Anabolic steroids are synthetic substances related to male sex hormones (androgens). Although it is illegal in the United States to possess or distribute anabolic steroids for nonmedical use, a "black market" for them exists, and many amateur and professional athletes take them to enhance performance. In many cases, the athletes take doses that are extremely high—perhaps 100 times the doses that might be prescribed for medical use. As a result, they put themselves in real danger of short-term and long-term health problems. Blood testing, as has been used in the Olympic Games, can detect, identify, and quantify the presence of anabolic steroids in the blood of athletes, which can lead to the disqualification of an athlete.
Gynecomastia refers to a syndrome of abnormal feminization with swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. 29 Gynecomastia is common during puberty in boys and can be seen in older males due to increased estrogen level-related obesity (increase aromatase activity), decreased hepatic clearance, estrogen ingestion, and estrogen producing tumors. Asymptomatic gynecomastia is common in older men, but individuals who present with gynecomastia of recent onset associated with pain and tenderness may require clinical workup. 29 Gynecomastia and other signs of male feminization may be caused by an absolute increase in E2 and/or E1. The testes may directly secrete too much estradiol due to a Leydif-cell or Sertoli-cell tumor. They may also secrete estradiol indirectly through the stimulatory effects of a human chorionic gonadotropin-secreting tumor of gonadal or extragonadal germ-cell origin. 29
A positive association has been observed between the amount of estrogen and progestogen in oral contraceptives and the risk of vascular disease. 36–38 A decline in serum high density lipoproteins ( HDL ) has been reported with many progestational agents. 22–24 A decline in serum high density lipoproteins has been associated with an increased incidence of ischemic heart Because estrogens increase HDL cholesterol, the net effect of an oral contraceptive depends on a balance achieved between doses of estrogen and progestogen and the nature and absolute amount of progestogens used in the contraceptives. The amount of both hormones should be considered in the choice of an oral contraceptive. 37