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The same test was also applied for the comparison of expressed telomerase activity. Non-parametric post-hoc comparisons were assessed using Dunn's test. Box and whisker plots were used for the graphical representation of the data. It can be seen that the highest values were observed in group III for both comet assay and telomerase activity assessment 5. All other values ranged between 3.

The expression of tail intensity is also presented in a box and whisker plot Fig. Apart from causing several adverse health effects, the DNA-damaging effects of different AAS have been studied using various techniques. Stanozolol is a widely abused steroid, particularly for the purposes of doping and improving physical status. Very limited information is available regarding the DNA-damaging effects of stanozolol, while a positive correlation between exposure to nandrolone and DNA damage has been determined 14 , 26 , In previous studies, a significant increase in DNA damage was determined in blood, liver, bone marrow, brain and testicle cells in experimental animals exposed to high doses of nandrolone 14 , In addition, in a review, Boettcher et al reported increased DNA damage with trenbolone treatment in zebrafish embryos via comet assay and the micronucleus test; however, this increase was not observed with high-dose trenbolone treatment 29 and refs therein.

Our results are in accordance with the findings of these studies, demonstrating the DNA-damaging effects of stanozolol. Although exercise has been defined as a key element of a healthy lifestyle, many controversial results have also been published 30 — According to our search, there was only one study available in the literature investigating stanozolol and exercise-induced genotoxicity.

Martins et al demonstrated that the administration of anabolic steroids decadurabulin and winstrol induced chromosomal damage, which was not associated with physical activity The results of our study indicated increased DNA damage in the exercise-exposed control group PG and exercise group ; however, stanozolol played a protective role in exercise-induced DNA damage in the stonozolol-exposed groups.

It is well-documented that telomerase activity plays a role in DNA damage and repair mechanisms. In addition, several pathways have been defined regarding the mechanisms of the effects of AAS on telomerase activity 20 , 37 , 38 Nourbakhsh et al demonstrated that testosterone and androstenedione both increased cell viability by upregulating telomerase activity in the OVCAR-3 cell line.

Zhou et al demonstrated that the testosterone derivative, estrogen, increased telomerase activity via the mitogen-activated protein kinase MAPK pathway in endometrial cancer cells Geier et al reported significantly increased telomerase activity and gene expression with testosterone and dihydrotestosterone DHT treatment According to our search, there was no study available in the literature on the effects of stanozolol on telomerase activity.

There is limited evidence regarding the genotoxicity of stanozolol, while there are several studies available on the effects of other AAS. We demonstrated that stanozolol induced telomerase activity and this increase may be associated with DNA damage. The effects of exercise on telomerase activity primarily depend on the amount of exercise and cell types. Increased telomerase enzyme activity in skeletal muscles with exercise has been shown by Ludlow et al Exercise may reduce telomere shortening-associated aging; however, extreme amounts of exercise have been reported to shorten telomeres.

Furthermore, the effects of exercise on telomeric genes and miRNA regulation provides insight into the mechanistic association between exercise, telomeres and health Mosallanezhad et al demonstrated significantly increased levels of telomerase activity and improved telomere length in sedentary women who performed high-intensity interval training In this study, we observed a decrease in telomerase activity in stanozolol-treated rats subjected to exercise.

Our results are in line with those of previous findings regarding the effects of exercise on telomerase activity. In conclusion, in this study, an increase in DNA damage was detected with exercise; however, it was observed that exercise did not have a significant DNA-damaging effect in the steroid treated group.

Therefore, the preventive role of stanozolol should be taken into consideration for the interpretation of these results for physically active or overtrained individuals. There is a need for further studies in order to clarify the preventive role of stanozolol in physical activity in terms of DNA damage. Thus, the effects of exercise warrant further clarifications for the determination of the genotoxic effects of stanozolol and the mechanisms responsible for stanozolol-induced DNA damage.

The DNA-damaging effects of stanozolol may be mediated through alterations in telomerase activity. However, further studies are required in order to fully elucidate the association between stanozolol use, exercise and DNA damage. National Center for Biotechnology Information , U. Journal List Exp Ther Med v. Exp Ther Med. Published online Dec Stivaktakis , 2 Demetrios A. Spandidos , 4 Aristides M.

