Biochemical assessment of erythropoietin products from Asia versus US Epoetin alfa manufactured by Amgen

9 Sep 2008

Biochemical assessment of erythropoietin products from Asia versus US Epoetin alfa manufactured by Amgen / Sungae S. Park, Jihea Park, Jason Ko, Louise Chen, David Meriage, Jill Crouse-Zeineddini, Wendy Wong, Bruce A. Kerwin. - (Journal of Pharmaceutical Sciences 98 (2009) 5 (1 May); p. 1688-1699)

  • PMID: 18781649
  • DOI: 10.1002/jps.21546


We compared the physical and chemical properties of purported copies of recombinant human erythropoietin (rHuEPO) purchased from Korea, China, and India with the innovator product, Epoetin alfa, manufactured by Amgen Inc. The products were characterized for similarity in the types of glycoforms present, the relative degree of unfolding, in vitro potency, presence of covalent aggregates, and presence of cleavage products using established analytical methods. All products were different from Epoetin alfa (Epogen). The purported copies of rHuEPO from Korea, India, and China contained more glycoforms and other impurities. The in vitro relative potency varied for each product when based on the labeled concentration, while the concentration based on ELISA analysis brought the relative potency, for most products closer to 100%. These data emphasize potential biochemical discrepancies resulting from different cell lines and manufacturing processes. Concentrations varied within products and did not always match the information provided on the product label. As it is not possible to reliably correlate such biochemical discrepancies to clinical consequences, or the lack thereof, these data support the need for extensive preclinical testing and clinical testing of all investigational products as not all safety and efficacy aspects can be assessed during preclinical evaluation.

Exploratory study on illegal pharmacologic agents in mixed martial arts performance

20 Jun 2018

Exploratory study on illegal pharmacologic agents in mixed martial arts performance = Estudo exploratório sobre agentes farmacológicos ilegais no desempenho em artes marciais mistas / Ciro José Brito, Rayssa Lodi Mozer, Erasmo Montes Assis de Bem, Pedro Henrique Berbert de Carvalho, Andréia Cristiane Carrenho Queiroz, Fábio dal Bello, Lindsei Brabec Mota Barreto, Bianca Miarka. - (Revista Brasileira de Cineantropometria 20 (2018) 3; p. 269-279)

  • DOI: 10.5007/1980-0037.2018v20n3p269


Mixed Martial Arts (MMA) is a combat sport that requires maximum physical effort during competitions. In this context, some athletes can use illicit substances in order to improve their performance. By means of paired analysis, the present study compared the motor actions of athletes who had failed an anti-doping test versus their performance in combat against a winner or loser without doping presence. For this, 267 rounds (male and female) were analyzed in professional matches. The rounds were paired by athletes in the conditions: doping, winning and losing. Motor actions were analyzed through a specific and previously-validated protocol. Of the substances detected, anabolic androgenic steroids represented 55% (p≤0.001). Doped athletes had lower pause time (83.4±68.3 vs. 131.7±95.2, p≤0.001) and longer time at high-intensity (85.2±86.6 vs. 51.2±73.3, p=0.002) compared to the losing condition. Regarding the technical-tactical analysis in standing combat, winning presented a higher mean compared to doping in all variables except for Knockdowns (p=0.08), single body strikes landed (p=0.15), single leg strikes landed (p=0.25) and single strike attempts (p=0.4). In conclusion, athletes who tested positive presented higher performance in the physical variables (effort and pause time) in comparison to the losing condition; however, doping did not reflect in better technical-tactical performance.

