Counterfeiting in performance- and image-enhancing drugs

9 Jun 2009

Counterfeiting in performance- and image-enhancing drugs / Michael R. Graham, Paul Ryan, Julien S. Baker, Bruce Davies, Non-Eleri Thomas, Stephen-Mark Cooper, Peter Evans, Sue Easmon, Christopher J. Walker, David Cowan, Andrew T. Kicman. - (Drug Testing and Analysis 1 (2009) 3 (March); p. 135-142)

  • PMID: 20355187
  • DOI: 10.1002/dta.30


Abstract

The current drastic escalation in obesity may be contributing to the exponential rise in drugs used for image enhancement. Drugs such as anabolic-androgenic steroids (AAS) are perceived as a viable method of achieving a perfect physique. They are also the most widely abused drugs in sport. The Internet has encouraged the abuse of expensive drugs, particularly human growth hormone (hGH), resulting in increased importation for personal use. The substantial increase in this market has opened up avenues for counterfeiting, estimated as a multi-million pound business. The acute adverse effects from contaminated vials may result in a variety of pathologies including communicable diseases. In 2007, in the UK, a series of intramuscular abscesses, requiring surgical treatment, led us to study samples obtained from the underground market.

The analysis of 38 parenteral samples and 19 oral samples of tablets was performed by a World Anti-Doping Agency (WADA) accredited laboratory, in an attempt to establish the extent of available counterfeit products. Fifty-three per cent (20) of the injectable AAS esters and 21% (4) of the oral tablets were counterfeit. Culture and sensitivity revealed the presence of skin commensal organisms, which may have contributed to the development of the abscesses. Users of AAS and hGH for sport, including bodybuilding, are currently risking their health because of counterfeit and poorly controlled products.

Human in vivo metabolism study of LGD-4033

25 Sep 2018

Human in vivo metabolism study of LGD-4033 / Argyro G. Fragkaki, Panagiotis Sakellariou, Polyxeni Kiousi, Nassia Kioukia-Fougia, Maria Tsivou, Michael Petrou, Yiannis Angelis. - (Drug Testing and Analysis 10 (2018) 11-12 (November-December); p. 1635-1645)

  • PMID: 30255601
  • DOI: 10.1002/dta.2512

Erratum in:

Human in vivo metabolism study of LGD-4033 / Argyro G. Fragkaki, Panagiotis Sakellariou, Polyxeni Kiousi, Nassia Kioukia-Fougia, Maria Tsivou, Michael Petrou, Yiannis Angelis. - (Drug Testing and Analysis 12 (2020) 1 (January); p. 164)

  • DOI: 10.1002/dta.2700. Epub 2019 Nov 17.
  • PMID: 31984662


Abstract

Selective androgen receptor modulators (SARMs) are an emerging class of therapeutics targeted to cachexia, sarcopenia, and hypogonadism treatment. LGD-4033 is a SARM which has been included on the Prohibited List annually released by the World Anti-Doping Agency (WADA). The aim of the present work was the investigation of the metabolism of LGD-4033 in a human excretion study after administration of an LGD-4033 supplement, the determination of the metabolites' excretion profiles with special interest in the determination of its long-term metabolites, and the comparison of the excretion time of the phase I and phase II metabolites. The results were also compared to those derived from previous LGD-4033 studies concerning both in vitro and in vivo experiments. Supplement containing LGD-4033 was administered to one human male volunteer and urine samples were collected up to almost 21 days. Analysis of the hydrolyzed (with β-glucuronidase) as well as of the non-hydrolyzed samples was performed using liquid chromatography-high resolution mass spectrometry (LC-HRMS) in negative ionization mode and revealed that, in both cases, the two isomers of the dihydroxylated metabolite (M5) were preferred target metabolites. The gluco-conjugated parent LGD-4033 and its gluco-conjugated metabolites M1 and M2 can be also considered as useful target analytes in non-hydrolyzed samples. The study also presents two trihydroxylated metabolites (M6) identified for the first time in human urine; one of them was recently reported in an LGD-4033 metabolism study in horse urine and plasma.

