Sports-related issues and biochemistry of natural and synthetic anabolic substances

Biotransformation of anabolic androgenic steroids in human skin cells

In comparison to well-known drug-metabolizing organs such as the liver, the metabolic capacity of human skin is still not well elucidated despite the widespread use of topical drug application. To gain a comprehensive insight into anabolic steroid metabolism in the skin, six structurally related anabolic androgenic steroids, testosterone, metandienone, methyltestosterone, clostebol, dehydrochloromethyltestosterone, and methylclostebol, were applied to human keratinocytes and fibroblasts derived from the juvenile foreskin. Phase I metabolites obtained from incubation media were analyzed by gas chromatography-mass spectrometry. The 5α-reductase activity was predominant in the metabolic pathways as supported by the detection of 5α-reduced metabolites after incubation of testosterone, methyltestosterone, clostebol, and methylclostebol. Additionally, the stereochemistry structures of fully reduced metabolites (4α,5α-isomers) of clostebol and methylclostebol were newly confirmed in this study by the help of inhouse synthesized reference materials. The results provide insights into the steroid metabolism in human skin cells with respect to the characteristics of the chemical structures.

Recovery of spermatogenesis after androgenic anabolic steroids abuse in men. A systematic review of the literature

OBJECTIVE

This systematic review aims to evaluate the optimal treatment for male infertility resulting from Anabolic Androgenic Steroids (AAS) abuse.

METHODS

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies that compared different protocols for the recovery of spermatogenesis in patients after AAS use were included.

RESULTS

13 studies investigating different protocols to restore spermatogenesis in patients with AAS abuse met the inclusion criteria. The available agents that showed restoration of spermatogenesis include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their use is still poorly described in the literature.

CONCLUSIONS

Clinicians need to be aware of the detrimental effects of AAS on spermatogenesis. AAS-associated infertility may be reversible, but sperm production may take over a year to normalize. Both conservative and aggressive treatment can boost spermatogenesis with positive results. Further understanding of male reproductive endocrinology and high-quality data on the field of restoration of spermatogenesis after AAS abuse are warranted.

The Uses of Anabolic Androgenic Steroids Among Athletes; Its Positive and Negative Aspects- A Literature Review

The use of anabolic androgenic steroids (AAS) for strength training and muscle building is a widespread practice among athletes and young individuals. Athletes and bodybuilders are using these substances for various purposes, such as enhancing muscle mass, strengthening their bodies, and enhancing their performances. AAS exert a wide range of physiological effects that result in the activation of central signaling, resulting in adverse effects. Moreover, excessive use of AAS which can be categorized as AAS abuse; is linked to biological and psychological pathologies, which can lead to mortality. Complications arising from steroid abuse involve both cellular and physiological complications. Cellular complications arise when activation of signaling proteins like mTOR, Akt, etc. leads to alteration in protein synthesis pathways, cell cycle, oxidative stress, and apoptosis, contributing to damage at the cellular level. Physiological complications are evident with cardiovascular pathologies, including an altered lipid profile, cardiac hypertrophy, hypogonadism after discontinuation of AAS, and modulation of GABA receptors in the brain, all contributed by the androgen receptor signaling. Clinical complications budding from these altered physiological processes lead to clinical effects like testicular dysfunction, acne, gynecomastia, and neuropsychiatric disorders. Despite potential therapeutic benefits, AAS use is prohibited by the World Anti-Doping Agency (WADA) due to concerns over adverse health effects. This review highlights the molecular mechanisms, physiological processes, and clinical complications arising from the excessive use of AAS among athletes.

The effects of anabolic-androgenic steroids on DNA damage in bodybuilders' blood lymphocytes

BACKGROUND

Nowadays bodybuilders use anabolic steroids frequently. Abuse of these substances can cause significant side effects; therefore, we aim to investigate the effect of anabolic steroids on DNA damage in bodybuilders' blood lymphocytes.

METHODS AND MATERIALS

This case-control study was performed on 36 male bodybuilders in Gonabad. The case group included bodybuilders with a history of taking anabolic-androgenic steroids (n = 18), and the control group composed of bodybuilders who did not use anabolic-androgenic steroids (n = 18). Intravenous blood samples were obtained and then the lymphocytes, cells and electrophoresis of blood were extracted. Afterward, the coloured slides and DNA damage were measured using a fluorescent microscope and CometScore software. The DNA damage was compared using t-tests .

RESULTS

Results showed that there was no significant difference between age, marital status, BMI, systolic and diastolic blood pressure in the case and control group. However, parameters related to the DNA damage including tail length, percent tail DNA, and tail moment were significantly higher in the case group.

CONCLUSION

The use of anabolic-androgenic steroids increases DNA damage in the bodybuilders' blood lymphocytes.

