Introduction: Synthetic anabolic androgenic steroids (AAS), compounds mimicking the action of endogenous testosterone in enhancing training performance, have been extensively studied during the last century. AAS abuse has become a major public health concern with an estimated worldwide lifetime prevalence of 1–5% (1). Long-term administration of AAS in supraphysiological doses may have detrimental effects on the cardiovascular system, presumably through direct action on cardiac myocyte androgen receptors. In severe cases, life-threatening conditions such as myocardial infarction, aortic dissection or cardiomyopathy, particularly dilated cardiomyopathy as the most common form, may occur. Hereby, we report a rare case of AAS-induced cardiomyopathy with an emphasis on the multidisciplinary approach.

Case report: 46-year-old male bodybuilder presented with exercise intolerance unrelated to maximum training load and post-workout water retention 6 weeks before the visit. History revealed previous administration of testosterone enanthate 500 mg every 8 to 12 days during the period of 4 years. After a month-long cessation, he started taking testosterone undecanoate 1000 mg in 6-week intervals. The cardiorespiratory part of the physical examination showed normal findings and blood pressure of 125/80 mmHg. The patient was of athletic build with no signs of increased hairiness and no palpable testicular mass. An electrocardiogram showed a normal electrical axis and sinus bradycardia. Laboratory assessment (Table 1) was followed by echocardiography which was in accordance with the diagnosis of AAS-induced cardiomyopathy (Figure 1). Further diagnostic assessment of osteoporosis, hepatic, renal and psychological complications was performed. Conclusion: Long-term administration of AAS with unknown pharmacokinetic and pharmacodynamic properties should be considered as a cause of newly diagnosed cardiomyopathy, especially in previously healthy individuals with an athletic background.