Plasma fibrinolytic activity following oral anabolic steroid therapy.

Thromb Diath Haemorrh. 1975 Sep 30;34(1):236-45.

Plasma fibrinolytic activity following oral anabolic steroid therapy.

Walker ID, Davidson JF, Young P, Conkie JA.

Six anabolic steroids were assessed for their ability to enhance plasma
fibrinolytic activity in males with ischaemic heart disease. Five
17alpha-alkylated steroids (Ethyloestrenol, Norethandrolone, Methandienone,
Methylandrostenediol and Oxymetholone) were examined and all produced a
significant increase in plasma plasminogen activator as measured by the
euglobulin lysis time. The only non-17alpha-alkylated steroid studied
(Methenolone acetate) failed to enhance fibrinolysis. The 17alpha-alkylated
steroids studied all deserve more detailed evaluation of their long term effects
on plasma fibrinolytic activity.

Hepatoma associated with anabolic steroid therapy.

Am J Roentgenol Radium Ther Nucl Med. 1975 Aug;124(4):638-42.

Hepatoma associated with anabolic steroid therapy.

Holder LE, Gnarra DJ, Lampkin BC, Nishiyama H, Perkins P.

A patient with Fanconi's anemia who developed a hepatoma after 50 months of
therapy with anabolic steroids is reported. The lesion presented as a cold focal
defect on a Tc99m sulfur colloid scintigram, but was avascular on dynamic
scintigraphy. Both the unusual avascularity of the hepatoma, and its association
with anabolic steriod therapy are discussed.

Publication Types:
    Case Reports
    Research Support, U.S. Gov't, P.H.S.

A study of the abortifacient effect of oxymetholone in early gestation.

Contraception. 1975 Jun;11(6):669-76.

A study of the abortifacient effect of oxymetholone in early gestation.

Brenner PF, Mishell DR Jr.

PIP: Oxymetholone, a steroid which inhibits progesterone synthesis, was given to
6 women in early pregnancy to produce abortions. Patients were less than 7 weeks
pregnant; duration since last menstrual period was less than 46 days when therapy
started. Dosage varied from 50 mg daily for 7 days to 100 mg 3 times a day for 10
days. Serum HCG, progesterone, and estradiol levels were measured before, during,
and after therapy. Also total serum proteins, albumin, globulin, total bilirubin,
direct bilirubin, alkaline phosphatase, SGOT, SGPT, and complete blood counts
were obtained before and immediately after treatment. All determinations were
normal, including the hormones. No abortions resulted from the therapy although
some vaginal bleeding was noted by 3 patients. Nausea, vomiting, or abdominal
pain were side effects in 4. Results indicate that oxymetholone is an ineffective
agent for termination of early pregnancy.

Oxymetholone treatment for sickle cell anemia.

Blood. 1975 Jun;45(6):769-77.

Oxymetholone treatment for sickle cell anemia.

Alexanian R, Nadell J.

Seven patients with sickle cell anemia were treated with oxymetholone for at
least 2 mo. Markedly increased basal rates of hemolysis and erythropoiesis were
confirmed. The urinary erythropoietin excretion was either normal or lower than
expected for the red cell mass, and an expanded blood volume was due primarily to
an increased plasma volume. After androgen therapy, six patients demonstrated
more than a fivefold increase in urinary erythropoietin, with an increase in red
cell mass ranging from 17%-75% above the control value. All showed a decline in
serum iron level to the 25-75 mug/100 ml range within 4 wk after the start of
therapy. Less marked changes followed lower oxymetholone doses. Reversible
hepatic toxicity, with a serum bilirubin concentration exceeding 50 mg/100 ml,
occurred in one patient. Androgenic hormone therapy may be useful for selected
adult patients with sickle cell disease when severe anemia contributes to disease
morbidity.

Androgen-induced hepatoma.

Lancet. 1975 Feb 22;1(7904):430-2.

Androgen-induced hepatoma.

Farrell GC, Joshua DE, Uren RF, Baird PJ, Perkins KW, Kronenberg H.

Three cases of hepatocellular carcinoma are reported in young men who had been
taking androgenic-anabolic steroids. The tumours were histologically similar to
those described in previous reports. The tumour progressed slowly in two patients
during four and seven years of observation, but in the latter bony metastases
occurred. In two patients the tumours regressed after administration of the drug
was discontinued. These cases strengthen the evidence that exogenous
androgenic-anabolic steroids may produce liver tumours. The use of these drugs
should be confined to serious conditions in which they are known to be effective.
Biochemical tests of liver function and serum alphs-fetoprotein estimation are
not useful as screening-tests for hepatoma in patients taking androgens, and
regular isotopic liver-scanning is recommended.

Perturbations of the human menstrual cycle by oxymetholone.

Am J Obstet Gynecol. 1975 Jan 1;121(1):121-6.

Perturbations of the human menstrual cycle by oxymetholone.

Cox DW, Heinrichs WL, Paulsen AC, Conrad SH, Schiller HS, Hezl MR, Herrmann WL.

The luteolytic activity of oxymetholone, and anabolic steroid, has been evaluated
in 10 women. Administration early in the follicular phase of the cycle inhibited
ovulation and prolonged the duration of the cycles in 2 of 3 subjects, but
treatment beginning on Day 10 (3 subjects) did not prevent ovulation, although
subsequent plasma progesterone concentrations were reduced. Treatment after
ovulation (4 subjects) suppressed progesterone levels by 50 to 80 per cent and
shortened cycle length by 6 to 8 days. Side effects were weight gain and
bromosulfophthalein retention. The most likely mechanisms producing these
perturbations are the inhibition of luteinizing hormone release early in the
cycle and, later, inhibition of progesterone biosynthesis.

PIP: 10 ovulating women were treated with oxymetholone in 1 of 3 ways: 1) 50 mg
twice daily every other day starting on the sixth day of the treatment cycle
(early follicular phase), 2) 50 mg twice daily every other day starting in the
late follicular phase (tenth day), or 3) 100 mg daily starting in early luteal
phase. 2 women treated in early follicular phase had ovulation suppression and
cycles prolonged 9 to 10 days, with progesterone suppressed by ovulated, and a
third had a 71% suppression of progesterone. In the third group, cycle lengths
were shortened due to a luteal phase shortening of 6 to 8 days, with progesterone
values decreased 53 to 81%. Side effects noted were: weight gain (9 out of 10
patients) transient nausea, and increased bromsulphalein retention.

Induction of premature menstruation with anabolic steroids.

Am J Obstet Gynecol. 1973 Sep 1;117(1):121-5.

Induction of premature menstruation with anabolic steroids.

Bolch OH Jr, Warren JC.

PIP: To determine the mechanism of the effect of certain anabolic steroids on
menstruation induction and to evaluate this effect as an interceptor of early
pregnancy, the luteal phase length was studied in the cycles of women ranging in
age from 21 to 37 years after postovulatory treatment with 7 different anabolic
steroids. Basal body temperature records were kept and endometrial biopsies were
obtained late in the pretreatment control periods to confirm ovulation. 2
steroids which had been proven to shorten the luteal cycle phase were
administered as follows: Nandrolone phenpropionate was given in a daily 50-mg
dose intramuscularly for 3 days. 30 mg of oxymetholone was administered orally
every 6 hours for 4 days. The previously untested steroids were administered
orally in evenly divided doses every 6 hours for 4 days as follows: oxandrolone,
60 mg daily; stanozolol, 28 mg; methandrostenolone, 60 mg; fluoxymesterone, 40
mg; and ethylestrenol, 30 mg. Plasma progesterone and gonadotropins were measured
by radioimmunoassay of blood samples taken 7 days after ovulation. Nandrolone and
oxymetholone were found to significantly shorten cycle and luteal phase lengths
and depress plasma LH and progesterone levels as compared to control cycles.
Nandrolone also significantly depressed plasma FSH levels. Of the 5 new drugs,
only ethylestrenol significantly shortened luteal phase length (p less than
.001). This finding is questioned by the small sample size and thus the use of
this steroid as a menstruation inducer is considered questionable. The mechanism
of the effect of nandrolone and oxymetholone appears to be due to their
antigonadotropic action that only secondarily reduces progesterone levels.
Whether these steroids can affect human chorionic gonadotropin and thus cripple
the corpus luteum and interrupt early pregnancy needs further research.

Induction of premature menstruation with catatoxic steroids

Am J Obstet Gynecol. 1971 Dec 15;111(8):1107-10.

Induction of premature menstruation with catatoxic steroids.

Bolch OH Jr, Warren JC.

PIP: The effects of spironolactone, diphenylhydantoin, oxymetholone, and
nandrolone phenproprionate, drugs which induce hepatic hydroxylase activity on
the menstrual cycle of healthy women from 21 to 39 years old, were studied. The 4
drugs were administered during the luteal phase of the menstrual cycle.
Diphenylhydantom and oxymetholone significantly shortened cycle length (p greater
than .001). The occurrance of ovulation was indicated by endometrial biopsies and
basal body temperature studies. Post nandrolone cycles were significantly longer
than control cycles (p greater than .05). Endometrial studies indicated that
ovulation occurred in the nandrolone and oxymetholone post treatment cycles. The
suggestion is made that these drugs might be used to terminate early pregnancy
and prevent pregnancy following sexual assault.

Hepatoma and peliosis hepatis developing in a patient with Fanconi's anemia.

N Engl J Med. 1971 May 20;284(20):1135-6.

Hepatoma and peliosis hepatis developing in a patient with Fanconi's anemia.

Bernstein MS, Hunter RL, Yachnin S.

PIP: Fanconi's anemia is a rare genetic disorder associated with congenital
deformities, infections, chromosomal abnormalities, and leukemia. This brief
article describes the case of a 20 year old man affected with the disease, who
was given 100 mg daily of oxymetholone to cure leukopenia and thrombocytopenia.
10 months later he died of hepatic failure. Autopsy revealed hepatoma and liver
peliosis, a rare condition of unknown etiology characterized by blood-filled
cysts in the liver. It is possible that in the case reported here the hepatoma
could have been related to the oxymetholone treatment, which conceivably could
have initiated hepatic damage.

Effects of use of anabolic steroids on the masticatory system: a pilot study.

J Oral Sci. 2008 Mar;50(1):19-24.

Effects of use of anabolic steroids on the masticatory system: a pilot study.

Barros TS, Santos MB, Shinozaki EB, Santos JF, Marchini L.

Department of Dentistry, University of Vale do Paraíba - UNIVAP, São José dos
Campos, Brazil.

The use of androgenic anabolic steroids (AAS) has increased significantly among
athletes in Brazil and other countries. These drugs alter the physiological
behavior of bone and muscles, also affecting these structures in masticatory
system. This paper aims to evaluate bone and dental changes in users of AAS, as
well as the incidence of temporomandibular dysfunction (TMD), compared to
athletes not using AAS. Eight athletes were equally divided in two groups, AAS
users and non-users. The groups were evaluated using Helkimo index, McNamara
cephalometric tracing and cast analysis. The AAS users presented more intense TMD
signs and symptoms (Di total value, P = 0.096, Mann-Whitney test), increased
cephalometric measures (Co-A, P = 0.020, Mann-Whitney test) and Angle Class II
malocclusion, compared to the non-users. These results suggested that the use of
AAS alters masticatory structures and increases the incidence of TMD.

