Warning about AS

[bodybuilder6949]

As some of you know, I reported to you that my red blood count was significantly up and have been treating with a Hemotologist since November.....Well I was diagnosed with Polycythemia and now require week phlebotomies (drawing of blood) in order to keep my red count within normal limits. Having said that, the AMA just published a paper indicating that AS can be significant factor in the development of the disease, and since I have been a long time user that makes sence. Now instead of injecting oils each week, I am giving a pint of blood. This will most likely occur for the rest of my life, or until I develop other egregious problems. The one problem that really scares me is leukemia.

So along with all the other concerns Users have about AS, this is now something new to think about while you are injecting or poping pills....

[Bouncer]

Why should anyone believe you when you copied and pasted all those FAQ writtings and said you wrote them?

[therock]

I dont see how this could happen with aas use. Also, Bouncer is right. You are going to have to give us some hard proof, b4 anyone should believe u.

[spidey]

There is a ton of evidence that some AAS can raise red blood cell levels but all the articles I have read point to this being a temporary phenomenon. I have never read or heard of AAS being linked to Polycythemia.

[Mr I]

I thought raising red blood cell count was a good thing in that it enables better transportation of oxygen

[oswald]

no, high count of red blood cell is bad. can cause leukemia, thickens the blood that leads to heart attacks or strokes.

[spidey]

Originally posted by spidey
There is a ton of evidence that some AAS can raise red blood cell levels but all the articles I have read point to this being a temporary phenomenon. I have never read or heard of AAS being linked to Polycythemia.

OK, I take that back. I just did a PUBMED search on Polycythemia and steroids and found a few articles. Note that the Polycythemia in question was temporary however and reversed upon cessation of testosterone replacement. Also, note that it is quite rare for test replacement to cause Polycythemia as evidenced by the physician's statement that they were unaware of any other publications at the time making that connection.

