Severe Persistent Jaundice after the Abuse of an Anabolic Androgenic Steroid Analogue

25 Sep 2020

Severe Persistent Jaundice after the Abuse of an Anabolic Androgenic Steroid Analogue / Hyun Gil Goh, Yoo Jin Lee, Tae Hyung Kim. - (Korean Journal of Gastroenterology 76 (2020) 3 (25 September); p. 167-170)

  • PMID: 32969366
  • DOI: 10.4166/kjg.2020.76.3.167


Abstract

Hepatic disorders with prominent cholestasis can be caused by a range of conditions, and anabolic androgenic steroids have been considered a cause of protracted cholestasis. A 29-year-old man who had taken an anabolic androgenic steroid analogue for 2 months visited the hospital complaining of jaundice and indigestion. After stopping the medication, the hyperbilirubinemia tended to decrease, but a transiently elevated aminotransferase level was observed. The endogenous testosterone level also decreased initially but recovered soon after. The liver function profiles were normalized after 2 months of conservative management. This case emphasizes that close drug history taking, including anabolic steroids, is important for identifying the cause of unexplained persistent jaundice.

Keywords: Anabolic agents; Chemical and drug induced liver injury; Jaundice; Steroids; Substance abuse; oral.

Anabolic-androgenic steroid abuse and psychopathology

1 Dec 1998

Anabolic-androgenic steroid abuse and psychopathology / John H. Porcerelli, Bruce A. Sandler. - (Psychiatric Clinics of North America 21 (1998) 4 (1 December); p. 829-833)

  • PMID: 9890124
  • DOI: 10.1016/s0193-953x(05)70043-5


Abstract

Anabolic steroid abuse is a significant public health problem. There is evidence from both case reports and empirical studies that abuse of these drugs causes significant psychiatric and medical effects. There appears to be a relationship between increased dosages and severity of psychiatric symptomatology. Research is needed on the role of pathologic personality traits in the initiation and maintenance of anabolic steroid abuse.

Pharmacoepidemiology of anabolic androgenic steroids: a review

9 Nov 2004

Pharmacoepidemiology of anabolic androgenic steroids : a review / Ingemar Thiblin, Anna Petersson. - (Fundamental & Clinical Pharmacology 19 (2005) 1 (February); p. 27-44)

  • PMID: 15660958
  • DOI: 10.1111/j.1472-8206.2004.00298.x


Abstract

Non-prescribed use of anabolic androgenic steroids (AAS) has been associated with a number of physical and psychiatric/behavioural complications, some of which are potentially lethal. Here, we review both observational and experimental studies on human subjects concerned with such side-effects. The only physical complication of AAS use that receives definitive support from such investigations is unfavourable changes in blood lipid profiles. Support for various psychiatric complications has also been provided by a number of cross-sectional studies, most involving comparisons between weight-training individuals who use or do not use AAS. Certain of these complications, in particular hypomania and increased aggressiveness, have been confirmed in some, but not all, randomized controlled studies. Epidemiological attempts to determine whether AAS use triggers violent behaviour have failed, primarily because of high rates of non-participation. Studies regarding the prevalence of AAS use in different populations typically report life-time prevalences of 1-5% among adolescents. However, the life-time prevalence (i.e. use on at least one occasion) is of doubtful relevance in attempting to estimate the number of individuals at risk for side-effects, as most of these complications appear to develop during prolonged use of AAS. Furthermore, it is reasonable to assume that the symptoms and signs of AAS use are often overlooked by healthcare professionals, so that the number of cases of possible AAS-related complications is virtually unknown. These limitations, together with an apparently low prevalence of prolonged AAS use among the general population, indicate that future epidemiological research in this area should focus on retrospective case-control studies and, perhaps, also on prospective cohort studies of populations selected for a high prevalence of AAS use, rather than attempting to perform large-scale population-based studies.