Fighting and doping: Professional mixed martial artists experience and exposure to performance-enhancing substances and supplements

25 Apr 2021

Fighting and doping : Professional mixed martial artists experience and exposure to performance-enhancing substances and supplements / Julian (Jules) R. Woolf, Hyunseo (Violet) Yoon, Kaushik Perkari. - (Performance Enhancement & Health 9 (2021) 1 (May); 100190)


In the last few decades, mixed martial arts (MMA) has grown to become a mainstream sport, broadcasted worldwide. The increased commercialization, structure, and physical requirements of the sport arguably make the use of performance-enhancing drugs (PED) attractive to MMA fighters. In contrast, cultural aspects within MMA and diverse expressions of masculinity may temper PED use. Yet, the sport has received little empirical inquiry. This exploratory study sought to understand MMA fighters’ experience and exposure to PED and sport supplements. Specifically, how fighters learn about, use, and rationalize the use of these substances was explored, along with cultural aspects of the sport that may influence use. Furthermore, given the rapid rise of this sport, generational differences between veterans and early-career fighters were examined. Seventeen semi-structured interviews with professional MMA fighters were conducted and analyzed using a two-cycle coding method. The presentation of results was organized into four categories: learning and conversing, supplement and PED use, rationalization of use, and MMA contextual factors. Multiple misconceptions existed and the use of both supplements and performance-enhancing substances followed similar justifications linked to recovery, performance enhancement, and deficiency correction. Marijuana emerged as a debated performance-enhancing substance. Experimentation was common and knowledge acquisition strategies differed based on career stage and standing within the fighting and doping community. Fighters acknowledged the pressure to dope. However, cultural aspects of the sport and a purity perspective provide deterrents to both supplement and PED use. The implications of these findings, along with recommendations for future research are discussed.

Physical appearance concerns are uniquely associated with the severity of steroid dependence and depression in anabolic-androgenic steroid users

27 Feb 2018

Physical appearance concerns are uniquely associated with the severity of steroid dependence and depression in anabolic-androgenic steroid users / Scott Griffiths, Brendan Jacka, Louisa Degenhardt, Stuart B Murray, Briony Larance. - (Drug and Alcohol Review 37 (2018) 5 (July); p. 664-670)

  • PMID: 29484740
  • DOI: 10.1111/dar.12688


Introduction and aims: Emerging research suggests that the sub-population of anabolic-androgenic steroid (AAS) users who experience physical appearance concerns may suffer greater psychological dysfunction than other sub-populations, including users with athletic or occupational concerns. Thus, among current AAS users, we sought to determine whether, and to what extent, social physique anxiety-an established measure of appearance concern-was associated with psychological dysfunction.

Design and methods: Interviews were conducted with a sample of 74 male AAS users living in Australia. Users completed self-report instruments of the severity of AAS dependence, depression, hazardous and risky drinking, use of non-AAS illicit drugs, psychological side-effects due to AAS use and abnormal test results due to AAS use.

Results: Multivariate analyses revealed that greater social physique anxiety was uniquely associated with more severe symptoms of both AAS dependence and depression. Moreover, the effect size of these relationships was large. Social physique anxiety was not associated with hazardous or risky drinking, non-AAS illicit drug use, psychological side-effects or abnormal test results.

Discussion and conclusions: Limitations notwithstanding, the study is consistent with the notion that AAS users who experience appearance concerns are at heightened risk of co-morbid psychological dysfunction. Given trends indicating an increase in the prevalence of AAS use in Australia and elsewhere, the findings suggest that health-care systems may need to consider prioritising the sub-population of AAS users who experience appearance concerns. Further investigation of the clinical syndrome of AAS dependence is required, including its relation to body image and eating disorders.

Olympic Doping, Transparency, and the Therapeutic Exemption Process

31 Oct 2017

Olympic Doping, Transparency, and the Therapeutic Exemption Process / Luke Cox, Andrew Bloodworth, Michael McNamee. - (Diagoras 1 (2017) 31 October; p. 55-74)


Within anti-doping policy, the Therapeutic Use Exemption policy enables athletes with a range of medical conditions to compete within elite sport even after receiving prohibited medication substances or methods. It has been claimed, however, that the policy is being misused as a means to enhancing performance in healthy athletes, or athletes who do not suffer from a relevant pathological condition. To counter misuse of TUEs, it has claimed that the data captured in the TUE process should be transparent, even though this would reveal medical information concerning the athlete that would normally be thought of as private. There are further concerns regarding the sharing of medical data within sports organisations, between medical professionals and performance directors or coaches. We critically explore the TUE process, and argue against proposals for a transparent TUE policy on grounds of privacy and concerns for athlete welfare .We conclude that the notion of sports integrity, the threat of doping, and the extension of anti-doping policy, need to be considered within a broader context that also concerns the goals of sports medicine and athlete welfare.