Ischemic stroke related to anabolic abuse.

Clin Neuropharmacol. 2008 Mar-Apr;31(2):80-5.

Ischemic stroke related to anabolic abuse.

Santamarina RD, Besocke AG, Romano LM, Ioli PL, Gonorazky SE.

Neurology Department, Hospital Privado de Comunidad, Mar del Plata, Argentina.
rsantamarina@sna.org.ar.

Anabolic-androgenic steroid (AAS) abuse increased in recent years, and it is
associated with numerous adverse effects. Few reports on ischemic stroke related
to anabolic steroid abuse have been published. We report a case of a 26-year-old
male amateur athlete who suffered a posterior territory ischemic stroke. No
abnormalities were found in angiography and echocardiography studies, neither in
hemostatic profile. His only significant risk factor was nonmedical use of
stanozolol, an anabolic steroid. Anabolic steroids are capable of increasing
vascular tone, arterial tension, and platelet aggregation; therefore, they are
prone to produce atherothrombotic phenomena. Because of young people's widespread
use of anabolic steroids, physicians should be aware of this kind of
complication.

Prevalence of the use of anabolic agents among strength training apprentices in Porto Alegre, RS

Arq Bras Endocrinol Metabol. 2007 Feb;51(1):104-10.

[Prevalence of the use of anabolic agents among strength training apprentices in
Porto Alegre, RS]

[Article in Portuguese]

Silva PR, Machado LC Jr, Figueiredo VC, Cioffi AP, Prestes MC, Czepielewski MA.

Faculdade de Medicina, UFRGS, RS.

This study aimed to determine through a questionnaire applied to interviewers,
the current or past use of anabolic androgenic steroids (AAS), as well as other
hormones (OH), and other medicines (OM), food supplement and illicit drugs among
strength training apprentices in the city of Porto Alegre, RS. We interviewed 288
subjects draw from a sample of 13 gyms. The prevalence of current and past use of
AAS was about 11.1% (32/288), OH 5.2% (16/288) and OM 4.2% (12/288). The most
used AAS were nandrolone and stanozolol; the OH were gonadotropin,
triiodothyronine (T3) and OM, like lipostabil, diuretics and veterinary medicines
(Monovin E). The most frequent side-effects were behavioral such as humor
oscillation, irritability and hostility, and endocrine disturbances such as acne
and increased or decreased libido. When analyzed together with other hormones in
a variable named "hormonal agents" (AH), AAS presented a statistical difference
(p< 0.05) among genders considering that the most frequent use of AH occurred
among men and those who consume food supplements. The comparison of these
findings to other national and international results is difficult due to the
epidemiological design. Even if it is considered, the observed prevalence
suggests that preventive attitudes as well as special care in the orientation and
education of this population must be taken.

Lupus nephritis remission, albeit with positive anti-doping test.

Joint Bone Spine. 2007 Jan;74(1):96-7. Epub 2006 Feb 17.

Lupus nephritis remission, albeit with positive anti-doping test.

Jakez-Ocampo J, Richaud-Patin Y, Llorente L.

Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas
y Nutrición, Salvador Zubirán, Vasco de Quiroga 15, Tlalpan 14000, México City,
México. lllyrp@quetzal.innsz.mx

A 39-year-old woman developed systemic lupus erythematosus with nephropathy after
a holiday in Jamaica. She was prescribed with prednisone, azathioprine and
aspirin. As she was obsessed with aesthetic procedures, she decided not to take
the prescription. Instead, she took her bodybuilding trainer's advice of one
intramuscular injection of stanozolol for 10 weeks in order to increase her
gluteus area. One week after finishing the latter regimen, there was no disease
activity. Whether lupus remission in this patient was spontaneous or a
consequence of stanozolol administration will remain a riddle for this fortunate
outcome.

Anabolic steroid and gonadotropin releasing hormone analog combined treatment increased pubertal height gain and adult height in two children who entered puberty with short stature.

J Pediatr Endocrinol Metab. 2006 Sep;19(9):1125-31.

Anabolic steroid and gonadotropin releasing hormone analog combined treatment
increased pubertal height gain and adult height in two children who entered
puberty with short stature.

Satoh M, Yokoya S.

First Department of Pediatrics, Toho University School of Medicine, Japan.
satomari@med.toho-u.ac.jp

We studied the effect of gonadal suppression treatment in combination with
anabolic steroid on pubertal height gain and adult height in two children who
entered puberty with short stature. Patient 1 was a female with idiopathic short
stature. She received combined treatment with an anabolic steroid (stanozolol)
and a gonadotropin releasing hormone analog (leuprorelin acetate). Her pubertal
height gain was 28.5 cm, which is greater than that in normal height girls (20-25
cm). Patient 2 was a male with Aarskog syndrome. Although his growth hormone (GH)
secretion was normal, he received GH treatment. Since GH administration did not
accelerate his growth, he received combined treatment with stanozolol and
leuprorelin acetate. His pubertal height gain was 27.0 cm, which is greater than
that observed in GH deficient boys treated with GH alone (21.9 cm). Combined
treatment with stanozolol and leuprorelin acetate appears to be effective in
increasing pubertal height gain and adult height in children who enter puberty
with short stature.

Impaired vasoreactivity in bodybuilders using androgenic anabolic steroids.

Eur J Clin Invest. 2006 Jul;36(7):483-8.

Impaired vasoreactivity in bodybuilders using androgenic anabolic steroids.

Lane HA, Grace F, Smith JC, Morris K, Cockcroft J, Scanlon MF, Davies JS.

Department of Endocrinology, University Hospital of Wales, Heath Park, Cardiff
CF14 4XW, Wales, UK. laneha@cf.ac.uk

BACKGROUND: Anabolic androgenic steroids are used by some bodybuilders to enhance
performance. While the cardiovascular implications of supraphysiological androgen
levels requires further clarification, use is associated with sudden death, left
ventricular hypertrophy, thrombo-embolism and cerebro-vascular events.

MATERIALS
AND METHODS: To further understand the effect of androgenic anabolic steroid
abuse on vascular function, this study assessed vascular stiffness (pulse-wave
analysis) and cardiovascular risk factors in 28 male, bodybuilding subjects, of
whom ten were actively receiving anabolic agents (group A; 26.4 +/- 7.2 years)
and eight had undergone a 3-month "wash-out" period (group B; 32.1 +/- 7.1
years). The remaining ten bodybuilding subjects (group C; 24.4 +/- 4.4 years)
denied any past use of anabolic steroids or other performance enhancing drugs.
Comparisons were made with ten sedentary male controls (group D, 29.3 +/- 4.7
years).

RESULTS: Endothelial independent dilatation in response to glycerol
trinitrate was significantly impaired in the group currently using anabolic
steroids (group A) compared with the other three groups [A (5.63 +/- 3.24%)
versus; B (11.10 +/- 4.91%), C (17.88 +/- 9.2%) and D (14.46 +/- 3.9%), P <
0.0005, respectively], whereas no significant differences in
endothelial-dependent dilatation were detected between the groups [A (5.0 +/-
3.0%), B (7.4 +/- 3.4%), C (9.6 +/- 4.5%) and D (8.2 +/- 3.3%), P < 0.059,
respectively].

CONCLUSIONS: Previous studies described a decline in vascular
reactivity occurring in bodybuilding subjects which is independent of anabolic
steroid use and may result from smooth muscle hypertrophy with increased vascular
stiffness. This study revealed impaired vascular reactivity associated with
anabolic agents and that improvement in vascular function may occur following
their discontinuation.

Stacking anabolic androgenic steroids (AAS) during puberty in rats: a neuroendocrine and behavioral assessment.

Pharmacol Biochem Behav. 2006 Mar;83(3):410-9. Epub 2006 Apr 17.

Stacking anabolic androgenic steroids (AAS) during puberty in rats: a
neuroendocrine and behavioral assessment.

Wesson DW, McGinnis MY.

The University of Texas at San Antonio, Department of Biology, 6900 North Loop
1604 West, San Antonio, TX 78249, USA.

Anabolic androgenic steroid (AAS) abuse is increasing in teenagers. We examined
the effects of stacked AAS in adolescent male rats. Stacking, in which multiple
AAS are taken simultaneously, is commonly employed by humans. Beginning at
puberty gonadally intact male rats received testosterone, nandrolone, or
stanozolol. Additional groups received stacked AAS: testosterone + stanozolol,
nandrolone + stanozolol, or nandrolone + testosterone. Injections continued
during tests for sexual behavior, vocalizations, scent marking, partner
preference, aggression and fertility. Body and reproductive tissue weights were
taken. Sexual and aggressive behaviors were increased by testosterone yet
inhibited by stanozolol; nandrolone had no effect. Stacking testosterone with
stanozolol prevented the inhibitory effects of stanozolol. Body weight was
decreased by testosterone and all stacked AAS. Cell nuclear androgen receptor
binding in brain was significantly increased in nandrolone males and decreased in
stanozolol males; testosterone males were slightly higher than controls. Androgen
receptors in stacked groups were intermediate between individual AAS suggesting
that stanozolol competed with other AAS for androgen receptors despite its low
affinity. The results indicate that stacking AAS influences the effects of
individual AAS on behavioral and endocrine measures, and levels of androgen
receptor occupation are not directly correlated with AAS effects on behavior.

Successful treatment of primary refractory anemia with a combination regimen of all-trans retinoic acid, calcitriol, and androgen.

Leuk Res. 2006 Aug;30(8):935-42. Epub 2006 Jan 30.

Successful treatment of primary refractory anemia with a combination regimen of
all-trans retinoic acid, calcitriol, and androgen.

Zhang W, Zhou F, Cao X, Cheng Y, He A, Liu J, Ma X, Chen G.

Department of Clinical Hematology, Affiliated No. 2 Hospital, Xi'an Jiaotong
University, 157 West Five Road, Xi'an 710004, PR China.
alisantra0351@yahoo.com.cn

We investigated the efficacy and safety of a combination regimen in 63 patients
with primary refractory anemia (RA). The daily treatment protocol comprised
all-trans retinoic acid (ATRA) (30 mg/m(2)), calcitriol (0.1 microg/m(2)), and
androgen (stanozolol 3mg/m(2), or danazol 300 mg/m(2)) in three separate doses
for eight consecutive weeks. Hematologic improvement was observed in 43 (68.3%)
patients. The treatment administered was generally well tolerated, with no severe
regimen-related toxicity. The overall survival rates at 3 and 5 years were 68.72%
and 53.18%, respectively. These results indicate that this combination regimen is
an effective and well-tolerated treatment for patients with RA.

Synchronous bilateral ductal carcinoma in situ of the male breast associated with gynecomastia in a 30-year-old patient following repeated injections of stanozolol.

Breast Cancer Res Treat. 2006 May;97(2):173-6. Epub 2005 Dec 3.

Erratum in:
    Breast Cancer Res Treat. 2006 May;97(2):177. Melcher, A [corrected to Melcher,
Gian A].

