# Reversible Gynecomastia and Hypogonadism Due to Usage of Commercial Performance-Enhancing Supplement Use

## TL;DR

A man developed gynecomastia and hormonal issues from using performance-enhancing supplements containing banned drugs, which resolved after stopping the supplements.

## Contribution

This case highlights the presence of banned PEDs and steroid hormones in commercial supplements and their clinical consequences.

## Key findings

- Performance-enhancing supplements contained banned drugs like RAD-140, MK-677, and cardarine.
- Undisclosed hormones like testosterone and estradiol were detected in the supplements.
- Symptoms and hypogonadism resolved after discontinuing the supplements.

## Abstract

Commercially available performance-enhancing supplements can contain banned performance-enhancing drugs (PEDs) and undisclosed steroid hormones that can induce hormonal abnormalities with associated clinical signs. We present a case of a 40-year-old male who developed bilateral gynecomastia and biochemical hypogonadotropic hypogonadism with a corresponding 6-month history of consuming commercially available performance-enhancing supplements for gym workouts. These performance-enhancing supplements were found to contain amounts of RAD-140, a selective androgen receptor modulator, MK-677, a GH secretagogue and cardarine, all of which are banned PEDs. In vitro analysis also detected undisclosed hormones testosterone, estradiol, and GH in all 3 supplements, with further steroid analysis using liquid chromatography mass spectrometry identifying an unidentified compound coeluting close to the testosterone peak. Cessation of these supplements led to full resolution of symptoms including normalization of hypogonadotropic hypogonadism. This case highlights the need for clinicians to consider commercially available performance-enhancing supplements as potential sources of PEDs and exogenous steroid hormones that can have adverse clinical consequences.