Adverse effects and potential benefits among selective androgen receptor modulators users : a cross-sectional survey / Iakov V. Efimenko, David Valancy, Justin M. Dubin, Ranjith Ramasamy. - (International Journal of Impotence Research (2021) 1 September)

• PMID: 34471228
• DOI: 10.1038/s41443-021-00465-0

Abstract

Selective androgen receptor modulators (SARMs) are a class of androgen receptor ligands that bind androgen receptors and display tissue selective activation of androgenic signaling. SARMs have selective anabolic effects on muscle and bone, and were originally synthesized for treatment of muscle wasting conditions, osteoporosis, breast cancer. To date, no SARM has been clinically approved and little is known about the beneficial effects and other adverse effects on users. We examined the adverse effects and potential benefits of SARMs amongst users. We performed an internet survey assessing the demographics of users via a 32-question survey. Using reddit as a platform, we distributed the survey through various subreddits that included potential SARMs users. Out of the 520 responses, 343 participants admitted having used SARMs. Most were males (98.5%), between the ages of 18-29 (72.3%). More than 90% of users acquired SARMs via the internet and did not consult with a physician. More than half of SARMs users experienced side effects including mood swings, decreased testicular size, and acne. More than 90% of men reported increased muscle mass and were satisfied with their SARMs usage. Despite having seemingly positive effects, more than 50% of SARMs users report significant adverse effects. Chi square was the main method of statistical analysis. Future studies should focus on comprehensive reproductive evaluation of men using SARMs.

Exploring the harms arising from polysubstance use among performance and image enhancing drug users among young Australian men / Timothy M. Piatkowski, Matthew Dunn, Katherine M. White, Leanne M. Hides, Patricia L. Obst

• Performance Enhancement & Health 9 (2021) 3-4 (October), 100197
• DOI: 10.1016/j.peh.2021.100197

Abstract

Evidence suggests young men who use performance and image enhancing drugs (PIEDs) in Australia also engage in alcohol and party drug use. Such polysubstance use is concerning as it could exacerbate the harms that come from using either PIEDs or other drugs alone. The present study employed semi-structured interviews with 12 young men which aimed to explore patterns of PIED and other drug use among a sample of young men who use PIEDs in Australia. Analysis of interview data identified typical patterns of PIED use and other drug use among this group. The analysis yielded two themes: 1) extent of compound use for body enhancement and 2) alcohol and other drug use resulting in harms for PIED users. The present findings underscore that young men who use PIEDs represent an at risk population for alcohol and party drug use and the increased array of harms that the combination of multiple substances produces.

Drug-Induced Liver Injury From Enobosarm (Ostarine), a Selective Androgen Receptor Modulator / Harjot Bedi, Carl Hammond, David Sanders, Hui-Min Yang, Eric M. Yoshida. - (ACG Case Reports Journal 8 (2021) 1 (January); p. 1-3)

• PMID: 34368386
• PMCID: PMC8337042
• DOI: 10.14309/crj.0000000000000518

Abstract

Anabolic steroids are well-known to cause liver injury, which may manifest with jaundice and elevated liver enzymes. Selective androgen receptor modulators (SARMs) have been developed to enhance muscle bulk without the side effects associated with exogenous androgen steroids. We report a case of significant cholestatic liver injury associated with a SARM, ostarine (enobosarm), similar to that associated with anabolic steroids. Liver injury from SARMs has not been reported frequently, and we speculate that this may be seen more often as the consumption of SARMs increases in the athletic market.

Double trouble? A mixed methods study exploring experiences with combined use of anabolic-androgenic steroids and psychoactive substances among women / Ingrid Amalia Havnes, Marie Lindvik Jørstad, Astrid Bjørnebekk. - (Performance Enhancement & Health (2021) 100198 (5 September);

• DOI: 10.1016/j.peh.2021.100198

Abstract

Concurrent use of anabolic-androgenic steroids (AAS) and psychoactive substances (illicit drugs and alcohol) is found common in studies among men and involves a higher risk of adverse events than AAS use alone. However, women who use AAS represent an understudied group, and little is known about their pattern of psychoactive substance use and possible links to AAS use. The aim of this mixed methods paper is to a) examine lifetime and problem use of psychoactive substances and AAS, and b) explore experiences of AAS and psychoactive substance use including understandings of how these substances may be related among women with current or previous AAS use.

Among sixteen women with current or previous AAS use, lifetime psychoactive substance and AAS use, AAS dependence and problem drug and alcohol use were assessed. In-depth semi-structured interviews were conducted, audio-recorded, transcribed verbatim and analyzed thematically within a biopsychosocial framework applying pharmacological agency; the concept of bodily surveillance of effect and the ability to handle substances instrumentally to feel oneselves/ones bodies better.

Twelve participants reported lifetime substance use, where cannabis, cocaine and amphetamines were most commonly used. Substance use problems were found among eight participants; five had lifetime AAS-dependence and clinically significant drug and/or alcohol dependence scores, two had lifetime AAS dependence, and one had clinically significant drug dependence scores. Psychoactive substance use was experienced as unrelated to AAS use or it could be used to counteract side effects of AAS. On the contrary, AAS was used to cope with the bodily and emotional change following withdrawal from psychoactive substances and to counteract bodily effects of long-term substance use. Being in substance use disorder (SUD) treatment after detoxification with affected mental health, a passive lifestyle and experiencing a transition from having an emaciated body, gaining weight and becoming unfit, was experienced to motivate AAS initiation during treatment.

