Post-pubertal patients whose sports supplements contain androgenic steroids may present with features of androgen deficiency due to suppression of the hypothalamic-pituitary axis (see Fig .). Symptoms can be non-specific, such as lethargy, fatigue, low mood, irritability and poor concentration. More specific problems include male pattern hair loss, acne, liver injury, increased cardiovascular risk, osteopenia or osteoporosis, reduced muscle mass and strength, increased fat mass and gynaecomastia. 17 There may be reduced sexual and reproductive function, with low libido and erectile dysfunction. 14 , 18 Infertility may also occur. 19 Other causes of hypogonadism must also be considered when making the diagnosis .
Although ephedrine and pseudoephedrine are classified as stimulants, they have different effects on performance. Ten-kilometer run time was decreased with ephedrine supplementation 30 and anaerobic performance was improved 31 ; however, a meta-analysis of eight studies found insufficient evidence to support a performance benefit with ephedrine. 32 Crossover studies have failed to demonstrate an improvement in fatigue 33 or prolonged high-intensity cycling performance 34 with pseudoephedrine ingestion, but one small study did find a decrease in 1,500-meter running time. 35