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How to Read Your Liver Blood Test Results (Please read) - Part 3

How to Read Your Liver Blood Test Results (Please read) - Part 3

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  The wisdom well

  2. REFERENCES
    Anabolic Steroids


    References Last Updated: 04 September 2013

    1. Singh C, Bishop P, Wilson R. Extreme hyperbilirubinemia associated with the use of anabolic steroids, health/nutritional supplements and ethanol: response to ursodeoxycholic acid treatment. Am J Gastroenterol 1996; 91: 783-5. PubMed Citation (24 year old male body builder developed jaundice after 3 month use of several anabolic steroids [stanozol and nandrolone] and Ma Huang [bilirubin 21 rising to 53 mg/dL, ALT 237 U/L, Alk P 129 U/L], with prolonged jaundice and pruritus resolving 5 months after onset: Case 1).
    2. Staub PG, Leibowitz CB. Peliosis hepatis associated with oral contraceptive use. Australas Radiol 1996; 40: 172-4. PubMed Citation (35 year old woman on oral contraceptives for several years developed abdominal pain and abnormal imaging studies with multiple lesions of varying size [2-5 cm], biopsy showing peliosis with decrease in size of lesions 6 months after stopping).
    3. Kosaka A, Takahashi H, Yajima Y, Tanaka M, Okamura K, Mizumoto R, Katsuta K. Hepatocellular carcinoma associated with anabolic steroid therapy: report of a case and review of the Japanese literature. J Gastroenterol 1996; 31: 450-4.PubMed Citation(35 year old woman with aplastic anemia developed hepatocellular carcinoma 3 years after starting oxymetholone therapy, with long term survival after resection and stopping androgens; review of 12 cases reported from Japan).
    4. Mork H, al-Taie O, Klinge O, Scheurlen M. Successful therapy of persistent androgen-induced cholestasis with ursodeoxycholic acid. Z Gastroenterol 1997; 35: 1087-91.PubMed Citation (55 year old man developed jaundice 12 months after starting methyltestosterone [bilirubin 5.1 mg/dL, ALT 177 U/L, Alk P normal]; when bilirubin rose to 8.0 mg/dL, ursodiol was started with resolution in 3 months, whereupon ursodiol was stopped without recurrence).
    5. Dourakis SP, Tolis G. Sex hormonal preparations and the liver. Eur J Contracept Reprod Health Care 1998; 3: 7-16. PubMed Citation(Review of sex hormones and liver injury; for estrogens complications include cholestasis, cholelithiasis, Budd-Chiari syndrome, peliosis, adenomas and focal nodular hyperplasia and hepatocellular carcinoma; androgenic steroids are not discussed).
    6. Schumacher J, Muller G, Klotz K-F. Large hepatic hematoma and intraabdominal hemorrhage associated with abuse of anabolic steroids. N Engl J Med 1999; 340: 1123-4. PubMed Citation (24 year old male body builder developed hepatic hemorrhage and rupture having used anabolic steroids for 2 years [bilirubin normal, ALT 927 U/L, Alk P normal], biopsy showing extensive hepatic necrosis without malignancy).
    7. Habscheid W, Abele U, Dahm HH. [Severe cholestasis with kidney failure from anabolic steroids in a body builder]. Dtsch Med Wochenschr 1999; 124: 1029-32. German.PubMed Citation (28 year old male body builder developed jaundice 3 months after starting anabolic steroids [initial bilirubin 4.5 mg/dL, ALT 38 U/L, Alk P 94 U/L], with worsening jaundice and renal failure despite stopping androgens [peak bilirubin 77.9 mg/dL], jaundice lasting 4 months).
    8. Bork K, Pitton M, Harten P, Koch P. Hepatocellular adenomas in patients taking danazol for hereditary angio-oedema. Lancet 1999; 353: 1066-7. PubMed Citation (Among 87 patients with hereditary angioneurotic edema, 41 were treated with danazol, 11 for more than 10 years, 3 of whom developed hepatocellular adenomas at ages 29, 39 and 67 which were resected and did not show carcinoma).