Synchronous bilateral ductal carcinoma in situ of the male breast associated with
gynecomastia in a 30-year-old patient following repeated injections of
stanozolol.

Staerkle RF, Lenzlinger PM, Suter SL, Varga Z, Melcher GA.

Department of Surgery, Spital Uster, Uster, Switzerland.

We report a rare case of synchronous bilateral and multifocal ductal carcinoma in
situ (DCIS) in a 30-year-old patient operated on for gynecomastia following
repeated injections of stanozolol, a non-aromatizable androgen. The familial
medical history was negative for breast cancer and work-up of serum hormone
levels was normal. The patient underwent a modified radical mastectomy without
axilla dissection 6 weeks following the primary procedure and recovered
uneventfully. The role of synthetic androgens in the development of male breast
neoplasia warrants further scrutiny.

Management of male sterility in patients taking anabolic steroids

 Arch Esp Urol. 2005 Apr;58(3):241-4.

[Management of male sterility in patients taking anabolic steroids]

[Article in Spanish]

de la Torre Abril L, Ramada Benlloch F, Sánchez Ballester F, Ordoño Domínguez F,
Ulises Juan Escudero J, Navalón Verdejo P, López Alcina E, Ramos de Campos M,
Zaragoza Orts J.

Servicio de Urología, Consorcio Hospital General Universitario, Valencia, España.
Luitorrr@hotmail.com

OBJECTIVES/METHODS: To review the incidence of male infertility secondary to
intake of anabolic products and our experience and outcomes with treatment. There
is a variety of such substances (testosterone, nandrolone, stanozolol, etc.) in
their intake may be unique or combinations, both orally or parenterally.
Comparisons between patients and case series are difficult because of the hiding
of this practice and various consumption practices and doses employed.
RESULTS/CONCLUSIONS: Most of the patients recover normal spermatogenesis does by
stopping intake of anabolic substances. The period of time until recovery is 6.35
months. Patients not recovering after six months were given tamoxifen 20
mg/24-hour, if having a normal or inhibited hypothalamus-hypophysis axis.
Duration of abuse, doses, and anarchical consumption maderesponse to treatment
with antiestrogen drugs or gonadotropins unpredictable in patients not responding
to conservative treatment.

Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature.

Br J Sports Med. 2005 May;39(5):e27.

Hepatocellular adenomas associated with anabolic androgenic steroid abuse in
bodybuilders: a report of two cases and a review of the literature.

Socas L, Zumbado M, Pérez-Luzardo O, Ramos A, Pérez C, Hernández JR, Boada LD.

Department of Radiology, Cajal Clinical Centre, Las Palmas de Gran Canaria,
Canary Islands, Spain.

Anabolic androgenic steroids (AAS) are used illicitly at high doses by
bodybuilders. The misuse of these drugs is associated with serious adverse
effects to the liver, including cellular adenomas and adenocarcinomas. We report
two very different cases of adult male bodybuilders who developed hepatocellular
adenomas following AAS abuse. The first patient was asymptomatic but had two
large liver lesions which were detected by ultrasound studies after routine
medical examination. The second patient was admitted to our hospital with acute
renal failure and ultrasound (US) studies showed mild hepatomegaly with several
very close hyperecogenic nodules in liver, concordant with adenomas at first
diagnosis. In both cases the patients have evolved favourably and the tumours
have shown a tendency to regress after the withdrawal of AAS. The cases presented
here are rare but may well be suggestive of the natural course of AAS induced
hepatocellular adenomas. In conclusion, sportsmen taking AAS should be considered
as a group at risk of developing hepatic sex hormone related tumours.
Consequently, they should be carefully and periodically monitored with US
studies. In any case, despite the size of the tumours detected in these two
cases, the possibility of spontaneous tumour regression must also be taken in
account.

Nonhealing ulcer secondary to factor V Leiden mutation and cryofibrinogenemia.

J Am Acad Dermatol. 2004 Nov;51(5 Suppl):S194-6.

Erratum in:
    J Am Acad Dermatol. 2004 Dec;51(6):1040.

Nonhealing ulcer secondary to factor V Leiden mutation and cryofibrinogenemia.

Barrio VR, Sanfilippo AM, Malone JC, Callen JP.

Department of Medicine, Division of Dermatology, University of Louisville School
of Medicine, Louisville, Kentucky 40202, USA.

Factor V Leiden is the most common genetic thrombophilia in people of European
descent, and is important to recognize as it can have significant implications in
dermatology. We report a case of a 30-year-old man who presented for evaluation
and treatment of a chronic ulceration on the site of his stump following a below
the knee amputation which had been performed for non-healing ulcerations. Despite
a variety of treatments, his ulcer persisted. He was referred to a dermatologist
who performed a biopsy that was interpreted ass non-specific, and treatment was
started for pyoderma gangrenosum. Further investigation revealed a homozygous
factor V Leiden mutation and cryofibrinogenemia. He was tapered off of the
methylprednisolone and was improving on stanozolol. He healed well after surgery
and no new ulcerations have developed. This case highlights the importance of
considering this mutation in a non-healing leg ulcer.

Oxandrolone treatment of childhood hereditary angioedema.

Ann Allergy Asthma Immunol. 2004 Mar;92(3):377-8.

Oxandrolone treatment of childhood hereditary angioedema.

Church JA.

Division of Clinical Immunology and Allergy, Department of Pediatrics, Childrens
Hospital Los Angeles and Keck of School of Medicine, The University of Southern
California, Los Angeles, California 90027, USA. jchurch@chla.usc.edu

BACKGROUND: The virilizing effects of danazol, stanozolol, and methyltestosterone
significantly restrict the usefulness of these agents in the treatment of
children with hereditary angioedema (HAE). Oxandrolone is a synthetic anabolic
steroid with limited virilizing effects that has been used in a variety of
pediatric conditions and has an acceptable safety profile.

OBJECTIVE: To report
the effective use of oxandrolone in a 6-year-old boy with recurrent,
life-threatening episodes of angioedema.

METHODS: Oxandrolone was administered at
a dose of 0.1 mg/kg per day. Symptoms and laboratory findings were evaluated by
parental report and laboratory analysis of serum C1 esterase inhibitor and C4
levels, respectively.

RESULTS: Oxandrolone therapy resulted in a marked reduction
in clinical episodes and normalization of serum complement levels; cessation of
oxandrolone therapy resulted in recurrence of symptoms and decreased complement
levels. However, early signs of virilization were noted.

CONCLUSIONS: Oxandrolone
treatment was associated with significant clinical and laboratory evidence of a
therapeutic effect in a prepuberal boy with HAE. It is imperative to treat HAE
with the lowest dose of oxandrolone that controls life-threatening episodes of
angioedema

The anti-doping hot-line, a means to capture the abuse of doping agents in the Swedish society and a new service function in clinical pharmacology.

Eur J Clin Pharmacol. 2003 Nov;59(8-9):571-7. Epub 2003 Sep 12.

The anti-doping hot-line, a means to capture the abuse of doping agents in the
Swedish society and a new service function in clinical pharmacology.

Eklöf AC, Thurelius AM, Garle M, Rane A, Sjöqvist F.

Department of Clinical Pharmacology, Huddinge University Hospital, 14185
Stockholm, Sweden.

With the support of the Swedish National Institute of Health a national
information service was started in 1993 aiming to capture the abuse of doping
agents in the general public. It was organized as a telephone service, called the
Anti-Doping Hot-Line, from our department and managed by trained nurses
co-operating with clinical pharmacologists. Important information collected about
all callers (anonymous) was: date of call, its origin, category of caller, doping
experience and main question being asked. Abusers were asked about their age,
sex, affiliation, abused drug(s), duration of abuse, habit of administration and
adverse reactions (ADRs). Between October 1993 and December 2000 25,835 calls
were received with a peak during spring and autumn. Most calls (12,400) came from
non-abusers, 60% being males. Callers connected with gyms represented the largest
group (30%). Most calls about specific drugs concerned anabolic androgenic
steroids (AAS). Other drugs or products included ephedrine, clenbuterol and
creatine. The most commonly abused anabolic steroids were testosterone,
nandrolone-decanoate, methandienone and stanozolol. The ten most commonly
reported ADRs of AAS were aggressiveness (835), depression (829), acne (770),
gynecomastia (637), anxiousness (637), potency problems (413), testicular atrophy
(404), sleep disorders (328), fluid retention (318) and mood disturbances (302).
Female side effects included menstruation disturbances, hair growth in the face,
lower voice and enlarged clitoris. During the period 1996-200, totally 4339
persons reported about 10,800 side effects. This figure should be compared with
the very low number of ADRs (27) reported by prescribers to the Swedish ADR
committee during the same period. Abuse of doping agents appears to be a new
public health problem that needs detection, medical care and prevention.

Growth-promoting effect of recombinant human growth hormone and stanozolol in girls with Turner syndrome.

J Tongji Med Univ. 1999;19(1):63-5.

Growth-promoting effect of recombinant human growth hormone and stanozolol in
girls with Turner syndrome.

Fang J, Ning C, Shu D, Wei H, Lin H, Wang M.

Department of Pediatrics, Tongji Hospital, Tongji Medical University, Wuhan
430030.

Ten girls with Turner syndrome were treated with a combination therapy of
recombinant human growth hormone (R-hGH) and low dose stanozolol for a period of
8 to 36 months. The results showed that when compared with the growth rate before
the treatment, the growth rates after treatment with R-hGH and stanozolol showed
a sustained increase, reaching 9.0 +/- 1.9 cm/year during the first year of
treatment; the height age increase by 2.5 +/- 0.8 years while the bone age
increase were 1.0 +/- 0.7 years; and the predicted final adult height at the end
of the first year of the treatment increased to 149.4 +/- 6.1 cm compared to
their original mean of 142.8 +/- 4.2 cm. We are led to conclude that therapy with
R-hGH in combination with stanozolol can increase the growth velocity and
significantly increase the predicted adult height of children with Turner
syndrome.

Species, sex and inter-individual differences in DNA repair induced by nine sex steroids in primary cultures of rat and human hepatocytes.

Mutat Res. 2003 Apr 20;536(1-2):69-78.

Species, sex and inter-individual differences in DNA repair induced by nine sex
steroids in primary cultures of rat and human hepatocytes.

Martelli A, Mattioli F, Angiola M, Reimann R, Brambilla G.

Department of Internal Medicine, Division of Clinical Pharmacology and
Toxicology, University of Genoa, Viale Benedetto XV 2, I-16132, Genoa, Italy.

