cochrane Library, and Scopus from their inception until July 2024 for randomized controlled trials (RCTs) involving adult males. The primary focus of these studies was on reproductive hormone parameters, analyzed using a random-effects meta-analysis and weighted mean difference (WMD). Evidence quality was assessed using ROB2 and GRADE. Meta-regression and dose–response analyses were performed. Results: Seventeen studies met the criteria for quantitative analysis. Vitamin D supplementation significantly increased total testosterone levels (WMD 0.38, 95% CI 0.06–0.70, n = 15, I2 = 67.03). However, it had no significant effect on other hormone parameters: free testosterone (WMD 0.00, 95% CI −0.02–0.03, n = 9, I2 = 48.12), FSH (WMD −0.02, 95% CI −0.57–0.53, n = 7, I2 = 48.72), LH (WMD −0.09, 95% CI −0.30–0.12, n = 8, I2 = 0.00), SHBG (WMD 0.73, 95% CI −1.14–2.61, n = 10, I2 = 69.05), FAI (WMD −0.92, 95% CI −2.12–0.27, n = 6, I2 = 0.00), and estradiol (WMD −0.02, 95% CI −2.95–2.92, n = 5, I2 = 20.63). Conclusion: This meta-analysis shows that vitamin D supplementation may increase total testosterone levels in men. However, further well-designed RCTs are needed to determine vitamin D's effects on other reproductive hormone parameters. [ABSTRACT FROM AUTHOR]

Background: Anabolic androgenic steroid (AAS) use among women has raising over years, especially due to aesthetic motivation, but performance improvement is another motivation. Since high-intensity functional training (HIFT) exhibits an intrinsic competitive aspect, we investigated the AAS use among women HIFT practitioners. Methods: Using the "virtual snowball," 291 Brazilian women HIFT practitioners answered an online survey. Results: The prevalence of AAS use was 22%, but the use after the HIFT adherence was 15%. Among those who never used, 12.3% reported intention to use. Age, marital status, and time of training were significantly associated with AAS use. Aesthetics was the main motivation for use, and 59.7% reported using it on medical advice. The main motivation was aesthetics, but it seems to have a trend to change the motivation for performance improvement over aesthetics, especially among women with longer training time. Conclusion: The prevalence of AAS use was high; however, it seems that HIFT adherence is not a factor raising the prevalence of AAS use among physically active women. Additionally, the motivation for AAS use among women HIFT practitioners seems to be trending toward change, increasing the motivation for performance improvement over aesthetic motivation, especially among women with longer HIFT adherence time. [ABSTRACT FROM AUTHOR]

Background: The use of Anabolic-androgenic steroids (AAS) among gym members has become a significant concern due to their impact on physical training and performance. Research worldwide indicates a notable prevalence of AAS use among athletes and gym attendees, often involving substances that are neither safe nor legal. Objectives: This study aims to determine the prevalence of AAS use among gym attendees in Amman, Jordan, and to explore the knowledge, attitudes, and behaviors associated with AAS use. Methods: The study involved 399 participants from 35 randomly selected gyms in the metropolitan area of Amman, Jordan. A cluster sampling technique was used to select a diverse and representative sample of gym attendees. Data was collected using a self-administered questionnaire that assessed AAS use, knowledge, attitudes, and behavioral factors. Statistical analyses were conducted using chisquare tests to explore the relationships between AAS use and categorical variables, while logistic regression was employed to identify predictors of AAS use. Results: The analysis revealed significant associations between AAS use and various factors, including knowledge, attitudes, behavioral factors, and demographic variables such as gender, age, exercise frequency, reasons for exercise, and total exercise duration. The study identified key predictors of AAS use among gym attendees in Amman, highlighting the importance of demographic and behavioral factors. Conclusion: The findings underscore the need for targeted interventions to address misconceptions and promote safer practices among gym-goers in Amman. The study provides critical insights that can guide the development of strategies, policy adjustments, and educational initiatives aimed at reducing AAS misuse and fostering a healthier gym culture in the region. [ABSTRACT FROM AUTHOR]

Anticholinergic toxicity is a common occurrence in the emergency room, making it crucial for emergency clinicians to have a good understanding of this toxidrome. The neuropsychiatric effects of anticholinergic agents and anabolic steroids (ASs) can manifest as symptoms like anxiety, agitation, dysarthria, confusion, seizures, visual hallucinations, bizarre behavior, delirium, psychosis, and coma. When dealing with a conscious patient who has ingested an anticholinergic substance, a detailed history of ingestion can aid clinicians in making an accurate diagnosis. However, the lack of information about the substances consumed can complicate diagnosis. In cases where the exposure is unknown, clinicians should consider anticholinergic poisoning in patients showing signs of altered mental status and physical examination findings consistent with anticholinergic toxicity. We report four cases presenting a range of symptoms, including neuropsychiatric manifestations, following the ingestion of the same bodybuilding powders with anticholinergic properties. All four patients consumed yellow and white powders at the same time and in the same place. Laboratory analysis revealed that yellow powder and white powder contained ASs and cyproheptadine, respectively. Anticholinergic toxicity is a frequently encountered condition in the emergency room. Anticholinergic drugs, used as muscle relaxants, compete with acetylcholine at muscarinic receptors in the body. Neuropsychiatric effects of anticholinergic agents and anabolic steroids (ASs) can manifest as symptomsz like anxiety, agitation, dysarthria, hallucinations, bizarre behavior, and psychosis. [ABSTRACT FROM AUTHOR]