    9. Bagia S, Hewitt PM, Morris DL. Anabolic steroid-induced hepatic adenomas with spontaneous haemorrhage in a bodybuilder. Aust N Z J Surg 2000; 70: 686-7.PubMed Citation (31 year old male body builder on long term anabolic steroids presented with hemorrhage into a hepatic adenoma ultimately requiring resection).
    10. Simon JA. Safety of estrogen/androgen regimens. J Reprod Med 2001; 46(3 Suppl): 281-90. PubMed Citation (Combinations of estrogen with low doses of methyltestosterone [1.25-2.5 mg] have been used to treat vasomotor symptoms in menopausal women with no serious adverse events, including no hepatic events or liver-enzyme elevations, in 641 women followed prospectively in controlled trials).
    11. Stimac D, Milić S, Dintinjana RD, Kovac D, Ristić S. Androgenic/Anabolic steroid-induced toxic hepatitis. J Clin Gastroenterol 2002; 35: 350-2. PubMed Citation(26 year old male body builder developed nausea and jaundice 5 weeks after starting anabolic steroids [bilirubin 27.5 mg/dL, ALT 10,580 U/L, Alk P 152 U/L] which he had taken intermittently for 9 years; gradual improvement over 3 months).
    12. Hengge UR, Stocks K, Wiehler H, Faulkner S, Esser S, Lorenz C, Jentzen W, et al. Double-blind, randomized, placebo-controlled phase III trial of oxymetholone for the treatment of HIV wasting. AIDS 2003; 17: 699-710. PubMed Citation(Controlled trial of 16 weeks of oxymetholone vs placebo is 89 HIV-infected patients; ALT levels rose above 5 times ULN in 31% of oxymetholone, but none of placebo treated patients; one developed jaundice and cholestasis).
    13. Tan RS, Salazar JA. Risks of testosterone replacement therapy in ageing men. Expert Opin Drug Saf 2004; 3: 599-606. PubMed Citation (Review of use of androgens in aging males for loss of libido and inability to focus mentally; ?to our knowledge, there has been no reported hepatotoxicity from testosterone delivered via topical gel, transdermal patch, or by intramusclar injections?).
    14. Orr R, Fiatarone Singh M. The anabolic androgenic steroid oxandrolone in the treatment of wasting and catabolic disorders: review of efficacy and safety. Drugs 2004; 64: 725-50. PubMed Citation (Review of clinical efficacy and side effects of anabolic steroids and oxandralone which is approved for use to promote weight gain and decrease catabolism after surgery or severe trauma).
    15. Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med 2004; 34: 513-54. PubMed Citation (Review of effects and toxicity of anabolic steroids used to improve athletic performance; ?Injectable testosterone ciprionate and enantate preparations do not appear to affect liver function enzymes?).
    16. Velazquez I, Alter BP. Androgens and liver tumors: Fanconi’s anemia and non-Fanconi’s conditions. Am J Hematol 2004; 77: 257-67. PubMed Citation(Systematic review of published literature on association of androgen therpay and liver tumors identified 133 cases, 36 in patients with Fanconi?s anemia, others with aplastic anemia, endocrine and gynecological disorders and body builders; most due to oxymetholone, metyltestosterone and danazol, but 6 associated with intramuscular testosterone injections; hepatocellular carcinoma 53%, adenomas 37%, others included cholangiocarcinoma and angiosarcoma).
    17. Maravelias C, Dona A, Stefanidou M, Spiliopoulou C. Adverse effects of anabolic steroids in athletes. A constant threat. Toxicol Lett 2005; 158: 167-75. PubMed Citation (Review of adverse effects of anabolic steroids in athletes; hepatic effects include serum enzyme elevations, cholestatic jaundice, hepatic tumors and peliosis hepatis).
