Endocrine effects in female weight lifters who self-administer testosterone and anabolic steroids William B. Malarkey, MDt b Richard H. Strauss, MD;' Daniel J. Leizman, MD, Mariah Liggett, PhD, c and Laurence M. Demers, PhD d C
C
Columbus, Ohio, and Hershey, Pennsylvania It appears that the self-administration of testosterone and anabolic steroids is increasingly practiced by women in sports where strength and endurance are important. We recently evaluated endocrine parameters in nine female weight lifters using steroids and seven not using these agents. Of the nine anabolic steroid users, seven took multiple anabolic steroids simultaneously. Thirty-fold elevations of serum testosterone were noted in the women injecting testosterone. In three of these women serum testosterone levels exceeded the upper limits for normal male testosterone concentrations. A significant compensatory decrease in sex hormone-binding globulin and a decrease in thyroid-binding proteins were noted in the women steroid users. Also, a 39% decrease in high-density lipoprotein cholesterol was noted in the steroid-using weight lifters. Most of the subjects in this study used anabolic steroids continuously, which raises concern about premature atherosclerosis and other disease processes developing in these women. (AM J OBSTET GVNECOL 1991 ;165:1385-90.)
Key words: Weight lifers, women, testosterone, anabolic steroids, endocrine effects The adverse effects of anabolic steroids are well described in men. These include endocrinologic (decrease in plasma testosterone and gonadotropin levels, decrease or absence of spermatogenesis, testicular atrophy, and gynecomastia), metabolic (decreased high-density lipoprotein [HDL] cholesterol, increased low-density lipoprotein [LDL] cholesterol, and hypertension), hepatic (hepatitis, cholestasis, benign and malignant tumors), and adverse psychologic effects.!" The effects of androgens vary significantly among users and reflect different influences of the particular androgen preparation and individual differences in response!·5 The long-term risks of androgen use are unknown. 6 Also, many of these studies do not evaluate androgenic steroids as they are commonly taken, where several types of oral and injectable androgens are taken simultaneously (called stacking). This practice may produce androgen levels 10 to 100 times the replacement dose.! There have been few studies in women steroid users, but the side effects that have been reported include hirsutism, deepening of the voice, hypertrophy of the
From the Departments of Internal Medicine," Medical Biochemistry,' and Preventive Medicine,' The Ohio State University, and the Departments ofMedicine and Pathology, M.S. Hershey Medical Center, Pennsylvania State University.d Supported in part by National Institutes of Health General Clinical Research Center grant M010034. Receivedfor publication September 6, 1990; accepted April 22, I 99 J. Reprint requests: William B. Malarkey, MD, The Ohio State University Hospitals, Room N-Il06 Doan Hall, 410 W. Tenth Ave.. Columbus, OH 432IO. 6/1/30435
clitoris, male pattern baldness, acne, menstrual abnormalities, increased aggressiveness, and, most recently, changes in lipoprotein profiles. 7,8 We recently had the opportunity to examine endocrinologic parameters in female weight lifters who were self-administering multiple androgenic steroids in preparation for competition,
Material and methods
Subjects. The study population consisted of nine female weight lifters using androgens and seven female weight lifters in the follicular phase of the menstrual cycle who were not using androgens (Table I). They were evaluated at The Ohio State University Clinical Research Center after informed consent and assurances of confidentiality were obtained. A patient interview, a detailed questionnaire, and a blood specimen were acquired. These women had no history of illness in the past month, other than upper respiratory infections. They were nonsmokers and alcohol intake was modest. The most frequently used steroids were methandrostenolone (Dianabol), stanozolol (Winstrol), nandrolone decanoate (Deca-Durabolin), oxandrolone (Anavar), and injectable testosterone preparations. Also used were mibolerone, methenolone acetate, trenbolone acetate, and Parabolin. These athletes obtained their steroids by nonprescription methods. A blood sample was obtained when androgen use was at its peak and also when androgen use ceased. However, only three subjects stopped steroids completely in a 12month period, for 3, 4, and 9 weeks, respectively. Assays. Laboratory studies included a complete blood cell count and chemical analyzer measurements 1385
November 1991 Am J Obstet Gynecol
1386 Malarkey et al.
Table I. Characteristics of weight lifters in relation to androgen use Androgens Subject No.
1 2 3 4 5 6 7 8 9 Mean ± SE Nonusers
Age (yr)
Weight (kg)
Height (cm)
29 28 41 40 30 35 26 23 33 31.7 ± 2* 25 ± 2
62.7 58.6 77.3 68.2 68.2 51.8 52.3 75.5 60.9 63.9 ± 3.1 60 ± 6.2
162.6 157.5 167.6 170.2 160.0 152.4 160.0 162.6 160.0 161.4 ± 1.8* 168 ± 2.0
Tmining (yr)
Dmg use Cyr)
12 7 7 5 5 7 4 3 5 6± 1* 3 ± 0.7
7.0 5.0 5.0 4.0 4.5 5.0 3.5 0.25 3.0 4 ± 0.6 NA
Menses
Oral
Oligomenorrhea Oligomenorrhea Amenorrhea Oligomenorrhea Amenorrhea Normal Normal Oligomenorrhea Oligomenorrhea
2
Normal
I
Injectable
2 3 3
I I I
2 2 1 2 0 1.3 ± 0.2 NA
I I I
0 2 1 1.6 ± 0.3 NA
NA, Not applicable.
*Significantly different from controls (p < 0.05).
Table II. Effect of self-administered androgens on gonadtropins and sex steroid metabolism in women
Subject No.
