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20171111_230408.jpg
Case: A 33 year old gentleman presented with significantly raised testosterone levels, testicular pain, erectile dysfunction and weight loss. He denied use of anabolic steroids. Upon physical examination he looked muscular and tanned. Left testicle was tender with no palpable mass. Raised androgen levels (Siemens immunoassay) were confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS), ruling out assay interference. In view of his ongoing denial of substance misuse and genuine presentation, ultrasound testes and CT Chest-Abdomen were requested, to rule out the rare possibility of an androgen-producing tumour. Instead, we found a pulmonary embolism. During hospital admission his testosterone levels normalised, rising again after discharge. He continued to deny substance abuse but consented to urinary ‘doping’ investigations. His urine showed a raised testosterone-epitestosterone ratio of >70:1 (ref 0.1–6), and a testosterone concentration >800 ng/ml (ref <150), most likely due to exogenous testosterone use. In addition, urinary Stanozolol metabolites, Trenbolone, Boldenone, Nandrolone and their metabolites were detected. Whilst discussing these results he presented a vial of Trenbolone, expressing his surprise at its long half-life as he used this 2 years ago. We had arranged for psychiatric review immediately thereafter, during which he confessed ongoing substance abuse.
20171111_230408.jpg
Case: A 33 year old gentleman presented with significantly raised testosterone levels, testicular pain, erectile dysfunction and weight loss. He denied use of anabolic steroids. Upon physical examination he looked muscular and tanned. Left testicle was tender with no palpable mass. Raised androgen levels (Siemens immunoassay) were confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS), ruling out assay interference. In view of his ongoing denial of substance misuse and genuine presentation, ultrasound testes and CT Chest-Abdomen were requested, to rule out the rare possibility of an androgen-producing tumour. Instead, we found a pulmonary embolism. During hospital admission his testosterone levels normalised, rising again after discharge. He continued to deny substance abuse but consented to urinary ‘doping’ investigations. His urine showed a raised testosterone-epitestosterone ratio of >70:1 (ref 0.1–6), and a testosterone concentration >800 ng/ml (ref <150), most likely due to exogenous testosterone use. In addition, urinary Stanozolol metabolites, Trenbolone, Boldenone, Nandrolone and their metabolites were detected. Whilst discussing these results he presented a vial of Trenbolone, expressing his surprise at its long half-life as he used this 2 years ago. We had arranged for psychiatric review immediately thereafter, during which he confessed ongoing substance abuse.
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