    18. Socas L, Zumbado M, Perez-Luzardo O, Ramos A, Perez C, Hernandez JR, Boada LD. Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and review of the literature. Br J Sports Med 2005; 39: 327. PubMed Citation (Two cases of hepatic adenomas in male body builders abusing anabolic steroids; ages 35 and 23 years old on anabolic steroids for 6 months and 15 years presented with hepatic masses which appeared to be benign and regressed on stopping anabolic steroids).
    19. Capra F, Nicolini N, Morana G, Guglielmi A, Capelli P, Vantini I. Vanishing bile duct syndrome and inflammatory pseudotumor associated with a case of anabolic steroid abuse. Dig Dis Sci 2005; 50: 1535-7. PubMed Citation (32 year old treated for 3 years with testosterone undecanoate for hypogonadism developed jaundice [bilirubin 37 mg/dL, ALT 182 U/L, Alk P 212 U/L], with inflammatory pseudo tumor and biopsy showing paucity of bile ducts, although patient ultimately recovered).
    20. Clark BM, Schofield RS. Dilated cardiomyopathy and acute liver injury associated with combined use of ephedra, gamma-hydroxybutyrate, and anabolic steroids. Pharmacotherapy 2005; 25: 756-61. PubMed Citation (40 year old man developed shortness of breath and jaundice starting 2 months after initiating therapy with androgens and ephedra to promote muscle development [bilirubin 3.9 mg/dL, ALT 2173 U/L, Alk P normal], requiring therapy for congestive cardiomyopathy, but ultimately recovering over next 18 months).
    21. Jasiurkowski B, Raj J, Wisinger D, Carlson R, Zou L, Nadir A. Cholestatic jaundice and IgA nephropathy induced by OTC muscle building agent Superdrol. Am J Gastroenterol 2006; 101: 2659-62. PubMed Citation (23 year old body builder developed abdominal pain and jaundice two months after starting an over-the-counter supplement called ?Superdrol? [containing methasteron] [bilirubin 36.2 mg/dL, ALT 93 U/L, Alk P 224 U/L], with protracted jaundice and itching and biopsy showing marked cholestasis with minimal inflammation).
    22. Kafrouni MI, Anders RA, Verma S. Hepatotoxicity associated with dietary supplements containing anabolic steroids. Clin Gastroenterol Hepatol 2007; 5: 809-12. PubMed Citation (Two cases; 31 and 40 year old body builders developed prolonged jaundice and pruritus beginning 4 and 6 weeks after starting ?Superdrol? [bilirubin 37.5 and 49.7 mg/dL, ALT 59 and 301 U/L, Alk P 375 and 416 U/L], with slow recovery over ensuing 2-3 months).
    23. McCullough MC, Namias N, Schulman C, Gomez E, Manning R, Goldberg S, Pizano L, et al. Incidence of hepatic dysfunction is equivalent in burn patients receiving oxandrolone and controls. J Burn Care Res 2007; 28: 412-20. PubMed Citation (Retrospective analysis of liver test results during oxandrolone therapy of patients with major burns; some evidence of hepatic dysfunction found in 43% of oxandrolone and 43% of 61 control subjects).
    24. Patil JJ, O’Donohoe B, Loyden CF, Shanahan D. Near-fatal spontaneous hepatic rupture associated with anabolic androgenic steroid use: a case report. Br J Sports Med 2007; 41: 462-3. PubMed Citation (43 year old professional body builder developed abdominal pain and hepatic rupture having used anabolic steroids for 25 years; cause of rupture not explained [peliosis vs adenoma vs carcinoma]).
    25. Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, et al.; Drug Induced Liver Injury Network(DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 2008; 135: 1924-34. PubMed Citation (Among 300 cases of drug induced liver disease in the US collected between 2004 and 2008, at least 6 were due to anabolic steroids being used for body building or for improving athletic performance, but none were attributed to physician-prescribed androgenic steroids).
    26. S?nchez-Osorio M, Duarte-Rojo A, Mart?nez-Ben?tez B, Torre A, Uribe M. Anabolic-androgenic steroids and liver injury. Liver Int 2008; 28: 278-82.PubMed Citation (29 year old man developed progressive fatigue, nausea and then jaundice and pruritis 2-3 months after starting high dose anabolic steroids [bilirubin 29 mg/dL, ALT 54 U/L, Alk P 694 U/L], jaundice persisting for 2 months, but resolving completely by 5 months after stopping).
