A 16-year-old boy is brought to the office for evaluation of irritability, slow growth, and acne. The patient plays soccer and has been following an aggressive strength-training program. When asked, he admits to using a performance-enhancing substance for the past 6 months. What additional findings would most likely be present in this patient now compared to 6 months ago?

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11ec160b_3cb6_b22a_9249_efc4cd0798c6_MD0001_00 Testosterone stimulates increased protein synthesis by skeletal myocytes. Some competitive athletes and body builders abuse testosterone and other exogenous androgens to increase muscle mass and improve athletic performance. However, excessive androgenic activity can cause significant adverse effects, including acne (increased dermal sebum production) and neuropsychiatric changes (eg, irritability, aggression, and anxiety). Androgen abuse can also result in profound endocrine and reproductive effects. Spermatogenesis in the seminiferous tubules is driven by FSH and requires a high local concentration of testosterone, which is produced by nearby Leydig cells and retained by androgen-binding protein. Exogenous androgens suppress GnRH, LH, and FSH secretion, leading to reduced endogenous testosterone secretion, impaired spermatogenesis (Choice D), and testicular atrophy. In addition, excess testosterone is converted by aromatase to yield high levels of estradiol (Choice F), which can lead to gynecomastia. In adolescent users, high circulating estrogen levels can also cause premature epiphyseal closure and short stature. (Choices A, B, and C) Excess circulating exogenous androgens (eg, testosterone) suppress pituitary LH release. Educational objective: Androgen abuse suppresses GnRH, LH, and FSH secretion, leading to reduced endogenous testosterone secretion, impaired spermatogenesis, and testicular atrophy. In addition, excess testosterone is converted by aromatase to estradiol, which can lead to gynecomastia. __________ References: Performance-enhancing drug use in adolescence. (http://www.ncbi.nlm.nih.gov/pubmed/30202322)

A 16-Year-Old Boy Is Brought to the Office for Evaluation