Determination of anabolic steroids in dried blood using microsampling and gas chromatography-tandem mass spectrometry: Application to a testosterone gel administration study / William Chih-Wei Chang, David A. Cowan, Christopher J. Walker, Nick Wojek, Alan D. Brailsford. - (Journal of Chromatography A 1628 (2020) 461445 (27 September)

• PMID: 32822984
• DOI: 10.1016/j.chroma.2020.461445

Abstract

Anabolic androgenic steroids (AAS) have been the most commonly abused substances taken by not only professional sportsmen but also recreational bodybuilders. The detection of micro-dose testosterone (T) misuse is particularly challenging as it possesses pseudo-endogenous origin and is sometimes impossible to be identified in urine samples. Dried blood (DB) obtained by finger pricking has been proven to be an alternative matrix for better correlating to physiological responses. Moreover, the introduction of the volumetric absorptive microsampling (VAMS) technology allows overcoming some major limitations of spotting blood onto a filter paper card. In this work, a fast and sensitive GC-MS/MS method was developed and validated for the quantification of AAS in DB collected by means of VAMS. T and the eight top abused synthetic AAS, namely nandrolone, boldenone, mesterolone, drostanolone, metenolone, metandienone, oxandrolone, and dehydrochloromethyl T were selected as the target analytes. The method based on VAMS exhibited good precision, accuracy as well as stability, and superior extraction recoveries over the punched DB spots reported in the literature. The chromatographic separation was achieved within 6.4 min and the detection limit is as little as 50 fg (i.e. able to detect 0.10 ng mL-1 in 20 μL of DB). Confirmed by forty real blood samples, the Deming regression and Bland-Altman analysis revealed that the VAMS DB could be employed for quantifying blood T level in agreement with using the serum specimen. The feasibility of the method was then successfully proven by the analysis of samples collected from a three-arm T administration trial. Our results highlighted that DB total T was a sensitive indicator for identifying transdermal micro-dosing of T. In the groups of receiving T gel administration, T concentrations could rise up to ten times higher than the baseline at 9 h after the application. As a future step, this approach is being expanded to a large cohort screening of bodybuilders at gym and ultimately may allow universal applications on monitoring sports drug misuse.

Rifampicin for Treatment of Cholestatic Pruritus Caused by Drug-Induced Acute Liver Injury as Assessed by the RUCAM Classification / Ali R. Ahmadi, Maria Chicco, Marcel van den Berge. - (Case Reports in Hepatology (2020) 872804 (8 August); p. 1-5)

• PMID: 32832174
• PMCID: PMC7429806
• DOI: 10.1155/2020/8872804

Abstract

A male bodybuilder of 39 years of age developed severe pruritus, nausea, and jaundice after injecting anabolic steroids purchased on the black market. The patient had no history of liver disease and no risk factors for viral hepatitis. Extensive laboratory testing, radiographic imaging, and liver biopsy excluded a majority of potential pathologies. The patient was diagnosed with drug-induced acute liver injury and secondary acute renal failure most likely caused by testosterone purchased on the black market. The pruritus caused insomnia and significant psychological distress. Treatment was initiated with cholestyramine and naltrexone for one week with no effect on the pruritus. Subsequently, all medications were stopped, and rifampicin was started. Pruritus resolved after starting rifampicin, and liver and kidney function improved rapidly and normalized within 5 months.

Anabolic Steroids and Cardiovascular Outcomes : The Controversy / Jamal C. Perry, Tayná M. Schuetz, Mohammad D. Memon, Sadaf Faiz, Ivan Cancarevic. - (Cureus 12 (2020)7 (22 July); p. 1-8)

• PMID: 32850208
• PMCID: PMC7444848
• DOI: 10.7759/cureus.9333

Abstract

Anabolic steroids (AS) are synthetic derivatives of the male sex hormone testosterone. The use of AS is not limited to bodybuilders and athletes, but non-athletes also use them. It is used to enhance athletic performance, induce muscle hypertrophy, and augment male sexual characteristics. AS use is associated with a wide range of side effects and potential cardiovascular complications. In this article, we have searched the available literature to investigate the association between AS use and cardiovascular disease (CVD). The results revealed that AS was linked to lipid metabolism derangements, hypertension, coagulation disorders, and cardiomyopathy. We concluded, based on the relevant data, that there was evidence that suggests an association with CVD, primarily myocardial infarction, fatal arrhythmias, and cardiomyopathy in AS users. The general population should be informed of the risk. Also, methods of primary and secondary prevention should be implemented to mitigate the risk of CVD secondary to AS.

