02.02.2005

Iron deficiency and stanozolol therapy

Anabolic steroids are now being recommended for the treatment of a variety of vascular disorders so it is important to identify side-effects. Disturbed liver function, increased sensitivity to warfarin, and fluid retention are well recognised complications.

In view of the effect of androgens in aplastic anaemia, a rise in haemoglobin might be expected with anabolic agents. Normal individuals showed no change in haemoglobin after six weeks of stanozolol therapy5 but the lack of observations on Hb and red blood cell (RBC) indices after longer periods of treatment prompted the following study.

Sixteen patients taking 10 mg stanozolol daily in a trial of fibrinolytic enhancement therapy in intermittent claudication experienced a significant fall in mean cell haemoglobin (MCH) after three months of treatment. The RBC count did not change significantly but Hb and mean cell volume (MCV) also fell (see table). These results were contrary to the expected rise in Hb and RBC count. After exclusion of one patient (who was iron deficient at baseline) six patients remained on therapy for a year or more, and four of these showed red cell indices suggestive of iron deficiency, which was confirmed by biochemical measurement and ferritin assay. In one of these four stanozolol was discontinued without iron supplementation: the red cell indices and iron status promptly returned to normal.

All these patients showed an increase in fibrinolytic activators while on therapy but there was no clinical or biochemical evidence of gastrointestinal bleeding to explain the iron deficiency. One patient was studied in detail and showed a normal red cell survival. There was no faecal red cell loss as judged by isotope studies. The four patients with iron deficiency all ate diets poor in iron. In such patients the increase in muscle bulk induced by the anabolic steroids may cause utilisation of iron at the expense of Hb, this being reflected in a change in RBC Hb.

Patients taking stanozolol for long periods should have RBC indices and liver function monitored regularly.

D.A. Taberner, Withington Hospital, Manchester M208LR.

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