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.

Oestrogens are Not Related to Emotional Processing: a Study of Regional Brain Activity in Female-to-Male Transsexuals Under Gonadal Suppression.

Although the prevailing opinion is that emotional processes are influenced by sex hormones, the literature is still inconclusive. The aim of the current study was to examine the effects of gonadal suppression on brain activity during affective picture processing. Twenty-one female-to-male (FtM) transsexuals and 19 control women were recruited and underwent functional magnetic resonance imaging scanning while rating emotional pictures adapted from the International Affective Picture System. The gonadal hormone production of the FtMs was suppressed for 8 weeks, the control group did not receive any treatment before scanning. Under gonadal suppression, FtMs showed less brain activation in the superior temporal lobe compared with female controls during perception of positive affective pictures. Regression analysis showed that during processing of positive affective images, brain activity within the right superior temporal lobe was not correlated with levels of estradiol, luteinizing hormone, and follicle-stimulating hormone. In the absence of associations with hormonal levels, the difference in activation in the superior temporal lobe during positive emotional stimuli between FtMs and control women may be attributed to a priori differences between the 2 groups. Future studies should clarify if these differences are a result of atypical sexual differentiation of the brain in FtMs.

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones.

OBJECTIVE: Adverse effects of long-term cross-sex hormone administration to transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones. DESIGN: A cohort study with a median follow-up of 18.5 years at a university gender clinic. Methods Mortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses. RESULTS: In the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population. CONCLUSIONS: The increased mortality in hormone-treated MtF transsexuals was mainly due to non-hormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death. In the FtM transsexuals, use of testosterone in doses used for hypogonadal men seemed safe.

[Use of androgenic anabolic steroids before and during the Olympic Games: less but has not died out]. / Gebruik van androgene anabole steroïden voor en tijdens de Olympische Spelen: verminderd, maar niet verdwenen.

Androgenic anabolic steroids are compounds with a chemical structure and clinical effect very similar to those of the male hormone testosterone. Since their introduction these substances have been misused in an effort to improve athletic performance. Detection of misuse has long been inadequate. For this reason a state doping programme was developed by the government of the former German Democratic Republic (GDR). Systematic doping abuse ended with the collapse of the GDR and the introduction of out-of-competition surprise drug testing. The performance-enhancing effects of doping and the introduction of intensive doping surveillance are reflected in the decline in performance in several women's track and field events.

[Some new aspects of the Klinefelter syndrome]. / Enkele nieuwe aspecten van het klinefeltersyndroom.

Klinefelter syndrome (KS) is the most frequent form of male hypogonadism. Still, at least 50% ofcases are not diagnosed, partly because of the great variation in the clinical symptoms, partly because physicians are unfamiliar with KS. Timely treatment with testosterone can contribute to a more positive body image and, consequently, to a healthier psychosexual development in men with KS. Men with KS experience significantly more health problems and an increased risk ofa malignancy. New reproductive techniques no longer automatically mean that men with KS will remain infertile. Treatment with testosterone is in principle life-long to prevent osteoporosis and loss of muscle mass and strength.

['Hungry bone' syndrome, characterized by prolonged symptomatic hypocalcemia, as a complication of the treatment for hyperthyroidism]. / 'Hungry bone'-syndroom, gekenmerkt door langdurige symptomatische hypocalciëmie, als complicatie van behandeling wegens hyperthyreoïdie.

A 22-year-old woman presented with palpitations, agitation, heat intolerance and unintentional weight loss that had started several months before. Pharmacotherapy for hyperthyroidism was prescribed, but a year later thyroidectomy was performed in connection with a lack of treatment compliance. A few hours after the operation the patient developed a tingling sensation and muscle cramp, which were found to be due to severe hypocalcaemia. Although surgery was complicated by hypoparathyroidism, there was an unusually high need for calcium combined with a low calcium excretion in the urine. Such a high need for calcium due to the increased bone reconstruction induced by the hyperthyroidism is referred to as the hungry bone syndrome. One should be particularly alert to this complication in cases of severe, prolonged hyperthyroidism, certainly in the presence of existing or peroperatively induced damage to the parathyroids. In this patient, calcium suppletion led to normalisation of the serum calcium level two weeks postoperatively; she was discharged from the hospital in good condition after 3 weeks.