Sex steroids, due to the generally negative responses observed in routinely
employed standard genotoxicity assays, are considered epigenetic carcinogens.
Some doubts on this conviction are raised by the results of recent studies
providing evidence that cyproterone acetate and two structural analogues,
chlormadinone acetate and megestrol acetate, are genotoxic in female rats but
only for the liver, and in primary human hepatocytes from donors of both genders.
The experimental evidence suggests that the metabolic activation of these
molecules to reactive species and the consequent formation of DNA adducts occur
only in the intact hepatocyte. Since the possibility that other sex steroids
cause a liver-specific genotoxic effect cannot be ruled out a priori, we
investigated nine drugs of this family for their ability to induce DNA repair
synthesis in primary cultures of rat and human hepatocytes. Each steroid was
tested in cultures from at least two male and two female donors of each species.
Hepatocytes were exposed for 20h to sub-toxic concentrations ranging from 1 to 50
micro M, and DNA repair induction was measured by quantitative autoradiography.
In primary rat hepatocytes, induction of DNA repair indicative of a frankly
positive response was detected in cultures from: 2/2 males and 3/3 females with
drospirenone, 2/2 males and 1/2 females with ethinylestradiol, 1/2 males and 1/2
females with oxymetholone, 1/2 males with norethisterone, 1/4 females with
progesterone, and 1/4 males with methyltestosterone. Consistent negative
responses were obtained with testosterone and stanozolol. A few inconclusive
responses were observed in rat hepatocytes exposed to progesterone,
medroxyprogesterone, norethisterone, methyltestosterone and oxymetholone. In
contrast, under the same experimental conditions the nine sex steroids provided
frankly negative responses in the large majority of cultures of primary
hepatocytes from both male and female human donors; the only exceptions being the
inconclusive responses obtained in cultures from two of the donors exposed to
norethisterone and to ethinylestradiol, and from one of the donors exposed to
testosterone, methyltestosterone, and stanozolol. These results and previous
findings concerning cyproterone and its structural analogues suggest that sex
steroids differ for their ability to induce DNA repair, and that their
genotoxicity may be: (i) different in rat and human hepatocytes, (ii) dependent
on the sex of the donor, and (iii) affected by inter-individual variability.

Androgenic/Anabolic steroid-induced toxic hepatitis.

J Clin Gastroenterol. 2002 Oct;35(4):350-2.

Androgenic/Anabolic steroid-induced toxic hepatitis.

Stimac D, Milić S, Dintinjana RD, Kovac D, Ristić S.

Division of Gastroenterology, Department of Internal Medicine, Clinical Hospital
Center Rijeka, Rijeka, Croatia. davor.stimac@ri.hinet.hr

Athletes and bodybuilders often misuse androgenic/anabolic steroids. When used in
therapeutic doses, these drugs produce clinical jaundice in just a small number
of recipients. We present a 26-year-old male bodybuilder who self-administered
high doses of androgenic/anabolic steroids that induced liver damage. One month
before admission to the hospital, he used testosterone enanthate (500 mg
intramuscularly, twice weekly), stanozolol (40 mg/d), and methylandrostenediol
(30 mg/d by mouth, for 5 weeks). On admission, his bilirubin level was 470
micromol/L (direct, 360 micromol/L), his aspartate aminotransferase (AST) level
was 5,870 IU/L, his alanine aminotransferase (ALT) level was 10,580 IU/L, his
alkaline phosphatase (ALP) level was 152 IU/L, his gamma-glutamyl-transpeptidase
level was 140 IU/L, his albumin level was 27.6 g/L, and his prothrombin time was
29%. During the patient's prolonged hospitalization, multiple tests and liver
biopsy were performed, showing only toxic hepatic lesions. The patient was
provided with supportive medical treatment. Clinical signs and laboratory
findings improved substantially 12 weeks after the patient discontinued
androgenic/anabolic steroids. The reasons for presenting this case were the much
higher values of AST and ALT levels than reported in other studies, although the
values of bilirubin and ALP were similar to those found in the literature. To our
knowledge, it is the first case of toxic hepatitis induced by androgenic/anabolic
steroids with predominantly hepatocellular necrosis instead of intrahepatic
cholestasis.

'Skin popping' ulceration in an HIV patient. Successful treatment with antiretroviral drugs and stanozolol.

Int J STD AIDS. 2002 Jul;13(7):508-9.

'Skin popping' ulceration in an HIV patient. Successful treatment with
antiretroviral drugs and stanozolol.

Redondo P, Molano E, Lloret P, Bauza A.

Departments of Dermatology and Internal Medicine, University Clinic of Navarra,
School of Medicine, Pamplona, Spain.

Skin popping refers to the practice of injecting drugs beneath the skin without
concern for vascular access. We describe a male HIV seropositive injecting-drug
user with chronic cutaneous ulcerations on the legs at sites of skin popping.
Treatment with antiretroviral drugs and stanozolol was associated with a striking
clinical improvement of the ulcer in two weeks. The mechanism of action,
improvement of immune function by the antiretroviral treatment or activity of
stanozolol on collagen and transforming growth factor-beta1 synthesis, remains
unknown.

Sources of variability in genetic association studies: insights from the analysis of hepatic lipase (LIPC).

Hum Mutat. 2002 May;19(5):536-42.

Sources of variability in genetic association studies: insights from the analysis
of hepatic lipase (LIPC).

Shohet RV, Vega GL, Bersot TP, Mahley RW, Grundy SM, Guerra R, Cohen JC.

Internal Medicine, University of Texas Southwestern Medical Center at Dallas,
Dallas, Texas, USA.

Genetic association studies have been widely used to identify loci that influence
plasma lipoprotein concentrations, but few of the associations reported have
proved consistently reproducible across different study populations. This lack of
consistency is a widely recognized limitation of association studies, and is
often ascribed to inadequate statistical power, population substructure, and
population-specific linkage disequilibrium. However, few studies have assessed
the causes of variability underlying a given genotype-phenotype association. We
have examined two possible sources of variability in the association between the
-514 polymorphism in hepatic lipase (LIPC) and plasma HDL-C concentrations.
First, we compared the association between this polymorphism and hepatic lipase
activity in four populations. A single copy of the -514C allele was associated
with a 10 mmol.hr(-1).l(-1) increase in hepatic lipase activity in white American
and Turkish men but only approximately 5 mmol.hr(-1).l(-1) in Chinese and
African-American men. Second, we tested the effects of a stanozolol-induced
increase in hepatic lipase activity on plasma HDL-C concentrations in men with
normal (< 150mg/dl) or elevated (150-300mg/dl) levels of plasma triglyceride. The
increase in hepatic lipase activity was similar in the two groups, but the
resulting decline in HDL-C levels was significantly greater in normolipidemic
men. These data suggest that the effect of a polymorphism on gene expression can
vary among individuals, and that the resulting phenotype may be further modified
by interactions with other factors. Three novel LIPC polymorphisms were
identified in the study (-1596insC, -2740A>G, and -2880G>C). Copyright 2002
Wiley-Liss, Inc.

Low dose cyclosporine-a therapy in severe aplastic anaemia.

J Assoc Physicians India. 2001 Oct;49:966-9.

Low dose cyclosporine-a therapy in severe aplastic anaemia.

Rai M, Singh VP, Shukla J, Sundar S, Jha VC.

Department of Medicine, Institute of Medical Sciences, Banaras Hindu University,
Varanasi.

OBJECTIVE: The present study was conducted to evaluate the efficacy of low dose
cyclosporine-A in the patients of severe aplastic anaemia, who cannot afford
allogenic bone marrow transplantation and immunosuppressive therapy with
antithymocyte globulin.

METHODS: The diagnosis of severe aplastic anaemia was
established by standard criteria. Twelve patients were given cyclosporine-A
orally at a dose of 6 mg/kg body weight in divided doses in two daily equal
proportions for six months. Eleven patients were put on oral stanozolol in the
dosage of 1 mg/kg body weight/day in divided doses. All surviving patients were
evaluated at three and six months.

RESULTS: At the end of six months, 41.66% of
twelve patients responded to cyclosporine-A. One patient had complete response
and four patients had partial response. Only one out of 11 patients receiving
stanozolol responded.

CONCLUSIONS: i) Cyclosporine-A is a viable therapeutic
option in the treatment of severe aplastic anaemia, ii) Low dose cyclosporine-A
is able to slow down the stormy course of the severe aplastic anaemia, iii)
Androgens have very little effect on the survival of patients of severe aplastic
anaemia.

Masseteric hypertrophy associated with administration of anabolic steroids and unilateral mastication: a case report.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Nov;92(5):515-8.

Masseteric hypertrophy associated with administration of anabolic steroids and
unilateral mastication: a case report.

Skoura C, Mourouzis C, Saranteas T, Chatzigianni E, Tesseromatis C.

Department of Oral and Maxillofacial Surgery, General District Hospital of Athens
KAT, Greece.

In this report we present a patient with unilateral masseteric hypertrophy who
used anabolic steroids and was chewing entirely unilaterally for 1 month.
Computed tomography and histologic examination were used to confirm the
diagnosis. The combined action of unilateral mastication and anabolic steroid use
is probably responsible for the rapid development of unilateral masseteric
hypertrophy.

Treatment of 34 cases of chronic aplastic anemia using prepared Rehmannia polysaccharide associated with stanozolol

Zhongguo Zhong Xi Yi Jie He Za Zhi. 1998 Jun;18(6):351-3.

[Treatment of 34 cases of chronic aplastic anemia using prepared Rehmannia
polysaccharide associated with stanozolol]

[Article in Chinese]

Yuan A, Liu C, Huang X.

Second Affiliated Hospital of Henan Medical University, Zhengzhou 450003.

OBJECTIVE: To investigate the effect and side effect of prepared Rehmannia
polysaccharide (PRP) associated with stanozolol in treating chronic aplastic
anemia (CAA).

METHODS: Thirty-four cases of CAA were treated by PRP liquid
associated with stanozolol, course of 3 week treatment, and control group (17
cases of CAA) was treated by stanozolol alone.

RESULTS: Effective rate was 85.3%
in treatment group, and that of control group was 58.8%, there was significant
difference between them (P < 0.05). Symptom remission of treatment group was
earlier than that of control group, symptom scoring between two groups, the
difference was highly significant (P < 0.01). Blood cell had a distinct elevation
after treatment with PRP associated with stanozolol, and had a significant
difference in comparing with pre-treatment in treatment group (P < 0.01). Side
effect of PRP was not found during treatment of CAA.

CONCLUSIONS: PRP associated
with stanozolol to treat CAA has an additional effect, it can accelerate symptom
remission without any additional side effect

Stanozolol in chronic urticaria: a double blind, placebo controlled trial.

J Dermatol. 2001 Jun;28(6):299-302.

Stanozolol in chronic urticaria: a double blind, placebo controlled trial.

Parsad D, Pandhi R, Juneja A.

Department of Dermatology, Postgraduate Institute of Medical Education and
Research, Chandigarh, India.

H1-type antihistamine drugs are mainstays in the management of chronic urticaria.
For patients with refractory, chronic, idiopathic urticaria who have failed to
benefit from conventional therapy, other safe therapeutic modalities are
required. To evaluate the role of stanozolol as an adjunctive therapeutic agent
with H1-antihistamine in refractory chronic idiopathic urticaria, we conducted
this study. Fifty-eight patients with chronic refractory urticaria were enrolled
in this trial and were randomly assigned to two groups (A and B). Patients in
group A received 2 mg stanozolol twice daily along with cetrizine 10 mg daily.
Patients in group B received cetrizine 10 mg daily and placebo tablets twice
daily. The improvement was monitored by estimation of severity score. Of the 58
patients, 26 in group A and 24 in group B could be evaluated. At the end of 12
weeks, 17 patients in group A showed marked to complete resolution as compared to
7 patients in group B (chi-square p<0.01). The intention to treat analysis p
value was a found to be <0.007. There was a highly significant decrease in mean
severity score at 12 weeks (p<0.001) in group A patients. The present study
demonstrated that stanozolol is an effective and safe adjuvant therapy for
treatment of chronic refractory urticaria.

