Muscle Dysmorphia : An Overview of Clinical Features and Treatment Options / Mitchell L. Cunningham, Scott Griffiths, Deborah Mitchison, Jonathan M. Mond, David Castle, Stuart B. Murray. - (Journal of Cognitive Psychotherapy 31 (2017) 4; p. 255-271)

• PMID: 32755900
• DOI: 10.1891/0889-8391.31.4.255

Abstract

An increasing public and empirical focus on male body image indicates that muscularity is a preeminent concern among boys and men. For some, these concerns develop into a complex and disabling psychiatric disorder termed muscle dysmorphia (MD), the hallmark of which is an intense preoccupation regarding one's (subjectively) insufficient muscularity. Treatment of MD is critical; however, evidence to inform treatment approaches is sorely lacking. The purpose of this article is twofold. First, we provide an overview of the clinical features of MD, drawing particular attention to the preoccupation, functional impairment and psychiatric comorbidity associated with the disorder. Second, we discuss and recommend potential treatment directions for MD, including techniques that have demonstrated efficacy in the treatment of related disorders, namely, body dysmorphic disorder and eating disorders (and anorexia nervosa in particular). Psychotherapeutic techniques, including cognitive restructuring of deleterious perfectionistic and egosyntonic beliefs, and dialectical behavioral techniques to improve the repertoire of emotion regulation skills available to afflicted individuals, are discussed, in addition to psychopharmacological approaches..

Adolescent muscle dysmorphia and family-based treatment : a case report / Stuart B. Murray, Scott Griffiths. - (Clinical Child Psychology and Psychiatry 20 (2014) 2 (19 February); p. 324-330)

• PMID: 24554557
• DOI: 10.1177/1359104514521639

Abstract

A growing body of evidence suggests that the prevalence of male body dissatisfaction and muscle dysmorphia is rising. To date, however, there is no published evidence on the efficacy of treatments for muscle dysmorphia. We present the case of a 15-year-old boy who met full diagnostic criteria for muscle dysmorphia, whose symptoms were treated into remission with eating disorder-focused, family-based treatment. The age of this patient fell within the time period in which symptoms of muscle dysmorphia are most likely to develop and this case represents the first published case report of family-based treatment for muscle dysmorphia in this age group. Thus, this case report has important implications for clinicians considering treatment options for presentations of muscle dysmorphia when first presenting in adolescence. Implications for the development of treatment guidelines for muscle dysmorphia and for the diagnostic debate surrounding muscle dysmorphia are also discussed.

How do clinicians in the field conceptualise muscle dysmorphia? / Stuart B. Murray, Stephen Touyz. - (Advances in Eating Disorders 1 (2013) 3 (7 June); p. 207-212)

• DOI: 10.1080/21662630.2013.794517

Abstract

Objective:
Muscle dysmorphia is a relatively recently identified psychiatric condition, whose precise nosological nature remains unclear. This study is aimed at investigating the diagnostic conceptualisation of muscle dysmorphia amongst a group of clinical practitioners.

Method: A clinical vignette, which ambiguously depicted the features of muscle dysmorphia in either male or female cases, was presented to a group of 100 clinical practitioners, who provided preliminary diagnoses based on the symptoms depicted.

Results: The majority of clinicians conceptualised this cluster of symptoms as an eating disorder phenotype, as opposed to variants of either body dysmorphic disorder or obsessive compulsive disorder.

Conclusions: These findings provide some support for the notion that muscle dysmorphia may best be conceptualised as an eating disorder phenotype. The findings are discussed in light of their clinical implications.

Anabolic steroid-induced hypogonadism : diagnosis and treatment / Cyrus D. Rahnema, Larry I. Lipshultz, Lindsey E. Crosnoe, Jason R. Kovac, Edward D. Kim. - (Fertility and Sterility 101 (2014) 5 (1 May); p. 1271-1279)

• PMID: 24636400
• DOI: 10.1016/j.fertnstert.2014.02.002

Abstract

Objective: To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management.

Design: Review of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria.

Setting: Not applicable.

Patient(s): Men seeking treatment for symptomatic hypogonadism who have used nonprescribed AAS.

Intervention(s): History and physical examination followed by medical intervention if necessary.

Main outcome measures(s): Serum testosterone and gonadotropin levels, symptoms, and fertility restoration.

Result(s): Symptomatic hypogonadism is a potential consequence of AAS use and may depend on dose, duration, and type of AAS used. Complete endocrine and metabolic assessment should be conducted. Management strategies for anabolic steroid-associated hypogonadism (ASIH) include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators.