Discontinuation of estrogen replacement therapy in GH-treated hypopituitary women alters androgen status and IGF-I

1 May 2005

Discontinuation of estrogen replacement therapy in GH-treated hypopituitary women alters androgen status and IGF-I / Jens Juel Christiansen, Sanne Fisker, Claus Højbjerg Gravholt, Paul Bennett, Birgit Svenstrup, Marianne Andersen, Ulla Feldt-Rasmussen, Jens Sandahl Christiansen, Jens Otto Lunde Jørgensen. - (European Journal of Endocrinology 152 (2005) 5 (May); p. 719-726)

  • PMID: 15879357
  • DOI: 10.1530/eje.1.01898


Abstract

Objective and design: Compared with their male counterparts, healthy females secrete more growth hormone (GH) and those with GH-deficiency have lower insulin-like growth factor I (IGF-I) levels and are less responsive to GH substitution. To test whether this gender difference is related to sex hormones we measured androgen status and IGF-I related parameters in 38 hypopituitary women (mean (range) age 41.5 (20–58) years) during continued GH substitution as compared with a control group of 38 healthy women matched for age and menopausal status. Twenty six patients were studied twice: with estrogen replacement and after 28 days of estrogen discontinuation in a randomised design.

Results: The patients were androgen deficient compared with controls (median, range), dehydroepiandrosterone sulphate (DHEAS): 185 (99–7800) nmol/l vs 4400 (820–13 000) nmol/l, P = < 0.001; androstenedione: 0.5 (0.1–7.1) nmol/l vs 4.3 (1.6–8.8) nmol/l, P = < 0.001; dihydrotestosterone (DHT): 0.13 (0.09–0.54) nmol/l vs 0.55 (0.09–0.89) nmol/l, P = < 0.001; testosterone: 0.28 (0.09–1.56) nmol/l vs 1.1 (0.71–2.24) nmol/l, (P = < 0.001); free testosterone: 0.004 (0.001–0.030) nmol/l vs 0.016 (0.001–0.030) nmol/l, P = < 0.001. The circulating levels of IGF-I, IGF-II, IGF-binding protein 1 (IGFBP-1), and IGFBP-3 did not differ between patients and controls. The subgroup of patients receiving hydrocortisone (HC) replacement (n = 24) had significantly lower levels of androgens (suppressed by 80–100%) as well as IGF-I and IGFBP-3 as compared with the patients not receiving HC. IGF-I was correlated to free testosterone in patients (r = 0.57, P = 0.0005) as well as controls (r = 0.43, P = 0.008), and free testosterone was a significant positive predictor of IGF-I. Estrogen discontinuation induced an increase in IGF-I (167 ± 15 vs 206 ± 14 μg/l, P = 0.005 and IGFBP-3 (3887 ± 139 vs 4309 ± 138 μg/l, P = 0.0005). Estrogen discontinuation was associated with a significant increase in median (range) free testosterone (0.004 (0–0.02) vs 0.0065 (0–0.03) nmol/l, P = 0.001) and a significant decrease in median (range) sex-hormone binding globulin (SHBG; 93 (11–278) vs 55.5 (20–142) nmol/l, P = 0.001). ΔIGF-I correlated with ΔSHBG (r = −0.45 P = 0.033) and ΔIGFBP-3 (r = 0.67 P = < 0.001). In a regression model ΔE2, Δtestosterone, ΔSHBG and ΔIGFBP-3 explained 93% of the variation in ΔIGF-I.

Conclusions: Androgen levels are low in hypopituitary women and free testosterone correlates with IGF-I. Discontinuation of estrogen replacement in these patients induces elevations in IGF-I as well as free testosterone, and ΔIGF-I correlated positively with Δfree testosterone. These effects may contribute to the gender differences observed in the GH–IGF axis in healthy adults as well as in the responsiveness of hypopituitary patients to GH substitution.