Exercise and anabolic steroids are expected to promote improvements in cardiovascular structure and reduction of visceral fat and, thus, help promote health in hyperglycemic patients. The aim of this study was to verify the influence of aerobic exercise associated with the use of steroids on cardiac structure and visceral fat in hyperglycemic Wistar rats. Methods: Thirty-two young male Wistar rats were divided into four groups: control group (n=8), control with treatment (n=8), diabetic (n=8) and diabetic with treatment (n=8). All animals were subjected to intense aerobic exercise and the animals undergoing treatment received intramuscular testosterone. Body weight, visceral fat and cardiac measurements (weight, length and width) were evaluated. The groups treated with testosterone showed a smaller than expected increase in body weight for food intake. Visceral, perirenal, retroperitoneal and epididymal fats were lower in the treated groups. Heart weight was relatively greater in the treated groups and greater width and length in the untreated groups. The proposed association of testosterone administration with aerobic exercise can provide significant benefits for the metabolism of hyperglycemic individuals. [ABSTRACT FROM AUTHOR]

Anabolic androgenic steroids (AAS) are a class of hormones that are used for hormonal replacement therapy in cases of male hypogonadism and for a few other medical conditions, mainly anemias, as well as for the female-to-male transition process. At the same time, AAS are widely abused for their muscle-building and strength-increasing properties. Among their side effects, androgens can exert a toxic effect on the liver, causing hepatotoxicity, but they can also induce hepatocyte proliferation and malignant transformation. Hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC) are two primary liver lesions that have been described as potentially related to AAS. This review provides an up-to-date analysis of how androgens can induce liver carcinogenesis and a comprehensive overview on the available data in the literature about AAS and primary liver tumors. [ABSTRACT FROM AUTHOR]

Background: It is well‐known that oral surgical procedures pose a high risk for medication‐related osteonecrosis of the jaw in patients taking bisphosphonates. Although some position papers and guidelines have been published with regard to its treatment, few studies have investigated prevention methods. This study investigates the effectiveness of methenolone enanthate, an anabolic steroid, for the prevention of medication‐related osteonecrosis of the jaw. Methods: Thirty‐six Wistar rats were divided into three groups. Two experimental groups, Z and ZM, took zoledronic acid for 6 weeks prior to extraction of the left maxillary first molar. The Group ZM also was given methenolone enanthate continuously for 1 week before and 4 weeks after the extraction. The control group was not given any medication. The rats were euthanized 5 weeks after extraction. The extraction socket was evaluated clinically for bone exposure and histologically for inflammation, hyperemia, collagen fibers, epithelialization, number of osteoclasts, and empty lacunae. Results: Six rats died during the experimental research. The bone exposure rate, mean numbers of attached osteoclasts (in 40× magnification), and empty lacunae (in 100× magnification) were 0%, 4%, and 0.8% in Group C; 75%, 1%, and 8% in Group Z; and 10%, 2.1%, and 3% in Group ZM, respectively. Significant differences exist between all groups regarding the number of empty lacunae. There were significant differences between Group C/ZM and Group Z in terms of bone exposure rate, inflammation, hyperemia, collagen fiber organization, and epithelialization. Conclusion: In our tested preclinical model, methenolone enanthate has shown potential for preventing medication‐related osteonecrosis of the jaw. [ABSTRACT FROM AUTHOR]

Non-prescription use of anabolic androgenic steroids (AAS) is associated with an increased risk of premature death. However, these substances are seldom screened in connection with forensic cause-of-death investigation, unless the forensic pathologist specifically suspects use, often based on a positive AAS use history. Since AAS use is often concealed from others, this practice may lead to mistargeting of these analyses and significant underestimation of the true number of AAS positive cases undergoing forensic autopsy. Thus, more accurate diagnostic tools are needed to identify these cases. The main objective of this study was to determine, whether a multivariable model could predict AAS urine assay positivity in forensic autopsies. We analyzed retrospectively the autopsy reports of all cases that had been screened for AAS during forensic cause-of-death investigation between 2016–2019 at the Finnish Institute for Health and Welfare forensic units (n = 46). Binary logistic regression with penalized maximum likelihood estimation was used to generate a nine-variable model combining circumferential and macroscopic autopsy-derived variables. The multivariable model predicted AAS assay positivity significantly better than a "conventional" model with anamnestic information about AAS use only (area under the receiver operating characteristic curve [AUC] = 0.968 vs. 0.802, p = 0.005). Temporal validation was conducted in an independent sample of AAS screened cases between 2020–2022 (n = 31), where the superiority of the multivariable model was replicated (AUC = 0.856 vs. 0.644, p = 0.004). Based on the model, a calculator predicting AAS assay positivity is released as a decision-aiding tool for forensic pathologists working in the autopsy room. [ABSTRACT FROM AUTHOR]

