Doping with testosterone and androgenic/anabolic steroids: Impact on health, screening tools and medical care

Abstract

Doping in elite or amateur athletes with testosterone, androgens and anabolic steroids (A/AS) has as a main objective to develop muscle strength and mass to improve sports performance. Massive doping is a worldwide public health issue insufficiently known by physicians in general and by endocrinologists in particular. Yet, its prevalence, probably underestimated, would be between 1 and 5% at the international level. Numerous deleterious effects associated with A/AS abuse have been identified: inhibition of the gonadotropic axis responsible for hypogonadotropic hypogonadism and infertility in men, and masculinization (defeminization), hirsutism and anovulation in women. Metabolic (very low HDL cholesterol), hematological (polycythemia), psychiatric, cardiovascular and hepatic complications have also been documented. As a result, anti-doping agencies have developed increasingly effective techniques for detecting A/AS, both to identify and punish cheating athletes and to protect the health of the greatest number of them. These techniques use a combination of liquid and gas chromatographic methods coupled with mass spectrometry, known respectively by the acronyms LC-MS and GC-MS. These detection tools have a remarkable sensitivity and specificity to detect natural steroids and synthetic A/AS of known structure. Furthermore, by distinguishing isotopes, it is also possible to distinguish natural endogenous hormones, testosterone and androgenic precursors from those administered for doping purposes. For elite athletes, a “biological passport” has also been introduced. It consists of monitoring the evolution of steroids and their metabolites, as well as other biological parameters in the blood and urine over time after having established a basal state athlete signature, established, a priori, without doping. Better training of health professionals, general practitioners and specialists should be a priority for academic institutions and medical societies. It would provide them with better knowledge of the populations at risk and the clinical and biological semiology of male and female doping, including withdrawal syndrome associated with anxiety and depression following cessation of chronic A/AS use. The ultimate goal is to provide these physicians with the keys to treating these patients while combining medical rigor and empathy. These points will be addressed in this short manuscript.