Hepatic effects of 17 alpha-alkylated anaboli-androgenic steroids.

HIV Hotline. 1998 Dec;8(5-6):2-5.

Hepatic effects of 17 alpha-alkylated anaboli-androgenic steroids.

[No authors listed]

AIDS: Use of 17 alpha-alkylated anabolic-androgenic steroids (17alpha-AAS) has
been connected to hepatotoxicity. These steroids are used clinically to treat
anemia, to prevent weight loss, and to treat wasting syndrome. The most common
types of 17alpha-AAS are Methyltestosterone, Oxandrolone, Oxymetholone and
Stanozolol. Liver disease and the effects of some anti-HIV drugs may contribute
to hepatic dysfunction. Signs of hepatic dysfunction are listed. For those
experiencing jaundice and related malfunctions, discontinuing the drug enables
patients to recover. In many cases those who did not exhibit jaundice may have
developed a tolerance for the drugs. Side effects such as cholestatic jaundice
only occurred in a small number of patients taking the recommended doses of
17alpha-AAS. Peliosis hepatitis, hepatic tumors, and hepatocellular adenomas are
other reported side effects. Proper dosing and monitoring of anabolic steroids
reduces the risk of hepatotoxicity.

Building your body to survive: the use of anabolic steroids for HIV therapy.

Posit Aware. 1998 Mar-Apr;9(2):37-41.

Building your body to survive: the use of anabolic steroids for HIV therapy.

Vergel N.

AIDS: The loss of lean body mass (LBM) that is commonly associated with wasting
syndrome has been linked to death in HIV disease. Bioelectrical Impedance
Analysis (BIA) is a simple, inexpensive and painless technique used to assess
body composition. The test gives a good reading of body cell mass, fat mass, and
body water, and can be used to detect loss of LBM when it first occurs. BIA is a
useful tool in managing and preventing wasting. Other factors that influence LBM
include testosterone levels and anabolic steroids. Anabolic steroids, synthetic
analogs of testosterone, are a Class III regulated drug. The use of anabolic
steroids is controversial, and abuse by athletes led to the drugs being banned
for many uses. A list of approved steroids, their actions, and potential problems
associated with their use is included. Another table rates the major steroids for
their effectiveness in AIDS therapy.

Anabolic steroid abuse and cardiac sudden death: a pathologic study.

Arch Pathol Lab Med. 2001 Feb;125(2):253-5.

Anabolic steroid abuse and cardiac sudden death: a pathologic study.

Fineschi V, Baroldi G, Monciotti F, Paglicci Reattelli L, Turillazzi E.

CONTEXT: Androgenic anabolic steroids (AAS) used for improving physical
performance have been considered responsible for acute myocardial infarction and
sudden cardiac death.

OBJECTIVE: To establish the relationship between AAS and
cardiac death.

DESIGN: Case report.

PATIENTS: Two young, healthy, male
bodybuilders using AAS.

MAIN OUTCOME MEASURES: Pathologic cardiac findings
associated with AAS ingestion.

RESULTS: The autopsy revealed normal coronary
arteries. In one case, we documented a typical infarct with a histologic age of 2
weeks. A segmentation of myocardial cells at the intercalated disc level was
observed in the noninfarcted region. This segmentation was the only anomaly
detected in the second case. No other pathologic findings in the heart or other
organs were found. Urine in both subjects contained the metabolites of
nortestosterone and stanozolol.

COMMENT: A myocardial infarct without vascular
lesions is rare. To our knowledge, its association with AAS use, bodybuilding, or
both lacks any evidence of a cause-effect relationship. The histologic findings
in our 2 cases and in the few others reported in medical literature are
nonspecific and do not prove the cardiac toxicity of AAS. A better understanding
of AAS action on the neurogenic control of the cardiac function in relation to
regional myocardial contraction and vascular regulation is required.

Anabolic steroids induce region- and subunit-specific rapid modulation of GABA(A) receptor-mediated currents in the rat forebrain.

J Neurophysiol. 2000 Jun;83(6):3299-309.

Comment in:
    NIH Guide Grants Contracts. 2007 Aug 17;:NOT-OD-07-086.

Anabolic steroids induce region- and subunit-specific rapid modulation of GABA(A)
receptor-mediated currents in the rat forebrain.

Jorge-Rivera JC, McIntyre KL, Henderson LP.

Department of Physiology, Dartmouth Medical School, Hanover, New Hampshire 03755,
USA.

Anabolic-androgenic steroids (AAS) have become significant drugs of abuse in
recent years with the highest increase reported in adolescent girls. In spite of
the increased use of AAS, the CNS effects of these steroids are poorly
understood. We report that in prepubertal female rats, three commonly abused AAS,
17alpha-methyltestosterone, stanozolol, and nandrolone, induced rapid and
reversible modulation of GABAergic currents in neurons of two brain regions known
to be critical for the expression of reproductive behaviors: the ventromedial
nucleus of the hypothalamus (VMN) and the medial preoptic area (mPOA). All three
AAS significantly enhanced peak synaptic current amplitudes and prolonged
synaptic current decays in neurons of the VMN. Conversely all three AAS
significantly diminished peak current amplitudes of synaptic currents from
neurons of the mPOA. The endogenous neuroactive steroids,
3alpha-hydroxy-5alpha-pregnan-20-one and 5alpha-androstane-3alpha,17beta-diol,
potentiated currents in the VMN as did the AAS. In contrast to the negative
modulation induced by AAS in the mPOA, the endogenous steroids potentiated
responses in this region. To determine the concentration response relationships,
modulation by the AAS, 17alpha-methyltestosterone (17alpha-meT), was assessed for
currents evoked by ultrafast perfusion of brief pulses of GABA to acutely
isolated neurons. Half-maximal effects on currents elicited by 1 mM GABA were
elicited by submicromolar concentrations of AAS for neurons from both brain
regions. In addition, the efficacy of 10(-5) to 10(-2) M GABA was significantly
increased by 1 microM 17alpha-meT. Previous studies have demonstrated a striking
dichotomy in receptor composition between the VMN and the mPOA with regard to
gamma subunit expression. To determine if the preferential expression of gamma(2)
subunit-containing receptors in the VMN and of gamma(1) subunit-containing
receptors in the mPOA could account for the region-specific effects of AAS in the
two regions, responses elicited by ultrafast perfusion of GABA to human embryonic
kidney 293 cells transfected with alpha(2), beta(3), and gamma(2) or alpha(2),
beta(3), and gamma(1) subunit cDNAs were analyzed. As with native VMN neurons,
positive modulation of GABA responses was elicited for alpha(2)beta(3)gamma(2)
recombinant receptors, while negative modulation was induced at
alpha(2)beta(3)gamma(1) receptors as in the mPOA. Our data demonstrate that AAS
in doses believed to occur in steroid abusers can induce significant modulation
of GABAergic transmission in brain regions essential for neuroendocrine function.
In addition, the effects of these steroids can vary significantly between brain
regions in a manner that appears to depend on the subunit composition of GABA(A)
receptors expressed.

Severe cholestasis with kidney failure from anabolic steroids in a body builder

Dtsch Med Wochenschr. 1999 Sep 10;124(36):1029-32.

[Severe cholestasis with kidney failure from anabolic steroids in a body builder]

[Article in German]

Habscheid W, Abele U, Dahm HH.

Medizinische Klinik, Paracelsus-Krankenhaus Ruit, Esslingen.

HISTORY AND ADMISSION FINDINGS: A 28-year-old body builder was admitted because
of jaundice. For 80 days, until 3 weeks before hospitalization, he had been
taking moderately high doses of anabolic steroids: metandienone (methandienone),
10-50 mg daily by mouth, and stanozolol, 50 mg intramuscularly every other day.
Physical examination was unremarkable except for yellow discoloration of the skin
and sclerae.

INVESTIGATIONS: Bilirubin concentration was raised to 4.5 mg/dl,
cholestasis enzymes were normal, while transaminase activities were raised. Liver
biopsy was compatible with cholestasis induced by anabolic steroids.

TREATMENT AND COURSE: Although the steroids had been discontinued, the patient's general
condition deteriorated over 7 weeks. Serum bilirubin rose up to a maximum of 77.9
mg/dl. In addition renal failure developed with a creatinine concentration of 4.2
mg/dl. The patient's state improved simultaneously with the administration of
ursodeoxycholic acid and the biochemical values gradually reached normal levels
after several weeks.

CONCLUSION: Anabolic steroids can cause severe cholestasis
and acute renal failure. In this case there was a notable temporal coincidence
between the administration of ursodeoxycholic acid and the marked clinical
improvement.

Atrial fibrillation and anabolic steroids.

J Emerg Med. 1999 Sep-Oct;17(5):851-7.

Atrial fibrillation and anabolic steroids.

Sullivan ML, Martinez CM, Gallagher EJ.

Department of Emergency Medicine, Jacobi Medical Center, Bronx, New York, USA.

A young male bodybuilder, consuming large doses of anabolic steroids (AS),
presented to the Emergency Department (ED) with symptomatic rapid atrial
fibrillation (AF). Echocardiogram revealed significant septal hypokinesis, and
posterior and septal wall thickness at the upper limit of normal for highly
trained athletes. The atrial fibrillation had not recurred at 10 weeks after
discontinuation of AS use. Consumption of these agents in athletes has been
associated with hypertension, ischemic heart disease, hypertrophic
cardiomyopathy, and sudden death.

Dihydrotestosterone, stanozolol, androstenedione and dehydroepiandrosterone sulphate inhibit leptin secretion in female but not in male samples of omental adipose tissue in vitro: lack of effect of testosterone.

J Endocrinol. 1999 Mar;160(3):425-32.

Dihydrotestosterone, stanozolol, androstenedione and dehydroepiandrosterone
sulphate inhibit leptin secretion in female but not in male samples of omental
adipose tissue in vitro: lack of effect of testosterone.

Piñeiro V, Casabiell X, Peinó R, Lage M, Camiña JP, Menendez C, Baltar J, Dieguez
C, Casanueva F.

Endocrine Section, Department of Medicine, Santiago de Compostela University,
Complejo Hospitalanó de Santiago, Santiago de Compostela, Spain.