Abstract Anticholinergic toxicity is a common occurrence in the emergency room, making it crucial for emergency clinicians to have a good understanding of this toxidrome. The neuropsychiatric effects of anticholinergic agents and anabolic steroids (ASs) can manifest as symptoms like anxiety, agitation, dysarthria, confusion, seizures, visual hallucinations, bizarre behavior, delirium, psychosis, and coma. When dealing with a conscious patient who has ingested an anticholinergic substance, a detailed history of ingestion can aid clinicians in making an accurate diagnosis. However, the lack of information about the substances consumed can complicate diagnosis. In cases where the exposure is unknown, clinicians should consider anticholinergic poisoning in patients showing signs of altered mental status and physical examination findings consistent with anticholinergic toxicity. We report four cases presenting a range of symptoms, including neuropsychiatric manifestations, following the ingestion of the same bodybuilding powders with anticholinergic properties. All four patients consumed yellow and white powders at the same time and in the same place. Laboratory analysis revealed that yellow powder and white powder contained ASs and cyproheptadine, respectively.

Anabolic androgenic steroids (AAS) are traditionally used for the treatment/control of various diseases; however, they are being used for non-therapeutic and indiscriminate purposes to enhance sports performance and physical appearance. This study aimed to assess the prevalence and associated factors of AAS use among professional CrossFit® competitors. We conducted an observational cross-sectional survey in which an anonymous questionnaire was applied to professional CrossFit® athletes. The prevalence of AAS usage was 33.3%. Most users were male (74.2%), aged between 30 and 39 years (51.6%), with completed higher education (83.9%), and had been training for more than 5 years (77.4%); the primary motivation for AAS use was performance enhancement (77.4%). Individuals who were older (p < 0.05) and more experienced in competitions (p < 0.01) are more likely to use AAS. Testosterone was the most employed AAS (71.0%); CrossFit® athletes typically used an average of 2 different AAS. The majority of users had notably sought advice from a physician (74.2%), and AAS were acquired from either drugstores (80.6%) or through illicit channels (29.0%). Moreover, 61.3% of AAS users reported experiencing adverse effects. Our results demonstrated a higher prevalence of AAS users among professional competitors in CrossFit® compared to the general population; older age and greater experience in official competitions were decisive factors for a greater inclination toward AAS use. A significant percentage of athletes seek drugs through illegal channels. Despite the majority of users experiencing adverse effects, athletes report satisfaction with use, believing that the benefits still outweigh the drawbacks. [ABSTRACT FROM AUTHOR]

Herbal and dietary supplements (HDS) are being used worldwide at an increasing rate. Mirroring this trend, HDS‐induced liver injury, also known as HDS‐induced liver injury (HILI), has increased significantly over the past three decades in the Drug‐Induced Liver Injury Network (DILIN), now accounting for 20% of cases of drug‐induced liver injury (DILI). There are significant challenges in the identification and prevention of HILI due to varying presentations, ability to make clear diagnosis, identification of the responsible ingredient, lack of treatment, and lack of regulatory oversight of HDS products to confirm their ingredients and ensure safety. The major implicated agents include anabolic steroids, green tea extract, garcinia cambogia, kratom, ashwagandha, turmeric and multi‐ingredient nutritional supplements. Fortunately, with the formation of major DILI consortiums across the world, the last decade has seen advances in the identification of at‐risk genetic phenotypes, the use of chemical analysis on multi‐ingredient nutritional supplements, and the publication of data/injury patterns of potentially risky HDS. [ABSTRACT FROM AUTHOR]

To discuss the use of hormonal contraception (HC) in elite women's competitive sports from an anti-doping perspective because 1) it changes the natural female hormonal milieu; 2) is used to manipulate the menstrual cycle with performance enhancement intent; 3) even though lowering endogenous testosterone levels, some HCs contain testosterone-like androgenic compounds with potential performance-enhancing effects. A complex interaction between rapidly advancing sports-relevant biomedical scientific discoveries, societal changes concerning sex and gender, and a zero-tolerance anti-doping ideology, leads to contentious results, jeopardizing the premises defining and protecting contemporary elite sport in general and that of women in particular. This is in part because of the two out of three criteria for inclusion on the World Anti-Doping Agency's List of forbidden substances and methods: i) actual or potential for performance enhancement, ii) actual or potential for health risk, and iii) counter to the Spirit of Sport concept. These criteria would suffice for the inclusion of HC on the List, especially in their androgenic form. The fact that they are not is good for women's reproductive rights but also illustrates the arbitrariness of the administration of WADA's Prohibited List of substances and methods in elite sports. [ABSTRACT FROM AUTHOR]

