A 28-year-old woman with her last menstruation period September 20, is now in week 8 of pregnancy.

Fråga: A 28-year-old woman with her last menstruation period September 20, is now in week 8 of pregnancy. From September 30 to November 10 ie week 1-6 of pregnancy, she has taken tablet Winstrol (stanozolol) 2 mg two times daily for 2 to 3 weeks and 2 mg daily for 3 weeks. Concomitantly she has taken clenbuterol 0.02 mg 2 to 3 tablets daily for 6 weeks. She has used the drugs with the aim of doping. What effects on the fetus can be expected? Indication for abortion?

Sammanfattning: The use of testosterone-like substances during pregnancy can cause masculinization in a female fetus, however this can be adjusted surgically. In the present case there is no medical reason for an abortion. No information has been found concerning teratogenic effects of clenbuterol.

Svar: Stanozolol has anabolic and androgenic properties and is a structural analogue of testosterone. The medical use of the drug is mainly for prevention and control of attacks of hereditary angioedema in low doses (1). Stanozolol does not belong to the drugs approved by the Medical Product Agency in Sweden but has been used in an illicit matter by athletes and body builders. The drug should not be given to pregnant women as there is a possibility that female fetuses will be virilized (2).

The question of masculinisation of a female fetus has been dealt with before, although earlier questions have discussed this effect when the mothers have been treated with gestagen-like substances, such as noretisterone (3,4). However, the risk of a virilizing effect of testosterone-like substances such as stanozolol should be more pronounced.

In the present case the development of the genitalia should have started approximately one week ago. Consequently, there is a risk of a slight influence on the female genitalia. Possibly there is a risk of an enlargment of clitoris and an initial fusion of labium minora that could be adjusted by plastic surgery. There is also a possible risk of influence on the long-term female fertility but this risk should be small in this early stage of pregnancy (5).

The question if abortion is indicated must be considered in relation to if the pregnancy is planned or not. However, in the present case there is no medical reason for an abortion (5).

The question concerning the use of clenbuterol during pregnancy has been answered before (6). No information could be found on this matter and no teratogenic properties of the drug have been revealed. 1 Martindale, The Extra Pharmacopoeia 1996; 31th ed:

2 Dollery, Therapeutic drugs. 1991; 1:
3 Drugline nr 11190 (year 1994)
4 Drugline nr 02891 (year 1981)
5 Personal communication Prof Bengt Källen, Dept of Embryology, Lund University

6 Drugline nr 10182 (year 1994)