Asynchronous bilateral Achilles tendon ruptures and androstenediol use

Anabolic steroid use is associated with an increased risk for tendon ruptures.(6,8,15,17) Parenteral corticosteroid ad ministration as well as corticosteroid injections have also been directly related to tendon ruptures.(5,10,13) More recently, case reports have implicated the use of ciprofloxacin as a risk factor for tendon rupture.(4,11,12) To date, androstenedione and androstenediol use in athletes has not been reported in association with tendon ruptures. Several studies have assessed plasma levels of testosterone precursors as well as plasma levels of testosterone in patients who were administered over-the-counter androstenedione supplements.(1-3,7) These studies demonstrated a transient increase in plasma steroid intermediates and a small but detectable increase in plasma testosterone levels. The authors of these reports concluded that the transient increases in testosterone and epitestosterone were too small to be detected by current testing methods. As a result of these findings, these supplements are attractive to the competitive athlete. No studies to date have evaluated the potential adverse clinical effects of increased levels of testosterone. We report a case of asynchronous bilateral Achilles tendon ruptures in a patient who intermittently used oral androstenediol supplements.