Tsatsakis , 2 and Buket Alpertunga 1. Polychronis D. Demetrios A. Aristides M. Author information Article notes Copyright and License information Disclaimer. Received Sep 8; Accepted Dec 2. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License , which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

This article has been cited by other articles in PMC. Abstract Anabolic androgenic steroids AAS are performance-enhancing drugs commonly abused by atheletes. Keywords: anabolic androgenic steroids, stanozolol, telomerase activity, DNA damage, comet assay.

Introduction Anabolic androgenic steroids AAS are synthetic testosterone derivatives, which are widely abused by athletes for enhancing performance and psychological well-being 1 , 2. Table I. Experimental groups in this study. Animal groups a No.

Open in a separate window. Comet assay The alkaline comet assay was performed as previously descrbibed by Singh et al 23 with slight modifications, as described in Ozcagli et al Statistical analysis The mean, standard deviation SD and the median were used for the expression of tail intensity.

Table II. Assay Exposure a group No. Figure 1. Discussion Apart from causing several adverse health effects, the DNA-damaging effects of different AAS have been studied using various techniques. References 1. Polypharmacy among anabolic-androgenic steroid users: A descriptive metasynthesis. Subst Abuse Treat Prev Policy. Detection of stanozolol in the urine of athletes at a pg level: The possibility of passive exposure.

Biomed Rep. Sudden or unnatural deaths involving anabolic-androgenic steroids. J Forensic Sci. Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med. Side effects of anabolic androgenic steroids: Pathological findings and structure-activity relationships. Handb Exp Pharmacol. Kicman AT. Pharmacology of anabolic steroids. Br J Pharmacol. Melatonin reduces oxidative stress and cardiovascular changes induced by stanozolol in rats exposed to swimming exercise.

Eurasian J Med. Chromosomal damage induced by androgenic anabolic steroids, stanozolol and trenbolone in human lymphocytes. Adv Environ Biol. Helfman T, Falanga V. Stanozolol as a novel therapeutic agent in dermatology. J Am Acad Dermatol. Royal Jelly alleviates sperm toxicity and improves in vitro fertilization outcome in Stanozolol-treated mice. Iran J Reprod Med. Pharmacokinetics of stanozolol in Thoroughbred horses following intramuscular administration.

J Vet Pharmacol Ther. World Anti-doping Agency, corp-author. Accessed September 16, Chem Cent J. Nandrolone androgenic hormone presents genotoxic effects in different cells of mice. J Appl Toxicol.

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Stanozolol is a synthetic testosterone-derived anabolic steroid. Although it is well known that AAS have several side-effects, there are only few toxicological studies available on the toxic effects and mechanisms of action of stanozolol. The aim of this study was to investigate the genotoxic effects of stanozolol and to determine its effects on telomerase activity in Sprague-Dawley male rats. PG is used as a solvent control in our study.

After 28 days, the animals were sacrificed, and DNA damage evaluation comet assay and telomerase activity assays were then performed using peripheral blood mononuclear cells PBMCs. The results of this study revealed that stanozolol treatment induced DNA damage, while exercise exerted a protective effect. Stanozolol treatment without exercise stimulation was associated with a significant increase in telomerase activity in the PBMCs. Anabolic androgenic steroids AAS are synthetic testosterone derivatives, which are widely abused by athletes for enhancing performance and psychological well-being 1 , 2.

These drugs have been abused for many years by athletes and teenagers for the purpose of performance enhancement 3 , 4. The chemical structure of steroids, dosage and usage frequency are the main factors responsible for the long-term side-effects of AAS. At supraphysiological doses, several side-effects have been reported due to the use of AAS. These effects include the disruption of lipid metabolism, high blood pressure, cardiac disorders, testicular atrophy, erectile dysfunction, impotence, decreased sex hormone levels, menstrual irregularities, clitoral enlargement, peliosis hepatis, neoplasia, cholestasis, jaundice, acne, alopecia, aggressiveness, depressive symptoms, manic symptoms and psychosis 5.