Exercise reinforcement, stress, and β-endorphins: an initial examination of exercise in anabolic-androgenic steroid dependence

19 Mar 2014

Exercise reinforcement, stress, and β-endorphins: an initial examination of exercise in anabolic-androgenic steroid dependence / Tom Hildebrandt, Sydney Shope, Eleanna Varangis, Diane Klein, Donald W. Pfaff, Rachel Yehuda. - (Drug and Alcohol Dependence 139 (2014) 1 June; p. 86-92)

  • PMID: 24690349
  • PMCID: PMC4039319
  • DOI: 10.1016/j.drugalcdep.2014.03.008


Abstract

Background: Anabolic-androgenic steroids (AASs) are abused primarily in the context of intense exercise and for the purposes of increasing muscle mass as opposed to drug-induced euphoria. AASs also modulate the HPA axis and may increase the reinforcing value of exercise through changes to stress hormone and endorphin release. To test this hypothesis, 26 adult males drawn from a larger study on AAS use completed a progressive ratio task designed to examine the reinforcing value of exercise relative to financial reinforcer.

Method: Sixteen experienced and current users (8 on-cycle, 8 off-cycle) and 10 controls matched on quantity×frequency of exercise, age, and education abstained from exercise for 24 h prior to testing and provided 24-h cortisol, plasma cortisol, ACTH, β-endorphin samples, and measures of mood, compulsive exercise, and body image.

Results: Between group differences indicated that on-cycle AAS users had the highest β-endorphin levels, lowest cortisol levels, higher ACTH levels than controls. Conversely, off-cycle AAS users had the highest cortisol and ACTH levels, but the lowest β-endorphin levels. Exercise value was positively correlated with β-endorphin and symptoms of AAS dependence.

Conclusion: The HPA response to AASs may explain why AASs are reinforcing in humans and exercise may play a key role in the development of AAS dependence.

Pharmacokinetics of dehydroepiandrosterone and its metabolites after long-term daily oral administration to healthy young men

1 Mar 2004

Pharmacokinetics of dehydroepiandrosterone and its metabolites after long-term daily oral administration to healthy young men / Brian D. Acacio, Frank Z. Stanczyk, Patrick Mullin, Payam Saadat, Neda Jafarian, Rebecca Z. Sokol. - (Fertility and Sterility 81 (2004) 3 (1 March) p. 595-604)

  • PMID: 15037408
  • DOI: 10.1016/j.fertnstert.2003.07.035


Abstract

Objective: To determine the effects of dehydroepiandrosterone (DHEA) supplementation on the pharmacokinetics of DHEA and its metabolites and the reproductive axis of healthy young men.

Design: A prospective, randomized, double-blind, placebo-controlled pharmacokinetic study.

Setting: General Clinical Research Center and laboratories at the Keck School of Medicine of the University of Southern California, Los Angeles, California.

Patient(s): Fourteen healthy men, ages 18-42 years.

Intervention(s): Daily oral administration of placebo (n = 5), 50 mg DHEA (n = 4), or 200 mg DHEA (n = 5) for 6 months. Blood samples were collected at frequent intervals on day 1 and at months 3 and 6 of treatment.

Main outcome measure(s): Quantification of DHEA, DHEA sulfate (DHEAS), androstenedione, T, E(2), dihydrotestosterone (DHT), and 5alpha-androstane-3alpha-17beta-diol glucuronide (ADG). Physical examination, semen analysis, serum LH, FSH, prostate-specific antigen, and general chemistries were carried out.

Result(s): Baseline DHEA, DHEAS, and ADG levels increased significantly from day 1 to months 3 and 6 in the DHEA treatment groups but not in the placebo group. No significant changes were observed in pharmacokinetic values. Clinical parameters were not affected.

Conclusion(s): DHEA, DHEAS, and ADG increased significantly during 6 months of daily DHEA supplementation. Although the pharmacokinetics of DHEA and its metabolites are not altered, sustained baseline elevation of ADG, a distal DHT metabolite, raises concerns about the potential negative impact of DHEA supplementation on the prostate gland.

Effects of short-term dehydroepiandrosterone supplementation on body composition in young athletes

28 Feb 2010

Effects of short-term dehydroepiandrosterone supplementation on body composition in young athletes / Sergej M. Ostojic, Julio Calleja, Morteza Jourkesh. - (Chinese Journal of Physiology 53 (2010) 1 (28 February); p. 19-25)

