Detection and Identification of Anabolic Steroids in Over-the-counter Nutritional Supplements

Introduction: During 2013, the New York State Department of Health (NYSDOH) investigated an outbreak among 29 persons reporting adverse health effects, including hirsutism, fatigue, myalgias, anxiety, and elevated liver and cholesterol tests. Of patients affected, one was hospitalized for acute liver injury and one woman exhibited signs of masculinization. NYSDOH received reports of other hundreds of potentially affected persons. The epidemiologic investigation implicated consumption of dietary supplements including vitamin B-50 (term used by the manufacturer) and multimineral supplements from the same supplier. 

Purpose: This study was to determine organic components and potential contaminants in the dietary supplement samples and to investigate whether these supplements were responsible for the adverse health effects observed.

Methods: Comprehensive chemical analyses of multiple marketed lots of the supplements were performed. Organic components and contaminants in the dietary supplement samples were extracted before analysis by gas chromatography–mass spectrometry, time-of-flight mass spectrometry, and liquid chromatography coupled to electrospray tandem mass spectrometry.

Results: Analyses revealed the presence of significant levels of methasterone (17β-hydroxy-2a,17a-dimethyl-5a-androstane-3-one), an anabolic steroid and Schedule III controlled substance, as well as other anabolic steroids (e.g. methylstenbolone).

Significance: Compounds in the dietary supplements were suspected to have caused the liver toxicity and masculinizing effects that were observed in these patients. Without cessation of consumption, certain adverse health effects can be permanent and have the potential of increasing morbidity and mortality.