A young man was referred to me for evaluation of low testosterone and gynecomastia. The initial total testosterone was 57 ng/dL; results of a repeat testosterone assessment were even lower. Prolactin was normal, but follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were both undetectable. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were previously normal but were now both over 200. His total and LDL cholesterol levels were high; his HDL was low.
He was muscular, physically fit and an avid weight lifter. I questioned him about the use of anabolic steroids. He had not knowingly used any product that was marketed as an anabolic steroid for a few years. He seemed sincere and I believed him.