  • PMID: 21789881
  • DOI: 10.4077/cjp.2010.amh090


Abstract

Dehydroepiandrosterone (DHEA) is often promoted as a slimming and weight/fat loss agent and ingestion of DHEA may have hypolipidemic and anti-obesity properties. The main aim of this study was to examine the effects of acute DHEA intake on body composition and serum steroid hormones in young athletes. Twenty young (19 to 22 years) male soccer players were allocated into two randomly assigned trials in double-blind design by ingesting 100-mg daily oral DHEA or as placebo (PLA) for 28 days. Body mass was not affected by 4 weeks of DHEA supplementation (P > 0.05). No significant changes in body mass index (BMI), waist-to-hip ratio (WHR) and body fat or total muscle mass for the two groups were detected at the end of the trial (P > 0.05). There was no within- or between-group difference in arm fat index (AFI) and corrected mid-upper-arm muscle area (cAMA) (P > 0.05). Treatment with DHEA resulted in a significant increase of total testosterone, estradiol and DHEA-S levels in treated subjects versus the placebo group (P < 0.05). Results of this study suggest that DHEA supplementation has no beneficial effects on body composition in young competitive athletes.

Neuropsychiatric Effects of Anabolic Steroids in Male Normal Volunteers

2 Jun 1993

Neuropsychiatric Effects of Anabolic Steroids in Male Normal Volunteers / Tung-Ping Su, Michael Pagliaro, Peter J. Schmidt. - (Journal of the American Medical Association 269 (1993) 21 (2 June); p. 2760-2764)

  • PMID: 8492402
  • DOI:10.1001/jama.1993.0350021006003


Abstract

Objective: To evaluate the acute effects of anabolic steroids on mood and behavior in male normal volunteers.

Design: A 2-week, double-blind (subject and rater), fixed-order, placebo-controlled crossover trial of methyltestosterone.

Setting: An inpatient research unit at the National Institutes of Health.

Subjects: A volunteer sample of 20 men who were medication free, free of medical and psychiatric illness, not involved in athletic training, and had no prior history of anabolic steroid use.

Intervention: A sequential trial for 3 days each of the following four drug conditions: placebo baseline, low-dose methyltestosterone (40 mg/d), high-dose methyltestosterone (240 mg/d), and placebo withdrawal.

Main outcome measures: Mood and behavioral ratings were completed during each drug condition and included both subjective and objective measures.

Results: Significant (P < .05) albeit subtle increases in symptom scores were observed during high-dose methyltestosterone administration compared with baseline in positive mood (euphoria, energy, and sexual arousal), negative mood (irritability, mood swings, violent feelings, and hostility), and cognitive impairment (distractibility, forgetfulness, and confusion). An acute manic episode was observed in one of the 20 subjects, representing a 5% incidence, even under these conservative conditions. An additional subject became hypomanic. Baseline characteristics including family psychiatric history or previous drug abuse did not predict symptom changes.

Conclusion: This is the first placebo-controlled prospective study demonstrating the adverse and activating mood and behavioral effects of anabolic steroids.

ADAK 2020 ADAK vs Boniface Mbuvi Muema

5 Nov 2020

In December 2019 the Anti-Doping Agency of Kenya (ADAK) has reported an anti-doping rule violation against the Athlete Boniface Mbuvi Muema after his sample tested positive for the prohibited substance 19-norandrosterone (Nandrolone).

After notification a provisional suspension was ordered. The Athlete filed a statement in his defence and he was heard for the Kenya Sports Disputes Tribunal.

The Athlete accepted the test result and denied the intentional use of the substance. He stated that he only had used a painkiller for his injury and requested for a reduced sanction.

The Panel holds that the Athlete different statement's were not substantiated by any evidence and deems that he failed to establish that the violation was not intentional nor how the substance entered his system.

Therefore the Sports Disputes Tribunal decides on 5 November 2020 to impose a 4 year period of ineligibility on the Athlete starting on the date of the provisional suspension, i.e. on 20 December 2019.

ADAK 2019 ADAK vs Beatrice Jepkorir Rutto

5 Nov 2020

In May 2019 the Anti-Doping Agency of Kenya (ADAK) has reported an anti-doping rule violation against the Athlete Beatrice Jepkorir Rutto after her sample, provided in Kenya in April 2019, tested positive for the prohibited substances Heptaminol and Enobosarm. After notification a provisional suspension was ordered

In August 2019 ADAK reported a new anti-doping rule violation against the Athlete after her sample, provided in Rwanda in June 2019, tested positive for Heptaminol and Enobosarm. After notification again a provisional suspension was ordered.

