Endocrine Abstracts

Background: Androgen abuse is associated with a threefold increase in mortality, primarily due to cardiovascular disease, with significant psychiatric and reproductive morbidity. Men are often reluctant to disclose androgen abuse to healthcare professionals, making clinical management highly challenging. World Anti-Doping Agency (WADA)-accredited laboratories use urinary testosterone-to-epitestosterone (T/E) ratio to detect undisclosed androgen abuse, but this is unavailable in the NHS. Identifying reliable, routinely available serum biomarkers of undisclosed androgen abuse could provide a feasible alternative to urinalysis, helping clinicians manage men withdrawing from androgen abuse.

Methods: A prospective, ethics-approved study recruited ninety-three community-dwelling men self-reporting cessation of androgen abuse. Fasting morning serum and urine samples were collected. Urine steroid profiles were analysed by the London-based WADA-accredited laboratory, with T/E ratio determined by tandem gas chromatography-mass spectrometry.

Results: Undisclosed androgen abuse was identified by a raised T/E ratio in 23% (21/93) of men self-reporting androgen abuse cessation. Men with undisclosed androgen abuse had higher serum testosterone (30.1±13.7 vs 14.0±8.0nmol/l; p<0.0001), oestradiol (183±73 vs 103±10pmol/l; p<0.0001), and haemoglobin (168±16 vs 158±13g/l; p=0.006), and lower LH (0.6±1.3 vs 2.6±1,4IU/l; p<0.0001), and FSH (0.5±0.8 vs 3.1±1.8IU/l; p<0.0001) compared with men with confirmed androgen cessation. Serum FSH (AUC=0.93, P < 0.0001) was highly discriminatory for undisclosed androgen abuse. FSH levels >1.0IU/l indicated a 96% probability that concealed androgen abuse was excluded. Serum oestradiol (AUC=0.91, P < 0.0001), LH (AUC=0.88), and testosterone (AUC=0.85) showed good discrimination for undisclosed androgen abuse.

Conclusion: In the largest study of its kind, using state-of-the-art toxicological analysis, we report that 23% of men continue undisclosed androgen abuse despite self-reporting cessation. However, our data reveal that routinely available serum markers could identify most of these men. Our data may have potential to help clinicians support men to safely withdraw from androgen abuse.