Beware: Nutritional supplements may be contaminated with anabolic steroids

A young man was referred to me for evaluation of low testosterone and gynecomastia. The initial total testosterone was 57 ng/dL; results of a repeat testosterone assessment were even lower. Prolactin was normal, but follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were both undetectable. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were previously normal but were now both over 200. His total and LDL cholesterol levels were high; his HDL was low.

He was muscular, physically fit and an avid weight lifter. I questioned him about the use of anabolic steroids. He had not knowingly used any product that was marketed as an anabolic steroid for a few years. He seemed sincere and I believed him.

However, he had recently been using some nutritional supplements and ergogenic aids purchased on the Internet and from a local health food store. Interestingly, one of these products was no longer available; it had been taken off the shelves. When he asked the salesman about it, he was told that “it was taken off the market for re-formulation.”

Intentional and unintentional contamination of nutritional and dietary supplements continues to be a common and serious problem. An international study found that, of 634 nutritional supplements purchased off the shelf, about 15% were contaminated by anabolic and androgenic steroids and pro-hormones.

Athletes have tested positive for restricted drugs and been barred from competition after taking supplements that they did not know were contaminated with anabolic steroids and other prohibited substances. Furthermore, these agents may have serious health consequences, including hepatotoxicity, gynecomastia, psychiatric disturbances and potentially increased risk for cancer and cardiovascular disease. In women and children, they can result in menstrual irregularity, virilization and precocious puberty. With long-term use, dependency may occur with withdrawal symptoms upon cessation.

Unfortunately, the FDA has limited regulatory authority over products marketed as dietary and nutritional supplements, many of which are manufactured in other countries where there is even less oversight. Worldwide nutrition and dietary supplements are a $60 billion dollar a year industry that is essentially unregulated.

Endocrinologists must be on the alert for intentional and unintentional exposure to anabolic steroids and other androgenic hormones and pro-hormones. Some of our patients may take these products knowingly and are in denial of the potential risks. However, I suspect that there are many others who are similar to the patient I described above. They have mistakenly assumed these products are safe because they are dietary supplements readily available without a prescription.

For more information:

Geyer H. Int J Sports Med. 2004;25:124.

Geyer H. J. Mass Spectrom. 2008;43:892-902.

de Hon O. Br J Sports Med.2007;41:800–805.