September 1989

Methyltesterone-Induced CholestasisThe Importance of Disproportionately Low Serum Alkaline Phosphatase Level

Author Affiliations

From the Departments of Medicine (Dr Borhan-Manesh) and Pathology (Dr Farnum), Veterans Administration Medical Center, and East Tennessee State University College of Medicine (Drs Borhan-Manesh and Farnum), Johnson City.

Arch Intern Med. 1989;149(9):2127-2129. doi:10.1001/archinte.1989.00390090147032

• We describe a 64-year-old man who developed cholestatic jaundice after receiving 20 to 40 mg of methyltestosterone daily for 6 months for impotence but failed to mention it as part of his drug history. He underwent endoscopic retrograde and papillotomy before a positive history for methyltestosterone ingestion could be obtained. Since methyltestosterone is most often used for sexual impotence, the patient may be quite reluctant to mention this hormone as part of his medication. A normal or mildly elevated alkaline phosphatase level, disproportionate to the level of hyperbilirubinemia seen in this patient and in all previous reports, appears to be characteristic of this phenomenon. This pattern of liver function abnormality can be a clue to suspect methyltestosterone as the causative agent and spare the patient unneeded expensive noninvasive and potentially harmful invasive procedures.

(Arch Intern Med. 1989;149:2127-2129)