POLYCYTHAEMIA AS A COMPLICATION OF TRANSDERMAL TESTOSTERONE THERAPY
As the population of Western developed countries becomes
older, the well-being of elderly citizens is an emerging
challenge. Hormonal replacement therapy is being prescribed
ever more frequently for the elderly, but the clinical
consequences of these treatments are not fully understood.
A 73-year-old man was hospitalized for evaluation of an
8-kg weight loss, sweats and redness of facial skin. His past
medical history included asthma and hypertension for
which he received fluticasone and losartan respectively.
The symptoms developed 10 months after beginning daily
transdermal testosterone therapy with 10 mg of androstanolone.
This drug was prescribed within the context of a
protocol to slow the natural ageing process, even though
the patient had low±normal serum testosterone levels. One
year before admission, the haemogram was normal and his
pulse was 100 beats/min and regular. The patient had no
fever and no hepatosplenomegaly, but he was hypertensive
(170/95 mmHg). Results of blood analyses were white
blood cells (WBCs) 6 109/l (62% granulocytes and 22%
lymphocytes), red blood cells (RBCs) 5´870 1012/l,
haemoglobin (Hb) 17´8 g/dl, haematocrit 56%, mean
corpuscular volume 95 fl (normal range 85±95 fl), platelet
count 176 109/l, serum B12 0´45 ng/l (normal range
250±750 ng/l), serum erythropoietin 1´07 U/l (normal
range 1´9±13´7 U/l) and red cell volume 52 ml/kg. Histological
examination of bone marrow aspirate and biopsy
samples demonstrated hyperplasia of the three cell lines
without dystrophy and fibrosis; bone marrow cells were
cytogenetically normal. Abdominal computerized tomography
scan detected no enlarged spleen or tumoral mass. The
diagnosis was consistent with secondary polycythaemia and
transdermal testosterone was stopped. Three months later,
the patient had gained 4 kg, Hb was 14´6 g/dl, haematocrit
was 45%, serum erythropoietin was 7´5 U/l and red cell
volume had decreased (40 ml/kg); the last was completely
normalized 9 months after testosterone withdrawal.
Serum androgen levels decline with age in normal men,
such that most men over 60 years of age have mean serum
total testosterone levels near the low end of the normal
adult range. It is not known whether lower testosterone in
older men has an effect on androgen-responsive organ
systems, such as muscle, bone and prostate. Consequently,
in Western countries, current studies are trying to evaluate
the relative benefits and risks of testosterone supplementation
in older men. Testosterone has been touted by some
members of the alternative medicine community as a sexual
potency enhancer, energy stimulator and all-round fountain
of youth. However, haematocrits and RBC volumes have
Correspondence 237
q 2000 Blackwell Science Ltd, British Journal of Haematology 110: 234±243
been shown to rise significantly during testosterone
replacement therapy and the stimulatory effects of androgens
on erythropoiesis are well documented (Shahidi, 1973;
Krauss et al, 1991; Tenover, 1992). Drinka et al (1995)
recently reported two cases of polycythaemia in two men,
one aged 66 and one aged 73 years old who had,
respectively, received intramuscular testosterone (150 mg/
70 kg every 2 weeks) for 14 and 17 weeks. The risk of
haemoconcentration during testosterone therapy might be
greater if the patient also has a condition considered as a
risk factor for polycythaemia, such as sleep apnoea
syndrome (Drinka et al, 1995). Although elevated haematocrits
have been reported for parenteral testosterone
supplementation (Tenover, 1992; Drinka et al, 1995), we
are unaware of reports linking topical testosterone with the
development of polycythaemia. We describe the first case in
which the transdermal delivery of testosterone across nonscrotal
skin of a male patient probably induced supraphysiological
concentrations of testosterone. Androstanolone
withdrawal led to the normalization of the red cell
volume, suggesting that the drug was responsible for the
appearance of polycythaemia. Testosterone is able to
increase erythropoiesis by stimulating the kidney to
produce erythropoietin but in our patient the serum
erythropoietin level was low, suggesting an erythropoietinindependent
mechanism of polycythaemia induction
(Shahidi, 1973). Thus, during testosterone replacement
therapy, haematocrit monitoring should be standard
practice in medical centres and older men should be tested
periodically throughout therapy.
1Clinique de MeÂdecine Interne
et Maladies Infectieuses, and
2Service d'HeÂmatologie,
HoÃpital Haut-LeÂveÃque,
Avenue de Magellan,
33604 Pessac, France.
E-mail:
[email protected]
J. F. Viallard1
G. Marit2
P. MercieÂ1
B. Leng1
J. Reiffers2
J. L. Pellegrin1
REFERENCES
Drinka, P.J., Jochen, A.L., Cuisinier, M., Bloom, R., Rudman, I. &
Rudman, D. (1995) Polycythemia as a complication of testosterone
replacement therapy in nursing home men with low testosterone
levels. Journal of the American Geriatric Society, 43, 899±900.
Krauss, D.J., Taub, H.A., Lantinga, L.J., Dunsky, M.H. & Kelly, C.M.
(1991) Risks of blood volume changes in hypogonadal men
treated with testosterone enanthate for erectile impotence. Journal
of Urology, 146, 1566±1570.
Shahidi, N.T. (1973) Androgens and erythropoiesis. New England
Journal of Medicine, 289, 72±80.
Tenover, J.S. (1992) Effects of testosterone supplementation in the
aging male. Journal of Clinical Endocrinology and Metabolism, 75,
1092±1098.
Keywords: polycythaemia, transdermal testosterone, elderly.