Long-term use of anabolic-androgenic steroids (AAS) might lead to distressing withdrawal symptoms following cessation. This paper aims to share challenges in recruiting patients to a pilot intervention study with parallel substance use disorder (SUD) treatment and to explore barriers to participation among AAS forum members. Eligible AAS-dependent men were recruited to receive hormone therapy for 16 weeks, and exclusion reasons were registered. Audience engagement from social media advertisements was measured. Information about the study was posted in an AAS online forum, and discussion among forum members was thematically analyzed. Twelve of 81 potential participants were included, whereas ten completed the intervention. Participants were excluded due to residency outside the study area, illicit substance use or severe medical conditions. Challenges in recruitment were linked to the COVID-19 pandemic, funding and advertisements on social media. AAS forum members suggested modifications to the intervention, were skeptical to the SUD-patient requirement, feared prosecution or other negative outcomes and/or preferred to seek online advice on self-initiated testosterone replacement therapy or post cycle therapy. AAS-related online recommendations among peers, criminalized AAS use setting and obligatory SUD treatment might have affected recruitment. Based on lessons learned, recommendations for future similar studies are presented. [ABSTRACT FROM AUTHOR]

Internally displaced persons (IDPs) are frequently subjected to traumatic events, making them vulnerable to using substances. This study explores predictors and types of substances used by IDPs, prevalence of substance dependence, and reasons for substance use. Cross-sectional survey data were obtained from 520 IDPs living in camps located in Borno State, Nigeria. The Drug Use Disorders Identification Test (DUDIT) was adapted and administered to the participants. IBM SPSS was used to conduct univariate and multivariate linear regression analyses. More than half (66.2%, n = 344) of the survey participants used at least one substance while a third of them (31.2%, n = 162) used more than one substance. About one in ten respondents met the instrument cut-off for dependence. The most popular substance used was Kolanut (46.5%, n = 242). Popular reasons for substance use were availability of substance, influence from others, and having a disease condition. Education, marital status, employment, and number of substances used were significantly associated with substance dependence. A high prevalence of substance use was found among the IDPs. The study highlights the need for intervention in the substance use problem affecting this vulnerable population. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodResultsConclusionsThis investigation explores the concept of stigma related to people who use anabolic-androgenic steroids (PWU-AAS) when accessing healthcare services. Anabolic-androgenic steroids (AAS) are used by subsections of the population and have been associated with various health harms. Responding to associated health risks, within the UK, harm reduction and healthcare service provisions have been established. Although these services provide essential support, various barriers, including stigma, exist which can limit engagement with them.Ten qualitative interviews were conducted with PWU-AAS and have accessed healthcare and harm reduction services related to their use of AAS.PWU-AAS anticipated stigma: (1) when accessing needle and syringe programs; (2) when seeking support from healthcare professionals; and (3) when experiencing specific adverse health implications. Stigma meant PWU-AAS were less likely to engage with healthcare professionals, attend harm reduction services, and were reluctant to disclose specific medial conditions.Interventions and messaging tackling AAS-related stigma ought to be considered for public-facing health and harm reduction services, to better support the needs and requirements of PWU-AAS. [ABSTRACT FROM AUTHOR]

Objective: To identify the lifetime prevalence and correlates of appearance- and performance-enhancing drugs and substances (APEDS) use among a national sample of US college and university students. Participants: Student participants from the 2020–2021 Healthy Minds Study (N = 7,401; ages 18–30 years). Methods: Lifetime prevalence of five forms of APEDS was estimated. Modified Poisson regression analyses were conducted to determine the sociodemographic correlates of protein and creatine supplement use. Results: Lifetime protein (23.8%) and creatine (7.7%) supplement use were most common among the sample. Older age within young adulthood, male sex, perceiving oneself to be normal weight or somewhat overweight, any athletics participation, and 2–3 or ≥ 5 h/week of exercise were associated with greater likelihood of lifetime protein and creatine supplement use. Conclusions: Awareness and prevention efforts on the potential harms of APEDS use are needed on campuses, particularly among males and those who participate in athletics and high-frequency exercise. [ABSTRACT FROM AUTHOR]

Food supplements consist of various substances, which can be used orally or enterally and are assigned for food supplementation. Research with dietary supplements pointed to substances not declared on the labels, such as prohormones or anabolic androgenic steroids (AAS). Objective: Conduct chemical and chromatographic tests with a sample of protein food supplements to detect possible anabolic androgenic steroids. Materials and Method: This is an analytical study of a quali-quantitative nature. Conclusion: Analyzes indicate the presence of steroids in all evaluations of dietary protein supplement samples. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence of anabolic steroid use and the level of knowledge on anabolic steroids among the male athletes in Al Madina Al Munawara, Saudi Arabia. Methods: A cross-sectional study was conducted on male athletes randomly selected from the private athletic centers in Al Madina Al Munawara over 5 months. Data were collected from all participants using a self-administered anonymous questionnaire with 33 questions. The questionnaire covered the socio- Original Article demographic characteristics of the participants, and their knowledge, attitudes, and use of anabolic steroids. Results: Of the 150 male athletes surveyed, 121 completed the questionnaire )response rate: 80.6%(. Over half were aged between 18 and 23 years )56.2%( and were single )79.3%(. Thirty-two percent reported using anabolic steroids, mainly to increase muscle mass, following coaches' advice )46.1%(. Key sources included the internet )30.7%(, coaches )30%(, and friends )27.9%(, and non-healthcare professionals. The top motivations were price, coach's/physician's advice, and availability. The perceived benefits included increased muscle mass, strength, and endurance, while the perceived adverse effects included kidney/liver damage and sexual problems. Conclusion: One-third of the male athletes surveyed used anabolic steroids, influenced by accessibility and social contact, rather than healthcare guidance. This highlights the need for greater awareness of the longterm health risks, ideally through education provided by sports medicine specialists. [ABSTRACT FROM AUTHOR]