The polysubstance nature of AAS use including use of psychoactive substances and risk of developing SUDs poses a significant health risk. Health professionals need to understand motivations for combined use of AAS and psychoactive substances among women to be able to prevent harms and address individual treatment needs.

iNADO Update (2021) 09 (6 September)
Institute of National Anti-Doping Organisations (iNADO)

Contents:

iNADO Community

• Two Athlete Focussed Updates from Drug Free Sport New Zealand
• UKAD Renews Partnership with The Drug Control Centre to Test Athlete Samples
• Eighth Session of the Conference of Parties to the International Conference against Doping in Sport scheduled for 26-28 October, 2021

Bulletin Board

• Reminder: Clean Sport Education Repository Webinar
• Reminder to apply for 2022 WADA Standing Committees

Athlete's Voice

• "Challenges of Paralympic athletes are different, as should
  be their anti-doping education."

Science

• Research Paper analyzes the Strengths and the Weaknesses of the 2021 WADA Code
• The Number of Records broken in Summer Olympic Games is decreasing

Practical Development in Anti-Doping

• iNADO's Survey about Substances of Abuse
• New Practical Information on the Use of Natural Products and Supplements

Feature of the Month

• TonTon visits iNADO

iNADO Partners & Sponsors

• New at the Anti-Doping Knowledge Center

Annual Report 2020 / Spanish Agency for the Protection of Health in Sport (AEPSAD). - Madrid : Agencia Española de Protección de la Salud en el Deporte, 2021

Annual Report 2020-2021 / South African Institute for Drugfree Sport (SAIDS). - Cape Town : SAIDS, 2021

• ISBN: 978-0-621-49694-9

Annual Report 2020 / Doping Control Agency of Thailand (DCAT). - Bangkok : DCAT, 2021

Related case:

World Athletics 2023 WA vs Carina Horn
August 2, 2023

In September 2019 the Athletics Integrity Unit (AIU) for World Athletics has reported an anti-doping rule violation against the South African Athlete Carina Horn after her A and B samples tested positive for the prohibited substances Ibutamoren and LGD-4033 (ligandrol).

After notification a provisional suspension was ordered. Analysis of the Athlete's supplement Mutant Madness in the Bloemfontein Lab and again in the Lausanne Lab revealed the presence of LGD-4033 in both an unsealed and a sealed bottle of Mutant Madness. Analysis of other supplements in question in the Lausanne Lab showed the presence of Ibutamoren in a sealed bottle of Amplify Whey.

The Athlete argued that she had ingested two contaminated supplements, Mutant Madness and Amplify Whey, which were analysed by two different WADA-accredited laboratories and which

• (i) detected LGD-4033 in the unsealed bottle of Mutant Madness with lot number #50381 used by the Athlete
• (ii) detected LGD-4033 in a sealed bottle of Mutant Madness with the same lot number #50381 and
• (iii) detected Ibutamoren in a sealed bottle of Amplify Whey which had been purchased form the same store that the Athlete had previously purchased the Amplify Whey that she used.

In support of her explanations the Athlete filed witness statements and an expert report about her use of the products Mutant Madness and Amplify Whey at the relevant time.

Finally in June 2021 the Athlete admitted the violation, denied the intentional use of the prohibited substances, waived her right for a hearing and accepted the sanction proposed by the AIU. She asserted that she had demonstrated how the substances had entered her system. 

Independent scientific advise for the AIU confirmed that the Athlete's explanations were consistent with the presence of the substances in the samples. As a result the AIU concludes that the Athlete's has established that the probable source of the LGD-4033 and Ibutamoren are the products Mutant Madness and Amplify Whey.

Therefore the AIU decides on 10 September 2021 to impose a 2 year period of ineligibility on the Athlete, starting on the date of the provisional suspension, i.e. on 13 September 2019.

Related case:

TJD-AD 2021-028 Appeal Decision - Boxing
December 16, 2021

In February 2021 the Brazilian Doping Control Authority (ABCD) reported an anti-doping rule violation against the boxer after his sample tested positive for the prohibited substance Enobosarm (Ostarine) in a low concentration. After notification a provisional suspension was ordered and the Athlete filed a statement in his defence.

The Athlete denied the intentional use of the substance and asserted that a contaminated supplement was the source of the prohibited substance. He provided ABCD two opened vials with supplements compounded in a pharmacy. Analysis of these supplements revealed the presence of Ostarine in one of these supplements.

The Compounding pharmacy in questioned confirmed to ABCD that prior on the same day Ostarine was compounded for another person and consequently thereupon the compounding supplement of the Athlete got contaminated.

The Rapporteur finds that the presence of a prohibited substance has been established in the Athlete's sample and accordingly that he committed an anti-doping rule violation.

The Rapporteur concludes that the violation was not intentional and the result of a contaminated supplement. Considered was that he was a high level athlete, had received anti-doping education, and was tested before without issues.

Further the Rapporteur deems that the Athlete acted with some degree of fault or negligence because he used his own unprescribed compounding supplements, not the prescribed supplements of his sports federation, whereas he failed to mention his supplements on the Doping Control Form.

Therefore the TJD-AD decides on 14 September 2021 to impose a 9 month period of ineligibility on the Athlete, starting on the date of the sample collection, i.e on 22 January 2021.