Endocrine Abstracts

36-year-old gentleman referred by his GP with poor libido and erectile dysfunction associated with hypogonadotrophic hypogonadism. 0900 h testosterone 0.3 nmol/l (10–35), LH <0.2 IU/l, FSH 0.1 IU/l, prolactin 71 mIU/l (50–500).

Symptoms started at time of break up of his marriage in 2011. No other symptoms of hypogonadism or of pituitary disease. Previously fit and well. Teetotal. On no medication. Patient an avid fitness fanatic. He had never knowingly used anabolic steroids. However, he had taken a ‘nutritional supplement’ called T-Bullets (purchased from a sports nutrition shop to improve his gym performance) for 20 days until just before GP’s blood test. Examination revealed a well virilised gentleman with no signs of hypogonadism.

Further investigations

0900 h cortisol 457 nmol/l (138–690); IGF1 331 μg/l (75–344); FT₄ 11 pmol/l (5.6–21); Normal U&E, FBC and LFT. MRI pituitary and hypothalamus within normal limits

6 months after stopping T-Bullet, testosterone level gradually returning to normal.

04/10/12 – 6.9 nmol/l, 29/10/12 – 10.2 nmol/l

Discussion: T-Bullets are marketed as a ‘nutritional supplement’ by the makers. They are easily available online and can be purchased from some sports nutrition shops. The active ingredient is: ‘2a, 17a-dimethy-5a-androst-3-one-17b-ol 13-ethyl-3-methoxy-gona-2,5,(10)-dien-17-one’ which Martindale: the complete drug reference lists as an anabolic steroid (related to testosterone)

Conclusion:: Anabolic steroids were first artificially synthesized in the 1930s. The misuse of anabolic steroid drugs to enhance physique, body strength and athletic performance is well-known. Use of anabolic steroids can result in hypogonadotrophic hypogonadism as a result of suppression of the hypothalamo-pituitary–gonadal axis (HPG).

The unwitting consumption of an anabolic steroid should be considered in any patient presenting with hypogonadotrophic hypogonadism who has been taking a ‘nutritional supplement’.

The unwitting consumption of an anabolic steroid should be considered in any patient presenting with hypogonadotrophic hypogonadism who has been taking a ‘nutritional supplement’.