Although men and women both experience eating disorders such as anorexia nervosa and bulimia nervosa, there are differences in the way their eating disorder may present. Body dissatisfaction or body dysmorphia in men may be more related to a drive for muscularity as opposed to thinness. Muscle dysmorphic disorder (also known as muscle dysmorphia) is a form or subtype of body dysmorphia that is characterised by an extreme desire for muscularity and a preoccupation with the idea that one's physique is too small or not sufficiently muscular. It is more common in men than women and is associated with body image distortion, excessive exercise routines, muscularity-orientated disordered eating and the use of appearance- and performance-enhancing drugs such as anabolic androgenic steroids. Risk factors for muscle dysmorphic disorder include social pressure (including to conform to gender stereotypes) and low self-esteem. The condition has negative psychological, physical, relational and financial effects. Nurses can play a role in health promotion as well as in the assessment, care and referral of men with muscle dysmorphic disorder. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the acute and long-term effects of nandrolone decanoate (ND) on fractional synthetic rates (FSR). Methods: Male C57BL/6 mice were randomized into ND (n = 20) or sham (n = 20) groups. ND injections (10 g⋅kg-1⋅wk-1) started at 7 months of ages and continued for 6 wk. Ten animals from each group were randomly separated and examined 1 wk following drug cessation. The remaining animals were examined at 16 months of age. Animals were injected IP with 1.5 mL of deuterated water 24 h before euthanasia. The kidney, liver, heart, gastrocnemius, and soleus were extracted. Samples were analyzed for deuterated alanine enrichment in the bound protein and intracellular fraction by liquid chromatography tandem mass spectrometry to measure estimated FSR (fraction/day (F/D)) of mixed tissue. Results: One-way ANOVA, with treatment and age as fixed factors, indicated that kidney FSR was greater (P = 0.027) in ND (0.41 ± 0.02 F/D) than sham (0.36 ± 0.014F/D) and higher (P = 0.003) in young (0.42 ± 0.2 F/D) than old (0.35 ± 0.01 F/D). Liver and heart FSR values were greater (P ≤ 0.001) in young (0.79 ± 0.06 F/D and 0.13 ± 0.01 F/D, respectively) compared with old (0.40 ± 0.01 F/D and 0.09 ± 0.01 F/D, respectively), but not between ND and sham. Gastrocnemius FSR was (P ≤ 0.001) greater in young (0.06 ± 0.01 F/D) compared with old (0.03 ± 0.002 F/D), and greater (P = 0.006) in ND (0.05 ± 0.01 F/D) compared with sham (0.04 ± 0.003 F/D). Soleus FSR rates were greater (P = 0.050) in young (0.13 ± 0.01 F/D) compared with old (0.11 ± 0.003 F/D), but not between ND (0.12 ± 0.01 F/D) and sham (0.12 ± 0.01 F/D). Old animals who had received ND displayed elevated FSR in the gastrocnemius (P = 0.054) and soleus (P = 0.024). Conclusions: ND use in young adult animals appeared to maintain long-term elevations in FSR in muscle during aging. [ABSTRACT FROM AUTHOR]

The article discusses the potential role of glucocorticoids and anabolic steroids in improving surgical outcomes through augmented prehabilitation. Surgery is a major treatment option for cancer, but postoperative complications can lead to increased mortality and hinder access to adjuvant therapy. Prehabilitation strategies, such as exercise and nutrition interventions, have been shown to reduce complications and improve patient well-being. However, not all patients respond to prehabilitation, and factors such as inflammation and anabolic resistance may contribute to this. The use of glucocorticoids and anabolic steroids as part of prehabilitation regimens is being explored to enhance the response to prehabilitation and improve surgical outcomes. However, the safety and efficacy of these drugs in surgical and cancer patients need further investigation. [Extracted from the article]

Background: International osteoporosis guidelines have recommended treatment approaches based on fracture risk stratification, in particular, anabolic therapy for patients with very high risk (VHR) of fragility fracture. Aim: To summarise Australian clinicians' perceptions of patients at VHR of fracture. Methods: Australian clinicians invited to educational webinars on anabolic treatments for osteoporosis were surveyed in March and April 2021 about a typical patient they had most recently seen and identified as at VHR of fracture. Results: Of the 268 clinician attendees who were invited to complete the post‐webinar surveys, 67 (25%) responded and permitted the publication of aggregated data. A typical patient perceived to have a VHR of fracture was a woman in her 80's, living at home, who had been diagnosed with osteoporosis between 5 and 10 years ago, and received treatment for 1–5 years' duration, most commonly denosumab. The patient frequently had a T‐score below −3.0 SD (standard deviation), multiple fragility fractures and most commonly suffered a vertebral fracture in the past 12 months, whereas on an adequate regimen of osteoporosis medication. There was a mismatch between the patient being eligible for anabolic therapy (64.2%) and actually having been prescribed an anabolic treatment in the past (20.9%). Conclusions: Australian clinicians' perceptions of patients with a VHR of fracture and the use of anabolic agents appear to be heavily influenced by local reimbursement criteria. The mismatch between patients deemed eligible for reimbursed anabolic therapy and those prescribed an anabolic agent suggests treatment inertia. [ABSTRACT FROM AUTHOR]