Leptin, the product of the Ob gene, is a polypeptide hormone expressed in
adipocytes which acts as a signalling factor from the adipose tissue to the
central nervous system, regulating food intake and energy expenditure. It has
been reported that circulating leptin levels are higher in women than in men,
even after correction for body fat. This gender-based difference may be
conditioned by differences in the levels of androgenic hormones. To explore this
possibility, a systematic in vitro study with organ cultures from human omental
adipose tissue, either stimulated or not with androgens (1 microM), was
undertaken in samples obtained from surgery on 44 non-obese donors (21 women and
23 men). The assay was standardized in periods of 24 h, ending at 96 h, with no
apparent tissue damage. Leptin results are expressed as the mean+/-s.e.m. of the
integrated secretion into the medium, expressed as ng leptin/g tissue per 48 h.
Spontaneous leptin secretion in samples from female donors (4149+/-301) was
significantly higher (P<0.01) than that from male donors (2456+/-428).
Testosterone did not exert any significant effect on in vitro leptin secretion in
either gender (4856+/-366 in women, 3322+/-505 in men). Coincubation of adipose
tissue with dihydrotestosterone (DHT) induced a significant (P<0.05) leptin
decrease in samples taken from women (3119+/-322) but not in those taken from men
(2042+/-430). Stanozolol, a non-aromatizable androgen, decreased (P<0.05) leptin
secretion in female samples (2809+/-383) but not in male (1553+/-671).
Dehydroepiandrosterone sulphate (DHEA-S) induced a significant (P<0.01) leptin
decrease in female samples (2996+/-473), with no modifications in samples derived
from males (1596+/-528). Exposure to androstenedione also resulted in a
significant reduction (P<0.01) of leptin secretion in samples taken from women
(2231+/-264), with no effect on male adipose tissue (1605+/-544). In conclusion,
DHT, stanozolol, DHEA-S and androstenedione induced a significant inhibition of
in vitro leptin secretion in samples from female donors, without affecting the
secretion in samples from men. Testosterone was devoid of activity in either
gender.

Hepatic lipase activity influences high density lipoprotein subclass distribution in normotriglyceridemic men. Genetic and pharmacological evidence.

J Lipid Res. 1999 Feb;40(2):229-34.

Hepatic lipase activity influences high density lipoprotein subclass distribution
in normotriglyceridemic men. Genetic and pharmacological evidence.

Grundy SM, Vega GL, Otvos JD, Rainwater DL, Cohen JC.

Center for Human Nutrition, University of Texas Southwestern Medical Center,
Dallas, TX, 75235-9052, USA.

Several studies have reported an inverse relationship between hepatic lipase
activity and plasma high density lipoprotein (HDL) cholesterol concentrations.
The purpose of the present study was to determine whether genetic and
pharmacological variation in hepatic lipase activity alters the distribution of
HDL subclasses. Two independent analytical methods (nuclear magnetic resonance
and gradient gel electrophoresis) were used to compare HDL subclass distributions
in 11 homozygotes for the -514C allele of hepatic lipase and in 6 homozygotes for
the -514T allele. Mean hepatic lipase activity was 45 +/- 15 mmol. l(-1). hr(-1)
in -514C homozygotes and 20 +/- 7 mmol. l(-1). hr(-1) in -514T homozygotes. Both
analytical methods indicated that HDL(2b) was significantly higher and HDL(3a)
was significantly lower in -514T homozygotes than in -514C homozygotes. No
differences were noted in the other HDL fractions (HDL(2a), HDL(3b), and
HDL(3c)). To determine the effects of increased hepatic lipase activity, 20 men
were given the synthetic anabolic steroid, stanozolol. Stanozolol treatment
increased hepatic lipase activity more than two-fold (38 +/- 18 to 85 +/- 25
mmol. l(-1). hr(-1) ), and markedly reduced the plasma concentrations of the
larger HDL subclasses (HDL(2b) and HDL(2a)). The plasma concentrations of the
smallest HDL subclasses (HDL(3b) and HDL(3c)) were unchanged by stanozolol
treatment. Taken together, these genetic and pharmacological data indicate that
variation in hepatic lipase activity has highly specific effects on the
distribution of HDL subclasses in the circulation.-Grundy, S. M., G. L. Vega, J.
D. Otvos, D. L. Rainwater, and J. C. Cohen. Hepatic lipase activity influences
high density lipoprotein subclass distribution in normotriglyceridemic men:

Stimulation of collagen synthesis by the anabolic steroid stanozolol.

J Invest Dermatol. 1998 Dec;111(6):1193-7.

Stimulation of collagen synthesis by the anabolic steroid stanozolol.

Falanga V, Greenberg AS, Zhou L, Ochoa SM, Roberts AB, Falabella A, Yamaguchi Y.

University of Miami School of Medicine, Department of Dermatology, Miami Veterans
Affairs Medical Center, Florida, USA.

There is evidence that anabolic steroids, which are derived from testosterone and
have markedly less androgenic activity, promote tissue growth and enhance tissue
repair; however, the mechanisms involved in their anabolic activities remain
unclear. In this report, we measured the effect of the anabolic steroid
stanozolol on cell replication and collagen synthesis in cultures of adult human
dermal fibroblasts. Stanozolol (0.625-5 microg per ml) had no effect on
fibroblast replication and cell viability (p = 0.764) but enhanced collagen
synthesis (p < 0.01) in a dose-dependent manner (r = 0.907). Stanozolol also
increased (by 2-fold) the mRNA levels of alpha1 (I) and alpha1 (III) procollagen
and, to a similar extent, upregulated transforming growth factor-beta1
(TGF-beta1) mRNA and peptide levels (p < 0.001). There was no stimulation of
collagen synthesis by testosterone. The stimulatory effects of stanozolol on
collagen synthesis were blocked by a TGF-beta1 anti-sense oligonucleotide, by
antibodies to TGF-beta, and in dermal fibroblast cultures derived from TGF-beta1
knockout mice. We conclude that collagen synthesis is increased by the anabolic
steroid stanozolol and that, for the most part, this effect is due to TGF-beta1.
These findings point to a novel mechanism of action of anabolic steroids

Clenbuterol and anabolic steroids: a previously unreported cause of myocardial infarction with normal coronary arteriograms.

South Med J. 1998 Aug;91(8):780-4.

Clenbuterol and anabolic steroids: a previously unreported cause of myocardial
infarction with normal coronary arteriograms.

Goldstein DR, Dobbs T, Krull B, Plumb VJ.

Department of Medicine, University of Alabama at Birmingham 35294-0007, USA.

During the last 10 years, several cases of myocardial infarction associated with
anabolic steroid use have been reported. Postulated mechanisms to explain this
association have included changes in lipid levels, the fibrinolytic system, and
platelet aggregation. Clenbuterol is a beta 2-agonist with anabolic properties
that has not been seen previously with myocardial infarction. We report a case of
myocardial infarction in an otherwise healthy 26-year-old body-builder who
recently used clenbuterol and anabolic steroids. In this case, synergistic
effects of the two agents seem likely to have played a role in the infarct. The
normal coronary arteriograms before any anticoagulant or thrombolytic therapy
strongly suggest coronary spasm as the mechanism of the infarct.

The -514 polymorphism in the hepatic lipase gene (LIPC) does not influence androgen-mediated stimulation of hepatic lipase activity.

J Lipid Res. 1998 Jul;39(7):1520-4.

The -514 polymorphism in the hepatic lipase gene (LIPC) does not influence
androgen-mediated stimulation of hepatic lipase activity.

Vega GL, Gao J, Bersot TP, Mahley RW, Verstraete R, Grundy SM, White A, Cohen JC.

The Center for Human Nutrition, Department of Clinical Nutrition, University of
Texas Southwestern Medical Center at Dallas, 75235, USA.

The -514T allele of hepatic lipase is associated with increased high density
lipoprotein-cholesterol levels in men, but not in women. This observation
suggests that the -514C to T polymorphism may diminish the response of hepatic
lipase to androgens. To test this hypothesis, five -514T and five -514C
homozygous men were treated with the anabolic steroid stanozolol for 6 days. The
mean increase in hepatic lipase activity was similar in the two groups (45+/-10
vs. 51+/-10 mmol x hr(-1) x l(-1), P = 0.5). To evaluate the association between
the -514 polymorphism and hepatic lipase activity at different physiological
androgen concentrations, hepatic lipase genotypes and activities were measured in
44 men and 40 premenopausal women. The effect of the -514T allele on hepatic
lipase activity was significant and quantitatively similar in both sexes. These
data indicate that the -514 polymorphism does not influence the response of
hepatic lipase activity to androgens, and that the effects of this polymorphism
on hepatic lipase activity are independent of androgen action.

The influence of 6 months of oral anabolic steroids on body mass and respiratory muscles in undernourished COPD patients.

Chest. 1998 Jul;114(1):19-28.

The influence of 6 months of oral anabolic steroids on body mass and respiratory
muscles in undernourished COPD patients.

Ferreira IM, Verreschi IT, Nery LE, Goldstein RS, Zamel N, Brooks D, Jardim JR.

Respiratory Division of Federal University of São Paulo, Brazil.

STUDY OBJECTIVE: To evaluate the influence of oral anabolic steroids on body mass
index (BMI), lean body mass, anthropometric measures, respiratory muscle
strength, and functional exercise capacity among subjects with COPD. DESIGN:
Prospective, randomized, controlled, double-blind study. SETTING: Pulmonary
rehabilitation program.

PARTICIPANTS: Twenty-three undernourished male COPD
patients in whom BMI was below 20 kg/m2 and the maximal inspiratory pressure
(PImax) was below 60% of the predicted value.

INTERVENTION:

The study group received 250 mg of testosterone i.m. at baseline and 12 mg of oral stanozolol a day for 27 weeks, during which time the control group received placebo. Both
groups participated in inspiratory muscle exercises during weeks 9 to 27 and
cycle ergometer exercises during weeks 18 to 27.

MEASUREMENTS AND RESULTS:
Seventeen of 23 subjects completed the study. Weight increased in nine of 10
subjects who received anabolic steroids (mean, +1.8+/-0.5 kg; p<0.05), whereas
the control group lost weight (-0.4+/-0.2 kg). The study group's increase in BMI
differed significantly from that of the control group from weeks 3 to 27
(p<0.05). Lean body mass increased in the study group at weeks 9 and 18 (p<0.05).
Arm muscle circumference and thigh circumference also differed between groups
(p<0.05). Changes in PImax (study group, 41%; control group, 20%) were not
statistically significant. No changes in the 6-min walk distance or in maximal
exercise capacity were identified in either group. CONCLUSION: The administration
of oral anabolic steroids for 27 weeks to malnourished male subjects with COPD
was free of clinical or biochemical side effects. It was associated with
increases in BMI, lean body mass, and anthropometric measures of arm and thigh
circumference, with no significant changes in endurance exercise capacity.

Aquagenic urticaria and human immunodeficiency virus infection: treatment with stanozolol.

Br J Dermatol. 1997 Oct;137(4):620-2.

Aquagenic urticaria and human immunodeficiency virus infection: treatment with
stanozolol.

Fearfield LA, Gazzard B, Bunker CB.

Department of Dermatology, Chelsea and Westminster Hospital, London, U.K.

We report the first case of aquagenic urticaria in a patient with human
immunodeficiency virus (HIV) infection. This is a rare physical urticaria not
previously described in this context. The disorder proved unamenable to
conventional treatment with antihistamines, but did respond dramatically to
stanozolol, suggesting a novel indication for this anabolic steroid.

Hyperinsulinemia accompanying hyperglycemia in Chinese patients with aplastic anemia.

Am J Hematol. 1997 Nov;56(3):151-4.

Hyperinsulinemia accompanying hyperglycemia in Chinese patients with aplastic
anemia.

Kailin X, Yushu H, Qingchao W, Yuanbo L.