The frequency of formation of a motivated refusal to take androgenic anabolic steroids by men with recreational activity

23 Nov 2019

The frequency of formation of a motivated refusal to take androgenic anabolic steroids by men with recreational activity = Частота формирования мотивированного отказа от использования андрогенных анаболических стероидов среди мужчин, занимающихся рекреационной активностью / M.P. Lykhonosov, A.Y. Babenko, V.A. Makarin, Y.N. Fedotov. - (Problems of Endocrinology 65 (2019) 5 (23 November); p. 341-350

  • PMID: 32202738
  • DOI: 10.14341/probl12108
  • Abstract in English, Article in Russian


Background: The widespread use of AAS for non-medical purposes is more than often becoming the cause of secondary hypogonadism. The study of the formation of the negative attitude towards the use of AAS among the gym visitors is quite relevant.

Aims: To identify the frequency of the formation of a motivated refusal to continue taking androgenic anabolic steroids among men who voluntarily declared their use.

Materials and methods: The study included 44 men, all users of AAS. There has been estimated the effectiveness of the clinical examination: how ready they were to disclose information about the use of AAS (drugs, doses, regimens, duration) or how much they were aware of the mechanisms of action of AAS and their effects on the body. The participants were also asked to evaluate their psychological and emotional state (on the scale Index of life satisfaction, Hamiltons depression, aggressiveness). The experience of our informational lectures on the topic Risks of using AAS prior to the selection of volunteers for research, anonymous surveys and interviews with potential participants in the clinical trial, the clinical work itself with the selected volunteers, the characteristic features of a medical history and tests that we identified were compared with clinical recommendations for hypogonadism diagnostic (domestic and foreign).

Results: More than 105 gym visitors responded positively to a motivated offer (free medical consultation and laboratory tests) to participate in a clinical study. Based on the results of the individual interview, 54 men (51.4%) who indicated the use of AAS signed an informed consent. 44 volunteers (41.9%) completed all stages of the study. Among them, 32 participants (72.7%) were aware of the mechanisms of action and side effects of AAS. 21 volunteers (47.7%) filled in the scales. The index of life satisfaction was determined as high, equal to 34 [29; 38] points; the index of aggressiveness was higher than the generally accepted standard and composed 27 [25; 29] points, the level of depression corresponded to a mild depressive disorder, equal to 9 [3; 12] points. Over the use of AAS 22.7% (n = 10) of the examined noted an increase in aggressiveness, which they themselves associated with the use of steroids. The clinical symptoms of hypogonadism (decreased libido, erectile dysfunction) after the cancellation of AAS were indicated by 25% (n = 11) of the volunteers and that was one of the reasons they continued to use anabolics. 31.8% (n = 14) of the participants were ready to completely stop using the steroids.

Conclusions: Individual informational interviews aimed at providing knowledge about the negative effects of steroids on the body motivated the desire to stop using them amongst 31.8% of AAS users. The obtained data points out to a developed AAS addiction which requires the involvement of psychiatrists to get rid of it.

Keywords: Abuse of steroids; Steroid-induced hypogonadism; anabolic-androgenic steroids; behavioral features; hypogonadism.

Potential risk for developing severe COVID-19 disease among anabolic steroid users

26 Feb 2021

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


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.

Anabolic-androgenic steroids: procurement and administration practices of doping athletes

1 Oct 2018

Anabolic-androgenic steroids : procurement and administration practices of doping athletes / Julius Fink, Brad Jon Schoenfeld, Anthony C. Hackney, Masahito Matsumoto, Takahiro Maekawa, Koichi Nakazato, Shigeo Horie. - (Physician and Sportsmedicine 47 (2019) 1; p. 10-14)