Copyright of Eurasian Journal of Veterinary Sciences is the property of Eurasian Journal of Veterinary Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sertraline, a selective serotonin reuptake inhibitor, is a medication recommended as a third line treatment of cholestatic liver injury pruritis. We report a case of a young male who developed liver injury secondary to self-administration of anabolic steroids and who complained of persistent pruritis leading to a treatment by sertraline. Two days later, the patient was admitted to the hospital with a severe hypoglycemia, while the liver function tests were in amelioration. Clinical and biological evaluation were in favor of sertraline-induced hypoglycemia, a side effect rarely reported in non-diabetic patients, and in the context of hepatic injury. [ABSTRACT FROM AUTHOR]

The effects of some widely abused doping substances such as anabolic androgenic steroids (AAS) on performance are well documented, particularly in the short term, and the use of these substances is banned by various sporting authorities, with athletes sanctioned from competing for up to 4 years. However, controversy exists on whether residual physiological effects of some doping practices could persist even years after discontinuation, granting unfair advantages to athletes long after sanctions have been served. Particularly, in support of the so-called muscle memory theory, growing evidence in both animals and humans suggests that AAS administration could exert long-term effects at the muscle level, notably a higher number of myonuclei. This effect could enhance retraining/muscle remodeling capacity long after AAS cessation, thus supposing an advantage for doped athletes even +4 years after doping practices have been discontinued. If confirmed, the persistence of physiological improvements resulting from past doping practices raises serious ethical concerns in the sports field and opens the door to lifelong sanctions. [ABSTRACT FROM AUTHOR]

Background & Aims: One of the most popular Anabolic Androgenic Steroids (AAS) among athletes and teenagers is Nandrolone Decanoate (ND), a synthetic testosterone analog. Chronic AAS consumption raises the risk of cardiovascular problems in athletes, however the mechanism causing such changes is not known. This experimental research aims to investigate the impact of nandrolone decanoate administration on heart in white male albino rats. Materials & Methods: Twenty male Albino rats, split into two groups, were used in the study. Group A served as a control, getting peanut oil injections, while Group B received decanoate injections at a dose of 10 mg/kg body weight weekly for eight weeks. After the eighth week, the rats were sacrificed under anesthesia in accordance with the recommendations issued by the Ethical Committee. Following sacrifice, the rats were dissected and their tissues processed using normal histology procedures. Sections were stained with hematoxylin and eosin, and microscopic observations were recorded in groups. In order to properly label and analyze the photos, photographic microscopy was used. Results: After Eighth week, the control group's heart showed no obvious changes under microscopic examination, whereas the ND treated group showed intermuscular hemorrhages, congested myocardial vessels, widely separated cardiomyocytes, fragmented muscle fibers, and cardiomyocytes showing vesicular nuclei and few degenerative changes. These results suggest that ND treatment may cause particular cardiac structural changes in white male albino rats. Conclusion: The study suggests that Nandrolone abuse can lead to cardiac problems such as severe degeneration, myocardial vascular congestion, and intermuscular hemorrhages. The study emphasizes the significance of investigating the long-term effects of these medications, as well as the importance of well-designed studies and proper dosage considerations.

Over the past few decades, anabolic androgenic steroids (AASs) have been abused in and out of competition for their performance-enhancing and muscle-building properties. Traditionally, AASs were commonly detected using gas chromatography-mass spectrometry in the initial testing procedure for doping control purposes. Gas chromatography-Orbitrap high-resolution mass spectrometry (GC-Orbitrap-HRMS) is a new technology that has many advantages in comparison with GC-MS (e.g., a maximum resolving power of 240,000 (FWHM at m/z 200), excellent sub-ppm mass accuracy, and retrospective data analysis after data acquisition). Anti-doping practitioners are encouraged to take full advantage of the updated techniques of chromatography-mass spectrometry to develop sensitive, specific, and rapid screening methods for AASs. A new method for screening a wide range of AASs in human urine using GC-Orbitrap-HRMS was developed and validated. The method can qualitatively determine 70 anabolic androgenic steroids according to the minimum required performance limit of the World Anti-Doping Agency. Moreover, the validated method was successfully applied to detect six metabolites in urine after the oral administration of metandienone, and their excretion curves in vivo were studied. Metandienone M6 (17β-hydroxymethyl-17α-methyl-18-nor-androst-1,4,13-trien-3-one) has been identified as a long-term urinary metabolite which can be detected up to 7 weeks, thus providing a longer detection window compared with previous studies. This study provides a rationale for GC-Orbitrap-HRMS in drug metabolism and non-targeted screening. [ABSTRACT FROM AUTHOR]