Institute of Hematology, Chinese Academy of Medical Sciences, Tianjin.
haoys@cdm.imicams.ac.cn

Serum insulin, and plasma glucagon and glucose levels were measured in 56 Chinese
patients with aplastic anemia (AA) and 40 normal controls. Serum insulin and
plasma glucose levels in 18 newly diagnosed cases and 11 previously treated cases
with prednisone were significantly higher than those in the controls. Serum
insulin and plasma glucose levels in 27 cases previously treated with stanozolol
were significantly higher than those in the newly diagnosed cases and the
previously treated cases with prednisone. There was no significant difference in
plasma glucagon levels between the patients and the controls. Serum insulin and
plasma glucose levels were significantly correlated with the amount of blood
transfusions and serum ferritin and cortisone concentrations in the AA patients.
Our findings suggest that AA patients may have hyperinsulinemia accompanying
hyperglycemia, which can be further aggravated by stanozolol and prednisone
therapy and iron overload.

Short-term modulation of the androgen milieu alters pulsatile, but not exercise- or growth hormone (GH)-releasing hormone-stimulated GH secretion in healthy men: impact of gonadal steroid and GH secretory changes on metabolic outcomes.

J Clin Endocrinol Metab. 1997 Nov;82(11):3710-9.

Short-term modulation of the androgen milieu alters pulsatile, but not exercise-
or growth hormone (GH)-releasing hormone-stimulated GH secretion in healthy men:
impact of gonadal steroid and GH secretory changes on metabolic outcomes.

Fryburg DA, Weltman A, Jahn LA, Weltman JY, Samojlik E, Hintz RL, Veldhuis JD.

Department of Internal Medicine, General Clinical Research Center,
Charlottesville, Virginia, USA. david_a_fryburg@groton.pfizer.com

Gonadal steroids are known to alter GH secretion as well as tissue metabolism.
The present study was designed to examine the effects of short term (2- to
3-week) alterations in gonadal steroids on basal pulsatile (nonstimulated) and
exercise- and GH-releasing hormone-stimulated GH secretion, urinary nitrogen
excretion, and basal and exercise-stimulated oxygen consumption. Two protocols
were conducted, which reflect a total of 18 separate studies. In the first
paradigm, 5 healthy young men were each studied in a double blind, randomized
manner during 3 different gonadal hormone manipulations, in which serum
testosterone was varied from hypogonadal (induced by leuprolide) to eugonadal
(saline injections) to high levels (testosterone enanthate, 3 mg/kg.week, i.m.).
There was a washout period of 8 weeks between treatments. In the second protocol,
3 of the original subjects were studied after 2 weeks of treatment with
stanozolol (0.1 mg/kg.day). Two to 3 weeks after the desired changes in serum
testosterone, each subject was admitted to the General Clinical Research Center
for study. The hypogonadal state (serum testosterone, 33 ng/dL) increased urinary
nitrogen loss (by 34%; P < 0.005) and decreased basal metabolic rate (by 12%; P <
0.02) compared with the eugonadal state (testosterone, 796 ng/dL). High dose
testosterone (1609 ng/dL) further decreased urinary nitrogen loss over the
eugonadal state (by 16%; P < 0.05). Stanozolol yielded the lowest urinary
nitrogen excretion of all (P < 0.03). Like urinary nitrogen, the basal metabolic
rate showed the greatest change between the hypogonadal and eugonadal states
(12%; P < 0.02), with a lesser change during high dose testosterone treatment
(4%). Analogously, end-exercise oxygen consumption rose by 11% between the
hypogonadal and eugonadal states (P < 0.05). Between the hypogonadal and
eugonadal states, no significant changes in pulsatile (nonstimulated),
exercise-stimulated, or GRF-stimulated GH secretion or serum insulin-like growth
factor I concentrations were observed. Raising testosterone to supraphysiological
levels increased pulsatile GH secretion by 62% over that with leuprolide and by
22% over that with saline (P < 0.05). High dose testosterone treatment also
increased serum insulin-like growth factor I concentrations by 21% and 34% over
those during the eugonadal and hypogonadal states, respectively (P < 0.01).
Testosterone did not affect either exercise- or GRF-stimulated GH secretion. In
protocol 2, stanozolol did not affect any parameter of GH secretion. To examine
the interaction between GH secretion and testosterone on urinary nitrogen
excretion and basal metabolic rate, a one-way analysis of covariance was
undertaken. Statistical examination of GH production as the covariate and
testosterone (by tertile) as the interactive factor demonstrated significant
relationships between serum testosterone levels and either urinary nitrogen (P <
0.02) or basal metabolic rate (P < 0.01), but not GH secretion (P = NS). In
summary, these results demonstrate that short term modulation of the androgen
milieu affects metabolic outcome without necessitating changes in GH secretion.
These results have significance for both normal physiology and for the treatment
of hypogonadal GH-deficient patients.

Effects of short-term stanozolol administration on serum lipoproteins in hepatic lipase deficiency.

Metabolism. 1997 Sep;46(9):992-6.

Effects of short-term stanozolol administration on serum lipoproteins in hepatic
lipase deficiency.

Bausserman LL, Saritelli AL, Herbert PN.

Lipid Research Laboratory, Miriam Hospital, Brown University Medical School,
Providence, RI, USA.

We have identified a kindred in Providence, RI, deficient in hepatic triglyceride
lipase (HL). The two affected brothers have coronary heart disease and elevated
levels of triglycerides, total cholesterol, high-density lipoprotein (HDL)
cholesterol, and apolipoprotein [apo] A-I. The lipoprotein lipase (LPL) activity
is normal. We and others have postulated that the effects of oral anabolic
steroids on HDL metabolism are mediated by HL. To test this hypothesis, we
treated these two men and two controls with the oral androgen stanozolol (6 mg/d)
for 2 weeks. Consistent with other reports, HL activity increased a mean of 277%
in controls with a concomitant decrease in HDL cholesterol (49%), HDL2
cholesterol (90%), HDL3 cholesterol (16%), and apo A-I (41%) and no change in apo
A-II. Although stanozolol failed to induce HL activity in the HL-deficient man,
HDL cholesterol, HDL2 cholesterol, and apo A-I were reduced a mean of 20%, 48%,
and 32%, respectively. In contrast to controls, HDL3 cholesterol (46%) and apo
A-II (14%) increased in HL-deficient subjects. Stanozolol treatment also
increased LPL activity (124% +/- 86%, n = 4) and decreased lipoprotein(a)
([Lp(a)] 66% +/- 3%, n = 3) in the three men with detectable levels. The data
indicate that in addition to stimulation of HL activity, stanozolol treatment
changes HDL cholesterol concentration and subfraction distribution by other
mechanisms.

Functional assessment and clinical classification of androgen sensitivity in patients with mutations of the androgen receptor gene. German Collaborative Intersex Study Group.

Eur J Pediatr. 1997 Jan;156(1):7-14.

Functional assessment and clinical classification of androgen sensitivity in
patients with mutations of the androgen receptor gene. German Collaborative
Intersex Study Group.

Sinnecker GH, Hiort O, Nitsche EM, Holterhus PM, Kruse K.

Department of Paediatrics, Medical University of Lübeck, Germany.

In the genetic male, mutations of the androgen receptor (AR) gene cause
phenotypes ranging from female to subfertile male. Binding assays on genital skin
fibroblasts and DNA analysis alone provide incomplete information about receptor
function. We used the sex hormone-binding globulin (SHBG) response to stanozolol
as a measure of AR function and correlated the results with phenotypes which were
classified according to the degree of defective masculinization. Of the 34
patients investigated, 9 had complete, and 14 had partial androgen insensitivity
syndrome (AIS) with predominantly female, ambiguous, or predominantly male
phenotype. Eleven subjects served as controls. Mutations were characterized using
polymerase chain reaction-single strand conformation polymorphism analysis and
direct DNA sequencing. DNA analysis revealed two major deletions, two minor
defects leading to premature stop codons in exon 1, and 19 point mutations in the
DNA- and hormone-binding domains of the AR gene. After stanozolol, SHBG remained
unchanged in patients with complete AIS (102.0 +/- 3.8 [SE]%; range 92.4%-129% of
the initial value). The SHBG decrease was diminished in partial AIS with
predominantly female (83.8% +/- 1.7%; range 81.3%-87.0%), ambiguous (80.4% +/-
4.4%, range 68.4%-89.1%), and predominantly male (mean 65.9% +/- 4.9%, range
48.6%-80.8%) phenotypes, and normal in controls (51.4% +/- 2.1%, range
35.6%-62.1%). Differences between controls and each AIS group were statistically
significant (P < 0.05 - < 0.0001). A close correlation was found between the
degree of undermasculinization (AIS phenotype) and the SHBG response.

CONCLUSIONS: The SHBG test provides functional information about the severity of
the receptor defect in vivo and hence adds to the structural information provided
by DNA analysis. It detects receptor defects due to mutations within the entire
gene, including the DNA-binding domain, and is a rapid, simple, and cost
effective procedure. It may provide useful information for the diagnosis and
management of affected children.

Effects of androgens on haemostasis.

Maturitas. 1996 Jul;24(3):147-55.

Effects of androgens on haemostasis.

Winkler UH.

Zentrum für Frauenheilkunde, Universitätsklinikum Essen, Germany.

Androgen deficiency is associated with an increased incidence of cardiovascular
disease. There is evidence that thromboembolic disease as well as myocardial
ifarction in hypogonadic males are mediated by low baseline fibrinolytic
activity. Hypogonadism in males is associated with an enhancement of fibrinolytic
inhibition via increased synthesis of the plasminogen activator inhibitor PAI 1.
On the other hand, stanozolol and danazol reduce PAI 1 and are associated with
increased fibrinolytic activity. However, in male abusers of anabolic steroids
the net effect on the haemostatic system may change from anti- to prothrombotic;
there appears to be an individual threshold dose above which thrombogenic effects
on platelets and vasomotion may overcome the profibrinolytic effects on PAI 1.
There are numerous reports on weight-lifters dying of atherothrombotic ischemic
heart disease while abusing anabolic steroids. Androgens are known to have
profound effects on carbohydrate and lipid metabolism. In fact, much of the
individual inconsistency of the effects of androgens on fibrinolytic and
haemostatic activity appears to be based on the close interrelationship of these
metabolic systems. Androgens may have unfavourable effects on the HDL/LDL
cholesterol ratio, on triglyceride levels and on the insulin/insulin-like growth
factor 1 (IGF 1) system. Hypertriglyceridemia as well as insulin resistance are
both associated with low fibrinolytic activity and increased PAI 1 levels. On the
other hand, lipoprotein(a), a recently acknowledged independent risk factor of
CVD was shown to respond favourable to androgen treatment, in men as well as in
women. In women, agonistic as well as antagonistic effects of estrogens and
progestins need to be taken into account. In fact, estradiol may modulate
testosterone effects on haemostasis. Androgen medication in premenopausal women,
such as danazol, was found to reduce PAI 1 suggesting an improvement of the
fibrinolytic activity. Also, in hormone replacement therapy (HRT) androgenic
progestins or complex compounds with androgenic effects are associated with a
marked reduction of PAI 1 and an improvement of fibrinolytic activity. Further
improvement of fibrinolytic activity may be associated with the marked decrease
of lipoprotein (a) (Lp(a)) in women on androgenic HRT. However, little is known
on the interrelationship of estrogens, 19-nortestosterone or progesterone
derivatives and testosterone. an interrelationship that may have substantial
impact on the metabolic and particularly haemostatic net effects of a
preparation. In summary, information on the effects of androgens on haemostasis
is limited and may be particularly incomplete due to the fact that interaction
with other sex steroids appears to be an important confounder. In any case, there
are numerous effects of synthetic androgens on the synthesis and release of
haemostatic factors, namely an increase of the inhibitors of coagulation and a
decrease of the inhibitor of the fibrinolytic system. However, the use of
androgens in patients with congenital deficiencies of these coagulation factors
or previous events of cardiovascular disease has yielded disappointing results.
On the other hand, particularly the reduction of fibrinolytic inhibition (PAI 1)
and Lp(a) were considered favourable effects of androgens with regard to the risk
of cardiovascular disease. Differences between preparations with pronounced
androgenic versus antiandrogenic effects and the effect of combined preparations
need to be studied in much more detail. The profibrinolytic effects of androgens
may be of particular interest with regard to favourable effects of HRT on
cardiovascular disease.