Effects of dehydroepiandrostenedione, superimposed on growth hormone substitution, on quality of life and insulin-like growth factor I in patients with secondary adrenal insufficiency

1 Jun 2005

Effects of dehydroepiandrostenedione, superimposed on growth hormone substitution, on quality of life and insulin-like growth factor I in patients with secondary adrenal insufficiency: a randomized, placebo-controlled, cross-over trial / Sjoerd W. van Thiel, Johannes A. Romijn, Alberto M. Pereira, Nienke R. Biermasz, Ferdinand Roelfsema, Albert van Hemert, Bart Ballieux, Johannes W.A. Smit. - (Journal of Clinical Endocrinology & Metabolism 90 (2005) 6 (1 June); p. 3295–3303)

  • PMID: 15797966
  • DOI: 10.1210/jc.2004-1802


Abstract

To assess whether dehydroepiandrostenedione (DHEA) substitution, superimposed on GH substitution, improves quality of life of patients with secondary adrenal failure, we studied the effects of DHEA (50 mg/d, 16 wk) vs. placebo (16 wk) in GH- and ACTH-deficient men (n = 15; age, 52 +/- 3 yr), and postmenopausal women (n = 16; age, 61 +/- 2 yr) in a double-blind, placebo-controlled, crossover study. All patients were receiving stable hormone replacement therapy, including a fixed dose of human recombinant GH during the study. The men received testosterone substitution. The female patients did not receive estrogen substitution. At baseline, multiple parameters of quality of life were impaired compared with age- and sex-matched controls, especially in female patients. These parameters were not improved by DHEA treatment. DHEA only slightly improved the depression score (women) and health perception (women and men), although these parameters were not abnormal at baseline. DHEA increased serum IGF-I concentrations in female patients (by approximately 18%; P < 0.001), but not in male patients. In neither group did DHEA affect IGF-binding protein-3 levels. We conclude that DHEA, superimposed on GH substitution, does not substantially improve quality of life in patients with secondary adrenal insufficiency regardless of gender. In addition, DHEA increases IGF-I levels only in estrogen-depleted females, but not in testosterone-treated males, with secondary adrenal insufficiency.

Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study

2 Jul 2014

Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study / Andreas Kimergård, Jim McVeigh. - (Harm Reduction Journal 11 (2014) 19 (2 July); p. 1-13)

  • PMID: 24986546
  • PMCID: PMC4098923
  • DOI: 10.1186/1477-7517-11-19


Abstract

Background: The UK continues to experience a rise in the number of anabolic steroid-using clients attending harm reduction services such as needle and syringe programmes.

Methods: The present study uses interviews conducted with harm reduction service providers as well as illicit users of anabolic steroids from different areas of England and Wales to explore harm reduction for this group of drug users, focussing on needle distribution policies and harm reduction interventions developed specifically for this population of drug users.

Results: The article addresses the complexity of harm reduction service delivery, highlighting different models of needle distribution, such as peer-led distribution networks, as well as interventions available in steroid clinics, including liver function testing of anabolic steroid users. Aside from providing insights into the function of interventions available to steroid users, along with principles adopted by service providers, the study found significant tensions and dilemmas in policy implementation due to differing perspectives between service providers and service users relating to practices, risks and effective interventions.

Conclusion: The overarching finding of the study was the tremendous variability across harm reduction delivery sites in terms of available measures and mode of operation. Further research into the effectiveness of different policies directed towards people who use anabolic steroids is critical to the development of harm reduction.

Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK

4 Jun 2014

Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK / Andreas Kimergård, Jim McVeigh. - (BMJ Open 4 (2014) 6 (4 June); p. 1-8)

  • PMID: 24898090
  • PMCID: PMC4054627
  • DOI: 10.1136/bmjopen-2014-005275


Abstract

Objectives: The illicit use of anabolic steroids among the gym population continues to rise, along with the number of steroid using clients attending harm reduction services in the UK. This presents serious challenges to public health. Study objectives were to account for the experiences of anabolic steroid users and investigate how 'risk environments' produce harm.

Methods: Qualitative face-to-face interviews with 24 users of anabolic steroids engaged with harm reduction services in the UK.

