Illicit injections in bodybuilders: a clinicopathological study of 11 cases in 9 patients with a spectrum of histological reaction patterns

Abstract

The practice of self-injection of anabolic steroids (AS) in bodybuilders is common. AS are not the only materials used by bodybuilders for muscle augmentation or image enhancement. Other materials, for example, plant oils, silicon, Vaseline, and paraffin are also injected either in a pure form or mixed with AS. Muscle bulking is the main aim. However, bodybuilders undergo illicit injections for cosmetic, therapeutic, and sexual purposes. Even though the practice of unsupervised injection is probably common in the sports community, site-specific complications are underreported in the medical literature and mostly limited to case reports. Complications can be clinically and pathologically challenging because some can be confused with nonneoplastic and, more important, with neoplastic lesions. Bodybuilders are reluctant to disclose information because of stigma and legal issues. This study attempts to correlate the clinical manifestations and histomorphological features of different injected materials used for different purposes by bodybuilders in our region. A series of 11 cases out of 9 male bodybuilders was studied. A variety of clinical presentations and histological tissue reactions was identified, with some overlapping features between some cases. We identified 5 basic tissue reaction patterns depending on the injected materials, site, and duration of injection. Certain histological features provide useful hints in the absence of prior knowledge of injection history. However, in other cases, a retrospective enquiry by clinicians is warranted to avoid pitfalls. The medical and sports community should be aware of these injection-site complications. Bodybuilders should be discouraged from this practice by implementing appropriate educational and legislative measures.

Keywords: bodybuilding; injections; muscle; oil; silicon; steroids.