Background: Almost 10% of women in reproductive age are diagnosed with ovarian endometriomas and can experience symptoms and infertility disorders. Ovarian endometriomas can be treated with medical or surgical therapy. Objective: To assess whether long-term therapy with dienogest or oral cyclic estrogen-progestogens is effective in reducing the size of ovarian endometriomas, alleviating associated symptoms, and reducing the requirement for surgery. Design: Prospective non-interventional cohort study. Methods: We enrolled childbearing women diagnosed with ovarian endometriomas. We collected demographic, clinical, and surgical data, including the evaluation of ovarian endometrioma-associated symptoms and pain using the visual analog scale. We grouped the women according to treatment regimen into dienogest, estrogen-progestogens, and no-treatment. Patient's assessment was performed at baseline and after 12 months evaluating the largest ovarian endometrioma diameter (in millimeters) and the associated symptoms. Furthermore, we analyzed the impact of hormonal treatment in a sub-group of women fulfilling at baseline the criteria for a first-line surgical approach (ovarian endometrioma > 30 mm with visual analog scale > 8 or ovarian endometrioma > 40 mm before assisted reproductive treatments or any ovarian endometrioma(s) > 60 mm). Results: We enrolled 142 patients: 62, 38, and 42 in dienogest, estrogen-progestogens, and no-treatment groups, respectively. No significant differences were found regarding baseline characteristics. After 12 months, the mean largest ovarian endometrioma diameter increased in the no-treatment group (31.1 versus 33.8; p < 0.01), while a significant reduction was registered in the dienogest (35.1 versus 25.8; p < 0.01) and estrogen-progestogens (28.4 versus 16.7; p < 0.01) groups; no significant difference in ovarian endometrioma diameter reduction between these two latter groups was noted (p = 0.18). Ovarian endometrioma-associated symptoms and pain improved in dienogest and estrogen-progestogens groups, with a significantly greater effect for dienogest than for estrogen-progestogens for dysmenorrhea (74% versus 59%; p < 0.01). In the sub-group of women eligible for first-line surgery at baseline, long-term treatment with dienogest and estrogen-progestogens reduced surgical eligibility by 30%. Conclusions: Decreased mean largest ovarian endometriomas'diameter after 12 months and reduction of the need for surgical treatment by 30% were observed in dienogest and estrogen-progestogens groups. Long-term treatment with dienogest had a greater effect in alleviating dysmenorrhea and pain. [ABSTRACT FROM AUTHOR]

The evolving prevalence of anabolic androgenic steroids (AAS) abuse among nonathletes is alarming because of the known harm to an individual's health. Among the adverse effects of AAS abuse, male infertility and sexual dysfunction have been often reported in the literature, but little is known regarding its actual prevalence, possible underpinning mechanisms, and potential treatments either during or post-AAS usage. Thus, the current narrative review summarizes the state-of-art regarding the effects of AAS on male fertility and sexual function. Evidence was gathered from the latest reviews and recent original studies, specifically from prospective cohorts and clinical trials, ultimately resulting in five main topics of discussion. First, AAS usage is briefly characterized by its historical background, main physiological mechanisms, and the most frequently used AAS substances. Second, data on the prevalence of AAS-induced male infertility and sexual dysfunction are described. Third, some new insights on possible underpinning mechanisms of AAS-induced male infertility and sexual dysfunction are thoroughly discussed, with particular attention to histological data derived from animal models and the latest insights from prospective cohorts in humans. Fourth, the potential treatments during and after the AAS usage are presented, highlighting the odds of resolving male infertility and sexual dysfunction. Fifth, future directions on this topic are discussed, focusing on the methodological robustness of scientific studies. [ABSTRACT FROM AUTHOR]

Purpose: In competitive sport, classic methods of measuring drug prevalence, such as doping controls or questionnaires, are challenging. Here we describe a novel urine sampling method to measure drug use in athletes. We hypothesize that the prevalence of drug use in ultramarathon runners is measured more accurately with our sampling method than randomized-response questionnaires. Methods: Urine samples and associated demographic data were collected from male participants using blind, automated urinals at the start ot ultramarathon races. Various nonprohibited and prohibited substances were subsequently screened. Concomitantly, 2931 male and female runners participating in the same ultramarathons completed an anonymized, randomized-response questionnaire regarding drug use. Results: Among 412 individual urine samples, 205 (49.8%) contained at least one substance, and 16.3% of the samples contained one or more prohibited substances. Substances detected in urine included nonsteroid anti-inflammatory drugs (NSAID) (22.1%), acetaminophen (15.5%), opioids (6.6%), diuretics (4.9%), hypnotics (4.4%), glucocorticoids (2.7%), beta-2 agonists (2.2%), cannabinoids (1.9%), and stimulants (1.2%). None of the samples contained erythropoietin-receptor agonists or suspicious testosterone. Drug use was not associated with the participants' characteristics or ranking. Respondents to the questionnaire reported using acetaminophen (13.6%) and NSAID (12.9%); however, no prohibited substances were declared. Conclusions: There was a high prevalence of drug use among male ultramarathon runners, in particular, NSAID and painkillers; however, performance-enhancing drugs were marginally used. Blind urine sampling highlighted prohibited drug use not declared in questionnaires, and it is useful to assess the prevalence of drug use and/or doping in competitive athletes. [ABSTRACT FROM AUTHOR]