    27. Gorayski P, Thompson CH, Subhash HS, Thomas AC. Hepatocellular carcinoma associated with recreational anabolic steroid use. Br J Sports Med 2008; 42: 74-5.PubMed Citation (35 year old male body builder presented with large hepatocellular carcinoma having used anabolic steroids for several years [bilirubin 0.6 mg/dL, ALT 364 U/L, Alk P 70 U/L, alphafetoprotein normal], no follow up provided).
    28. Martin NM, Abu Dayyeh BK, Chung RT. Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage. World J Gastroenterol 2008; 14: 4573-5.PubMed Citation (27 year old male body builder having used anabolic steroids for 5 years had spontaneous hepatic bleeding from 10 cm hepatic adenoma [bilirubin 2.2 mg/dL, ALT 2457 U/L, Alk P 275 U/L], treated with resection and had recurrence 3 years later having restarted anabolic steroid use).
    29. Shah NL, Zacharias I, Khettry U, Afdhal N, Gordon FD. Methasteron-associated cholestatic liver injury: clinicopathologic findings in 5 cases. Clin Gastroenterol Hepatol 2008; 6: 255-8. PubMed Citation. (5 cases of jaundice due to methasteron use by male body builders, ages 20-33 years, with onset of symptoms 1 to 2 months after starting the nutritional supplement [inital bilirubin 7.6-41.8 mg/dL, ALT 59-151 U/L, Alk P 85-189 U/L], all resolving with stopping the 17-alkylated androgenic steroid).
    30. Singh V, Rudraraju M, Carey EJ, Byrne TJ, Vargas HE, Williams JE, Balan V, et al. Severe hepatotoxicity caused by a methasteron-containing performance-enhancing supplement. J Clin Gastroenterol 2009; 43: 287. PubMed Citation. (3 men, ages 25, 33, and 51, developed jaundice and pruritus 1-2 months after starting “Superdrol” a form of methasterone [bilirubin 8.3, 17.3 and 22 mg/dL, ALT 69, 236 and 1025 U/L, Alk P 106, 111 and unknown U/L], associated with hepatic encephalopathy and peak INR 1.5, in one patient, but resolving spontaneously in all within 6-12 weeks of onset).
    31. Nasr J, Ahmad J. Severe cholestasis and renal failure associated with the use of the designer steroid Superdrol (methasteron): a case report and literature review. Dig Dis Sci 2009; 54: 1144-6. PubMed Citation. (42 year old man developed jaundice and pruritus 7 weeks after starting “Superdrol” with methasterone [bilirubin 41.2 mg/dL, ALT 98 U/L, Alk P 353 U/L, creatinine 3.5 mg/dL], both renal and liver injury resolving slowly over the following 4 months).
    32. Choi SK, Jin JS, Cho SG, Choi SJ, Kim CS, Choe YM, Lee KY. Spontaneous liver rupture in a patient with peliosis hepatis: a case report. World J Gastroenterol 2009; 15: 5493-7.PubMed Citation (20 year old man with aplastic adnemia treated with oxymetholone for 8 years developed spontaneous rupture of liver due to peliosis hepatis, responding to hemi-hepatectomy and stopping androgenic steroids).
    33. Bispo M, Valente A, Maldonado R, Palma R, Gl?ria H, N?brega J, Alexandrino P. Anabolic steroid-induced cardiomyopathy underlying acute liver failure in a young bodybuilder. World J Gastroenterol 2009; 15: 2920-2. PubMed Citation(40 year old body builder developed fatigue followed by jaundice having used large doses of anabolic steroids for 10 years [bilirubin 6.8 mg/dL, ALT 7125 U/L, INR 3.3, LDH 7140 U/L], acute liver failure being due to ischemic hepatitis caused by cardiomyopathy, responding rapidly to treatment of right heart failure).
