In the case report, doctors provided a more complete picture of the man, noting that he lived with his wife and children in eastern Massachusetts, worked as a facilities manager, and described himself as a workout “fanatic.” He used tanning beds and applied spray tans. He told doctors he had erectile dysfunction and reduced libido for several years. They also noticed that he had mildly enlarged breast tissue (a condition called gynecomastia), progressive insulin resistance, decreased levels of “good” cholesterol (HDL or high-density lipoprotein), and fatty liver disease.
When he arrived at the hospital, he reported five days of worsening chest tightness and pressure, fatigue, swelling in his legs, and trouble breathing. His heart was racing at 134 beats per minute. His blood pressure was high at 146/106 mm Hg. Doctors described him as “muscular, tanned, anxious, and in mild distress.” Tests showed his heart was once again failing, with the left chamber pumping out just 20 percent of its blood.
The doctors started reviewing a long list of possible explanations. They ruled out infectious diseases that can cause heart inflammation (myocarditis), as well as autoimmune conditions, medication side effects, and toxins. The explanation they were left with—which also seemed to explain much of his other problems—was high doses of testosterone, or perhaps an AAS.
Illicit use of AAS is clearly linked to the heart problems, including the decreased blood pumping the man had, as well as strain and damage. It could also explain his enlarged breast tissue, fatty liver and signs of liver damage, progressive insulin resistance, kidney injuries, high blood pressure, and high levels of red blood cells (erythrocytosis). The sleep problems, fatigue, and low testosterone levels—which doctors previously guessed were from obstructive sleep apnea—could actually be from a drop in natural hormone production after doses of AAS (a condition called hypogonadism).
In the man’s lengthy medical history, he had never mentioned using AAS or testosterone supplements. Doctors prepared to have a delicate conversation to determine if he was secretly using the drugs. When they finally broached the topic, he confessed; he had been intermittently using high doses of AAS to boost his muscles, taking the most recent dose before his vacation to the Caribbean. The testosterone derivative he used was trenbolone, an AAS only approved for use in veterinary medicine; it’s mostly used in livestock.
