Endocrine Abstracts

Testosterone is frequently used by bodybuilders to increase muscle bulk. It is associated with polycythemia. We present a case of a bodybuilder with polycythemia vera taking testosterone injections presenting with a stroke.

A 38 years old bodybuilder, a non-smoker was admitted with sudden onset of vertigo, slurring of speech and weakness of left leg. Symptoms resolved within few hours. He had a large right sided cerebellar infarct 9 years ago and few transient ischemic attacks later. He was on aspirin and denied taking testosterone injections and had a strongly positive family history for vascular disease.

Initial investigations showed high haemoglobin (18.5 g/dl), haematocrit (0.55%), platelet count (677×10⁻⁹/l), total cholesterol (6.63 mmol/l) and LDL (5.49 mmol/l). White cell count, blood urea and liver function tests were normal. Serum testosterone was high (103.2 nmol/l). Serums LH, FSH were suppressed and other pituitary function tests were normal. MRI scan of the head showed a left cerebellar infarct and a severely narrowed right vertebral artery. Echocardiogram was normal. He was positive for janus kinase 2 (JAK2) gene mutation suggesting polycythemia vera. Methylenetetrahydrofolate reductase (C677T-MTHFR) gene mutation was positive (heterozygous).

He was managed with venesections until haematocrit was <45% and advised to stop testosterone with effect normalisation of testosterone. He is currently on Atorvastatin, Asasantin and Folic acid. We monitor his haematocrit to maintain <45%. Since stopping testosterone he has only needed two venesections for last 6 months.

This young body-builder had a stroke due to combination of risk factors, polycythemia vera, hypercholesterolemia, vertebral artery stenosis and positive C677T-MTHFR gene mutation. Illegal testosterone injections have compounded the risk; such complications should be shown in gyms so that others can learn.