The causes of adverse changes of testosterone levels in men

INTRODUCTION

As men age, progressive testosterone deficiency syndrome becomes an increasingly common problem. However, the decreased testosterone levels are not only the result of advanced age.

AREAS COVERED

PubMed search of published data on testosterone, nutritional deficiency, stress, sleep, and obesity. Many factors impact the male HPG axis (the hypothalamic-pituitary-adrenal), including body weight, calorific and nutritional value of a diet, the amount and quality of sleep, as well as the level of stress. In the case of persons of healthy weight, a below-average calorific value of a diet may decrease the levels of testosterone in men. On the other hand, the same caloric deficiency in obese persons may result in a neutral or positive impact on testosterone levels.

EXPERT OPINION

Many factors, including external, environmental and internal factors, influence testosterone levels. Undoubtedly, nutritional deficiency, and particularly of such nutrients as zinc, magnesium, vitamin D, together with low polyphenols intake, affects the HPG axis. The levels of mental and oxidative stress can also adversely impact the axis. Hence, a diagnosis of the cause of disturbance in testosterone levels depends on many factors and requires a broad range of research, as well as a change of patients' lifestyle.

Dietary Supplement and Food Contaminations and Their Implications for Doping Controls

A narrative review with an overall aim of indicating the current state of knowledge and the relevance concerning food and supplement contamination and/or adulteration with doping agents and the respective implications for sports drug testing is presented. The identification of a doping agent (or its metabolite) in sports drug testing samples constitutes a violation of the anti-doping rules defined by the World Anti-Doping Agency. Reasons for such Adverse Analytical Findings (AAFs) include the intentional misuse of performance-enhancing/banned drugs; however, also the scenario of inadvertent administrations of doping agents was proven in the past, caused by, amongst others, the ingestion of contaminated dietary supplements, drugs, or food. Even though controversial positions concerning the effectiveness of dietary supplements in healthy subjects exist, they are frequently used by athletes, anticipating positive effects on health, recovery, and performance. However, most supplement users are unaware of the fact that the administration of such products can be associated with unforeseeable health risks and AAFs in sports. In particular anabolic androgenic steroids (AAS) and stimulants have been frequently found as undeclared ingredients of dietary supplements, either as a result of cross-contaminations due to substandard manufacturing practices and missing quality controls or an intentional admixture to increase the effectiveness of the preparations. Cross-contaminations were also found to affect therapeutic drug preparations. While the sensitivity of assays employed to test pharmaceuticals for impurities is in accordance with good manufacturing practice guidelines allowing to exclude any physiological effects, minute trace amounts of contaminating compounds can still result in positive doping tests. In addition, food was found to be a potential source of unintentional doping, the most prominent example being meat tainted with the anabolic agent clenbuterol. The athletes’ compliance with anti-doping rules is frequently tested by routine doping controls. Different measures including offers of topical information and education of the athletes as well as the maintenance of databases summarizing low- or high-risk supplements are important cornerstones in preventing unintentional anti-doping rule violations. Further, the collection of additional analytical data has been shown to allow for supporting result management processes.

Mass spectral fragmentation analyses of isotopically labelled hydroxy steroids using gas chromatography/electron ionization low-resolution mass spectrometry: A practical approach

RATIONALE

Gas chromatography coupled to electron ionization mass spectrometry (GC/EI-MS) is used for routine screening of anabolic steroids in many laboratories after the conversion of polar groups into trimethylsilyl (TMS) derivatives. The aim of this work is to elucidate the origin and formation of common and subclass-specific fragments in the mass spectra of TMS-derivatized steroids. Especially in the context of metabolite identification or analysis of designer drugs, isotopic labelling is helpful to better understand fragment ion generation, identify unknown compounds and update established screening methods.

METHODS

Stable isotope labelling procedures for the introduction of [² H₉ ]-TMS or ¹⁸ O were established to generate perdeuterotrimethylsilylated, mixed deuterated and ¹⁸ O-labelled derivatives for 13 different hydroxy steroids. Fragmentation proposals were substantiated by comparison of the abundances of isotopically labelled and unlabelled fragment ions in unit mass resolution GC/MS. Specific fragmentations were also investigated by high-resolution MS (GC/quadrupole time-of-flight MS, GC/QTOFMS).