According to worldwide testing data, it has been demonstrated that testosterone, nandrolone, methandienone and stanozolol are the most commonly abused steroids 6. It is medically used for the treatment of anemia and hereditary angioedema 8. It is known that stanozolol abuse causes a wide range of adverse effects The consumption steroid hormone drugs is associated with toxicity, mutagenicity, genotoxicity and cancerogenesis, depending on several factors, including genetic and epigenetic modifications However, Hana et al indicated that testosterone synthetic derivatives had no genotoxic effects on mouse germ cells Controversial results have been obtained regarding the genotoxic effects of steroids 17 , Telomeres play a key role in cell aging and DNA damage mechanisms.

The loss of telomere function causes several adverse effects, such as genomic instability, aneuploidy and even cancer. It has been reported that tumor tissues express elevated levels of telomerase compared to normal tissues The inhibition of telomerase activity is known to be associated with genomic instability, and plays an important role in DNA damage mechanisms and cancer development.

It has been demonstrated that the expression of telomerase enzyme protects cells from DNA-damaging events, and it has been shown that this protective function is independent from its telomere synthesis function In this study, we investigated the DNA-damaging potential of stanozolol and its effects on telomerase activity in stanozolol-treated Sprague-Dawley rats. The role of exercise in DNA damage and telomerase activity was also assessed, as the main target population of stanozolol users are usually physically active individuals.

Swimming was selected as a mode of exercise. The mice were subjected to exercise swimming 1 week prior to the commencement of the treatments so that the animals may be able to adapt. During the 28 days of the experiment, the animals subjected to 20 min of swimming for 5 days per week. After 28 days, the animals were lightly anesthetized and euthanized by cervical dislocation.

Peripheral blood samples were collected from the tail vein of the rats for the determination of telomerase activity and DNA damage by comet assay. During centrifugation, cells migrate differentially and layers are formed. PBMCs were retrieved from just above the boundary between plasma and Histopaque. Comet assay and telomerase activity assays were all performed using the PBMCs. The alkaline comet assay was performed as previously descrbibed by Singh et al 23 with slight modifications, as described in Ozcagli et al Each microscopic slide was covered with 0.

Histopaque density gradient centrifugation was used for lymphocyte isolation. The isolated cells were mixed with 0. The electrophoresis step was conducted at 1. Prior to ethidium bromide EB dye staining, the alkali conditions were neutralizated with tris buffer 0. All these steps were conducted under dimmed light and the slides were evaluated by one slide reader, blindly. One hundred cells per slide were analyzed under a fluorescence microscope equipped with an excitation filter of nm and a barrier filter of nm Olympus BX53; Olympus Corp.

Tail intensity data was selected for the evaluation of DNA damage. The kit protocol was followed for telomerase activity assessment as previously described The assay principle was consisting of two steps. The mean, standard deviation SD and the median were used for the expression of tail intensity. The non-parametric Kruskal-Wallis test was applied for comparing the results of comet assay. The same test was also applied for the comparison of expressed telomerase activity.

Non-parametric post-hoc comparisons were assessed using Dunn's test. Box and whisker plots were used for the graphical representation of the data. It can be seen that the highest values were observed in group III for both comet assay and telomerase activity assessment 5. All other values ranged between 3.

The expression of tail intensity is also presented in a box and whisker plot Fig. Apart from causing several adverse health effects, the DNA-damaging effects of different AAS have been studied using various techniques. Stanozolol is a widely abused steroid, particularly for the purposes of doping and improving physical status. Very limited information is available regarding the DNA-damaging effects of stanozolol, while a positive correlation between exposure to nandrolone and DNA damage has been determined 14 , 26 , In previous studies, a significant increase in DNA damage was determined in blood, liver, bone marrow, brain and testicle cells in experimental animals exposed to high doses of nandrolone 14 , In addition, in a review, Boettcher et al reported increased DNA damage with trenbolone treatment in zebrafish embryos via comet assay and the micronucleus test; however, this increase was not observed with high-dose trenbolone treatment 29 and refs therein.

Our results are in accordance with the findings of these studies, demonstrating the DNA-damaging effects of stanozolol. Although exercise has been defined as a key element of a healthy lifestyle, many controversial results have also been published 30 — According to our search, there was only one study available in the literature investigating stanozolol and exercise-induced genotoxicity.

