Gynecomastia refers to a syndrome of abnormal feminization with swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. 29 Gynecomastia is common during puberty in boys and can be seen in older males due to increased estrogen level-related obesity (increase aromatase activity), decreased hepatic clearance, estrogen ingestion, and estrogen producing tumors. Asymptomatic gynecomastia is common in older men, but individuals who present with gynecomastia of recent onset associated with pain and tenderness may require clinical workup. 29 Gynecomastia and other signs of male feminization may be caused by an absolute increase in E2 and/or E1. The testes may directly secrete too much estradiol due to a Leydif-cell or Sertoli-cell tumor. They may also secrete estradiol indirectly through the stimulatory effects of a human chorionic gonadotropin-secreting tumor of gonadal or extragonadal germ-cell origin. 29
Cardiovascular risk factors include the alteration or diminishing of her glucose tolerance and hyperinsulinism (become resistant to insulin), a change in lipoproteins (carry cholesterol in blood) fraction which can cause cardiovascular disease and atherosclerosis (deposition of fatty substances onto inner walls of arteries causing blockage), increased triglyceride levels, hypertension (abnormally high blood pressure), changes in her myocardium (middle muscular layer of heart wall), and increased concentration levels of several different clotting factors. Cardiomyopathy (a typically chronic disorder of heart muscle that may involve hypertrophy and obstructive damage to the heart), myocardial infarction (localized death of the myocardium tissue usually leading to heart failure), heart attack, stroke, and cerebro-vascular accidents have all been causes in deaths where AAS abuse was implicated. Of course the liver, the body’s primary filtration system will come under attack as it has to accommodate the increased toxicity. Among the liver problems promoted are holestatic jaundice (failure of bile flow that causes yellowish pigmentation of skin, tissues, and body fluids), peliosis hepatis (blood-filled cysts develop on liver), hepatocellular hyperplasia (unusual increase of an epithelial parenchymatous cell called hepatocytes in the liver), and cancer. Secondary filters such as the kidneys and gallbladder also become more susceptible to disease.