Anabolic steroids purchased on the Internet as a cause of prolonged hypogonadotropic hypogonadism

To report a case of hypogonadotropic hypogonadism due to the chronic abuse of anabolic steroids.

Case report.

Endocrinology unit of the University of Brescia.

A 34-year-old man.

A single dose (100 μg) of triptorelin (triptorelin test).

Main Outcome Measure(s)
Clinical symptoms, androgen normalization, levels of serum testosterone, follicle-stimulating hormone, and luteinizing hormone.

Within 1 month, the patient’s serum testosterone was in the normal range, and he reported a return to normal energy and libido.

Case report
A 34-year-old man presented to our department in September 2008 for loss of libido and energy and for mild depression. He was a computer programmer and a nonprofessional bodybuilder with an unremarkable personal medical history. He admitted to having used doping drugs since he was 21 years old. More specifically, he would perform cycles of intramuscular injections of nandrolone (25 mg) and stanazol (25 mg) daily for 8 weeks, followed by mesterolone (50 mg/day) for 15 days. Then he would then take clomiphene citrate (50 mg/day) for 1 week, followed by an injection of human chorionic gonadotropin (2,000 IU) three times in 1 week. He had repeated these cycles from 1995 to 2005. From 2005 to August 2008, to his nandrolone and stanazol cycle he added an intramuscular injection of boldenone (50 mg) daily for 3 weeks. He said he had bought all the drugs on the Internet.

The patient was 175 cm tall and 80 kg, and he appeared very muscular and toned. His blood pressure and pulse rate were normal. Examination of his heart, lungs, and abdomen were likewise unremarkable. The physical examination showed normal secondary sexual characteristics, but the genital examination revealed bilateral testicular atrophy (volume 2.9 mL and weak consistence). Despite his testicular atrophy, the semen analysis revealed a normal count (79 × x106spermatozoa/mlmL) and mild morphology derangements (between 46% and 58%). The blood count and chemistry were normal, but his level of creatine kinase was 454 IU/L (normal range: 20–170 IU/L), alanine aminotransferase 61 IU/L (normal range: 5–50 IU/L), and aspartate aminotransferase 23 IU/L (normal range: 5–50 IU/L).

In February 2009, the patient continued to report loss of libido and great tiredness. A second physical examination was performed. His levels of alanine transferase and creatine kinase were all within the normal range, but the endocrinologic investigations were still abnormal with the exception of sex hormone-binding globulin level. *The patients testosterone measured 0.3 ng/mL – normal range is between 2.0 ng/mL and 12 ng/ML. Because the situation had persisted for months after ASS withdrawal,

we administered a single dose (100 μg) of triptorelin (triptorelin test), which showed a normal response (Fig. 1). Ten days after the triptorelin test, the patient reported a great amelioration of energy, and his serum testosterone was 7.0 ng/mL. One month later, his serum testosterone was within the normal range, and he reported a return to normal libido and energy.