Acute Myocardial Infarction in a Young Bodybuilder : A Case Report and Review of the Literature / Abrão José Melhem Jr., Amélia Cristina Araújo, Felipe Nathan S. Figueiredo, David Livingstone A. Figueiredo. - (American Journal of Case Reports (2020) 21:e924796 (August 27); p. 1-8)

• PMID: 32848124
• DOI: 10.12659/AJCR.924796

Abstract

BACKGROUND Misuse of androgenic anabolic steroids (AAS) is a current practice associated with vigorous bodybuilding for muscular hypertrophy, especially among gym practitioners and bodybuilders, influenced by the culture of body image. In addition to liver, psychiatric, genital, urinary, dermatological, and musculoskeletal complications, AAS misuse reportedly can lead to development of cardiovascular complications, such as hypertension, dyslipidemia, cardiac hypertrophy, and early coronary disease, and potentially acute myocardial infarction (AMI) and sudden death.

CASE REPORT A 26-year-old male farmer who was also an amateur bodybuilder developed an extensive Killip Class I AMI in the anterior wall while using AAS. A few days before the acute event, his lipid and hormone levels were measured and found to be significantly elevated. The patient was asymptomatic after left anterior descending branch angioplasty, but he had significant electrocardiographic sequelae and ventricular dysfunction.

CONCLUSIONS We describe the case of a young male bodybuilder using AAS who presented with AMI and was treated with primary angioplasty. Documentation of high levels of lipids and hormones 1 week before the acute event suggests some relationship between AAS and cardiovascular disease. The main effects of using these steroids on the cardiovascular system are reviewed. It is time for a new global warning about the risks of misusing AAS to obtain muscle hypertrophy. Based on current medical knowledge, these hormones should not be prescribed without a clear indication for their use.

Body Building and Aminotransferase Elevations : A Review / Jaimy Villavicencio Kim, George Y. Wu. - (Journal of Clinical and Translational Hepatology 8 (2020) 2; p. 161-167)

• PMID: 32832396
• PMCID: PMC7438350
• DOI: 10.14218/JCTH.2020.00005

Abstract

In addition to liver injury, elevation of aminotransferases can be caused by strenuous exercise and use of muscle-building and weight-loss supplements. The purpose of this review is to discuss the various mechanisms of elevation of aminotransferases related to body building. A literature review was performed on clinical trials and case reports involving exercise or supplement use and their effects on aminotransferases. Normal aminotransferase levels varied according to gender, age, body mass index, and comorbidities. Strenuous exercise and weight lifting, especially in the unaccustomed, can cause elevated aminotransferases in the absence of liver damage. Supplements such as anabolic steroids, ephedra, and LipoKinetix, amongst others, have also been associated with aminotransferase elevations. The pattern of elevation of aminotransferases is not helpful in distinguishing liver from muscle injury. Other associated muscle enzymes can be useful in making that distinction. To prevent aminotransferase elevations, subjects not accustomed to moderate-high intensity workouts, are recommended to undertake gradual increase in intensity. When causes of liver injury have been ruled out, investigation into bodybuilding, extreme exercise, and supplement use is warranted.

Long term effects of doping in sporting records : 1886-2012 / Aaron Hermann, Maciej Henneberg. - (Journal of Human Sport and Exercise 9 (2014) 3; p. 727-743)

• doi:10.14198/jhse.2014.93.05

ABSTRACT

Best life times of top athletes, Olympic records, world records, and any doping information were collected from the IOC, IAAF, WADA and national anti-doping associations. About 1560 records of male and female athletes in 22 disciplines of summer and 4 winter sports were collected. Data were analysed for long-term effects of doping using non-linear regression techniques. Comparisons were made of pre-1932 records (when steroids became available) and post. Analyses were repeated using 1967, when widespread use of doping was formally acknowledged. After these dates records in a number of disciplines did not improve as predicted by extrapolation of pre-doping years results. Averaged best life records for ‘doped’ top athletes did not differ significantly from those considered ‘non-doped’. Even assuming that not all cases of doping were discovered, the practice did not alter sporting records as commonly believed, Doping may be damaging image of sports without benefitting results.

Beyond the androgen receptor: the role of growth hormone secretagogues in the modern management of body composition in hypogonadal males / Deepankar K. Sinha, Adithya Balasubramanian, Alexander J. Tatem, Jorge Rivera-Mirabal, Justin Yu, Jason Kovac, Alexander W. Pastuszak, Larry I. Lipshultz. - (Translation Andrology and Urology 9 (2020) Supplement 2 (March); p. 149-159)

• PMID: 32257855
• PMCID: PMC7108996
• DOI: 10.21037/tau.2019.11.30

Abstract

Male hypogonadism is an increasingly prevalent clinical condition that affects patients' quality of life and overall health. Obesity and metabolic syndrome can both cause and result from hypogonadism. Although testosterone remains the gold standard for hypogonadism management, its benefits are not always conserved across different populations, especially with regards to changes in body composition. Partially in response to this, growth hormone secretagogues (GHS) have emerged as a potential novel adjunctive therapy for some of the symptoms of hypogonadism, although current data on their clinical efficacy largely remain lacking. The present review examines the existing literature on the use of GHS and explores their potential complementary role in the management of hypogonadal and eugonadal males with metabolic syndrome or subclinical hypogonadism (SH). The GHS that will be discussed include sermorelin, growth hormone-releasing peptides (GHRP)-2, GHRP-6, ibutamoren, and ipamorelin. All are potent GH and IGF-1 stimulators that can significantly improve body composition while ameliorating specific hypogonadal symptoms including fat gain and muscular atrophy. However, a paucity of data examining the clinical effects of these compounds currently limits our understanding of GHS' role in the treatment of men with hypogonadism, but does open opportunities for future investigation.

