title: Acute hepatitis and fevers in an amateur body-builder: a new complication of synthetic androgen abuse?
abstract: OBJECTIVE
  Although the illicit use of synthetic androgens is common among amateur body builders in Australia, the toxicology of these drugs is largely limited to case reports, and the health effects are not well understood. Furthermore, combined use with off-label prescription drugs carries undefined medical risks.
  
  
  METHODS
  We describe a 35-year-old male amateur body-builder who developed acute hepatitis with accompanying fever.
  
  
  RESULTS
  This phenomenon occurred several weeks after he commenced high-dose methandrostenolone, a nonmarketed 17-alpha-alkylated synthetic androgen available over the internet or in gyms, in combination with anti-estrogen drugs to purportedly prevent gynecomastia and diuretics to lower body weight prior to a body-building competition.
  
  
  CONCLUSIONS
  In the absence of infection, this is the first reported case of acute hepatitis occurring in association with fever secondary to the use of a 17-alpha-alkylated androgen. This case serves to increase public, physician, and health authority awareness of this prevalent form of drug abuse and toxicity.
authors.affiliation: Faculty of Medicine, University of Sydney, Sydney, Australia Garvan Institute of Medical Research, Sydney, Australia.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Girgis
authors.affiliation: Nepean Hospital, Kingswood, Sydney, Australia School of Medicine, University of Western Sydney, Sydney, Australia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Kuo
authors.affiliation: Faculty of Medicine, University of Sydney, Sydney, Australia ANZAC Research Institute, Sydney, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Handelsman