Conclusion(s): Although complications of AAS use are variable and patient specific, they can be successfully managed. Treatment of ASIH depends on the type and duration of AAS use. Specific details regarding a patient's AAS cycle are important in medical management.

Androgen deficiency in the aging man / Ranjan Arianayagam, Mohan Arianayagam, Shaun McGrath, Prem Rashid. - (Australian Family Physician 39 (2010) 10 (October); p. 752-755)

• PMID: 20890477

Abstract

Background: Androgen deficiency in the aging man is an area of considerable debate because a gradual decline in testosterone may simply be part of the normal aging process. However, there is an alternative view that androgen deficiency in the aging man may constitute a valid and underdiagnosed disorder.

Objective: To discuss the aetiology, clinical features, diagnosis and management of androgen deficiency in the aging man.

Discussion: Late onset hypogonadism has clinical features that overlap with both normal aging and some pathological conditions. It can only be diagnosed on the basis of both suggestive clinical features and clear biochemical evidence of testosterone deficiency. In this group of patients medication may play a role.

Doping by athletes could become tougher to hide with new detection method. -  (American Chemical Society (2021) 5 April)

ACS Virtual PRESS SESSION 01: Monday, April. 5th at 10 a.m. EDT Welcome to ACS Spring 2021meeting! Please check out the archived video here:

• http://www.acs.org/spring2021doping​

As the world awaits the upcoming Olympic games, a new method for detecting doping compounds in urine samples could level the playing field for those trying to keep athletics clean. Today, scientists report an approach using ion mobility-mass spectrometry to help regulatory agencies detect existing dopants and future “designer” compounds. 

ACS Spring 2021 Press Conferences

10 video's

Welcome to ACS Spring 2021! The American Chemical Society (ACS) will be holding scientific press conferences here during the meeting, which runs from April 5 to 16. For press releases on these topics, please visit:

• http://www.acs.org/spring2021releases.

Stability of Oxandrolone in Medium-Chain Triglyceride Oil and Pharmacokinetics Following Buccal Administration of the Extemporaneous Formulation in Neonates and Adults / Matthew W. Linakis, Joseph E. Rower, Susan Sorenson, Christopher A. Reilly, Linda M. Lambert, Richard V. Williams, Phillip T. Burch. - (Journal of Pediatric Pharmacology and Therapeutics 25 (2020) 3 (1 April); p. 220-227)

• PMID: 32265605
• PMCID: PMC7134583
• DOI: 10.5863/1551-6776-25.3.220

Abstract

Objectives: Growth failure following surgical palliation of complex congenital heart defects (CHDs) is a prognosticator of poor outcomes. Many strategies for improving weight gain have been implemented in this population, with limited success. We recently described the potential of the anabolic steroid oxandrolone to improve weight gain following surgical repair of CHD when administered via a medium-chain triglyceride (MCT) oil suspension to the buccal mucosa. The current study evaluates the stability of oxandrolone in the MCT oil formulation, as well as the pharmacokinetics of oxandrolone when administered via buccal mucosa in both neonates and adults.

Methods: Stability was assessed by long-term storage of the preparation 1) at ambient conditions and 2) under photodegradative conditions for 3 days. Neonatal pharmacokinetic parameters were determined in a cohort of neonates following surgical CHD repair, whereas adult pharmacokinetics parameters were collected as part of a prospective study to evaluate the relative bioavailability of the oxandrolone in MCT oil formulation.

Results: We found that oxandrolone was stable in the MCT oil formulation for at least 1 month, although exposure to light hastened drug degradation. Both neonatal and adult oxandrolone pharmacokinetics were variable; however, oxandrolone in MCT oil was relatively well absorbed through the buccal mucosa (mean bioavailability = 62.5%).

Conclusions: These data suggest that the variability in oxandrolone exposures is inherent to the drug, and not the formulation or route of administration. Combined, these data support further study of this novel oxandrolone in MCT oil formulation and its impact on growth following complex surgical repair of CHD in neonates.