Martins et al demonstrated that the administration of anabolic steroids decadurabulin and winstrol induced chromosomal damage, which was not associated with physical activity The results of our study indicated increased DNA damage in the exercise-exposed control group PG and exercise group ; however, stanozolol played a protective role in exercise-induced DNA damage in the stonozolol-exposed groups. It is well-documented that telomerase activity plays a role in DNA damage and repair mechanisms.

In addition, several pathways have been defined regarding the mechanisms of the effects of AAS on telomerase activity 20 , 37 , 38 Nourbakhsh et al demonstrated that testosterone and androstenedione both increased cell viability by upregulating telomerase activity in the OVCAR-3 cell line. Zhou et al demonstrated that the testosterone derivative, estrogen, increased telomerase activity via the mitogen-activated protein kinase MAPK pathway in endometrial cancer cells Geier et al reported significantly increased telomerase activity and gene expression with testosterone and dihydrotestosterone DHT treatment According to our search, there was no study available in the literature on the effects of stanozolol on telomerase activity.

There is limited evidence regarding the genotoxicity of stanozolol, while there are several studies available on the effects of other AAS. We demonstrated that stanozolol induced telomerase activity and this increase may be associated with DNA damage. The effects of exercise on telomerase activity primarily depend on the amount of exercise and cell types. Increased telomerase enzyme activity in skeletal muscles with exercise has been shown by Ludlow et al Exercise may reduce telomere shortening-associated aging; however, extreme amounts of exercise have been reported to shorten telomeres.

Furthermore, the effects of exercise on telomeric genes and miRNA regulation provides insight into the mechanistic association between exercise, telomeres and health Mosallanezhad et al demonstrated significantly increased levels of telomerase activity and improved telomere length in sedentary women who performed high-intensity interval training In this study, we observed a decrease in telomerase activity in stanozolol-treated rats subjected to exercise.

Our results are in line with those of previous findings regarding the effects of exercise on telomerase activity. In conclusion, in this study, an increase in DNA damage was detected with exercise; however, it was observed that exercise did not have a significant DNA-damaging effect in the steroid treated group. Therefore, the preventive role of stanozolol should be taken into consideration for the interpretation of these results for physically active or overtrained individuals.

There is a need for further studies in order to clarify the preventive role of stanozolol in physical activity in terms of DNA damage. Thus, the effects of exercise warrant further clarifications for the determination of the genotoxic effects of stanozolol and the mechanisms responsible for stanozolol-induced DNA damage. The DNA-damaging effects of stanozolol may be mediated through alterations in telomerase activity. However, further studies are required in order to fully elucidate the association between stanozolol use, exercise and DNA damage.

National Center for Biotechnology Information , U. Journal List Exp Ther Med v. Exp Ther Med. Published online Dec Stivaktakis , 2 Demetrios A. Spandidos , 4 Aristides M. Tsatsakis , 2 and Buket Alpertunga 1. Polychronis D. Demetrios A. Aristides M. Author information Article notes Copyright and License information Disclaimer. Received Sep 8; Accepted Dec 2. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License , which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

This article has been cited by other articles in PMC. Abstract Anabolic androgenic steroids AAS are performance-enhancing drugs commonly abused by atheletes. Keywords: anabolic androgenic steroids, stanozolol, telomerase activity, DNA damage, comet assay. Stanozolol is used in the treatment of angioedema. How stanozolol works. Stanozolol reduces the release of a chemical called.

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PG is known to be a good vehicle for in vivo experimental studies 28 , However, it has been reported that high concentrations of PG can induce DNA damage in eukaryotic cells and mouse oocytes 30 , Subcutaneous administration was selected and the doses were selected in accordance with previous studies 32 — After 28 days of treatment, the animals underwent light anesthesia using a percentage of 1.

Liver tissue samples were collected and divided into 2 sections. Approximately 0. The homogenates were strongly vortexed and then incubated in an ultrasonic bath for 10 min. The addition of 1. A gradient of 0. The detector voltage was 1. The kit protocol was followed for telomerase activity assessment as previously described 35 , PCR amplifications were performed according to manufacturer's instructions in triplicate.

A reaction mixture without cDNA template was used as a negative control. The slides were treated with xylene and rehydrated in increasing grades of ethanol solutions. In order to quench endogenous peroxidase activity, the tissue sections were treated with Blocking Reagent 1 for 15 min and washed with PBS.