Results: Body satisfaction was an important factor when deciding to start the use of anabolic steroids. Many users were unaware of the potential dangers of using drugs from the illicit market, whereas some had adopted a range of strategies to negotiate the hazards relating to the use of adulterated products, including self-experimentation to gauge the perceived efficacy and unwanted effects of these drugs. Viewpoints, first-hand anecdotes, norms and practices among groups of steroid users created boundaries of 'sensible' drug use, but also promoted practices that may increase the chance of harms occurring. Established users encouraged young users to go to harm reduction services but, at the same time, promoted risky injecting practices in the belief that this would enhance the efficacy of anabolic steroids.

Conclusions: Current steroid-related viewpoints and practices contribute to the risk environment surrounding the use of these drugs and may undermine the goal of current public health strategies including harm reduction interventions. The level of harms among anabolic steroid users are determined by multiple and intertwining factors, in addition to the harms caused by the pharmacological action or injury and illness associated with incorrect injecting techniques.

Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs

12 Sep 2013

Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study / Vivian D. Hope, Jim McVeigh, Andrea Marongiu, Michael Evans-Brown, Josie Smith, Andreas Kimergård, Sara Croxford, Caryl M. Beynon, John V. Parry, Mark A. Bellis, Fortune Ncube. - (BMJ Open 3 (2013) 9 (12 September); p. 1-11)

  • PMID: 24030866
  • PMCID: PMC3773656
  • DOI: 10.1136/bmjopen-2013-003207


Abstract

Objective: To describe drug use, sexual risks and the prevalence of blood-borne viral infections among men who inject image and performance enhancing drugs (IPEDs).

Design: A voluntary unlinked-anonymous cross-sectional biobehavioural survey.

Setting: 19 needle and syringe programmes across England and Wales.

Participants: 395 men who had injected IPEDs.

Results: Of the participants (median age 28 years), 36% had used IPEDs for <5 years. Anabolic steroids (86%), growth hormone (32%) and human chorionic gonadotropin (16%) were most frequently injected, with 88% injecting intramuscularly and 39% subcutaneously. Two-thirds also used IPEDs orally. Recent psychoactive drug use was common (46% cocaine, 12% amphetamine), 5% had ever injected a psychoactive drug and 9% had shared injecting equipment. 'Viagra/Cialis' was used by 7%, with 89% reporting anal/vaginal sex in the preceding year (20% had 5+ female-partners, 3% male-partners) and 13% always using condoms. Overall, 1.5% had HIV, 9% had antibodies to the hepatitis B core antigen (anti-HBc) and 5% to hepatitis C (anti-HCV). In multivariate analysis, having HIV was associated with: seeking advice from a sexual health clinic; having had an injection site abscess/wound; and having male partners. After excluding those reporting male partners or injecting psychoactive drugs, 0.8% had HIV, 8% anti-HBc and 5% anti-HCV. Only 23% reported uptake of the hepatitis B vaccine, and diagnostic testing uptake was poor (31% for HIV, 22% for hepatitis C).

Conclusions: Previous prevalence studies had not found HIV among IPED injectors. HIV prevalence in this, the largest study of blood-borne viruses among IPED injectors, was similar to that among injectors of psychoactive drugs. Findings indicate a need for targeted interventions.

Keywords: HIV; Image and Performance Enhancing Drugs; Injecting Drug Use; Prevalence; Viral Hepatitis.

ECHR 48151/11 & 77769/13 NASS vs France

18 Jan 2018

Affaire Fédération Nationale des Associations et Syndicats de Sportifs (FNASS) et autres c. France (Requêtes nos 48151/11 et 77769/13) : Arrêt / European Court Of Human Rights (ECHR). - Strasbourg : Council of Europe (CoE), 2018. - (Requêtes Nos 48151/11 et 77769/13)



Originating Body Court:

  • (Fifth Section)

Document Type

  • Judgment (Merits and Just Satisfaction) Published in Recueil des arrêts et décisions 2018 (extraits)

Title

  • AFFAIRE FÉDÉRATION NATIONALE DES ASSOCIATIONS ET SYNDICATS DE SPORTIFS (FNASS) ET AUTRES c. FRANCE

App.No(s).