1 2 3 4 5 6 7 8 9 Mean ± SE Nonusers Normal range
Folliclestimulating hormone (IV IL)
12 3 3 4 6 12 14 3 10
7.4 ± 1.5* 12.3 ± 1.1
C
Columbus, Ohio, and Hershey, Pennsylvania It appears that the self-administration of testosterone and anabolic steroids is increasingly practiced by women in sports where strength and endurance are important. We recently evaluated endocrine parameters in nine female weight lifters using steroids and seven not using these agents. Of the nine anabolic steroid users, seven took multiple anabolic steroids simultaneously. Thirty-fold elevations of serum testosterone were noted in the women injecting testosterone. In three of these women serum testosterone levels exceeded the upper limits for normal male testosterone concentrations. A significant compensatory decrease in sex hormone-binding globulin and a decrease in thyroid-binding proteins were noted in the women steroid users. Also, a 39% decrease in high-density lipoprotein cholesterol was noted in the steroid-using weight lifters. Most of the subjects in this study used anabolic steroids continuously, which raises concern about premature atherosclerosis and other disease processes developing in these women. (AM J OBSTET GVNECOL 1991 ;165:1385-90.)
Key words: Weight lifers, women, testosterone, anabolic steroids, endocrine effects The adverse effects of anabolic steroids are well described in men. These include endocrinologic (decrease in plasma testosterone and gonadotropin levels, decrease or absence of spermatogenesis, testicular atrophy, and gynecomastia), metabolic (decreased high-density lipoprotein [HDL] cholesterol, increased low-density lipoprotein [LDL] cholesterol, and hypertension), hepatic (hepatitis, cholestasis, benign and malignant tumors), and adverse psychologic effects.!" The effects of androgens vary significantly among users and reflect different influences of the particular androgen preparation and individual differences in response!·5 The long-term risks of androgen use are unknown. 6 Also, many of these studies do not evaluate androgenic steroids as they are commonly taken, where several types of oral and injectable androgens are taken simultaneously (called stacking). This practice may produce androgen levels 10 to 100 times the replacement dose.! There have been few studies in women steroid users, but the side effects that have been reported include hirsutism, deepening of the voice, hypertrophy of the
From the Departments of Internal Medicine," Medical Biochemistry,' and Preventive Medicine,' The Ohio State University, and the Departments ofMedicine and Pathology, M.S. Hershey Medical Center, Pennsylvania State University.d Supported in part by National Institutes of Health General Clinical Research Center grant M010034. Receivedfor publication September 6, 1990; accepted April 22, I 99 J. Reprint requests: William B. Malarkey, MD, The Ohio State University Hospitals, Room N-Il06 Doan Hall, 410 W. Tenth Ave.. Columbus, OH 432IO. 6/1/30435
clitoris, male pattern baldness, acne, menstrual abnormalities, increased aggressiveness, and, most recently, changes in lipoprotein profiles. 7,8 We recently had the opportunity to examine endocrinologic parameters in female weight lifters who were self-administering multiple androgenic steroids in preparation for competition,
Material and methods
Subjects. The study population consisted of nine female weight lifters using androgens and seven female weight lifters in the follicular phase of the menstrual cycle who were not using androgens (Table I). They were evaluated at The Ohio State University Clinical Research Center after informed consent and assurances of confidentiality were obtained. A patient interview, a detailed questionnaire, and a blood specimen were acquired. These women had no history of illness in the past month, other than upper respiratory infections. They were nonsmokers and alcohol intake was modest. The most frequently used steroids were methandrostenolone (Dianabol), stanozolol (Winstrol), nandrolone decanoate (Deca-Durabolin), oxandrolone (Anavar), and injectable testosterone preparations. Also used were mibolerone, methenolone acetate, trenbolone acetate, and Parabolin. These athletes obtained their steroids by nonprescription methods. A blood sample was obtained when androgen use was at its peak and also when androgen use ceased. However, only three subjects stopped steroids completely in a 12month period, for 3, 4, and 9 weeks, respectively. Assays. Laboratory studies included a complete blood cell count and chemical analyzer measurements 1385
November 1991 Am J Obstet Gynecol
1386 Malarkey et al.
Table I. Characteristics of weight lifters in relation to androgen use Androgens Subject No.
1 2 3 4 5 6 7 8 9 Mean ± SE Nonusers
Age (yr)
Weight (kg)
Height (cm)
29 28 41 40 30 35 26 23 33 31.7 ± 2* 25 ± 2
62.7 58.6 77.3 68.2 68.2 51.8 52.3 75.5 60.9 63.9 ± 3.1 60 ± 6.2
162.6 157.5 167.6 170.2 160.0 152.4 160.0 162.6 160.0 161.4 ± 1.8* 168 ± 2.0
Tmining (yr)
Dmg use Cyr)
12 7 7 5 5 7 4 3 5 6± 1* 3 ± 0.7
7.0 5.0 5.0 4.0 4.5 5.0 3.5 0.25 3.0 4 ± 0.6 NA
Menses
Oral
Oligomenorrhea Oligomenorrhea Amenorrhea Oligomenorrhea Amenorrhea Normal Normal Oligomenorrhea Oligomenorrhea
2
Normal
I
Injectable
2 3 3
I I I
2 2 1 2 0 1.3 ± 0.2 NA
I I I
0 2 1 1.6 ± 0.3 NA
NA, Not applicable.
*Significantly different from controls (p < 0.05).
Table II. Effect of self-administered androgens on gonadtropins and sex steroid metabolism in women
Subject No.
1 2 3 4 5 6 7 8 9 Mean ± SE Nonusers Normal range
Folliclestimulating hormone (IV IL)
12 3 3 4 6 12 14 3 10
7.4 ± 1.5* 12.3 ± 1.1
