Sex, drugs and sports: Prostaglandins, epitestosterone and sexual development

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Summary

Amateau and McCarthy’s findings published in Nature Neuroscience (June 2004) are noteworthy for suggesting a role for prostaglandins in sexual development. However, evidence suggests that in manipulating PGE2, they unknowingly implicated 3α-hydroxysteroid dehydrogenase [E.C. 1.1.1.50], 3(or 17)α-hydroxysteroid dehydrogenase [E.C. 1.1.1.209] and their respective products, androsterone (ADT) and epitestosterone (EpiT), in the developmental masculinization of sex behavior. EpiT is generally regarded as a hormonally inactive 17α-epimer of testosterone (T). In rats, the kidney is the primary site of EpiT formation, whereas in humans it originates from the gonads, with only a small contribution secreted by the adrenals. Because the ratio of T to EpiT is nearly constant, it is presently used for assessing steroid abuse in competitive sports, where the World Anti-Doping Agency (WADA) considers a T/EpiT ratio >4 evidence of T doping. Despite its central role in the detection of illict anabolic steroid use, our knowledge of factors effecting EpiT production is poor. Clues in the literature, however, reveal that prostaglandin-mediated processes, such as LHRH release, may influence its production. Antimycotics, NSAIDs, and opioid analgesics used in sports medicine are all known to effect prostaglandin E2 synthesis. Primary PGs are potent inhibitors of ADT oxidation, while indomethacin, a prostaglandin blocker, powerfully inhibits 3α-HSD reduction and ADT oxidation. This is significant because ADT inhibits the oxidation of EpiT, and may modulate its antiandrogenic and neuroprotective effects. It is hypothesized that the T/EpiT ratio is increased by COX-2 inhibitors and opiod analgesics, and decreased by antimycotics that do not impair testosterone biosynthesis. Given the devastating personal and career consequences that may result from false positive drug tests, substantive research on the effects of PGE2 manipulations on EpiT is warranted.

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      Unfortunately, the large body of literature developed around them represents missed opportunities to clarify the significance of Gustafsson et al. findings and, by extension, the potential role of epiT in the development, diagnosis and treatment of brain disorders. Consequently, the inferential discovery that epiT plays a central role in the sexual differentiation of the brain presented here and elsewhere [43] serves to clarify the influence of gender on the nature and expression of brain disorders including but not limited to ASD. As Bejerot et al. [5] reported, women with ASD were found to have elevated T levels and several masculinized characteristics compared with female controls (i.e., less feminine facial features and larger head circumference), whereas men with ASD displayed several feminized characteristics (i.e., less masculine body characteristics and voice quality, and higher 2D:4D ratios) but similar T levels to controls.

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