POLYCYTHEMIA IN A PHYSICIAN SECONDARY
TO SELF-ADMINISTERED GROWTH HORMONE,
TESTOSTERONE, AND DEHYDROEPIANDROSTERONE
TO PREVENT AGING
To the Editor: Recently, the use of hormonal supplementation
in healthy elderly subjects to prevent the effects of
aging has generated much interest in the lay and medical
literature.1,2 During normal aging, there is progressive
decline in growth hormone (GH) secretion (somatopause),
impairment of ovarian and testicular function, and reduced
adrenal androgen secretion. GH supplementation increases
lean body mass, skin thickness, and bone density and
decreases adipose tissue in normal elderly people.1 Testosterone
administration in elderly men might improve lean
body mass and sexual function.3 Dehydroepiandrosterone
(DHEA) administration might also have beneficial effects
on some age-related bodily changes.4 Nevertheless, the side
effects and long-term safety of hormonal supplementation
remain unknown.
A healthy 65-year-old physician practicing family
medicine decided to self-administer a combination of GH,
testosterone, and DHEA to maintain vigor and prevent
aging. Before commencement of treatment, his blood
counts were hemoglobin (Hb) 16.8 g/dL, white blood cell
(WBC) 7.7 109/L, and platelet (plt) 238 109/L. He had
not undergone endocrinological evaluations. The treatment
consisted of four units of recombinant human GH
subcutaneously every week, testosterone 250 mg intramuscularly
every month, and oral DHEA 50 mg every day. After
3 months of hormonal administration, a blood count
showed Hb519.8 g/dL, WBC55.9 109/L, and plt5
189 109/L. The treatment was stopped and venesection
Figure 1. Power flow Doppler ultrasound reveals no flow
through the external carotid artery.
LETTERS TO THE EDITOR 1031 JAGS JUNE 2004–VOL. 52, NO. 6
of two units of blood performed. Physical examination was
normal. Ultrasonogram of the abdomen and kidneys were
normal. Plasma erythropoietin was suppressed to an
undetectable level. A diagnosis of hormone-induced polycythemia
was made. He was reassured but advised to stop the
medication. Two months after cessation of treatment, his
blood counts had returned to normal (Hb515.4 g/dL,
WBC56.6 109/L, and plt5182 109/L). Plasma erythropoietin
level had risen to 5.9 mU/mL (reference range5
2.9–24.5). His latest blood counts and erythropoietin levels
have remained normal, nearly 1 year afterward.
None of the hormones used in this case has been
reported to give rise to polycythemia when administered at
the dose described. Therefore, the development of polycythemia
was likely due to the synergistic interactions of the
three hormonal supplements. Neither the benefits nor the
long-term safety of hormonal supplementation are known.
In elderly subjects, concerns have been raised about the
possibility of increased cancer risks with GH administration.
2 This case showed that even physicians might find it
difficult to determine the risk and benefits from the existing
literature. The medical profession and the lay public should
wait for future clinical and laboratory research to determine
the role of hormonal supplementation in the elderly
population.
Yok L. Kwong, MD
Department of Medicine
Clarence C. K. Lam, FRC Path
Department of Pathology
Queen Mary Hospital
Hong Kong
REFERENCES
1. Rudman D, Feller AG, Nagraj HS et al. Effects of human growth hormone in
men over 60 years old. N Engl J Med 1990;323:1–6.
2. Vance ML. Can growth hormone prevent aging? N Engl J Med 2003;348:779–
780.
3. Steidle C, Schwartz S, Jacoby K et al. AA2500 testosterone gel normalizes
androgen levels in aging males with improvements in body composition and
sexual function. J Clin Endocrinol Metab 2003;88:2673–2681.
4. Baulieu EE, Thomas G, Legrain S et al. Dehydroepiandrosterone (DHEA),
DHEA sulfate, and aging: Contribution of the DHEAge study to a sociobiomedical.
Proc Natl Acad Sci U S A 2000;97:4279–4284.

[bodybuilder6949]

FYR

My doc told me of the AMA findings yesterday and it was not based on HRT....it was based on AS used 7 to 10 higher ......which is about what I was taking, and probably what many of the board members are taking....I will ask her for the article and post it asap. There is no cure for polycythemia if you have it...you can only control the symtoms, and at any time your bone marrow can decide to stop producing red blood cells, causeing the spleen to take over....all this leads to disaster and leukemia.....as a matter of fact, if bleeding you does not work, the medical profession introduces chemotherapy into your system to slow down the production of RBC...after 15-20 years of this stuff you stand a 78% chance of leukemia.....

[therock]

Originally posted by therock
I dont see how this could happen with aas use. Also, Bouncer is right. You are going to have to give us some hard proof, b4 anyone should believe u.

I take this statement back bro. After reading what Spidey put and doing my own research, I come to the conclusion that you are in fact telling the truth. Also keep us posted bro, and what the hell were you on and at what dosage if you dont mind me asking.

[jipped genes]

you the man spidey

[house1]

nice stuff spidey

[Twix]

bump

[Keiser]

sorry to hear that man, thanks for posting and letting everyone know. Good luck and keep us updated on your condition.

[bodybuilder6949]

therock

for the last 6 years I have been on a variety of AS....including Deca, Cyp test, Enan test, sust, fina, dbol and a50.......I would take about 1200-1600 mg per week of the injectibles and run the orals for about 4-6 weeks during the 12 week cycle.....According to my doctor, its not the amount you take.....Polycythemia can strike anyone one at anytime.....my dad passed away 10 years ago with luekemia so I am assuming that at some point in my life the disease will develop into that....thanks for asking.....this is a source of deep concern for me and a source of depression. It's nice to be in your 50's an have a 224lb body of a 20 y.o., but it's nicer to have your health.......be careful gentlemen.....don'
t be in denial......this can happen to you..........bob

[therock]

How old are you?