Postoperative Course and Anabolic-Androgenic Steroid Abuse : A Case Report / M. Medras, U. Tworowska, P. Jozkow, A. Dumanski, A. Dubinski
(Anaesthesia 60 (2005) 1 (January); p. 81-84).
- PMID: 15601278.
- DOI: 10.1111/j.1365-2044.2004.03998.x

Abstract

It is estimated that 80% of weight lifters and body-builders take anabolic-androgenic steroids. Their long-term use is associated with a variety of pathological conditions and premature death. Anabolic-androgenic steroid abuse may lead to changes in the presentation and progression of some conditions. It remains unclear whether anabolic steroids should be given to patients with a history of abuse of these drugs who are to undergo surgery. We report on a fatal outcome following surgery in a 48-year-old weight lifter.

Potential benefits of recombinant human growth hormone (rhGH) to athletes / Michael R. Graham, Julien S. Baker, Peter Evans, David Hullin, Non-Eleri Thomas, Bruce Davies. - (Growth Hormone & IGF Research 19 (2009) 4 (August); p. 300-307)

• PMID: 19539505
• DOI: 10.1016/j.ghir.2009.04.008

Abstract

Athletes have enjoyed almost a thirty year amnesty of rhGH abuse, which they consider has contributed to the winning of medals and the breaking of world records. Such a reprieve is almost at an end, since WADA have identified a method to detect rhGH abuse. Or have they? The anecdotal word "on the street" is that rhGH is still undetectable and athletes believe that the benefits, at the dosages they administer, far outweigh the risks! Scientists are aware that in a hormone deficiency condition, replacement can halt and in certain situations reverse some of the adverse effects. Growth hormone deficiency can lead to a loss of skeletal muscle mass and an increase in abdomino-visceral obesity, which is reversed on replacement with rhGH. Since the availability of GH, athletes have been trying to extrapolate these effects from the deficiency state to the healthy corpus and increase their sporting prowess. Past confessions from athletes, such as Ben Johnson, Kelly White, Tim Montgomery, Marion Jones and currently Dwain Chambers have demonstrated that they are prepared to tread the very fine lines that separate the "men from the boys". Rewards are so great, that anonymous surveys have identified that athletes will risk ill health, if they believe they can cheat, win and not get caught. The question that still needs to be answered is, "does growth hormone enhance performance"? Recent research suggests that it could. There is also a suspicion that in "cycled" low supraphysiological doses, it is no where near as harmful as WADA claim it to be.

Potential for Dehydration to Impact the Athlete Biological Passport / Kirsten E. Coffman, Katherine M. Mitchell, Roy M. Salgado, Geoffrey D. Miller, Robert W. Kenefick, Samuel N. Cheuvront. - (Drug Testing and Analysis (2020) 20 April).
- PMID: 32311833.
- DOI: 10.1002/dta.2811

Abstract

Purpose: In order to inform the Athlete Biological Passport (ABP), this study determined whether the elevation in hemoglobin (Hb) following intracellular or extracellular dehydration would trigger an atypical passport finding (ATPF).

Methods: Seven male and three female volunteers (age: 23±4y; height: 170±8cm; body mass: 78±12kg) were carefully euhydrated (EUH) to determine baseline Hb levels. Volunteers then completed both an exercise-induced sweating dehydration (SW) protocol and a diuretic-induced dehydration (DI) protocol. Dehydration was assessed via body mass changes and Hb was measured via bench-top automated hematology analyzer. Using the ABP module, the expected baseline range for each individual was determined using EUH trials, and the impact of each dehydration protocol was then assessed in comparison to these thresholds.

Results: Volunteers lost on average 3.1% and 3.7% body mass in the SW and DI trials, respectively. While only one subject exceeded the upper threshold following DI dehydration, six additional subjects demonstrated highly unusual ABP profiles; this was not the case for SW.

Conclusion: Sweating is not a feasible explanation for elevated Hb during ABP testing; however, recent illness such as secretory diarrhea, which is mimicked by diuretic administration, may be capable of producing elevated Hb in athletes' biological passports.

