// ARS TECHNICA — MONDO
Man's secret use of synthetic testosterone for cows nearly destroyed his heart
Doctors warn that such life-threatening cases are becoming more common.
For 11 years, a Massachusetts man had an alarming array of health problems, most notably that his heart kept failing. He landed in the hospital over and over again, needed life support at one point, spent years going to specialists, and underwent a barrage of tests along the way.
But through it all, he never revealed a key detail behind his ailments: He was taking powerful, illicit synthetic testosterone derivatives (aka anabolic-androgenic steroids, or AAS). One of the drugs he took was approved only for use in animals; it’s primarily used to beef up cows.
Left in the dark, his doctors had to puzzle this out on their own. In a case report in this week’s issue of the New England Journal of Medicine, they explain how they did it. They also offer a warning: These cases will only become more common, and clinicians need to know what they look like.
“Use of AAS has now become a major international substance use disorder,” they wrote. In the US, it’s estimated that between 2.9 and 4 million people, mostly male athletes, use AAS. To put this in a public health perspective, this is more than the number of people in the US with an HIV infection.
“Clinicians should be prepared to encounter increasing numbers of patients presenting with the long-term effects of AAS exposure, including cardiomyopathy, atherosclerotic disease, and anabolic steroid–induced hypogonadism.”
Patients also need to be prepared for what recovery looks like, which they described as being “lengthy and varied.” The man’s case offers a stark example.
The problems started when he was 39. He fell ill after returning from a trip to the Caribbean and went to Massachusetts General Hospital in Boston with a fever, chills, and trouble breathing. Tests suggested he had an acute kidney injury, liver damage, and an injured heart. Testing of his heart showed that the left chamber was pumping out just 21 percent of its blood in a beat (a normal amount is above 50 percent). His heart only got worse from there, and within hours, he ended up on a type of life support called ECMO (venoarterial extracorporeal membrane oxygenation), a machine that does the work of both the heart and lungs in dire circumstances. He luckily recovered—and quickly. But doctors were baffled by the cause.
When he was weaned off ECMO a few days later, his heart function normalized. Doctors looked for evidence of anything that could have sparked the sudden cardiac spiral. They found nothing but a mildly elevated level of antibodies against a toxin made by Streptococcus bacteria. In rare instances, an infection with these germs can lead to a condition called poststreptococcal myocarditis, which could potentially explain some of his symptoms. It was their best guess. They prescribed him antibiotics, as well as drugs to lower his blood pressure.
Two years later, he went to another hospital. This time it was for acute pain in his abdomen and legs. Doctors found signs of cell death in his kidneys. The arteries that supply blood to his kidneys appeared narrowed, suggesting a condition called renal-artery stenosis. There were also signs of inflammation in his blood vessels. But the doctors at the hospital couldn’t pinpoint the problem. They prescribed him anti-inflammatory drugs and sent him on his way.