Bodybuilding, as a high-performance sport, requires regular strength and resistance exercises with the principal objective of increasing muscle hypertrophy. However, many bodybuilders resort to the use of anabolic-androgenic steroids (AASs) to improve their performance in a short period of time. This study employs a survey-type, cross-sectional, descriptive–analytical method to evaluate the profile of bodybuilding athletes in the State of Sergipe, Brazil, and verify the level of knowledge/awareness about the health risks and impacts resulting from the use of such substances. Finite- and convenience-type populations are assessed, including individuals of both sexes, aged older than 18 years, self-declared bodybuilding athletes residing in the State of Sergipe, Brazil, and participating in regional and/or state competitions. As a result, no significant relationships were determined between sex (p = 0.492), age (p = 0.460), family income (p = 0.141), and medical follow-up sessions. For the variables level of education and medical follow-up vs. no follow-up sessions, a significant result was achieved (p = 0.01), with 74.3% of individuals reporting having follow-up treatment and 25.7% responding that they had no follow-up treatment, a percentage representing the group that completed their higher education. The substances most used by the athletes were Sustanon 250 or Durateston, Nandrolone Decanoate (Deca or Deca-Durabolin), and Testosterone. The most-reported acute side effects were acne at 33.8% (n = 20), irritability at 32.1% (n = 19), alopecia (hair loss), and nervousness at 23.7% (n = 14). The most-reported chronic side effects were arterial hypertension at 36.0% (n = 9), liver disease at 28.0% (n = 7), and cancer (non-specific) at 8.0% (n = 2). We concluded that, regardless of the athletes' socioeconomic profiles, the use of AASs was high, with two or more substances being used in combination and for a prolonged period. Thus, it is necessary to promote awareness campaigns regarding the use of AASs and their effects on high-performance and recreational athletes. [ABSTRACT FROM AUTHOR]

The control of the cardiovascular system depends on the autonomic nerve system. Chronic anabolic andorogenic steroids (AAS) use causes sympathovagal imbalance and increases sympathetic nerve activity. The reduction in heart rate from the peak exercise rate following the end of the exercise stress test is known as the heart rate recovery index (HRRI). Several methods have been utilized to assess myocardial repolarization, such as QT interval (QT), corrected QT interval (QTc), and T-wave peak-to-end interval (Tp-e interval). Based on a growing number of data a higher Tp-e/QT ratio is linked to malignant ventricular arrhythmias, and an increased Tp-e interval may correlate with the transmural dispersion of repolarization. Our hypothesis is that the use of chronic AAS was decrease HRRI during maximal exercise and increased risk of cardiac arrhythmias and sudden cardiac death. This study included 44 male bodybuilders, with an average age of 29.7 ± 8.14 years, divided into AAS abuse [AAS users (n = 21) and AAS nonuser (n = 23)]. The first (p = 0.001) and second minute (p = 0.001) HRRI of the subjects with AAS users were significantly lower than those of the control group. Additionally, HRRI after the third (p = 0.004) and fifth minutes (p = 0.007) of the recovery period were significantly lower in AAS group compared with the control group. Who used AAS had significantly higher QT, QTc, Tp-e, Tp-e/QT, and Tp-e/QTc values than non-users (all p = 0.001). Chronic AAS use has been shown to cause sympathetic dominance, which may be a pro arrhythmic state. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Prescrição e Fisiologia do Exercício is the property of Instituto Brasileiro de Pesquisa e Ensino em Fisiologia do Exercicio and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Testosterone is an anabolic and androgenic steroid hormone therapeutically used to produce male sex characteristics. It has also been shown to have a modulating effect on proinflammatory biomarkers. Critical illness is characterised by a proinflammatory and catabolic state and is accompanied by altered testosterone production, which may persist into the recovery phase. Testosterone may, therefore be a potential therapeutic option in critical illness. This paper reviews normal testosterone physiology, and the changes seen during critical illness and systematically reviews testosterone therapy during both the acute and chronic phases of critical illness. [ABSTRACT FROM AUTHOR]

We describe a case of an Asian-Indian female patient who presented to us with abnormal fat accumulations in the torso and upper arms following indiscriminate use of corticosteroid and anabolic steroids for about 7 years. Despite prolonged steroid use, the patient did not display cushingoid phenotype or metabolic decompensation. Bone density, echocardiography, and ultrasonogram of the liver were also normal with no evidence of excess pericardial fat, hepatic steatosis, or peliosis hepatis. Concurrent use of anabolic androgen is thought to be protective against the ill effects of steroids, especially on the muscle and bone. This phenomenon has been observed in children and adolescents with Cushing syndrome where the adrenal androgen excess and increased physical activity have shown to reasonably reduce protein catabolism and help in preserving muscle and bone mass. The patient was withdrawn from the drugs and was put on replacement hydrocortisone that was gradually tapered over the next few weeks and planned for surgical correction. This case highlights the fact that medical providers should be aware that a combination of anabolic steroids and glucocorticoids are still used for weight-building purposes, and these patients may present with atypical signs/symptoms as a result of this combination of drugs. [ABSTRACT FROM AUTHOR]