Manifestation of severe coronary heart disease after anabolic drug abuse.

Clin Cardiol. 1996 Feb;19(2):153-5.

Manifestation of severe coronary heart disease after anabolic drug abuse.

Mewis C, Spyridopoulos I, Kühlkamp V, Seipel L.

Medical Clinic III of University Tübingen, Germany.

Anabolic steroids are frequently abused, thus increasing the risk of
cardiovascular disease, despite the known unfavorable influence on lipid
profiles. We report on a young bodybuilder who presented with ventricular
tachycardia as the first manifestation of severe underlying coronary heart
disease. Coronary angiogram revealed severe stenotic lesions in the right
coronary artery and the left descending coronary artery, and hypokinetic regions
corresponded to posterolateral and anterior myocardial infarctions. This young
patient had a history without any coronary risk factors, but with a 2-year abuse
of the anabolic steroid stanazolol. No report published so far has shown possible
atherogenic consequences of long-term abuse of stanazolol.

Stanozolol as a novel therapeutic agent in dermatology.

J Am Acad Dermatol. 1995 Aug;33(2 Pt 1):254-8.

Stanozolol as a novel therapeutic agent in dermatology.

Helfman T, Falanga V.

Department of Dermatology and Cutaneous Surgery, University of Miami School of
Medicine, FL 33101, USA.

Anabolic steroids are synthetic derivatives of testosterone that were developed
in the 1950s in an attempt to dissociate the anabolic and androgenic effects of
testosterone. The anabolic steroid stanozolol has been particularly helpful
because it has one of the largest anabolic/androgenic ratios. In addition,
stanozolol has substantial fibrinolytic properties. We discuss the safety profile
and the use of stanozolol for a variety of clinical applications. Stanozolol is
approved for use in the treatment of hereditary angioedema, but numerous reports
have detailed the effectiveness of this agent in the treatment of urticaria,
Raynaud's phenomenon, and, more recently, cryofibrinogenemia and
lipodermatosclerosis. Side effects are mostly dose related and are preventable
with appropriate follow-up.

A decreasing CD4+/CD8+ ratio after one month of treatment with stanazolol in postmenopausal women.

Steroids. 1995 Jul;60(7):430-3.

A decreasing CD4+/CD8+ ratio after one month of treatment with stanazolol in
postmenopausal women.

Zofková I, Kancheva RL, Hampl R.

Institute of Endocrinology, Prague, Czech Republic.

Androgens influence some immunological processes, including the differentiation
of T-cells in CD4+ (helpers) or CD8+ (suppressors/cytotoxic) phenotype. In nine
postmenopausal osteoporotic women the effect of stanazolol on lymphocyte counts,
CD3+ and the immunoregulatory index (CD4+/CD8+) were investigated. In the placebo
group, ten postmenopausal osteoporotic women of similar age were included. The
means of the investigated indices after stanazolol as compared with the values
before treatment were as follows: lymphocyte counts (cells/microL +/- SEM) 2974
+/- 225 versus 2313 +/- 166, CD3+ (%) 54.3 +/- 5.5 versus 70.9 +/- 1.6 (P <
0.05); CD4+/CD8+ ratio 1.8 +/- 0.02 versus 2.5 +/- 0.28 (P < 0.05). The values
after placebo as compared with the values before placebo were: 2558 +/- 201
versus 2370 +/- 256, 62.9 +/- 2.1 versus 64.8 +/- 1.7 and 1.6 +/- 0.2 versus 1.6
+/- 0.1 in sequence. The treatment was controlled by the serum stanazolol levels
before and after steroid administration (unmeasurable versus 20.8 +/- 3.4 nmol/L,
P < 0.01). The good compliance of the therapy was confirmed by a decline of serum
LH (U/L; 30.1 +/- 3.1 versus 24.7 +/- 2.8, P = 0.014), FSH (U/L; 108.9 +/- 13.1
versus 93.3 +/- 12.8, P = 0.012) and serum sex hormone binding globulin (SHBG;
nmol/L; 53.3 +/- 13.3 versus 11.2 +/- 1.9, P < 0.01). The decline of SHBG
indicates a good tissue sensitivity to the androgen. There were no significant
differences between hormonal parameters before and after placebo treatment. In
conclusion, the immunosuppressive effect of the androgen, stanazolol, was
confirmed in the investigated postmenopausal osteoporotic women.(ABSTRACT
TRUNCATED AT 250 WORDS)

Testosterone and risk factors for cardiovascular disease in men.

Diabete Metab. 1995 Jun;21(3):156-61.

Testosterone and risk factors for cardiovascular disease in men.

Barrett-Connor EL.

Department of Family and Preventive Medicine, University of California, San
Diego, La Jolla 92093-0607, USA.

It has been assumed for years that male testosterone levels play a central role
in worsening lipoprotein patterns and causing greater susceptibility to ischemic
heart disease. Yet most clinical trials of quasi-physiologic doses of
intramuscular testosterone in older men show no effect on high-density
lipoprotein (HDL)-cholesterol, while cross-sectional epidemiologic studies almost
uniformly find that endogenous testosterone levels are positively associated with
HDL-cholesterol levels. Further work is required to determine whether and why
physiologic testosterone levels in the high normal range appear to be conducive
to optimal cardiovascular health for adult men.

Idiopathic osteonecrosis, hypofibrinolysis, high plasminogen activator inhibitor, high lipoprotein(a), and therapy with Stanozolol.

Am J Hematol. 1995 Apr;48(4):213-20.

Idiopathic osteonecrosis, hypofibrinolysis, high plasminogen activator inhibitor,
high lipoprotein(a), and therapy with Stanozolol.

Glueck CJ, Freiberg R, Glueck HI, Tracy T, Stroop D, Wang Y.

Cholesterol Center Jewish Hospital, Cincinnati, OH 45229, USA.

In five patients with idiopathic osteonecrosis (ON) of the hip, four having
hypofibrinolysis mediated by high plasminogen activator inhibitor (PAI-Fx), and
one with high Lp(a), our specific aim was to determine whether therapy (Rx) with
the anabolic-androgenic steroid, Stanozolol (6 mg/day), would normalize PAI-Fx
and Lp(a) and thus potentially ameliorate ON. Prior to Rx, none of the four
patients with high PAI-Fx could normally elevate tissue plasminogen activator
(tPA-Fx) after 10 min venous occlusion at 100 mm Hg. After 12-18 weeks on Rx,
PAI-Fx and stimulated tPA-Fx normalized in all four patients. Prior to Rx, mean
(SD) stimulated tPA-Fx was low, 0.4 +/- 0.3 IU/ml (lower limit of normal 2.28
IU/ml). On Rx, stimulated tPA-Fx normalized, rising to 2.83 +/- 1.9 IU/ml, P =
.004. Prior to Rx, mean (SD) basal PAI-Fx was high, 99 +/- 68 (upper limit of
normal 26.9 U/ml), and fell on Rx to 22.5 +/- 22, P = .004. In two of the five
patients normalization of hypofibrinolysis or high Lp(a) was accompanied by major
symptomatic improvement. Prior to Rx, and 2 years after onset of unilateral hip
pain, one of the four patients with high PAI-Fx and low stimulated tPA-Fx could
walk only one block painfully. After 8 weeks on Stanozolol Rx, and continuing
through 54 weeks on Rx, he walked 2 miles per day without pain, despite
radiographic progression of ON. In three of the four patients with high PAI and
with osteonecrosis present 0.3, 2, and 6 years prior to Stanozolol Rx, there was
no clinical improvement after 14-156 weeks of Rx despite normalization of
stimulated tPA-Fx and PAI-Fx. The fifth patient, 1 month after onset of disabling
hip pain, had normal PAI-Fx but high Lp(a) (27 mg/dl), and MRI evidence of bone
marrow edema ("transient osteoporosis").(ABSTRACT TRUNCATED AT 250 WORDS)

Tonsillectomy in a patient with hereditary angioedema after prophylaxis with C1 inhibitor concentrate.

Ann Allergy. 1994 Nov;73(5):435-8.

Tonsillectomy in a patient with hereditary angioedema after prophylaxis with C1
inhibitor concentrate.

Maves KK, Weiler JM.

Department of Internal Medicine, University of Iowa, Iowa City.

BACKGROUND: A 15-year-old young man with a history of recurrent streptococcal
pharyngitis and hereditary angioedema presented for tonsillectomy. Preoperative
physical examination was normal with the exception of enlarged pharyngeal tonsils
with crypts and pustules; there was no evidence of angioedema. Laboratory studies
were remarkable for a C4 level of 8 mg/dL (normal 20-50 mg/dL) and C1 inhibitor
(C1 INH) level of 4 mg/dL (normal 11-26 mg/dL).

OBJECTIVE: To report the use of
C1 INH concentrate as prophylactic treatment for a patient with hereditary
angioedema who required tonsillectomy. METHODS: The patient was treated with
stanozolol 4 mg po quid and clindamycin 150 mg po tid during the week before the
procedure. Two hours prior to surgery, he received 2300 plasma units of
intravenous C1-inhibitor (Human) Vapor Heated, IMMUNO (IMMUNO Clinical Research
Corporation, New York, NY). RESULTS: Approximately eight hours after an
uncomplicated tonsillectomy, the patient began to experience crampy abdominal
pain, typical of his hereditary angioedema. Beginning 22 hours after surgery, he
had facial swelling and complained of difficulty swallowing and the sensation of
throat swelling. The symptoms resolved over the next eight hours. Serial
laboratory examinations revealed: [table: see text]

CONCLUSIONS: We believe that
the occurrence of abdominal pain, facial swelling, and difficulty swallowing
suggests that this patient may have experienced a mild, generalized flare of
hereditary angioedema during the postoperative period in spite of prophylactic
therapy with both anabolic steroids and C1 INH concentrate. This serves as a
reminder that patients with hereditary angioedema require close observation
following invasive procedures even after premedication with stanozolol and C1 INH
concentrate.