Potential risk for developing severe COVID-19 disease among anabolic steroid users / Flavio Cadegiani, Erica M. Lin, Andy Goren, Carlos G. Wambier. - (BMJ Case Reports 14 (2021) 2 (26 February))

• PMID: 33637513
• PMCID: PMC7919571
• DOI: 10.1136/bcr-2021-241572

Abstract

A severe case of COVID-19 was observed in an otherwise healthy 28-year-old man who had taken oxandrolone 40 mg/day as an anabolic steroid. The patient had been taking oxandrolone for enhanced bodybuilding 30 days prior to presenting to an outpatient clinic with COVID-19 symptoms. The patient reported that his symptoms have rapidly worsened over the course of 4 days prior to presenting at the clinic. As part of an experimental antiandrogen treatment for hyperandrogenic men suffering from COVID-19, he was administered a single 600 mg dose of the novel antiandrogen proxalutamide. Twenty-four hours after administration of this dose, marked improvement of symptoms and markers of disease severity were observed. To our knowledge, this is the first case that potentially links anabolic steroid use to COVID-19 disease severity.

Potential Risk of Higenamine Misuse in Sports: Evaluation of Lotus Plumule Extract Products and a Human Study / Ching-Chi Yen, Chun-Wei Tung, Chih-Wei Chang, Chin-Chuan Tsai, Mei-Chich Hsu, Yu-Tse Wu. - (Nutrients 12 (2020 2 (21 January); 285).
- PMID: 31973198.
- DOI: 10.3390/nu12020285

Abstract

Since 2017, higenamine has been added to the World Anti-Doping Agency (WADA) prohibited list as a β2-agonist prohibited at all times for sportspersons. According to WADA's report, positive cases of higenamine misuse have been increasing yearly. However, higenamine occurs naturally in the Chinese herb lotus plumule-the green embryo of lotus (Nelumbo nucifera Gaertn) seeds-commercially available as concentrated powder on the Asian market. This study evaluated the major phytochemical components of lotus plumule products using an appropriate extraction method, followed by a human study in which the products were orally administered in multiple doses to investigate the risk of doping violations. Comparing various extraction methods revealed that optimized microwave-assisted extraction exhibited the highest extraction efficiency (extraction time, 26 min; power, 1046 W; and temperature, 120 °C). Subsequently, the alkaloids in lotus plumule products were quantitatively confirmed and compared. Human study participants (n = 6) consumed 0.8 g of lotus plumule (equivalent to 679.6 μg of higenamine) three times daily for three consecutive days. All participants' urinary higenamine concentrations exceeded the WADA reporting cut-off of 10.0 ng/mL. Accordingly, lotus plumule consumption may engender adverse analytical findings regarding higenamine. Athletes should avoid consuming lotus plumule-containing products during in- and out-of-competition periods.

Polish version of the 'Say NO! To Doping' video of WADA

The 30-second clip emphasizes the true values of sport and delivers a very clear message that genuine sporting success and enjoyment comes only through hard work and fair play, not through doping.

The 'Say NO! To Doping' campaign emphasizes the key sporting messages of courage, respect, effort and to accept challenges and is designed so international and national sports organizations can unite behind it in support of clean sport.

The clip was produced by Montreal-based media companies TP1 (http://www.tp1.ca) and OUTAN (http://www.outanmedias.com)

Practical experience with the implementation of an athlete's biological profile in athletics, cycling, football and swimming / M. Zorzoli, A. Pipe, P.Y. Garnier, M. Vouillamoz, J. Dvorak. – (British Association of Sport and Medicine 48 (2014) 10 (19 March) : p. 1-5)

• doi: 10.1136/bjsports-2014-093567. Epub 2014 Mar 19

Content:

- Introduction
- The cycling experience: UCI
• Athlete’s testing pool and whereabouts
• Sample collection
• APMU and the panel of experts
• Antidoping rule violation
• Agreements with NADO
- The football experience: FIFA/UEFA
- The aquatics experience: FINA
- The athletics experience: IAAF
• Particulatities of athletics
• Athlete’s testing pool and whereabouts
• Athlete passport management
• Antidoping rule violations
- Conclusions

The introduction of the athlete's biological passport (ABP) has been a milestone in the fight against doping. The ABP is a collection of measurements of different biological parameters influenced by the administration of doping agents through the time and for each athlete. Two different modules have been developed and validated so far: the haematological module, which aims to identify enhancement of oxygen transport, including use of erythropoiesis-stimulating agents and any form of blood transfusion or manipulation, which became effective in 2010; and the steroidal module, which intends to detect the use of endogenous anabolic androgenic steroids when administered exogenously and other anabolic agents, which was introduced in 2014. Prior to the implementation of the haematological module, it is important to define an athlete's testing pool on whom to collect blood and/or urine in-competition and out-of-competition (for the steroidal module, this is irrelevant because all collected urine samples will be subjected to analysis for the steroidal variables) and to be compliant with the strict requirements of the World Anti-Doping Agency ABP Operating Guidelines. The established individual profile can be used either to target traditional antidoping tests (recombinant erythropoietins, or homologous blood transfusion tests for the haematological module; isotope ratio mass spectrometry (IRMS) for the steroidal module) or to support an antidoping rule violation due to the use of a forbidden substance or method. In this article, we present the experience of four major International Federations which have implemented an ABP programme, focusing on the haematological module. They constitute examples which could be followed by other antidoping organisations wishing to introduce this new, efficient and innovative antidoping tool.

