A 50-year-old Massachusetts man spent 11 years cycling through hospitals and specialists, puzzled by recurring heart failure, kidney damage, and other ailments. Doctors finally discovered the cause in 2026: he had been secretly taking trenbolone, a synthetic testosterone derivative approved only for veterinary use in livestock, to build muscle.
The man never disclosed his use of anabolic-androgenic steroids (AAS) during his initial hospitalizations. When his heart first failed at age 39, he landed on ECMO life support. Doctors found only a mildly elevated antibody level and guessed at poststreptococcal myocarditis. Over the next several years, he developed kidney artery narrowing, abnormally high red blood cell counts, and other complications that baffled his rotating team of specialists across cardiology, nephrology, rheumatology, and endocrinology.
When he returned to Massachusetts General Hospital with heart failure again, doctors ruled out infections, autoimmune conditions, and medication side effects. They confronted him about AAS use, and he admitted to intermittently taking high doses of trenbolone, most recently before a Caribbean vacation. His testosterone level measured over 1,500 nanograms per deciliter, exceeding the test's maximum range of 1,500 ng/dl (normal: 249 to 836 ng/dl).
Doctors diagnosed androgen excess-related cardiomyopathy. He stopped taking the drugs and started medications for high blood pressure, heart failure, and diabetes. After four months, his heart's left chamber improved to pumping 49 percent of its blood, and his liver function improved. However, his testosterone-induced hypogonadism proved harder to reverse, particularly because he was over 35, had used AAS for over a decade, and had preexisting dysfunction.
Physicians writing in the New England Journal of Medicine warn that AAS abuse is becoming a major public health concern. Between 2.9 and 4 million people in the US, mostly male athletes, use AAS. The authors note this exceeds the number of Americans living with HIV. They called on clinicians to prepare for rising cases of long-term AAS effects including cardiomyopathy, atherosclerotic disease, and AAS-induced hypogonadism.