Reversible Gynecomastia and Hypogonadism Due to Usage of Commercial Performance-Enhancing Supplement Use.
This case report describes a 40-year-old male who developed bilateral gynecomastia and biochemical hypogonadotropic hypogonadism after approximately six months of using commercially available performance-enhancing supplements. Laboratory analysis of the three supplements identified several banned performance-enhancing drugs (PEDs): RAD-140 (a selective androgen receptor modulator), MK-677 (a growth hormone secretagogue), and cardarine. In vitro testing also revealed undisclosed hormones — testosterone, estradiol, and growth hormone — present in all three products. Liquid chromatography-mass spectrometry further identified an uncharacterized compound eluting near the testosterone peak. Upon cessation of all supplements, the patient experienced full clinical and biochemical resolution of his symptoms, including normalization of gonadotropin and testosterone levels. The authors argue this case underscores the importance of clinicians considering commercially available supplements as potential covert sources of exogenous PEDs and steroid hormones. Key limitations include the single-patient design, which precludes generalization, the inability to isolate which specific compound(s) caused the adverse effects, and the lack of confirmed identity of the uncharacterized coeluting compound.
Why this grade: Single case report in one human patient; findings are observational and cannot establish causation or be generalized beyond this individual.
Commercially available performance-enhancing supplements can contain banned performance-enhancing drugs (PEDs) and undisclosed steroid hormones that can induce hormonal abnormalities with associated clinical signs. We present a case of a 40-year-old male who developed bilateral gynecomastia and biochemical hypogonadotropic hypogonadism with a corresponding 6-month history of consuming commercially available performance-enhancing supplements for gym workouts. These performance-enhancing supplements were found to contain amounts of RAD-140, a selective androgen receptor modulator, MK-677, a GH secretagogue and cardarine, all of which are banned PEDs. In vitro analysis also detected undisclosed hormones testosterone, estradiol, and GH in all 3 supplements, with further steroid analysis using liquid chromatography mass spectrometry identifying an unidentified compound coeluting close to the testosterone peak. Cessation of these supplements led to full resolution of symptoms including normalization of hypogonadotropic hypogonadism. This case highlights the need for clinicians to consider commercially available performance-enhancing supplements as potential sources of PEDs and exogenous steroid hormones that can have adverse clinical consequences.
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