The Athlete filed a statement in her defence and she was heard for the Kenya Sports Disputes Tribunal.

The Athlete denied the intentional use of the substances and denied that she waived her right to test her B sample. She stated that she sufffered from asthmatic symptoms and chest pain and had used prescribed medication. She mentioned her medication on the Doping Control Form and provided medical information about the severe asthmatic attacks she had.

The Panel accepts that the violations were not intentional since the Athlete mentioned her medication on the Doping Control Form when tested in April and in June 2019.

Further the Panel establish that the Athlete was duly notified in May 2019 about her first anti-doping rule violation and that she was well aware that a provisional suspension was ordered. Nevertheless she participated in the Marathon in Rwanda in June 2019 where she again tested positive. As a result the Athlete committed a second anti-doping rule violation and she also failed to apply for a TUE.

Therefore the Sports Disputed Tribunal decides on 5 November 2020 to impose a 2 year period of ineligibility for the Athlete's First Anti-Doping Rule Violation and a 4 year period for her second anti-doping rule violation. The Tribunal deems that the Athlete has to serve the 2 and 4 year period of ineligibility consecutively.

CAS 2020_A_6978 Andrea Iannone vs FIM | WADA vs FIM and Andrea Iannone

10 Nov 2020

CAS 2020/A/6978 Andrea Iannone v. FIM
CAS 2020/A/7068 WADA v. FIM and Andrea Iannone

On 31 March 2020 the Disciplinary Court of the International Motorcycling Federation (FIM) decided to impose a reduced 18 month period of ineligibility on the Italian motorcycle racer Andrea Iannone after he tested positive for the prohibited substance Drostanolon.

Here the Disciplinary Court accepted that the positive test was the result of contaminated meat he had ingested in Malaysia prior to the 2019 Sepang FIM World Championship MotoGP. 

Hereafter the Athlete, in April 2020, and WADA, in May 2020, appealed the FIM Decision with the Court of Arbitration for Sport (CAS).

Both parties seeked to set aside the FIM Decision of 31 March 2020: the Athlete requested the Panel for a further reduced sanction while WADA requested the Panel for the imposition of a 4 year period of ineligibility. 

The Athlete asserted, supported by expert witnesses, that there are grounds for No Fault or Negligence to impose a further reduced sanction. He argued that the violation was not intentional; the source of the prohibited substance was contaminated meat; he was tested before without issues; he voluntarily underwent a hair test; and he made any possible and reasonable efforts to prevent the contested anti-doping violation.

FIM supported the Athlete’s assertations that the violation was not intentional and that he demonstrated on a balance of probability that the presence of Drostanolone was the result of his consumption of contaminated meat. 

WADA contended that the Athlete failed to establish on the balance of probability that the origin of the prohibited substance was contaminated meat, nor did he demonstrate that there are grounds to reduce the sanction. 

The Panel deems that the Athlete failed to establish neither the precise type of meat he had consumed nor the origin of the meat in question. It finds that the Athlete nor his expert witnesses were able to establish specifically that there was an issue of meat contamination by Drostanolone in Malaysia. 

The Panel concludes that the Athlete has not established on a balance of probabilities that the violation was not intentional and thus it upholds WADA’s Appeal and sets aside the FIM Decision of 31 March 2020.

Therefore the Court of Arbitration for Sport decides on 10 November 2020 that:

1.) The appeal filed by Mr. Iannone on 21 April 2020 against the decision rendered by the International Disciplinary Court of the Fédération Internationale de Motocyclisme dated 31 March 2020 is rejected.

2.) The appeal filed by WADA on 12 May 2020 against the decision rendered by the International Disciplinary Court of the Fédération Internationale de Motocyclisme dated 31 March 2020 is upheld.

3.) The decision rendered by the International Disciplinary Court of the Fédération Internationale de Motocyclisme dated 31 March 2020 is set aside.

4.) Mr. Iannone is sanctioned with a period of ineligibility of four years commencing on 17 December 2019.

5.) All competitive results obtained by Mr. Iannone within from and including 1 November 2019 through the commencement of his suspension are disqualified, with all resulting consequences, including forfeiture of any medals, points and prizes.

6.) (…)

7.) (…)

8.) (…)

9.) All other or further requests or motions for relief are dismissed.

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