Related cases:

FINA 2016 FINA vs Mauricio Fiol Villanueva
March 14, 2016

CAS 2016_A_4534 Mauricio Fiol Villanueva vs FINA
March 16, 2017

On 14 March 2016 the FINA Doping Panel decided to impose a 4 year period of ineligibility on the Peruvian swimmer Mauricio Fiol Villanueva after his A and B samples tested positive for the prohibited substance Stanozolol. The Athlete appealed however on 16 March 2017 the Court of Arbitration for Sport (CAS) decided to dismissed the Athlete's appeal and to confirm the FINA decision.

In 2019 FINA reported multiple anti-doping rule violations against the swimmer after his 6 samples - collected between June 2019 and September 2019 - tested positive for the prohibited substance Stanozolol. After notification a provisional suspension was ordered. The Athlete failed to respond to the FINA communications, nor did he file a statement in his defence.

Considering the evidence in this case the FINA Doping Panel finds that the Athlete committed the reported anti-doping rule violations and that these multiple violations shall be considered as a single anti-doping rule violation. The Doping Panel holds that the Athlete was duly notified of the proceedings but failed to establish that the violation was not intentional.

Since this is the Athlete's second anti-doping rule violation the FINA Doping Panel decides on 19 August 2020 to impose an 8 year period of ineligibility on the Athlete starting on the date of the provisional suspension, i.e. on 3 August 2019.

The FINA costs of the analysis of the Athlete's A and B samples and Documentation Packages for all 6 samples shall be borne by the Athlete.

Mr Erol Bilgin is a Turkish Athlete competing the 62 kg Weightlifting event at the London 2012 Olympic Games. 

In 2018, the IOC decided to perform further analyses on certain samples collected during the 2012 Olympic Games. These additional analyses were performed with analytical methods which were not available in 2012.

In December 2019 the International Testing Agency (ITA), on behalf of the IOC, reported an anti-doping rule violation against the Athlete after his 2012 A and B sample tested positive for the prohibited substance Dehydrochlormethyltestosterone (Turinabol) and Stanozolol. 

After notification the Athlete submitted that he did not accept the test results, he waived his right to be heard and refrained to file a statement in his defence. 

The IOC Disciplinary Commission finds that the test result established the presence of the prohibited substances in the Athlete’s samples and accordingly that the Athlete committed an anti-doping rule violation. 

The Commission holds that the substances found in the Athlete's sample correspond to substances which have very commonly been used as a doping substances. The use of these substances are clearly consistent with and indicative of the intentional use of Prohibited Substances specifically ingested to deliberately improve performance. 

Therefore the IOC Disciplinary Commission decides on 26 August 2020 that the Athlete, Erol Bilgin: 

1.) is found to have committed an anti-doping rule violation pursuant to the IOC Anti-Doping Rules applicable to the Games of the XXX Olympiad in London in 2012 (presence, and/or use, of Prohibited Substances or its Metabolites or Markers in an athlete’s bodily specimen),

2.) is disqualified from the event in which he participated upon the occasion of the Olympic Games London 2012, namely the Men’s 62 kg weightlifting event, in which he ranked 8th and for which he was awarded a diploma,

3.) has the diploma obtained in the Men’s 62 kg weightlifting event withdrawn and is ordered to return the same.

4.) The IWF is requested to modify the results of the above-mentioned event accordingly and to consider any further action within its own competence.

5.) The Turkish Olympic Committee shall ensure full implementation of this decision.

6.) The Turkish Olympic Committee shall notably secure the return to the IOC, as soon as possible, of the diploma awarded in connection with the Men’s 62 kg weightlifting event to the Athlete

7.) The decision enters into force immediately.

iNADO Update (2020) 8 (25 August)
Institute of National Anti-Doping Organisations (iNADO)

Contents:

iNADO Community

• Upcoming Webinar
• iNADO Live Chat - New Episodes available

From our Members

• Leaving on a high Note

Research

• Chronic Low Dose Carbon Monoxide Exposure might increase Endurance Performance
• Registration for UNESCO Master Programme in Doping Studies reopens
• NCSC Manual on Cyber Threats to Sport Organisations and how to avoid them

Testing

• What Dietary Supplement Certification means to Athletes and Health Practitioners

Vacancies

New at the Anti-Doping Knowledge Center