special subjects
Anabolic Steroids
Diagnosis of Anabolic Steroid Use
Usually a clinical diagnosis Sometimes urine testing Although elite athletes are tested for anabolic steroid use by anti-doping agencies, there is no practical diagnostic test to evaluate for surreptitious anabolic steroid use in the general patient population. When a patient presents with signs and symptoms of chronic anabolic steroid use, it is important to have anabolic steroid use in differential diagnoses. It might be useful to measure serumtestosterone, follicle-stimulating hormone, and luteinizing hormone levels, since they are more commonly available tests. Exogenoustestosteroneand anabolic steroids decrease gonadotropin levels. When testing to detect anabolic steroids is done, urine analysis is by gas chromatography-mass spectrophotometry. Testosteronetaken exogenously is indistinguishable from endogenoustestosteroneby gas chromatography-mass spectrophotometry. However, if high levels oftestosteroneare detected, the ratio betweentestosteroneand epitestosterone (an endogenous steroid that chemically is nearly identical totestosterone) is measured. Atestosterone:epitestosterone ratio>6:1 is suggestive of exogenoustestosteroneuse. 