NADO Flanders reported in 2019 two anti-doping rule violations against the Athlete for use and possession after an imported parcel was intercepted by Customs and addressed to the Athlete containing the prohibited substance Testosterone. Hereafter the police conducted a search in the Athlete's residence where multiple prohibited substances were found: Boldenone, Drostanolone, Methandienone, Oxandrolone, Tamoxifen, Testosterone and Trenbolone.

After notification the Athlete was heard for the NADO Flanders Disciplinary Commission. Against the Police and at the hearing the Athlete admitted the purchase of the Testosterone and stated that the found substances were used for bodybuilding.

Considering the evidence in this case the Commission finds that the Athlete intentionally had committed the admitted anti-doping rule violations without grounds for a reduced sanction.

Therefore the NADO Flanders Disciplinary Commission decides on 28 January 2020 to impose a fine and a 4 year period of ineligibility on the Athlete starting on the date of the decision.

Fees and expenses for this Commission shall be borne by the Athlete.

The Cardiac Toxicity of Anabolic Steroids / Mack Lee Sullivan, Charles M. Martinez, Paul Gennis, E. John Gallagher. - (Progress in Cardiovascular Diseases 41 (1998) 1 (July/August); p. 1-15)

• PMID: 9717856
• DOI: 10.1016/s0033-0620(98)80019-4

Abstract

Anabolic steroids are synthetic derivatives of testosterone that were developed as adjunct therapy for a variety of medical conditions. Today they are most commonly used to enhance athletic performance and muscular development. Both illicit and medically indicated anabolic steroid use have been temporally associated with many subsequent defects within each of the body systems. Testosterone is the preferred ligand of the human androgen receptor in the myocardium and directly modulates transcription, translation, and enzyme function. Consequent alterations of cellular pathology and organ physiology are similar to those seen with heart failure and cardiomyopathy. Hypertension, ventricular remodeling, myocardial ischemia, and sudden cardiac death have each been temporally and causally associated with anabolic steroid use in humans. These effects persist long after use has been discontinued and have significant impact on subsequent morbidity and mortality. The mechanisms of cardiac disease as a result of anabolic steroid use are discussed in this review.

High Estrogen in Men After Injectable Testosterone Therapy: The Low T Experience / Robert S. Tan, Kelly R. Cook, William G. Reilly. - (American Journal of Men's Health 9 (2014) 3 (13 June); p. 229-234)

• PMID: 24928451
• DOI: 10.1177/1557988314539000

Abstract

Testosterone replacement improves quality of life and is aromatized in men in adipose tissues to estrogen. Hyperestrogenism is believed to be harmful to male sexuality. This is a description of our experience of screening 34,016 men in the Low T Centers, of which approximately 50% were converted to treatment. Men were treated with injectable testosterone, and we have available data from 2009 to 2014. The data were extracted from our electronic health record (AdvancedMD) of 35 Low T Centers across the United States. In all, 7,215 (20.2%) out of the 34,016 patients had high estradiol levels defined as ≥42.6 pg/ml. Estradiol was measured using electro-chemiluminescence immunoassay. Of the patients who had high estradiol levels, the age distribution was as follows: 132/989 (13.3%) were older than 65 years, 3,753/16,955 (22.1%) were between 45 and 65 years; 2,968/15,857 (18.7%) were between 25 and 44 years, 7/215 (3.3%) were younger than 25 years. The difference between extreme age groups (<25 and ≥65) was statistically significant using a chi-square test (p = .013). The correlation coefficient of serum estradiol to age was .53, SD = 8.21. It was observed that practitioners used aromatase inhibitor and selective estrogen receptor modulator to treat symptoms of hyperestrogenism, irrespective of blood estradiol levels. Gynecomastia was rarely documented as a reason for the prescription. Our finding was that high estradiol levels were not associated with higher rates of low libido but established higher rates of documented low libido with those with normal or lower estradiol levels. The difference was statistically significant (p < .05).

Anabolic steroid-induced hypogonadism – Towards a unified hypothesis of anabolic steroid action / R.S. Tan, M.C. Scally. - (Medical Hypotheses 72 (2009) 6 (June); p. 723-728)

Summary

Anabolic steroid-induced hypogonadism (ASIH) is the functional incompetence of the testes with subnormal or impaired production of testosterone and/or spermatozoa due to administration of androgens or anabolic steroids. Anabolic–androgenic steroid (AAS), both prescription and nonprescription, use is a cause of ASIH. Current AAS use includes prescribing for wasting associated conditions. Nonprescription AAS use is also believed to lead to AAS dependency or addiction. Together these two uses account for more than four million males taking AAS in one form or another for a limited duration. While both of these uses deal with the effects of AAS administration they do not account for the period after AAS cessation. The signs and symptoms of ASIH directly impact the observation of an increase in muscle mass and muscle strength from AAS administration and also reflect what is believed to demonstrate AAS dependency. More significantly, AAS prescribing after cessation adds the comorbid condition of hypogonadism to their already existing chronic illness. ASIH is critical towards any future planned use of AAS or similar compound to effect positive changes in muscle mass and muscle strength as well as an understanding for what has been termed anabolic steroid dependency. The further understanding and treatments that mitigate or prevent ASIH could contribute to androgen therapies for wasting associated diseases and stopping nonprescription AAS use. This paper proposes a unified hypothesis that the net effects for anabolic steroid administration must necessarily include the period after their cessation or ASIH.

