A very typical case of severe cholestasis due to anabolic steroid use. Because the steroids were being used without medical supervision, the dose and actual duration of use of each preparation was unclear, but cholestasis usually arises within 4 to 12 weeks of starting a C-17 alkylated androgenic steroid. The jaundice can be severe and prolonged and accompanied by severe pruritus and marked weight loss. The serum enzymes are typically minimally elevated except for a short period immediately after stopping therapy. The pattern of enzyme elevations can be hepatocellular, cholestatic or mixed. Liver biopsy shows a “bland” cholestasis with minimal inflammation and hepatocellular necrosis. Ma Huang has also been implicated in cases of drug induced liver injury, but is associated with an acute hepatocellular pattern of injury.
Richard Pound , chairman of the World Anti-Doping Agency and a partner in the Canadian law firm Stikeman Elliott, says: "The use of performance-enhancing drugs is not accidental; it is planned and deliberate with the sole objective of getting an unfair advantage. I don't want my kids, or your kids, or anybody's kids to have to turn themselves into chemical stockpiles just because there are cheaters out there who don't care what they promised when they started to participate. I don't want my kids in the hands of a coach who would encourage, condone or allow the use of drugs among his or her athletes."