RESULTS

Methyl radical cleavage occurs primarily from the TMS groups in saturated androstanes and from the steroid nucleus in the case of enol-TMS of oxo or α,β-unsaturated steroid ketones. Loss of trimethylsilanol (TMSOH) is dependent on steric factors, degree of saturation of the steroid backbone and the availability of a hydrogen atom and TMSO group in the 1,3-diaxial position. For the formation of the [M - 105]⁺ fragment ion, methyl radical cleavage predominates from the angular methyl groups in position C-18 or C-19 and is independent of the site of TMSOH loss. The common [M - 15 - 76]⁺ fragment ion was found in low abundance and identified as [M - CH₃ - (CH₃ )₂ SiH - OH]⁺ . For the different steroid subclasses further diagnostic fragment ions were discussed and structure proposals postulated.

CONCLUSIONS

Stable isotope labelling of oxo groups as well as derivatization with deuterated TMS groups enables the detection of structure-related fragment ion generation in unit mass resolution GC/EI-MS. This may in turn allow us to propose isomeric assignments that are otherwise almost impossible using MS only.

Left Ventricular Systolic Function Assessed by Speckle Tracking Echocardiography in Athletes with and without Left Ventricle Hypertrophy

The aim of this study was to evaluate selected parameters of strain and rotation of the left ventricle (the basal rotation (BR) index, the basal circumferential strain (BCS) index, and the global longitudinal strain (GLS) of the left ventricle) in male athletes with physiological cardiac hypertrophy (LVH group), and athletes (non-LVH group) and non-athletes without hypertrophy (control group, CG). They were evaluated using transthoracic echocardiography and speckle tracking echocardiography before and after an incremental exercise test. The LVH group demonstrated lower BR at rest than the non-LVH group (p < 0.05) and the CG (p < 0.05). Physical effort had no effect on BR, nor was this effect different between groups (p > 0.05). There was a combined influence of LVH and physical effort on BR (F = 5.70; p < 0.05) and BCS (F = 4.97; p < 0.05), but no significant differences in BCS and GLS at rest between the groups. A higher BCS and lower GLS after exercise in the LVH group were demonstrated in comparison with the CG (p < 0.05). Left ventricular basal rotation as well as longitudinal and circumferential strains showed less of a difference between rest and after physical effort in subjects with significant myocardial hypertrophy. In conclusion, the obtained results may suggest that echocardiographic assessment of basal rotation and circumferential strain of the left ventricular can be important in predicting cardiac disorders caused by physical effort in individuals with physiological and pathological heart hypertrophy.

Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use

The use of testosterone replacement therapy (TRT) for hypogonadism continues to rise, particularly in younger men who may wish to remain fertile. Concurrently, awareness of a more pervasive use of anabolic-androgenic steroids (AAS) within the general population has been appreciated. Both TRT and AAS can suppress the hypothalamic-pituitary-gonadal (HPG) axis resulting in diminution of spermatogenesis. Therefore, it is important that clinicians recognize previous TRT or AAS use in patients presenting for infertility treatment. Cessation of TRT or AAS use may result in spontaneous recovery of normal spermatogenesis in a reasonable number of patients if allowed sufficient time for recovery. However, some patients may not recover normal spermatogenesis or tolerate waiting for spontaneous recovery. In such cases, clinicians must be aware of the pathophysiologic derangements of the HPG axis related to TRT or AAS use and the pharmacologic agents available to reverse them. The available agents include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their off-label use is poorly described in the literature, potentially creating a knowledge gap for the clinician. Reviewing their use clinically for the treatment of hypogonadotropic hypogonadism and other HPG axis abnormalities can familiarize the clinician with the manner in which they can be used to recover spermatogenesis after TRT or AAS use.

The Availability and Acquisition of Illicit Anabolic Androgenic Steroids and Testosterone Preparations on the Internet

The lifetime prevalence of anabolic androgenic steroids (AAS) use in the United States is over 1%. Recent reports have suggested AAS can easily be obtained over the Internet without a prescription, but this has been poorly studied. This study focused on determining the availability and ease of purchase for AAS, testosterone, and other non-AAS therapies on the Internet from the perspective of a typical consumer. A Google search was performed and the top-ranking sites offering AAS for sale were individually evaluated for selection of AAS offered, the purchasing process, and additional consumer information to support AAS use. The current results revealed that 87% of sites offered commonly used forms of AAS, injectable testosterone, and non-AAS hormone therapies. Seventy-five percent offered at least one postcycle recovery agent and 62% offered at least one erectile dysfunction medication. No site required a prescription for purchase of any substance, 75% accepted common forms of payment including credit card, and all sites were supplied by unregulated international pharmacies providing shipment to home addresses with disclaimers that consumers are liable to local laws. Seventy-five percent of sites provided specific cycle and stacking recommendations, 62% provided postcycle recovery information, but only one site offered information on non-AAS alternatives. In conclusion, AAS, injectable testosterone, and other non-AAS therapies are readily available and remarkably easy to purchase on the Internet without a prescription. It is of paramount importance that clinicians are aware of this considerable public health problem given the detrimental physiologic effects including infertility and sexual dysfunction.