Higher Muscle Mass but Lower Gynoid Fat Mass in Athletes Using Anabolic Androgenic Steroids / Anna Nordström, Gabriel Högström, Anders Eriksson, Patrik Bonnerud, Yelverton Tegner, Christer Malm. - (Journal of Strength and Conditioning Research 26 (2012) 1 (January); p. 246-250)

• PMID: 22201697
• DOI: 10.1519/JSC.0b013e318218daf0

Abstract

This study evaluated the relationship between anabolic androgenic steroid (AAS) use and body constitution. Dual-energy x-ray absorptiometry was used to measure bone mineral density (BMD, g·cm(-2)) of the total body, arms, and legs. Total gynoid and android fat mass (grams) and total lean mass (grams) were measured in 10 strength trained athletes (41.4 ± 7.9 years) who had used AASs for 5-15 years (Doped) and 7 strength trained athletes (29.4 ± 6.2 years) who had never used AASs (Clean). Seventeen sedentary men (30.3 ± 2.1 years) served as Controls. Doped athletes had significantly more lean body mass (85.5 ± 3.8 vs. 75.3 ± 2.5 vs. 60.7 ± 1.9, p < 0.001) and a greater index of fat-free/fat mass (5.8 vs. 2.6 vs. 2.5, p < 0.001) compared with Clean athletes and Controls. Doped athletes also had significantly less gynoid fat mass compared with that of Clean athletes (2.8 ± 0.4 vs. 4.8 ± 0.2 kg, p = 0.02). There were no differences in BMD between the athletes (p = 0.39-0.98), but both groups had significantly higher BMDs at all sites compared with that of Controls (p = 0.01 to <0.001). Thus, long-term AAS use seems to alter body constitution, favoring higher muscle mass and reduced gynoid fat mass without affecting BMD.

1,5-Dimethylhexylamine (Octodrine) in Sports and Weight Loss Supplements : Natural Constituent or Synthetic Chemical? / Mei Wang, Saqlain Haider, Amar G. Chittiboyina, Jon F. Parcher, Ikhlas A. Khan. - (Journal of Pharmaceutical and Biomedical Analysis 152 (2018) 15 April; p. 298-305)

• PMID: 29454882
• DOI: 10.1016/j.jpba.2018.02.008

Abstract

In the past years, there has been a mounting trend toward the addition of sympathomimetic stimulants in sports and weight loss supplements sold in the US and claimed to be from natural constituents. The latest among those pharmaceutical stimulants is 1,5-dimethylhexylamine (1,5-DMHA or octodrine), an ingredient in newly introduced sports and weight loss supplements with its 'natural' origin being cited from Aconitum or Kigelia plants. In order to validate the natural existence of 1,5-DMHA, two GC/MS methods were developed. One method involved using thick film megabore capillary columns to analyze the underivatized 1,5-DMHA. The second method was to determine enantiomeric distribution of 1,5-DMHA. Fifteen Aconitum or Kigelia plant samples originating from various locations were analyzed, and none of them contained 1,5-DMHA within the limit of detection (25 ng/mL) of the method. In contrast, although 1,5-DMHA was listed on the labels or website for all the 13 dietary supplements, only four products were found to contain this compound, with the highest quantity being reported as 112 mg per serving size. This is equivalent to more than three times the highest pharmaceutical dose established in Europe. The enantiomeric ratios of 1,5-DMHA in these products were determined to be between 0.9-1.0 (expressed as peak area ratio of one enantiomer over another), suggesting racemic nature. Interestingly, two byproducts from 1,5-DMHA synthesis were identified in commercial supplements containing 1,5-DMHA, indicating that 1,5-DMHA indeed originated from a poor quality source. Overall, the significant amount of 1,5-DMHA observed in the supplements, the enantiomeric distribution and the presence of the synthetic byproducts all suggested the synthetic origin of 1,5-DMHA in the commercial products.

Thyroid Therapy or Dysfunction in Athletes : Is It Time to Revisit the Clinical Practice Guidelines? / Krista G. Austin, Steven Petak. - (Current Sports Medicine Reports 18 (2019) 12 (December); p. 474-476)

• PMID: 31834179
• DOI: 10.1249/JSR.0000000000000663

Abstract

Recent media have highlighted the controversy surrounding treatment of elite athletes for hypothyroidism. The World Anti-Doping Agency denied a request by the United States Anti-Doping Agency to ban the use of thyroid medication. At present, there is no scientific evidence that thyroid medication has the potential to enhance performance. Clinical practice guidelines are not definitive in regard to what classifies a patient as having hypothyroidism. Thyroid-stimulating hormone and free T4 are recommended to screen for thyroid disease; however, the thyrotropin-releasing hormone stimulation test is still advocated by some for detecting the earliest stages of hypothyroidism. Hypothyroidism has been demonstrated to reduce cardiopulmonary function and result in musculoskeletal symptoms, such as fatigue and muscle stiffness. Symptoms of hypothyroidism, including depression, fatigue, and impaired sleep, are similar to those reported in overtraining. These patients may have hypothalamic-pituitary dysfunction that may complicate interpretation of basal thyroid-stimulating hormone and free T4. To date, no association has been identified between training state and hypothyroidism. Research to more clearly define hypothyroidism using provocative testing, evaluate the potential for thyroid medication to enhance performance, and examine whether training may induce hypothyroidism in athletes is desirable.