    34. Masumori N, Ikeda H, Endo T. Acute hepatitis induced by replacement oral testosterone product in a female-to-male patient with gender identity disorder. Int J Urol 2009 May; 16(5): 530-1. PubMed Citation (27 year old female-to-male transgender woman developed fatigue 3 months after switching from fluoxymesterone to methyltestosterone [both oral 17-alpha methylated androgenic steroids] [bilirubin 1.2 mg/dL, peak ALT 1418 U/L, Alk P not given], resolving within 6 weeks of stopping).
    35. Krishnan PV, Feng ZZ, Gordon SC. Prolonged intrahepatic cholestasis and renal failure secondary to anabolic androgenic steroid-enriched dietary supplements. J Clin Gastroenterol 2009; 43: 672-5. PubMed Citation (Three cases of anabolic steroid induced hepatotoxicity; 21, 30 and 38 year old men developed jaundice and pruritus 4 to 8 weeks after starting a nutritional supplement with an oral anabolic steroid [bilirubin 8.0-53 mg/dL, ALT 200-467 U/L, Alk P 104-494 U/L], with slow recovery after stopping).
    36. Reuben A, Koch DG, Lee WM; Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology 2010; 52: 2065-76. PubMed Citation (Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury, but none were linked to anabolic steroid use).
    37. Woerdeman J, de Hon O, Levi M, de Ronde WP. [Anabolic androgenic steroids in amateur sports in the Netherlands]. Ned Tijdschr Geneeskd 2010; 154: A2004. Dutch.PubMed Citation (Review of anabolic steroid use in the Netherslands and their complications including cholestasis).
    38. Wingert N, Tavakoli H, Yoder E. Acute hepatitis and personality change in a 31-year-old man taking prohormone supplement SUS500. Psychosomatics 2010; 51: 340-4.PubMed Citation (31 year man developed fatigue and personality change having used an prohormone nutritional supplement for one year [ALT 1754 U/L, bilirubin and Alk P not given], resolving rapidly after stopping the supplement).
    39. van Amsterdam J, Opperhuizen A, Hartgens F. Adverse health effects of anabolic-androgenic steroids. Regul Toxicol Pharmacol 2010; 57: 117-23.PubMed Citation(Review of the health consequences of anabolic steroid use including cholestasis, hepatic adenoma and peliosis).
    40. B?ttner A, Thieme D. Side effects of anabolic androgenic steroids: pathological findings and structure-activity relationships. Handb Exp Pharmacol 2010; (195): 459-84.PubMed Citation (Review of the side effects of anabolic steroids based upon structure-activity relationships).
    41. Tornai I. [Role of environmental factors in the etiology of hepatocellular carcinoma]. Orv Hetil 2010; 151: 1132-6. PubMed Citation(Review of risk factors for hepatocellular carcinoma mentions that oral contraceptives may play a role in some cases).
    42. Schwingel PA, Cotrim HP, Salles BR, Almeida CE, dos Santos CR Jr, Nachef B, Andrade AR, et al. Anabolic-androgenic steroids: a possible new risk factor of toxicant-associated fatty liver disease. Liver Int 2011; 31: 348-53. PubMed Citation (Among 180 recreational body builders, mean aminotransferase levels were higher [ALT: 43 vs 31 U/L and AST: 55 vs 32 U/L] and more likely to be elevated [33% vs 7%] in those who admitted to use of injectable anabolic steroids, who were also more likely to have steatosis by ultrasound evaluation).
    43. Machado MV, Cortez-Pinto H. The dark side of sports: using steroids may harm your liver. Liver Int 2011; 31: 280-1. PubMed Citation (Editorial in response to Schwingel [2011]).
    44. Yurci A, Yucesoy M, Unluhizarci K, Torun E, Gursoy S, Baskol M, Guven K, Ozbakir O. Effects of testosterone gel treatment in hypogonadal men with liver cirrhosis. Clin Res Hepatol Gastroenterol 2011; 35: 845-54. PubMed Citation(Among 10 hypogonadal men with cirrhosis treated with transdermal testosterone, there was no change in ALT or bilirubin and none developed clinically apparent liver injury).