Practice Makes Perfect: An analysis of the World Anti-Doping Code 2009 / John O’Leary. – (International Sports Law Journal (2012) 1-2 : p. 12-20)

Content:
- The changing legal and political landscape
- The need for anti-doping regulation
- Out of Competition Testing
- Strict Liability
- Proof of Doping
- Banned substance
• Enhancing Sport Performance
• Health Risk
- Sanctions
- The Future of Anti-Doping

The 2009 WADA Code contains some important amendments to the 2003 code. The objects of this chapter are twofold: to evaluate the importance of the World Anti- Doping Code (the Code) in the light of a changing legal and political landscape and to evaluate whether the 2009 Code improves on the 2003 model by satisfactorily balancing between the right of individual athletes to complete with the desire on the part of sports governing bodies to regulate effectively against those who seek to avoid anti-doping restrictions.
In this context it is necessary to consider both the legal and the sport regulatory framework because, whether it is considered conceptually as a process of juridification or as an example of legal pluralism, the interaction between law and regulation has become so interwoven that the significance to the athlete of this distinction is practically irrelevant.
Equally, as lawyers are actively involved in both the process of law and regulation, such a distinction might be considered more accurately as the difference between hard and soft law.

Prasterone (DHEA) and mania / C.E. Dean

• Annals of Pharmacotherapy 34 (2000) 12 (1 December) p. 1419-1422
• PMID: 11144700
• DOI: 10.1345/aph.10115

Abstract

Objective: To inform clinicians and investigators of the potential for severe mania in conjunction with the use of prasterone (DHEA; dehydroepiandrosterone).

Case summary: A 31-year-old Hispanic man was admitted on a 72-hour observation period from a neighboring hospital after threatening to kill himself, family members, and a friend. A loaded rifle was found under his bed. The family confirmed that he had begun using DHEA several weeks prior to his mood and behavioral changes. He denied any past violence, but had once been given an unsubstantiated diagnosis of bipolar disorder. He used alcohol episodically, and had difficulties controlling his anger while intoxicated. Although he improved with valproate, his threats of homicide led to involuntary commitment.

Discussion: Several studies and case reports strongly suggest that anabolic steroids can induce significant psychiatric difficulties, including mania, impaired cognition, and overt psychosis. Although the Food and Drug Administration noted in 1985 that the efficacy and safety of DHEA were never confirmed, the agent continues to be sold over the counter. Several groups have used DHEA in the treatment of AIDS, memory loss, and depression, but reported no serious adverse events; however, recent studies indicate that severe psychiatric symptoms can develop in a subset of users. Although uncertain, potential risk factors include high doses of DHEA; history of mood disorder; concurrent use of alcohol, street drugs, or antidepressants; and cytochrome P450 polymorphisms.

Conclusions: The use of DHEA in those under age 35 years may be especially risky, as endogenous DHEA concentrations peak at age 20-30 years. Those using or investigating DHEA should be cognizant of the potential for severe psychiatric complications.

Pre-Workout Supplement Induced Cardiac Ischaemia In A Young Female / Samuel S.Y. Young. - (Journal of Sports Sciences 38 (2020) 2); p. 187-191).
- PMID: 31783721.
- DOI: 10.1080/02640414.2019.1689598

Abstract

The popularity of pre-workout supplements is rising amongst professional athletes and fitness enthusiasts. Despite increased usage, the safety profile of pre-workout supplements is likely to be not well understood. Additionally, many different brands use various undisclosed proprietary blends of active ingredients creating safety regulation difficulties. This lack of oversight could prove unsafe for certain patients. This patient MK is a 33-year-old healthy housewife who presented with central chest tightness, pre-syncope and mild dyspnoea to the emergency department via ambulance. The presentation was in the context of recent strenuous exercise and ingestion of a pre-workout supplement (Alpha Lean-7). Most striking in her presentation was a troponin rise of 50 ng/L, while not very high it is unusual given her lack of cardiac risk factors. She had a 3-day uneventful admission with a downtrending troponin prior to discharge. This case highlights the possible dangers of pharmacologically active ingredients in pre-workout supplements.