  • PMID: 30247933
  • DOI: 10.1080/00913847.2018.1526626


Performance enhancing substances are becoming increasingly popular amongst bodybuilders and people who want to enhance their physiques. However, due to the rise of the Internet and laws prohibiting sales of these substances without prescription, the route of procurement and administration practices have become more and more dangerous. Prior to the mid-1970's, anabolic steroids were not regulated and easily available from physicians and pharmacies in several countries. In 1990, the United States enacted the Anabolic Steroid Control Act, leading to the proliferation of black markets and underground laboratories. The shift from pharmacy to underground online sites for the procurement of anabolic steroids led to an increase of fake products with low purity and the ability to potentially endanger the health of anabolic steroid users. Underground laboratories emerged both locally and in countries with lax legal regulations. 'Anabolic steroid tourism' and large networks of online resellers emerged, leading to the banalisation of the illegal procurement of anabolic steroids. Furthermore, the increase of anecdotal information spreading on the internet among anabolic steroid user forums nourishes the rampant misinformation and dangerous practices that currently exist. The dosages and ways of administration recommended on these forums can be false and misleading to those who lack a medical background and cannot go to their physician to seek advice because of the fear of repercussions. This review aims to elucidate and describe current practices of the anabolic-androgenic steroids black market and draw attention to potential dangers for users.

Anabolic Steroid-induced Mania

20 Aug 2018

Anabolic Steroid-induced Mania / Daniel G. Franey, Eduardo D. Espiridion. - (Cureus 10 (2018) 8 (August 20)

  • PMID: 30357054
  • PMCID: PMC6197512
  • DOI: 10.7759/cureus.3163


There are numerous reports of the psychiatric effects of anabolic-androgenic steroid (AAS) use. However, these effects have not been clearly elicited in controlled clinical trials. This discrepancy is largely due to the presence of a variety of synergistic factors seen in the real-life setting of AAS abuse. In this case, we report a patient in acute mania admitted to Frederick Memorial Hospital in Frederick, Maryland. He had no prior history or family history of manic episodes. His symptoms were refractory to initial pharmacologic intervention. The onset of his symptoms was likely related to the initiation of AAS use. However, his symptoms were likely potentiated by heavy daily cannabis use. The patient showed a gradual improvement over the second week of his hospitalization. He was discharged on antipsychotics and scheduled to follow up with a therapist and psychiatrist.

Effects of Exogenous Androgens on Platelet Activity and Their Thrombogenic Potential in Supraphysiological Administration: A Literature Review

4 Jan 2021

Effects of Exogenous Androgens on Platelet Activity and Their Thrombogenic Potential in Supraphysiological Administration : A Literature Review / Adrian Eugen Roşca, Ana-Maria Vlădăreanu, Alina Mititelu, Bogdan Ovidiu Popescu, Corin Badiu, Constantin Căruntu, Suzana Elena Voiculescu, Minodora Onisâi, Şerban Gologan, Radu Mirica, Leon Zăgrean. - (Journal of Clinical Medicine 10 (2021) 1 (4 January); p. 1-27)

  • PMID: 33406783
  • PMCID: PMC7795962
  • DOI: 10.3390/jcm10010147


Anabolic androgenic steroids (AAS), simply called "androgens", represent the most widespread drugs used to enhance performance and appearance in a sporting environment. High-dosage and/or long-term AAS administration has been associated frequently with significant alterations in the cardiovascular system, some of these with severe endpoints. The induction of a prothrombotic state is probably the most life-threatening consequence, suggested by numerous case reports in AAS-abusing athletes, and by a considerable number of human and animal studies assessing the influence of exogenous androgens on hemostasis. Despite over fifty years of research, data regarding the thrombogenic potential of exogenous androgens are still scarce. The main reason is the limited possibility of conducting human prospective studies. However, human observational studies conducted in athletes or patients, in vitro human studies, and animal experiments have pointed out that androgens in supraphysiological doses induce enhanced platelet activity and thrombopoiesis, leading to increased platelet aggregation. If this tendency overlaps previously existing coagulation and/or fibrinolysis dysfunctions, it may lead to a thrombotic diathesis, which could explain the multitude of thromboembolic events reported in the AAS-abusing population. The influence of androgen excess on the platelet activity and fluid-coagulant balance remains a subject of debate, urging for supplementary studies in order to clarify the effects on hemostasis, and to provide new compelling evidence for their claimed thrombogenic potential.

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