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Bodybuilder drugs his liver to oblivion twice

A medical case study that will give you goose bumps, this report from doctors at the US Massachusetts General Hospital. The article tells the story of a 27-year-old competitive bodybuilder and part-time policeman who turned up at the Emergency Department.

The man's been using anabolics for five years, but now he's got stomach pains and is nauseous. The doctors do blood tests and discover that the man's liver is no longer functioning properly. For a start, the concentration of the enzyme ALT is 2457 units per litre: 35 is the healthy maximum. The bodybuilder's blood is syrupy and his haematocrit level is fifty percent. The bodybuilder says he injects nandrolone and takes androstenedione.

The scan the doctors make of his liver shows a real mess, shown in Picture A below. The light patches are swellings, the biggest of which measures 10 x 10 cm.

Bodybuilder drugs his liver to oblivion  twice

The doctors operate and discover that the liver is in an even worse state than they had feared. The organ contains swellings that are filled with blood. Peliosis hepatis is the doctors' diagnosis, the same condition that killed Andreas Muenzer.

The doctors also found a swelling with a diameter of 23 cm. This kind of swelling doesn't usually get bigger than 3 cm. The doctors decide to amputate part of the liver.

After the operation the bodybuilder recovers and is allowed home. When the doctors make another scan three months later they see that the swellings in the remaining part of the liver have shrunk by 40 percent, Picture B above. The bodybuilder thinks it's time to start doping again, and says he's going to start again with androstenedione.

After three years the bodybuilder returns to the doctors. Six weeks previously he had treated himself to injections of a nandrolone derivative. And bingo, he's got stomach pains again.

Three days after admission to the hospital, the bodybuilder's heart rate starts to increase. When the doctors make another scan the picture above on the right they see that his liver is in a bad way again. The swellings have started to grow again, and the liver has a protuberance that has started to bleed.

The doctors discuss briefly whether they should give the guy a new liver, but reject the idea. It would be a waste: he would only destroy it again with pills and injections. Alcoholics are not given a new liver either. So they just stop the bleeding and send the bodybuilder home again.

Thinking about it, we find it difficult to believe that the bodybuilder was only using deca and androstenedione. True, a number of cases have been published of bodybuilders who, as the result of a mild course of deca, developed a blood clot the size of a brick in their stomach, or became psychotic after one single deca injection. But to be honest, we don't believe those studies.

Moreover, neither androstenedione nor nandrolone is harmful to the liver. Laboratory research on liver cells has shown this. And, by the time the doctors were seeing their patient, George Bush had already outlawed androstenedione. Although androstenedione is still on the market, bodybuilders hardly ever use it. Why would they? In countries like the US there are much more effective legal anabolic steroids available. But among these, there are a number of substances that are notoriously bad for the liver.

The most dangerous is Superdrol, an anabolic that was developed at the end of the fifties by Syntex. Doctors have recorded damaged livers and destroyed kidneys in users of Superdrol more than once.

This is what makes us suspect that the bodybuilder in this case study used stronger stuff than androstenedione and deca. Bodybuilders are often not entirely honest about what they have been using when they visit a doctor about medical problems. Even when being honest could have saved their life.

World J Gastroenterol. 2008 Jul 28;14(28):4573-5.