All the sections were incubated with Blocking Reagent 2 for 5 min at room temperature to avoid any non-specific binding. The slides were incubated with Linking Reagent 4 and then Labeling Reagent 5 for 20 min at room temperature. Analysis was performed using a one slide reader for minimizing variability due to subjective scoring.

The Kolmogorov-Smirnov with Liliefors correction test was applied for examining the normality of continuous variables. Spearman's R was applied to measure bivariate correlations between two continuous variables e. The non-parametric Kruskal-Wallis test and parametric one-way ANOVA were applied for comparing differences in levels of stanozolol and its metabolites between the study groups control, stanozolol, PG and exercise groups.

Non-parametric post hoc comparisons were assessed by using Dunn's non-paremetric and Tukey's HSD tests for parametric tests. A level of 0. The sample sizes for the individual analyses differed slightly due to some missing values arose from experimental conditions. The results are summarized in Table IV. Of note, the stanozolol-induced increase in TERT expression vs. A similar pattern was observed for percentage telomerase activity, as well. PTEN gene expression was practically unaffected either by exercise or stanozolol administration.

It should be noted that not all values presented above are shown in Table V due to the large number of pairwise comparisons. Scatter diagram of TERT gene expression and percentage relative telomerase activity. TERT, telomerase reverse transcriptase. The IHC staining images are shown in Fig. PTEN gene expression levels were observed around the vena centralis and the parenchyma. In the STE group, the staining was moderate in the hepatocytes surrounding these areas.

The rat groups were as follows: i The control C group; ii the propylene treatment PG group; iii the stanozolol treatment ST group; iv the propylene treatment and exercise PGE group; and v the stanozolol treatment and exercise STE group. Stanozolol is a widely abused and most potent AAS responsible for a number of side-effects, including cardiovascular, reproductive, behavioral effects and hepatotoxicity To the best of our knowledge, this is the first study to investigate stanozolol-induced molecular pathways of telomerase activity in rat liver and any relevant effect of exercise.

Stanozolol induces intrahepatic structural changes with cholestasis and increases the risk of HCC In addition, AAS abuse in general has been found to be responsible for hepatocellular adenomas 12 , Even though the mechanisms responsible for stanozolol-induced hepatotoxicity have not yet been clearly identified, proliferative effects on liver cells may play a central role in the observed hepatotoxicity 12 , 40 , In our previous study, we demonstrated that stanozolol exerted DNA-damaging effects in peripheral blood lymphocytes, probably related to telomerase activity alterations Although various environmental factors are known to up- and downregulate telomerase activity, the effects of exercise on telomerase activity have not yet been clearly identified Telomere length and telomerase activity have been shown to be affected by several factors, including oxidative stress, psychological stress and socioeconomic status.

One possible mechanism for telomere shortening is oxidative stress by oxidized DNA base products 8-OHdG in the guanine or protein adducts 43 , In addition, it is well documented that the majority of healthy cells exhibit a lack of telomerase activity 19 , 20 , The results of this study demonstrated increased levels of percentage relative telomerase activity in the liver tissue in the ST group, in line with nandrolone, another well-known ASS, which has shown similar effects by increasing telomerase activity in a dose-dependent manner both at the heart tissue and at peripheral blood monocytes 2 , This may represent a compensating repair mechanism at the tissue level, while increased circulating levels of telomerase activity can depict systemic inflammation.

The association of increased telomerase activity and expression with proliferative effects was not likely to occur in this study due to the short time of exposure 28 days. In general, the mechanisms underlying the effects of AASs on telomerase activity have not been elucidated and remain practically unknown.

TERT is a catalytic subunit of a telomerase, which plays a role in its regulation at transcriptional level. It has been reported that TERT mutations are associated with adenoma-carcinoma transitions in the liver According to the results of the present study, no significant alterations were observed in PTEN expression levels between the groups. Exercise reversed the increase in TERT expression induced by stanozolol, particularly in the parenchyma, where metabolic zonation is reported: Glucose release from glycogen and via gluconeogenesis, amino acid utilization and ammonia detoxification, protective metabolism, bile formation and the synthesis of certain plasma proteins, such as albumin and fibrinogen occur mainly in the periportal area, whereas glucose utilization, xenobiotic metabolism and the formation of other plasma proteins, such as alpha 1-antitrypsin or alpha-fetoprotein occur predominantly in the perivenous zone 49 , Several studies have indicated that physical exercise increases telomerase activity in different cell types 52 , Our results indicated the elevation of telomerase activity and TERT expression in the liver tissue, which could be associated either with an increased proliferation risk due to stanozolol treatment 10 , rather unlikely for such a short exposure period, or may represent a counteracting mechanism Exercise reverses the stanozolol-induced increase in telomerase activity.