    45. Rosenfeld GA, Chang A, Poulin M, Kwan P, Yoshida E. Cholestatic jaundice, acute kidney injury and acute pancreatitis secondary to the recreational use of methandrostenolone: a case report. J Med Case Reports 2011; 5: 138. PubMed Citation (50 year old man with chronic hepatitis C developed anorexia, weight loss and jaundice 8 weeks after starting methandrostenolone [bilirubin 53.9 mg/dL, ALT 56 U/L, Alk P 154 U/L] accompanied by mild pancreatitis and renal insufficiency, resolving slowly after stopping anabolic steroids).
    46. Neri M, Bello S, Bonsignore A, Cantatore S, Riezzo I, Turillazzi E, Fineschi V. Anabolic androgenic steroids abuse and liver toxicity. Mini Rev Med Chem 2011; 11: 430-7.PubMed Citation (Review of the hepatic complications of anabolic steroid use).
    47. Stickel F, Kessebohm K, Weimann R, Seitz HK. Review of liver injury associated with dietary supplements. Liver Int 2011; 31: 595-605. PubMed Citation (Review of current understanding of liver injury from herbals and dietary supplements focusing upon herbalife and hydroxycut products, green tea, usnic acid, Noni juice, Chinese herbs, vitamin A and anabolic steroids).
    48. Avelar-Escobar G, M?ndez-Navarro J, Ortiz-Olvera NX, Castellanos G, Ramos R, Gallardo-Cabrera VE, Vargas-Alem?n Jde J, et al. Hepatotoxicity associated with dietary energy supplements: use and abuse by young athletes. Ann Hepatol 2012; 11: 564-9.PubMed Citation. (17 year old boy developed jaundice and pruritus 3 months after starting dietary supplements [N.O.Xplode, Growth Factor ATN and SimiCaritina] for body building [bilirubin 17.5 rising to 31.5 mg/dL, ALT 640 U/L, Alk P 850 U/L, GGT normal] with resolution within 6-8 weeks of stopping).
    49. Kou T, Watanabe M, Yazumi S. Hepatic failure during anabolic steroid therapy. Gastroenterology 2012; 143: e11-2. PubMed Citation. (78 year old man developed jaundice and fatigue 2 years after starting danazol for thrombocytopenic purpura [bilirubin 11.7 mg/dL, ALT 185 U/L, Alk P 677 U/L] and died 26 days later, autopsy showing peliosis hepatis).
    50. Timcheh-Hariri A, Balali-Mood M, Aryan E, Sadeghi M, Riahi-Zanjani B. Toxic hepatitis in a group of 20 male body-builders taking dietary supplements. Food Chem Toxicol 2012; 50: 3826-32. PubMed Citation. (20 male body builders, ages 24 to 32 years, presented with jaundice and pruritus having been taking 3 supplements for a year [bilirubin 3.9-8.0 mg/dL, ALT 225-600 U/L, Alk P 325-701 U/L], the responsible agent causing the injury being unclear from the list of ingredients).
    51. Elsharkawy AM, McPherson S, Masson S, Burt AD, Dawson RT, Hudson M. Cholestasis secondary to anabolic steroid use in young men. BMJ 2012; 344: e468. PubMed Citation. (Two cases, 16 and 32 year old men developed jaundice and pruritus 5 days and 2 months after starting an anabolic steroid “methandrostenolone” [bilirubin 25.8 and 38.0 mg/dL, ALT 156 and 76 U/L, Alk P 203 and 262 U/L], requiring 4 months to resolve after stopping).
    52. Elsharkawy AM, McPherson S, Masson S, Burt A, Dawson RT, Hudson M. [Cholestasis in young men after taking anabolic steroids]. Praxis (Bern 1994) 2012; 101: 661-4. German. PubMed Citation. (Same cases as described by the authors in BMJ [2012]).