Undeclared Doping Substances are Highly Prevalent in Commercial Sports Nutrition Supplements / Erik Duiven, Luc J.C. van Loon, Laila Spruijt, Willem Koert, Olivier M. de Hon. - 
(Journal of Sports Science and Medicine 20 (2021); p. 328-338)

• DOI: 10.52082/jssm.2021.328

ABSTRACT

Sports nutrition supplements have previously been reported to contain undeclared doping substances. The use of such supplements can lead to general health risks and may give rise to unintentional doping violations in elite sports. To assess the prevalence of doping substances in a range of high-risk sports nutrition supplements available from Dutch web shops. A total of 66 sports nutrition supplements - identified as potentially high-risk products claiming to modulate hormone regulation, stimulate muscle mass gain, increase fat loss, and/or boost energy - were selected from 21 different brands and purchased from 17 web shops. All products were analyzed for doping substances by the UK life sciences testing company LGC, formerly known as the Laboratory of the Government Chemist, using an extended version of their ISO17025 accredited nutritional supplement screen. A total of 25 out of the 66 products (38%) contained undeclared doping substances, which included high levels of the stimulants oxilofrine, β-methylphenethylamine (BMPEA) and N,β-dimethylphenethylamine (NBDMPEA), the stimulant 4-methylhexan-2-amine (methylhexaneamine, 1,3-dimethylamylamine, DMAA), the anabolic steroids boldione (1,4-androstadiene-3,17-dione) and 5-androstene-3β,17α-diol (17α-AED), the beta-2 agonist higenamine and the beta-blocker bisoprolol. Based upon the recommended dose and the potential variability of analyte concentration, the ingestion of some products identified within this study could pose a significant risk of unintentional doping violations. In addition to inadvertent doping risks, the prescribed use of 3 products (4.5%) could likely impose general health risks.

Improving detection capabilities of doping agents by identification of new phase I and phase II metabolites by LC-MS/MS / Cristina Gómez Castellà. - Barcelona : Pompeu Fabra University, 2014. - (TESI DOCTORAL UPF / 2013)

Abstract:  

Metabolic studies of doping agents have been traditionally performed by using gas chromatography coupled to mass spectrometry (GC-MS). In the last years, liquid chromatography coupled to mass spectrometry (LC-MS) has demonstrated to offer new possibilities to perform metabolic studies. The objective of this thesis was to study the metabolism (phase I and phase II) of different doping agents by LC-MS/MS in order to improve the detection capabilities of the studied substances.

For mesocarb, a thermolabile compound, the parent drug 19 metabolites were detected in urine including mono-, di- and tri-hydroxylated metabolites excreted free or conjugated with glucuronic acid and sulphate. For toremifene, an anti-estrogenic drug with poor electron ionization properties, the parent drug and 20 metabolites were detected in urine. The structure of most of the metabolites was proposed.

Anabolic androgenic steroids (AAS) metabolites conjugated with sulphate were investigated to improve the retrospectivity of the detection of these compounds. A study of hydrolysis and MS/MS behaviour of sulphate metabolites of AAS was performed, and sulphate conjugated metabolites of boldenone, methyltestosterone and metandienone were studied. Boldenone sulphate and epiboldenone sulphate were identified as boldenone metabolites in humans. They can be used as markers of exogenous boldenone administration. For methyltestosterone, three new sulphate metabolites were detected and structures were proposed. One of them, 17β-methyl-5α-androstan-3α,17α-diol 3α-sulphate was detected in urine up to 21 days after methyltestosterone administration, improving three times the retrospectivity of the detection with respect to other previously reported long-term metabolites. Several new sulphate metabolites were detected after metandienone administration. One of them was characterized as 18-nor-17β-hydroxymethyl-17α-methylandrost-1,4,13-triene-3-one conjugated with sulphate, and it was detected up to 26 days after administration, improving the retrospectivity of the detection with respect to other long-term metabolites described.

The usefulness of LC-MS/MS for the detection and characterization of metabolites of doping agents has been demonstrated, especially for the study of new phase II metabolites and for metabolic studies of compounds where GC-MS shows relevant limitations.

Androgens in postmenopausal women : production, possible role, and replacement options / R A Lobo. - (Obstetrical & Gynecological Survey 56 (2001) 6 (June); p. 361-376)

• PMID: 11466487
• DOI: 10.1097/00006254-200106000-00022

Abstract

The physiology of normal androgen production in women has not been well understood. Aging, per se, accounts for much of the reduction in both ovarian and adrenal androgen production; and natural menopause does not result in an abrupt decline in testosterone production. Therefore, the definition of an androgen deficiency state in women, in the absence of adrenal suppression and/or bilateral oophorectomy, has been difficult. Nevertheless there are well-documented beneficial effects of androgen on many organ systems, including bone and the brain. This review focuses on the physiology of androgens in postmenopausal women and includes a discussion of the definition of an androgen deficiency state, the anticipated effects of androgen on several parameters of health, and possible ways in which androgens may be administered to women.