Disruption and recovery of testicular function during and after androgen abuse: the HAARLEM study.

STUDY QUESTION: What is the speed and extent by which endogenous testosterone production and spermatogenesis recover after androgen abuse? SUMMARY ANSWER: Testosterone concentrations normalized within 3 months after discontinuation of androgen abuse in most subjects but recovery of spermatogenesis took longer-approximately 1 year. WHAT IS KNOWN ALREADY: An estimated 4-6% of amateur strength athletes use androgens. Abuse of supraphysiological doses of androgens completely suppresses endogenous testosterone production and spermatogenesis. STUDY DESIGN, SIZE, DURATION: Prospective and observational cohort study in which 100 male amateur athletes participated for 1 year. PARTICIPANTS/MATERIALS, SETTING, METHODS: Subjects (≥18 years) were included if they had not used androgens for at least 3 months and intended to start an androgen cycle within 2 weeks. Clinic visits took place before (T0), at the end (T1), and 3 months after the end of the cycle (T2), and 1 year after start of the cycle (T3), and included a blood test for gonadotrophins and sex hormones, and semen analysis. MAIN RESULTS AND THE ROLE OF CHANCE: During androgen abuse, 77% of subjects had a total sperm count (TSC) below 40 million. Three months after the end of the cycle (T2), total (-1.9 nmol/l, CI -12.2 to 8.33, P = 0.71) and free (-38.6 pmol/l, CI -476 to 399, P = 0.86) testosterone concentrations were not different compared to baseline, whereas mean TSC was 61.7 million (CI 33.7 to 90.0; P < 0.01) lower than baseline. At the end of follow-up (T3), there was no statistically significant difference for total (-0.82 nmol/l, CI -11.5 to 9.86, P = 0.88) and free (-25.8 pmol/l, CI -480 to 428, P = 0.91) testosterone compared to baseline, but there was for TSC (-29.7 million, CI -59.1 to -0.39, P = 0.05). In nine (11%) subjects, however, testosterone concentrations were below normal at the end of follow-up (T3), and 25 (34%) subjects still had a TSC below 40 million. LIMITATIONS, REASONS FOR CAUTION: The follow-up period (after the cycle) was relatively short, especially considering the long recovery time of spermatogenesis after discontinuation of androgens. WIDER IMPLICATIONS OF THE FINDINGS: Endogenous testosterone production and spermatogenesis recover following androgen abuse in the vast majority of users. Nevertheless, not all users achieve a normalized testicular function. This may especially be the case for athletes with a high past exposure to androgens. STUDY FUNDING/COMPETING INTEREST(S): There is no conflict of interest. The study was funded by the Spaarne Gasthuis academy. TRIAL REGISTRATION NUMBER: N/A.

Hereditary leiomyomatosis and renal cell cancer in families referred for fumarate hydratase germline mutation analysis.

Heterozygous fumarate hydratase (FH) germline mutations cause hereditary leiomyomatosis and renal cell cancer (HLRCC), an autosomal dominant syndrome characterized by multiple cutaneous piloleiomyomas, uterine leiomyomas and papillary type 2 renal cancer. The main objective of our study was to evaluate clinical and genetic data from families suspected of HLRCC on a nationwide level. All families referred for FH mutation analysis in the Netherlands were assessed. We performed FH sequence analysis and multiplex ligation-dependent probe amplification. Families with similar FH mutations were examined for haplotype sharing. In 14 out of 33 families, we identified 11 different pathogenic FH germline mutations, including 4 novel mutations and 1 whole-gene deletion. Clinical data were available for 35 FH mutation carriers. Cutaneous leiomyomas were present in all FH mutation carriers older than 40 years of age. Eleven out of 21 female FH mutation carriers underwent surgical treatment for symptomatic uterine leiomyomas at an average of 35 years. Two FH mutation carriers had papillary type 2 renal cancer and Wilms' tumour, respectively. We evaluated the relevance of our findings for clinical practice and have proposed clinical diagnostic criteria, indications for FH mutation analysis and recommendations for management.

[Outpatient clinic for users of anabolic androgenic; experiences and practical tools]. / De Anabolenpoli.

In the Netherlands, an estimated 20,000 men abuse illegal androgens. The confrontation with a patient who uses illegal substances can evoke questions and emotions. We advise not to moralize users of anabolic steroids, but to strive for harm reduction by starting a discussion about the pros and cons of androgen abuse, taking into account your assumptions and judgments about this subject. Underlying psychopathology should be recognized and treated if the user is open to it. We recommend against prescribing anabolic steroids without medical indication and not to perform health checks routinely while the patient continues using anabolic steroids as long as it is not established that this can prevent health damage. If the user reports with health problems, this should be used as a starting point to (re) open the conversation about the advantages and disadvantages of use. Harmful effects of use must be handled according to appropriate guidelines.

Spontaneous haemorrhage of hepatic adenoma in a patient addicted to anabolic steroids.

This case report describes a patient with a nearly fatal spontaneous haemorrhage of a hepatic adenoma that occurred in association with anabolic androgenic steroid (AAS) use. The patient was addicted to AAS and had been using exceptionally high dosages as well as growth hormone. After cessation of AAS use, testosterone replacement therapy was started to prevent post-AAShypogonadism and consequent relapse.

Outpatient clinic for users of anabolic androgenic steroids: an overview.

BACKGROUND: Anabolic androgenic steroids (AAS) are used by approximately 20,000 amateur athletes in the Netherlands. AAS are harmful but data are lacking as to precisely how harmful they are. An outpatient clinic for past and current users of AAS was established in 2011 to acquire more knowledge about the health risks associated with AAS abuse. METHODS: All case files of the patients who visited the AAS clinic were reviewed retrospectively. RESULTS: 180 patients visited the AAS clinic between May 2011 and May 2016. Patients were strength athletes (99% male, mean age 34 years, range 19-61) who had started AAS use at a median age of 23 years (range 16-53). 95% used AAS in cycles (median of 4 cycles completed, median duration 10 weeks). Cycles consisted of a median of three different AAS, most commonly testosterone, nandrolone and trenbolone. Growth hormone was used by 34% in addition to AAS. Side effects occurred in 96% of patients, mainly acne (38%), gynaecomastia (34%) and agitation (27%) during cycles; decreased libido (34%) and erectile dysfunction (20%) afterwards. Medications regularly used by patients to self-treat side effects were aromatase inhibitors, clomiphene citrate, human choriogonadotropin, and tamoxifen. CONCLUSION: AAS abuse did not lead to critical health issues. However, the incidence of less severe side effects among AAS users appears high. Considering the large number of abusers in the community, AAS abuse poses an important public health problem. A prospective study with a systematic approach is required to provide more reliable data regarding health risks of AAS abuse.