SHM Converge Scientific Abstract ePoster Gallery-Testing the Heart: A Case of Testosterone Induced Cardiomyopathy

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This case describes a 31-year-old male bodybuilder with no prior medical history who presented to the ED with acute chest pain, shortness of breath, and a 30-pound weight gain after prolonged starvation and heavy supplement use. He reported frequent use of exogenous testosterone, T3, and protein supplements over several months.<br /><br />On presentation, he was tachycardic, febrile, and required high-flow oxygen. Exam showed jugular venous distention, bibasilar crackles, trace generalized edema, and a positive Murphy’s sign. Labs revealed elevated cardiac and muscle injury markers, including CK, troponins, and proBNP, along with mild transaminitis and hypomagnesemia. EKG showed sinus tachycardia without ischemic ST changes. CTA chest was negative for pulmonary embolism but showed right-sided ground-glass opacities and a small pleural effusion.<br /><br />The differential included viral or bacterial infection, coronary thrombosis, tachyarrhythmia-induced cardiomyopathy, endocrine/metabolic causes, and steroid/testosterone-induced cardiomyopathy. Echocardiography demonstrated moderate global left ventricular systolic dysfunction with severe reversible diastolic dysfunction, consistent with stage III heart failure and an EF of 44% (HFmrEF). Infectious studies were negative, RUQ ultrasound was unrevealing, and pituitary MRI was normal. Endocrine testing showed high testosterone with low FSH, low TSH, low-normal ACTH, and elevated prolactin, supporting suppression of the hypothalamic-pituitary axis from supplementation.<br /><br />He was started on guideline-directed medical therapy, including furosemide, carvedilol, and Entresto, with plans to titrate further. The case highlights that exogenous testosterone and anabolic supplements can be associated with cardiomyopathy, heart failure, and thromboembolic risk. Stopping hormone supplementation and providing appropriate hormone management are essential to prevent further complications.

Asset Subtitle

Iffath Islam

Meta Tag

Author List Iffath Islam, Manile A. Dastagir, Spencer F. Weintraub

Category Clinical Vignettes

Concept Exogenous Testosterone

Concept Anabolic Steroid Use

Concept Acute Cardiomyopathy

Concept Heart Failure

Concept Exogenous Hormone Supplementation

Distinguished Non-Finalist

Presenter Organization Zucker School of Medicine at Hofstra University

Presenting Author Iffath Islam

Track Adult

Keywords

bodybuilder

acute chest pain

shortness of breath

exogenous testosterone

anabolic supplements

cardiomyopathy

heart failure

HFmrEF

echocardiography

hypothalamic-pituitary suppression

Exogenous Testosterone

Anabolic Steroid Use

Acute Cardiomyopathy

Heart Failure

Exogenous Hormone Supplementation