A number of studies have supported that exercise exerts hepatoprotective effects. Huang et al demonstrated that a week swimming exercise program suppressed senescence markers and downregulated inflammatory mediators in the liver tissues of D-galactose-induced senescence in rats Yi et al demonstrated that both acute and chronic exercise exerted preventive effects on the livers of rats with type 2 diabetes On the other hand, exercise has been reported to increase liver enzymes in humans 57 and concerns exist regarding the effects of exercise on portal hypertension in patients with cirrhosis In conclusion, stanozolol induces telomerase activity at a molecular level and exercise reverses this induction, at least regarding TERT expression.

This may reflect premature tissue aging due to decreased telomerase activity Future studies are warranted in order to investigate the mechanisms through which exercise can be used to prevent the adverse health effects of stanazolol and to elucidate the molecular hepatocellular mechanisms of the stanozolol-induced adverse effects.

The authors would like to thank Dr Alegakis Athanasios for his valuable help on the statistical advice and comments. All authors have read and approved the final manuscript. DAS is the Editor-in-Chief of the journal, but had no personal involvement in the reviewing process, or any influence in terms of adjudicating on the final decision, for this article.

National Center for Biotechnology Information , U. Int J Mol Med. Published online Apr Tzatzarakis , 3 Christina Tsitsimpikou , 4 Polychronis D. Stivaktakis , 3 Dimitrios Tsoukalas , 3 Demetrios A. Spandidos , 5 Aristides M. Tsatsakis , 3 and Buket Alpertunga 1. Manolis N. Polychronis D. Demetrios A. Aristides M. Author information Article notes Copyright and License information Disclaimer. Professor Aristides M. Box , Heraklion, Greece, E-mail: moc. Received Feb 28; Accepted Apr This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License , which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

This article has been cited by other articles in PMC. Abstract Anabolic agents are doping substances which are commonly used in sports. Introduction Stanozolol is a performance-enhancing anabolic androgenic steroid AAS.

Open in a separate window. Figure 1. Figure 2. Table I Weight of the rats upon purchase. Table II Experimental design of the study. Groups No. Bioaccumulation of stanozolol and its metabolites in liver tissues The results are summarized in Table IV. Figure 3. Figure 4. Figure 5. Discussion Stanozolol is a widely abused and most potent AAS responsible for a number of side-effects, including cardiovascular, reproductive, behavioral effects and hepatotoxicity Acknowledgments The authors would like to thank Dr Alegakis Athanasios for his valuable help on the statistical advice and comments.

Consent for publication Not applicable. Competing interests DAS is the Editor-in-Chief of the journal, but had no personal involvement in the reviewing process, or any influence in terms of adjudicating on the final decision, for this article. References 1. Detection of stanozolol O- and N-sulfate metabolites and their evaluation as additional markers in doping control. Drug Test Anal. Nephrotoxicity in rabbits after long-term nandrolone decanoate administration. Toxicol Lett.

World Anti-doping Agency The list of prohibited substances and methods. Accessed Feb 14, Synthetic and natural nutritional supplements: Health 'allies' or risks to public health. The use of nutritional supplements among recreational athletes in Athens, Greece.

The global epidemiology of anabolic-androgenic steroid use: A meta-analysis and meta-regression analysis. Ann Epidemiol. Stanozolol-induced bland cholestasis. Gastroenterol Hepatol. Effects of short-term stanozolol administration on serum lipoproteins in hepatic lipase deficiency. Racial differences in the progression to cirrhosis and hepatocellular carcinoma in HCV-infected veterans. Am J Gastroenterol. Fatal liver cyst rupture due to anabolic steroid use: A case presentation.

Am J Forensic Med Pathol. Hepatotoxicity of stanozolol in cats. J Am Vet Med Assoc.

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