    53. Porro LJ, Herndon DN, Rodriguez NA, Jennings K, Klein GL, Mlcak RP, Meyer WJ, et al. Five-year outcomes after oxandrolone administration in severely burned children: a randomized clinical trial of safety and efficacy. J Am Coll Surg 2012; 214: 489-502.PubMed Citation. (Among children with severe burns, 70 received oxandrolone for one year and 152 served as standard of care controls; ALT levels were elevated to a similar degree in both groups during the acute period returning to normal levels 3 to 6 months after the burns).
    54. Pais-Costa SR, Lima OA, Soares AF. Giant hepatic adenoma associated with anabolic-androgenic steroid abuse: case report. Arq Bras Cir Dig 2012; 25: 180-2. PubMed Citation. (28 year old male body builder developed abdominal pain having been on anabolic steroids for 6 years, surgery revealing two hepatic adenomas, one being 10 cm in diameter).
    55. Vilella AL, Limsuwat C, Williams DR, Seifert CF. Cholestatic jaundice as a result of combination designer supplement ingestion. Ann Pharmacother 2013; 47: e33.PubMed Citation. (50 year old man developed jaundice and pruritus 2 months after starting body building supplements [bilirubin 29.4 mg/dL, ALT 125 U/L, Alk P 160 U/L] with slow recovery upon stopping).
    56. El Sherrif Y, Potts JR, Howard MR, Barnardo A, Cairns S, Knisely AS, Verma S. Hepatotoxicity from anabolic androgenic steroids marketed as dietary supplements: contribution from ATP8B1/ABCB11 mutations? Liver Int 2013; 33: 1266-70. PubMed Citation.(Two men, ages 25 and 45 years, developed jaundice 3 and 6 weeks after starting an anabolic steroid “Mass-Drol” [bilirubin 10.8 and 6.0 mg/dL, ALT 207 and 152 U/L, Alk P 137 and 259 U/L, GGT 72 and 59 U/L = normal], sequencing of ABC B11 [the gene that is abnormal in FIC1] was normal).
    57. Hymel BM, Victor DW, Alvarez L, Shores NJ, Balart LA. Mastabol induced acute cholestasis: A case report. World J Hepatol 2013; 5: 133-6. PubMed Citation. (26 year old man developed jaundice and pruritus 10 days after starting daily injections of the anabolic steroid “Mastabol” [peak bilirubin 23.6 mg/dL, ALT 117 U/L, Alk P 441 U/L], improving slowly on withdrawal).
    58. Archer JR, Dargan PI, Hudson S, Wood DM. Analysis of anonymous pooled urine from portable urinals in central London confirms the significant use of novel psychoactive substances. QJM 2013; 106: 147-52. PubMed Citation. (Analysis of pooled urine samples collected from 12 public urinals in central London identified cocaine, cannabis and MDMA from 11 sites, amphetamines from 10 and anabolic steroids from 4).
    59. Bj?rnsson ES, Bergmann OM, Bj?rnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. Gastroenterology 2013; 144: 1419-25. PubMed Citation (In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2-year period, including 15 due to herbals and dietary supplements, including one each attributed to dianabol [methandrostenolone], “Mega men heart” and “Serious Mass”).

CHEMICAL FORMULA AND STRUCTURE

compounds used in study

DRUG CAS REGISTRY NUMBER MOLECULAR FORMULA STRUCTURE
Danazol 17230-88-5 C22-H27-N-O2
Fluoxymesterone 76-43-7 C20-H29-F-O3
Methandienone 72-63-9 C20-H28-O2
Methenolone 303-42-4 C27-H42-O3
Methyltestosterone 58-18-4 C20-H30-O2
Nandrolone 434-22-0 C18H26O2
Norethandrolone 52-78-8 C20-H30-O2
Oxandrolone 53-39-4 C19-H30-O3
Oxymetholone 434-07-1 C21-H32-O3
Stanozolol 10418-03-8 C21-H32-N2-O
Testosterone 58-20-8 C27-H40-O3
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