Stimulant doping agents used in Brazil: prevalence, detectability, analytical implications, and challenges

This article presents the prevalence of stimulant doping among Brazilian athletes, the analytical approaches used, as well as a general evolution of the detectability of the stimulants being used. Results from the Brazilian accredited doping control laboratory are compared with the global statistics disclosed by the World Anti-Doping Agency. The high prevalence of stimulant doping in Brazil can be attributed to several reasons, including "self-administration," a "body-shaping" culture, and the use of nutritional supplements.

Current status and bioanalytical challenges in the detection of unknown anabolic androgenic steroids in doping control analysis

Androgenic anabolic steroids (AAS) are prohibited in sports due to their anabolic effects. Doping control laboratories usually face the screening of AAS misuse by target methods based on MS detection. Although these methods allow for the sensitive and specific detection of targeted compounds and metabolites, the rest remain undetectable. This fact opens a door for cheaters, since different AAS can be synthesized in order to evade doping control tests. This situation was evidenced in 2003 with the discovery of the designer steroid tetrahydrogestrinone. One decade after this discovery, the detection of unknown AAS still remains one of the main analytical challenges in the doping control field. In this manuscript, the current situation in the detection of unknown AAS is reviewed. Although important steps have been made in order to minimize this analytical problem and different analytical strategies have been proposed, there are still some drawbacks related to each approach.

The anabolic/androgenic steroid nandrolone exacerbates gene expression modifications induced by mutant SOD1 in muscles of mice models of amyotrophic lateral sclerosis

Anabolic/androgenic steroids (AAS) are drugs that enhance muscle mass, and are often illegally utilized in athletes to improve their performances. Recent data suggest that the increased risk for amyotrophic lateral sclerosis (ALS) in male soccer and football players could be linked to AAS abuse. ALS is a motor neuron disease mainly occurring in sporadic (sALS) forms, but some familial forms (fALS) exist and have been linked to mutations in different genes. Some of these, in their wild type (wt) form, have been proposed as risk factors for sALS, i.e. superoxide dismutase 1 (SOD1) gene, whose mutations are causative of about 20% of fALS. Notably, SOD1 toxicity might occur both in motor neurons and in muscle cells. Using gastrocnemius muscles of mice overexpressing human mutant SOD1 (mutSOD1) at different disease stages, we found that the expression of a selected set of genes associated to muscle atrophy, MyoD, myogenin, atrogin-1, and transforming growth factor (TGF)β1, is up-regulated already at the presymptomatic stage. Atrogin-1 gene expression was increased also in mice overexpressing human wtSOD1. Similar alterations were found in axotomized mouse muscles and in cultured ALS myoblast models. In these ALS models, we then evaluated the pharmacological effects of the synthetic AAS nandrolone on the expression of the genes modified in ALS muscle. Nandrolone administration had no effects on MyoD, myogenin, and atrogin-1 expression, but it significantly increased TGFβ1 expression at disease onset. Altogether, these data suggest that, in fALS, muscle gene expression is altered at early stages, and AAS may exacerbate some of the alterations induced by SOD1 possibly acting as a contributing factor also in sALS.

Anabolic steroids and male infertility: a comprehensive review

What's known on the subject? and What does the study add? The negative impact of AAS abuse on male fertility is well known by urologists. The secondary hypogonadotropic hypogonadism is often highlighted when AAS and fertility are being discussed. On the other hand, the patterns of use, mechanisms of action and direct effects over the testicle are usually overseen. The present study reviews the vast formal and "underground" culture of AAS, as well as their overall implications. Specific considerations about their impact on the male reproductive system are made, with special attention to the recent data on direct damage to the testicle. To our knowledge this kind of overview is absolutely unique, offering a distinguished set of information to the day-by-day urologists. For several decades, testosterone and its synthetic derivatives have been used with anabolic and androgenic purposes. Initially, these substances were restricted to professional bodybuilders, becoming gradually more popular among recreational power athletes. Currently, as many as 3 million anabolic-androgenic steroids (AAS) users have been reported in the United States, and considering its increasing prevalence, it has become an issue of major concern. Infertility is defined as the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse, with male factor being present in up to 50% of all infertile couples. Several conditions may be related to male infertility. Substance abuse, including AAS, is commonly associated to transient or persistent impairment on male reproductive function, through different pathways. Herein, a brief overview on AAS, specially oriented to urologists, is offered. Steroids biochemistry, patterns of use, physiological and clinical issues are enlightened. A further review about fertility outcomes among male AAS abusers is also presented, including the classic reports on transient axial inhibition, and the more recent experimental reports on structural and genetic sperm damage.