  • 48151/11
  • 77769/13

 Respondent State(s)

  • France Judgment

Date

  • 18/01/2018

Conclusion(s)

  • Partiellement irrecevable (Art. 35) Conditions de recevabilité
  • (Art. 35-3-a) Ratione materiae
  • (Art. 35-3-a) Ratione personae
  • Non-violation de l'article 8 - Droit au respect de la vie privée et familiale (Article 8-1 - Respect de la vie familiale; Respect du domicil; Respect de la vie privée)

 
Abstract:

The Chamber judgement in the case of Fédération Nationale des Syndicats Sportifs (FNASS) and Others v. France (application no. 48151/11) the European Court of Human Rights held, unanimously, that there had been:

no violation of Article 8 (right to respect for private and family life) of the European Convention on Human Rights.

The case concerns the requirement for a targeted group of sports professionals to notify their whereabouts for the purposes of unannounced anti-doping tests.

Taking account of the impact of the whereabouts requirement on the applicants’ private life, the Court nevertheless took the view that the public interest grounds which made it necessary were of particular importance and justified the restrictions imposed on their Article 8 rights. It found that the reduction or removal of the relevant obligations would lead to an increase in the dangers of doping for the health of sports professionals and of all those who practise sports, and would be at odds with the European and international consensus on the need for unannounced testing as part of doping control.

The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research

2 Jul 2014

The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research / Dominic Sagoe, Cecilie Schou Andreassen, Ståle Pallesen. - (Substance Abuse Treatment, Prevention, and Policy 9 (2014) 27 (2 July); p. 1-14)

  • DOI: 10.1186/1747-597X-9-27


Abstract

Background

To our knowledge, there has never been a systematic review and synthesis of the qualitative literature on the trajectory and aetiology of nonmedical anabolic-androgenic steroid (AAS) use.

Methods

We systematically reviewed and synthesized qualitative literature gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference lists of relevant literature to investigate AAS users’ ages of first use and source(s), history prior to use, and motives/drives for initiating use. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines.

Results

A total of 44 studies published between 1980 and 2014 were included in the synthesis. Studies originated from 11 countries: the United States (n = 18), England (n = 8), Australia (n = 4), Sweden (n = 4), both England and Wales (n = 2), and Scotland (n = 2). One study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. The majority of AAS users initiated use before age 30. Sports participation (particularly power sports), negative body image, and psychological disorders such as depression preceded initiation of AAS use for most users. Sources of first AAS were mainly users’ immediate social networks and the illicit market. Enhanced sports performance, appearance, and muscle/strength were the paramount motives for AAS use initiation.

Conclusions

Our findings elucidate the significance of psychosocial factors in AAS use initiation. The proliferation of AAS on the illicit market and social networks demands better ways of dealing with the global public health problem of AAS use.

Looking ‘acceptably’ feminine: A single case study of a female bodybuilder’s use of steroids

17 Sep 2020

Looking ‘acceptably’ feminine : A single case study of a female bodybuilder’s use of steroids / Justin Kotzé, Andrew Richardson, Georgios A. Antonopoulos. - (Performance Enhancement & Health (2020) 100174 (17 September); p. 1-7)

  • DOI: 10.1016/j.peh.2020.100174


Abstract

This article aims to shed some light on the motivations for and methods of female steroid consumption apropos broader changes in female body image ideals. Moreover, the study attempts to explore the connections between the competitive logic of liberal-postmodern consumer capitalism, ‘competitive femininity’ and steroid use. There is a growing consensus that an increasing number of women are consuming steroids, yet this phenomenon remains relatively under-researched and as such not much is known about this particular group of users. Utilising a single in-depth case study, this paper offers some additional insight gleaned from an ethnographic interview with a female bodybuilder who uses steroids. Her narrative elucidates some of the risks, harms and motivations for steroid consumption alongside broader changes in female body image ideals. Among the central findings, this paper highlights that the female bodybuilder is not resisting cultural norms but rather hyper-conforming to them by over-identifying with a hyper-idealised form of what constitutes ‘acceptable femininity’. We conclude that steroid consumption retains a strong connection to the desire for aesthetic appeal and that both short and long-term motivations for using steroids are grounded in the drive for conformity. This has pertinent clinical implications for health professionals, particularly in relation to the efficacy of attempts to reduce steroid consumption by warning users of the potential adverse health effects.

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