Endocrine Abstracts

Background: The widespread use of anabolic steroids and contaminated supplements poses a growing challenge in endocrine practice, often leading to hypogonadism, mood disturbances, and impaired quality of life. We present two cases of androgen-related hypogonadism, highlighting the diagnostic complexities and lifestyle factors contributing to these presentations.

Case 1: A 51-year-old man presented to the endocrine clinic with fatigue, “brain fog,” and low mood. He reported self-administering intramuscular testosterone enanthate (0.5–2 ml weekly) intermittently for nearly 15 years to enhance muscle growth and recovery after gym training. His testosterone concentrations during supplementation reached as high as 72 nmol/l. While on exogenous testosterone, his hemoglobin was 180 g/l, and he donated blood every four months to manage polycythemia. Eleven months after discontinuing injections, his testosterone levels ranged between 6.2–6.5 nmol/l. Despite preserved libido, erectile function, and secondary sexual characteristics, he described persistent fatigue and low mood, suggestive of androgen withdrawal and suppression of the hypothalamic–pituitary–testicular axis.

Case 2: A 34-year-old man presented with reduced libido, persistent fatigue, and low mood, which had strained his marital relationship. His background included long-term shift work in a chocolate factory and prior engagement in intensive gym training. Four years earlier, a routine GP blood test showed an elevated testosterone of 34.3 nmol/l, with hemoglobin 178 g/l and hematocrit 55.4%. He later reported taking protein supplements for over a decade, which were likely adulterated with exogenous testosterone—a recognized issue with some commercial preparations. Following discontinuation of supplements, serial investigations revealed borderline-low testosterone (8.0–8.2 nmol/l) with normal gonadotrophins.

Discussion: These cases highlight the spectrum of hypogonadism associated with exogenous androgen exposure, whether deliberate or inadvertent. Case 1 demonstrates long-term anabolic steroid use leading to biochemical and symptomatic hypogonadism, while Case 2 underscores the risk of hidden androgen adulteration in dietary supplements. Both patients experienced significant impairment in quality of life, despite relatively modest biochemical abnormalities, reflecting a relative deficiency state after prior exposure to supra-physiological testosterone levels.

Conclusion: Clinicians should maintain a high index of suspicion for exogenous androgen exposure in patients presenting with unexplained hypogonadal symptoms, particularly in those with a history of bodybuilding, supplement use, or performance-enhancing drug exposure.