Comparison of the Effects of High Dose Testosterone and 19-nortestosterone to a Replacement Dose of Testosterone on Strength and Body Composition in Normal Men / K.E. Friedl, J.R. Dettori, C.J. Hannan Jr, T.H. Patience, S.R. Plymate. - (The Journal of Steroid Biochemistry and Molecular Biology 40 (1991) 4-6; 607-612)

• PMID: 1958561
• DOI: 10.1016/0960-0760(91)90283-b

Abstract

We examined the extent to which supraphysiological doses of androgen can modify body composition and strength in normally virilized men. In doubly blind tests, 30 healthy young men received testosterone enanthate (TE) or 19-nortestosterone decanoate (ND), at 100 mg/wk or 300 mg/wk for 6 weeks. The TE-100 mg/wk group served as replacement dose comparison, maintaining pretreatment serum testosterone levels, while keeping all subjects blinded to treatment, particularly through reduction in testicular volumes. Isokinetic strength measurements were made for the biceps brachii and quadriceps femoris muscle groups before treatment and 2-3 days after the 6th injection. Small improvements were noted in all groups but the changes were highly variable; a trend to greater and more consistent strength gain occurred in the TE-300 mg/wk group. There was no change in weight for TE-100 mg/wk but an average gain of 3 kg in each of the other groups. No changes in 4 skinfold thicknesses or in estimated percent body fat were observed. Of 15 circumferences, significant increases were observed only for men receiving TE-300 mg/wk (shoulders) and ND-300 mg/wk (shoulders and chest). The data suggest that high dose androgens increase body mass and may increase strength in normal men but, except for a consistent weight gain with greater than replacement doses, the detectable changes were highly variable and relatively small, especially in comparison to the significant alterations which were observed for other markers of androgen action.

Androgen regulation of satellite cell function / Yue Chen, Jeffrey D. Zajac, Helen E. MacLean. - (Journal of Endocrinology 186 (2005) 1 (July); p. 21–31)

• PMID: 16002532
• DOI: 10.1677/joe.1.05976

Abstract

Androgen treatment can enhance the size and strength of muscle. However, the mechanisms of androgen action in skeletal muscle are poorly understood. This review discusses potential mechanisms by which androgens regulate satellite cell activation and function. Studies have demonstrated that androgen administration increases satellite cell numbers in animals and humans in a dose-dependent manner. Moreover, androgens increase androgen receptor levels in satellite cells. In vitro, the results are contradictory as to whether androgens regulate satellite cell proliferation or differentiation. IGF-I is one major target of androgen action in satellite cells. In addition, the possibility of non-genomic actions of androgens on satellite cells is discussed. In summary, this review focuses on exploring potential mechanisms through which androgens regulate satellite cells, by analyzing developments from research in this area.

Selective Androgen Receptor Modulators (SARMs) as Pharmacological Treatment for Muscle Wasting in Ongoing Clinical Trials / Guilherme Wesley Peixoto Da Fonseca, Elke Dworatzek, Nicole Ebner, Stephan Von Haehling. - (Expert Opinion on Investigational Drugs (2020) 18 June; p. 1-11)

• PMID: 32476495
• DOI: 10.1080/13543784.2020.1777275

Abstract

Introduction: Skeletal muscle wasting is a frequent clinical problem encountered in patients with chronic diseases. Increased levels of inflammatory markers play a role in the imbalance between muscle protein synthesis and degradation. Although testosterone has long been proposed as a treatment for patients with muscle wasting, undesirable side effects have raised concerns about prostatic hypertrophy in men as well as virilization in women. Selective androgen receptor modulators (SARMs) have demonstrated similar results like testosterone at improving lean body mass (LBM) with less side effects on androgen-dependent tissue.

Areas covered: This review outlines the ongoing clinical development in the field of SARMs and their effectiveness in improving body composition and physical function. The included articles were collected at pubmed.gov and analyzed integrally.

Expert opinion: There is an unmet clinical need for safe and effective anabolic compounds such as SARMs. Despite the effect on LBM shown by SARMs in phase II clinical trials, results on improved physical function and muscle strength are still lacking and long-term outcomes have to be assessed in these patients. Moreover, there is a need to determine the effect of resistance exercise training and protein intake associated with SARMs in the treatment of patients with muscle wasting.